Doing, being, becoming and belonging at the heart of occupational therapy: An analysis of theoretical ways of knowing

'A new sense of my former self' - transforming the self through vocational rehabilitation for people with acquired brain injury

BACKGROUND

Acquired Brain injury (ABI) causes ripples throughout the occupational and social fabric. It enters people's lives at a significant personal cost, encroaching on people's sense of self. Vocational rehabilitation is a viable venue to regain control of their life and support them in forming a new sense of self. From an occupational perspective, little is known about how vocational rehabilitation can support people through transforming their sense of self.

AIM

This study aims to explore how vocational rehabilitation may influence the relationship between sense of self and occupational engagement for persons with ABI. Material and Methods: Six persons with ABI were purposely sampled. Data were collected using semi-structured individual interviews and analysed using a hermeneutic approach.

RESULTS

The analysis resulted in three themes: a new sense of my former self, engaging in occupations as transformation, and the significance of support.

CONCLUSIONS

Participating in vocational rehabilitation can enable persons with ABI to form a new sense of self. Engaging in occupations and professional support is significant in the transformation process.

SIGNIFICANCE

From an occupational perspective, the knowledge gained in this study stresses the essential role occupational engagement and proper targeted support have for people struggling to return to work after ABI.

Unveiling human-nature interaction: Qualitative exploration of perceived benefits of urban gardening

The study seeks to provide insights into the subjective experiences and perceived benefits of urban gardening by gardeners in the city of Belgrade. It encompassed several forms of urban gardens, both collective and individual. The study involved conducting semi-structured interviews with 44 gardeners, supplemented by field observations. Thematic analysis revealed seven key themes of benefits. The findings slightly diverged from studies in developed countries, demonstrating less emphasis on the social aspects of urban gardening, as participants did not view social interaction as a primary motivation. Also, there was a stronger focus on the productive and economic aspects of gardening among the retired low-income population of home gardeners with previous experience in agriculture.

College Students' Adaptations of Activities and Experiences During the Pandemic Occupational Disruption

During life disruptions, people adapt their activities responding to environmental stressors, resulting in new routines that support well-being. To explore college students' daily life experiences during the pandemic. Thirty students completed three time-use diaries, and responded to a survey on activity change during Coronavirus Disease 2019, satisfaction with social/leisure occupations, and well-being. Survey questions, duration of activities, and levels of were analyzed across 3 days. Exercise, school, socializing, and work were the most changed, often eliminating the activity, or modifying the activity, social context, or location. Time-use data indicated participants engaged in similar types of activities compared with nonpandemic times, but experienced different levels of pleasure and productivity related to some activities. Participants adjusted their activities/experiences to support their well-being. Examination of students' occupations and experiences uncovered the dynamic interaction between all levels of context-the macro (pandemic) and the micro (place to study).

Maintaining autonomy: How older persons with chronic conditions and their significant others interpret, navigate, and overcome everyday difficulties

BACKGROUND

The vast majority of older adults live in their own homes. Many of them live with chronic conditions that lead to activity limitations and participation restrictions. To support them adequately, we need to better understand how they cope with everyday difficulties.

AIM

To identify and examine difficulties in everyday life older people with chronic conditions who live in private homes face and how they and their significant others interpret, navigate, and overcome these difficulties.

MATERIAL AND METHODS

We conducted a focus group interview with 10 participants including eight older adults with chronic conditions and two of their significant others. We then transcribed the interviews verbatim and thematically analysed them.

RESULTS

We generated the three closely interrelated themes struggling not to lose control, a shifting balance between resources and environmental challenges, and negotiating independence and interdependence. Participants interpreted the difficulties they faced as multicausal. Their main goal was maintaining autonomy, agency, and a positive identity. They employed individual, creative strategies to achieve these goals.

CONCLUSIONS

Older persons with chronic conditions prioritise autonomy and agency in order to maintain a positive identity.

SIGNIFICANCE

Interventions to support older persons with chronic conditions should centre their priorities and build on their creativity.

Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography

BACKGROUND

Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed.

AIM

Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach.

MATERIAL AND METHODS

The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data.

RESULTS

Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied.

CONCLUSION AND SIGNIFICANCE

The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

Beyond conventional healthcare for mental health problems: Experiences of existential group conversations

BACKGROUND

Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

AIMS

To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

MATERIALS AND METHODS

Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

RESULTS

The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

CONCLUSION

Existential conversations in group may contribute to a more reflected doing in accordance with one's own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual's own preferences.

