The ethics of sense-making

In this paper, we contribute to the arising field of "enactive ethics," that is, the application of enactive cognitive science to the field of ethics. To this end, we will make a case that an "ethics of sense-making" should exist. With "sense-making," we mean the permanent everyday embodied activity of interpreting the surroundings we are in, as well as our role in them. In other words, we mean the activity of understanding our environments in such a way that certain things, but not others, stand out as meaningful and relevant to us. We argue that sense-making can be performed in ethically better or worse ways. For example, one might make sense of a potentially provocative comment either as an insult or as an invitation for a respectful discussion. How one makes sense in this case will affect oneself, the other, and their present and future relations. We propose that it is often helpful to hold humans responsible for their ways of sense-making. This opens up the possibility to transform their sense-making and the worlds they inhabit. This also has significance for their eudaimonic well-being. Our ethics of sense-making focusses on the ubiquitous activities of sense-making, which, when changed, will lead to great ethical improvements of people's actions, choices, and character traits.

Cross-Cultural Validation of the Chinese Version of the Health Promoting Activities Scale

IMPORTANCE

The Health Promoting Activities Scale (HPAS) measures the frequency of participation in health-promoting activities of mothers of children with disabilities. Translation of the HPAS into Chinese and validation of the Chinese version will enable its use with Chinese-speaking mothers of children with disabilities.

OBJECTIVE

To translate the HPAS into Chinese and assess its construct validity in relation to measures of well-being, mental health, and activity satisfaction.

DESIGN

Cross-cultural validation.

SETTING

Community.

PARTICIPANTS

Eight bilingual Chinese speakers were involved in the translation. Ethnic Chinese mothers of children with disabilities living in Australia, Singapore, or Taiwan (N = 89) were recruited via purposive snowball sampling. Participants self-selected to complete the Chinese e-survey.

OUTCOMES AND MEASURES

Translation was guided by recommended frameworks. The Chinese versions of the Warwick-Edinburgh Mental Well-being Scale (WEMWS), Personal Well-being Index (PWI), and Kessler Psychological Distress Scale-10 (K10) were used to determine construct validity. Internal reliability was investigated.

RESULTS

The Chinese version of the HPAS correlated significantly with satisfaction ratings (r = .45, p < .001; n = 87), WEMWS Total score (r = .61, p < .001; n = 85), PWI mean score (r = .44, p < .001; n = 84), and K10 total score (r = -.33, p = .002; n = 81). Internal reliability was moderate (Cronbach's α = .74).

CONCLUSIONS AND RELEVANCE

The Chinese version of the HPAS was found to be cross-culturally equivalent to the original HPAS and psychometrically sound for use with Chinese-speaking mothers of children with disabilities. What This Article Adds: This study provides an example of the cross-cultural validation process. The Chinese version of the HPAS is psychometrically sound and could be used as an outcome measure of Chinese mothers' participation in health-promoting activities.

Occupations creating joy for people living with advanced cancer: A qualitative descriptive study

Introduction

For people living with advanced cancer, the possibilities for experiences of joy are seriously influenced by the consequences of the illness. Due to the limited expected lifetime, the need to support such experiences that may entail joy and contribute to quality of life are of importance. Research shows that people with advanced cancer experience quality of life through occupations they are able to perform and enjoy. The aim of this study was to describe which occupations contribute to joy for people living with advanced cancer and explore how they reflect upon these occupations during an occupational therapy intervention.

Methods

In total, 111 people with advanced cancer from the intervention group in a randomised controlled trial participated in the present study. Thirty-six of these participants were interviewed, and for 10 participants, this was combined with participant observations. A directed and a conventional content analysis were applied.

Results

148 occupations contributing to joy were categorised into self-care, leisure and productivity. Most occupations were placed into leisure (89%). Participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; having an all or nothing approach; and hoping to resume occupations contributing to joy.

Conclusion

This study found a wide range of occupations contributing to joy and shows the importance of focusing on enabling leisure occupations for people living with advanced cancer. The wide range of occupations as well as participants’ approaches to occupations may be useful to inform future interventions to enable enjoyment for people living with advanced cancer.

The experiences of people with severe mental health conditions participating in the Occupation Matters Programme: An interpretative phenomenological analysis

Introduction

The Occupation Matters Programme is an occupational therapy intervention promoting recovery in people with severe mental health conditions, adapted from the Lifestyle Redesign© approach. With the increasing demand for mental health services and the United Kingdom’s current financial position, there is reason to research the Occupation Matters Programme.

Method

Interpretative phenomenological analysis provided a rich account of the experience of the Occupation Matters Programme, eliciting the service user voice. Four participants participated in semi-structured interviews following session 10 and at the completion of the 20-week programme. Data analysis followed the step-by-step interpretative phenomenological analysis guidelines, enabling themes to be identified that reflected participants’ experiences.

