Understanding the Role of Participation, Mattering, and Reciprocal Social Support in Improving Health-Related Quality of Life among Hawai'i's Mental Health Clubhouse Members

Abstract

People with severe and persistent mental illness (PWSMI) experience dramatic disparities in health, quality of life, and longevity. Past research shows that social support can help ameliorate these disparities, and that mental health Clubhouses are a community-based mental health treatment model that is particularly effective at increasing social support among PWSMI. However, few studies investigate the process within Clubhouses, and what factors are related to the development of social support or improvement in health. Furthermore, most Clubhouse research follows a conventional research paradigm that focuses on questions and insights of interest to the researcher rather than the participants. This research helps fill those gaps by offering a conceptual model of how Clubhouses contribute to health-related quality of life (HRQOL) that was developed using a community-based participatory approach. The model was created using qualitative methods, combining Photovoice and grounded theory. To test and refine the model, 217 Clubhouse members were surveyed and results were analyzed in Mplus using path analysis. The final model illustrates the relationships between quality of participation, reciprocal social support, mattering, self-efficacy, stigma, and health-related quality of life (operationalized as positive affect and well-being and general self-rated health). Trends in Clubhouse members’ experiences were also examined. Results showed Native Hawaiians had lower stigma, higher self-efficacy, and higher positive affect and well-being, and members with activity limitations reported lower quality of participation, higher stigma, lower self-efficacy, and poorer general self-rated health. Despite a cross-sectional design and small sample size, this work makes a substantial contribution to the Clubhouse literature. It highlights the important roles of quality of participation, reciprocal social support, and mattering, and offers insights that are applicable to multiple bodies of research geared towards improving HRQOL among PWSMI.