Evaluationstudy "Happiness route" / Evaluatieonderzoek "Geluksroute"

The Dutch professional field for the prevention of mental and physical health is changing rapidly. Not only do local councils carry more legal responsibility for providing prevention, there is also a shift in focus. These changes ask for an effective, short, accessible and nonbureacratic intervention. The present project therefore studies the effectiveness of the “Geluksroute”/”Happiness Route”, an intervention intending to improve positive mental health as defined by the World Health Organisation, i.e.,happiness, self-realisation, and social integration. The approach used in ”Happiness Route” is based on principles from economic theory (“nudging”) and positive psychology (mental health promotion). Rather than the traditional question in the welfare sector (“what is your problem?” and “how can I help you?”), a positive “nudge” or gentle push is given with questions like “what makes you happy?”, “what do you want in life?”, “how can you participate in society?”, “how can you realise that?”. Recent reviews and meta-analyses from positive psychology show that it is both important and possible to obtain health gains by such an approach. The project has three innovative features: it focuses on the promotion of mental health, it uses an outreaching approach to involve individuals with an accumulation of risk factors, and it studies the effects of the intervention in a practice based research design. The target group of the “Happiness Route” are people with an accumulation of risk factors for low positive mental health: low socioeconomic status, poor health, and social isolation. They are recruited using an out-reach approach through professional intermediaries who are in frequent contact with the target group. The intervention consists of an intake, around four home visits and a booster session. The intervention progresses through five stages: (1) mutual definition of the situation by the participant and counsellor, (2) goal orientation, (3) choice of an activity, (4) planning and carrying out the activity, and (5) early evaluation and feedback. Counsellors will make use of evidence-based methods during each phase. The intervention is supported through a small budget (maximum of 500euro) to help the participant carry out the chosen activities. The ”Happiness Route” has been developed in 2004 in Almelo and it has been implemented in nine cities in the Dutch province Overijssel. The intervention has won several Dutch and European awards. Over 65 counsellors have been trained and more than 400 participants have been reached. Pilot studies have shown that the intervention reaches vulnerable members of society and that it is well-received by counsellors and participants. Furthermore, a pilot study found a retrospectively reported increase in well-being and decrease in consumption of care. A client file analysis showed that activities focus mainly on establishing new contacts and going out as well as learning and making new experiences. Given the social isolation and health problems this analysis revealed a highly functional use of the budget. It is now time to recruit more organisations to start working from this “happiness perspective” as well as carrying out a robust study on the effectiveness of the intervention. The main goal of the proposed project is to study the effectiveness of the ”Happiness Route” compared to “care-as-usual”. The second goal is to study moderating effects to ascertain which characteristics of participants and counsellors predict the best results of the intervention. Given the practice based research setting, we propose a pragmatic, non-blind, multi-site randomised controlled trial in ten Dutch cities. The trial will have two conditions. Participants in the experimental condition receive the intervention ”Happiness Route”, whereas participants in the control condition receive a short home visit programme which serves to optimize the use of existing care-as-usual. The Dutch Mental Health Continuum – Short Form is used to assess the primary outcome, positive mental health. Well-validated instruments will be used to measure secondary outcomes: loneliness, resilience, depression, health-related quality of life, care consumption, and social participation. Actual consumption of care will be analysed using data from Vektis, the Dutch information centre for care. Furthermore, characteristics of participants and counsellors will be assessed to make analyses of moderating effects possible. Questionnaires will be filled out by participants at baseline, three months, and nine months. Power analysis shows that 256 participants are needed for statistical analysis, i.e., 26 participants per city. The results of the project will be communicated to the practical field as well as the scientific field through conferences, publications in appropriate journals, a monograph on the approach as well as a PHD-dissertation.