Findings

Three major themes were revealed: connecting with others; experiencing an opened-up world through a temporary project and finding a place in the world through a changing sense of self. Three participants described a temporary improvement in their mental health at the halfway point, which became more permanent by the completion of the programme.

Conclusions

This study suggests that the Occupation Matters Programme was influential in the participants’ recovery journeys and provides evidence for Wilcock’s Doing, Being, Belonging and Becoming framework. It encourages occupational therapists to concentrate on occupation-centred practice, occupational integrity and implementing all four aspects of Wilcock’s framework.

The lived experience of people with mental health and substance misuse problems: Dimensions of belonging

Introduction

People with co-occurring mental health and substance misuse problems are among the most excluded in society. A need to feel connected to others has been articulated in the occupational science literature although the concept of belonging itself has not been extensively explored within this paradigm. This paper reports findings from research that explored the meaning and experience of belonging for four people living with dual diagnosis in the United Kingdom.

Method

Researchers employed an interpretative phenomenological approach to the study. Four semistructured interviews were carried out. The interviews were guided by questions around the meaning of belonging, barriers to belonging and how belonging and not belonging impacted on participants’ lives. Data analysis facilitated the identification of themes across individual accounts and enabled comparisons.

Findings

Data analysis identified four themes – belonging in family, belonging in place, embodied understandings of belonging and barriers to belonging.

Conclusion

The findings add further insights into the mutable nature of belonging. A link between sense of belonging and attachment theory has been proposed, along with a way to understand the changeable and dependent nature of belonging through ‘dimensions of belonging’.

Expressing care in narratives about occupations

Introduction

Engagement in occupations impacts on wellbeing, but this relationship needs to be better understood by occupational therapists. A focus on the meanings of occupations, rather then their purpose, might help further this understanding. Being meaningful, an occupation enables the individual to participate in society in a way that reflects personal and societal values. This paper explores how people can express personal values and caring in the narratives that they tell about leisure occupations.

Method

Seventeen serious leisure enthusiasts were interviewed and encouraged to talk about their chosen occupation. Narratives were extracted from the transcripts and analysed, giving attention to content, structure and interaction. Those narratives that appeared to have a meaning associated with caring were examined further in order to establish the types of caring that they revealed.

Findings

Thirty-one narratives were found to have a meaning associated with values or caring, relating either to a moral struggle, caring close to home or caring further afield.

Conclusion

For some individuals, the meaningfulness of their leisure occupations lies, in part, in using them as a vehicle to express care towards themself, towards others or towards the environment. This has implications for the uses of occupations in therapy.

In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging

The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.

In the footsteps of Wilcock, Part one: The evolution of doing, being, becoming, and belonging

This article will present a critical analysis of the four dimensions of occupation, doing, being, becoming and belonging, and propose clearer understandings of the terms. The concepts have developed and evolved since Wilcock first introduced them as main constructs of Occupational Perspective of Health (OPH), with doing and being receiving the most comprehensive development. However, the concepts of becoming and belonging remain underdeveloped. Given the complex nature of occupation, this comprehensive analysis of each dimension adds greater depth to our understanding, and provisional definitions of each term are provided to guide their ongoing development.

Well-Being and Engagement in Valued Activities: Experiences of Young People with Psychosis

The purpose of this study was to understand how engagement in valued activities contributes to the well-being of young people diagnosed as having psychosis within the past 3 years. Using a qualitative approach, the authors conducted semi-structured interviews and photography-elicited focus groups with 17 participants between the ages of 18 and 24 years who were recruited from an early intervention program for psychoses and a psychiatric service specializing in providing care to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Participants derived six well-being enhancing experiences from engaging in highly valued activities: making meaning; expressing thoughts and emotions; changing physical, emotional, and cognitive states; cultivating skills, strengths, and virtues; connecting and belonging; and making a contribution. These findings highlight the importance of identifying activities that young people perceive as being valuable to their well-being, the meanings and experiences derived from these activities, and how best to support engagement in them.

The axiological ontology of occupational therapy: a philosophical analysis

OBJECTIVE

This article describes the results of a study analyzing several discourses on the values of occupational therapy and some philosophical assumptions upon which these values are based.

METHOD

A qualitative study of several values statements using the hermeneutical method--a conventional analytical approach in philosophy--was conducted.

RESULTS

The literature review reveals that opinions on the values of occupational therapy differ greatly--no one value is shared among all the values statements examined. However, the majority of the texts mention occupational participation. A philosophical analysis of the literature shows that this value is based on a conception of human beings that can be traced back to the philosophical anthropologies of thinkers like Marx, Rousseau, Sartre, and Kant. The philosophical analysis also brought to light a certain conceptual confusion about what a value is.

CONCLUSIONS

This article therefore offers some conceptual clarifications to help distinguish between values, beliefs, attitudes, principles, and non-evaluative concepts. It also presents the implications for practice of this philosophical analysis of values statements of the profession.