SROI to IMN Case Study 5: Yang Sheng Foundation’s Self-Healing Enhancement Program for Older Adults

As official statistical data revealed, Taiwan has become an aged society since 2018 (i.e., the proportion of people over 65 is greater than 14%) and will soon become a super-aged society in 2026. The third sector can contribute as demands for health care and others increase quickly while entering an aging society. The Yang Sheng Foundation (YSF) is a non-profit organization that actively pioneers in this field. Based on the latest research results, it developed the Self-Healing Enhancement Program, an integrated health self-management program surrounding the “self-healing power” concept. It attempts to address future social problems by changing the public’s mindset and behavior from health treatment to health prevention, mainly focusing on lifestyle and habit adjustment to improve the functional abilities of older adults. This report evaluates the SEP’s social value from August 1st, 2018, to July 31st, 2019.

Taiwan has become an aged society since 2018, but many still lack the knowledge to address aging-related issues like dementia. Some even think it is the responsibility of family members, doctors, and the government to deal with these problems. The establishment of the Yang Sheng Foundation was in such a context. It endeavors to change the public’s mindset and behavior from health treatment to health prevention, mainly focusing on lifestyle and habit adjustment to improve the functional abilities of older adults. Therefore, it created the Self-Healing Enhancement Program.

Project description

The Self-Healing Enhancement Program contains five characteristics: 1) stimulate social interaction; 2) fun and easy to do in daily life; 3) increase self-efficacy; 4) create a learning environment to motivate older adults for behavior changes; 5) develop a progressive and structured design program with multi-domains. The Program is divided into three stages. Each stage is an 8-week long, 2 hours per week. The focus for Stage 1 is to flip traditional aging perception, enhance health literacy, and understand self-healing and integrated action. Program content covers physical exercise, diet education, oral health education, mindfulness, and interpersonal relationship activities. The aim of Stage 2 is to facilitate the implementation of integrated action into daily life. An instructional guidebook and eight weeks’ workbooks with daily practices are distributed to progressively build up healthy self-management habits. Finally, in Stage 3, the aim is to introduce the concept of mindfulness, increase self-awareness, and learn stress management skills. Program content covers body scans, breathing techniques, meditation, body stretching, and mindfulness eating.

Analysis

The original assessment report that applies the Social Return on Investment (SROI) analysis is converted into a five-dimension analysis aligned with the framework of Impact Management Norms (IMN)

Tables 1-4 show the original report details. Four stakeholders are involved in the Self-Healing Enhancement Program: Program Attendees, Attendees’ Spouses, Seed Teachers, and Site Teachers in the Dahu community, Bitou Township in Changhua County. In this conversion report, only one group of stakeholders, Program Attendees, receives discussion because most (74%) of the outcome value is generated from them. Seven outcomes were changes experienced by Program Attendees in the Self-Healing Enhancement Program. 

The WHAT dimension in Table 1 below explains the outcomes resulting from intervention activities. It involves five categories of data: outcome level in period, outcome indicator, outcome threshold, the importance of the outcome to stakeholders, and SDG. These data correspond to the second step in analyzing using the SROI approach, which is mapping outcomes and can be found in Chapter 5 of the original report. The review reveals that the initial report lists Outcome Indicator information but not Outcome Level in Period and Outcome Threshold. As for the Importance of Outcome to Stakeholders, Improvement of Mental Health and Sense of Well-Being is of the highest value, followed by Improvement of Diet Quality and Increase of Physical Activity. Finally, although not specified in the original report, in terms of the content, the Self-Healing Enhancement Program by the Yang Sheng Foundation corresponds to one of 17 Sustainable Development Goals, namely Good Health and Well-being (SDG 3).

The WHO dimension of the IMN framework describes those who are affected by intervention activities and includes four data categories: stakeholder, geographic boundary, outcome level at baseline, and stakeholder characteristics. Table 2 shows this information. The review reveals that no variances in geography and characteristics existed among this group of stakeholders, the Program Attendees. The review also reveals that no Outcome Level at Baseline information was available. 

HOW MUCH dimension describes the importance of outcomes derived from intervention activities and involves three data categories: Scale, Depth, and Duration. Chapter 5 of the original report provides this information, and relevant figures can be found in Table 3. Results show that the improvement of mental health and the sense of well-being is a relatively significant outcome in terms of the number of individuals experiencing change and the degree of change experienced.

Table 4 provides a detailed breakdown of two crucial dimensions of the IMN framework: CONTRIBUTION and RISK. Representing the fourth dimension of the IMN framework, the CONTRIBUTION dimension delineates the extent to which intervention activities yield outcomes. This encompasses four distinct data categories: Deadweight, Attribution, Displacement, and Dropoff. The data content for this dimension aligns with the fourth step of the Social Return on Investment (SROI) analysis, aptly termed Establishing impact. Improvement of diet quality and Increase of physical activity have the highest Deadweight at 18% and 20% respectively, implying these outcomes might have naturally occurred without intervention. All outcomes have a 0% Displacement, meaning the positive outcomes didn’t introduce negative effects elsewhere. The increase of self-confidence has the highest Deadweight and Dropoff percentages at 21% and 12% respectively, implying it’s the most influenced by natural occurrence and decreases over time. Readers can delve into this in greater depth in Chapter 6 of the report.

RISK dimension offers insights into the potential risks associated with intervention activities. It classifies these risks into two primary data categories: type and level. Type is further subdivided into nine categories. Whereas Level is categorized into three levels – high, medium, and low. It’s worth noting that the six stages of SROI don’t directly address differentiating risk types and levels. In Chapter 7 of the SROI report, the analyst underscores specific limitations, notably the challenges in engaging with all stakeholders directly and the potential of stakeholders not transparently expressing the changes they’ve undergone. Two of these limitations, Stakeholder Participation Risk and Evidence Risk, are among the nine risk categories delineated in the IMN. The report elucidates the strategies adopted to navigate these limitations, concluding with an estimated low level of risk for both categories.

A Social Return on Investment Study of Yang Sheng Foundation’s Self-Healing Enhancement Program for Older Adults is of good quality, for it explains in detail every step of calculating the SROI value and clarifies possible disputes. Even so, as shown in this conversion report, some materials (e.g., information on Outcome Level at Baseline) remain absent, suggesting room for future improvement.