SIGNIFICANCE

This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

Occupation as means and ends in paediatric occupational therapy - A systematic review

BACKGROUND

There is a lack of evidence-based knowledge in paediatric occupational therapy about the effectiveness of interventions using daily activities as a treatment modality in improving children's participation.

OBJECTIVE

This study aimed to evaluate the effectiveness of occupation-based and occupation-focused interventions in improving participation in everyday occupations for young children with a disability.

MATERIAL AND METHODS

A systematic review based on Joanna Briggs Institute methodology and critical appraisal tools was conducted. Six databases were searched for quantitative intervention studies aimed at improving participation in everyday occupations of young children with a disability through the use of everyday occupation.

RESULTS

The search yielded 3732 records, of which 13 studies met inclusion criteria. Ten studies met methodological quality criteria and were included in the synthesis, five randomised controlled trials and five quasi-experimental studies, involving a total of 424 children with a mean age of 6.5 years. The studies were classified into cognitive (n = 5), context-focussed (n = 2) and playgroup interventions (n = 3). Study quality ranged from low to moderate, only one study was rated high quality.

CONCLUSIONS AND SIGNIFICANCE

Occupation-based and occupation-focused interventions may have a positive effect on participation in everyday occupations for young children with a disability, but study design, risk of bias and insufficient reporting limit confidence in the body of evidence.

Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy intervention for people with psychiatric disabilities. Results from a randomized controlled trial

BACKGROUND

Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities.

AIM

To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery.

METHODS

In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up.

RESULTS

Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes.

CONCLUSION

We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness.

TRIAL REGISTRATION

The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

Sociomaterial influence on social media: exploring sexualised practices of influencers on Instagram

Purpose

Relying on social influence and sociomateriality theories, this research provides new insights about the social and material drivers relating to the sexualisation of online behaviour of social media influencers.

Design/methodology/approach

Using a netnographic approach, observation data were gathered from the Instagram accounts of 20 influencers dedicated to beauty and fashion. In addition, 15 in-depth interviews were conducted with women adopting sexualisation practices online. The data were analysed using an abductive strategy; all materials were coded according to thematic analysis principles.

Findings

The authors observe that sexualisation is a result of a complex system of social interactions encouraged and reinforced by multiple factors and actors. In particular, the authors outline the major influence of technology that has become a non-human authority defining implicit norms and shaping the beliefs and behaviours of women influencers.

Originality/value

In contrast to existing literature which mainly focuses on the negative consequences of sexualisation, this work sheds some light on social constructs in social media. The authors contribute to the growing literature on social media influencers. Although many works focus on their persuasiveness, this work helps to better understand the social setting, motivations and pressures that are contained in social and technological contexts.

Effects of Occupational Therapy via Telerehabilitation on Occupational Balance, Well-Being, Intrinsic Motivation and Quality of Life in Syrian Refugee Children in COVID-19 Lockdown: A Randomized Controlled Trial

We aimed to evaluate the effects of an occupational training program via telerehabilitation on well-being (WB), occupational balance (OB), intrinsic motivation (IM), and quality of life (QoL) in Syrian refugee children resettled in Turkey during the COVID-19 pandemic. This was a single-center, prospective, randomized, non-blinded trial in which children aged 13-15 years and attending a secondary school were recruited. OB, WB, IM, and QoL were evaluated via the OB Questionnaire (OBQ11), the Well-Star Scale (WSS), the IM Scale (IMS), and the Pediatric Quality of Life Inventory (PedsQL). The intervention group attended online occupational therapy classes. Online classes were carried out as five sessions per week, each session lasting 1 h, for 3 weeks. Questionnaires were performed at the outset of the study and following the training program. Overall, 52 refugee children were randomized into the intervention and control groups, each including 26 children. The mean OBQ11, WSS, IMS, and PedsQL scores significantly improved more in the intervention group than in the control group. This was the first study investigating the effects of a customized online training course on OB, WB, IM, and QoL in Syrian refugee children, also affected unfavorably by the COVID-19 lockdown. Our results showed significant improvements in all the study scales that we used to quantify the alterations in the aforementioned traits.

Rheumatic disease and fatigue: Participants' experiences of an activity-pacing group

BACKGROUND

Fatigue is a common symptom of inflammatory rheumatic disease and has a great impact on everyday life. Activity-pacing is proposed as an intervention to increase participation in meaningful activities.

AIMS

To explore participants' experiences with an activity-pacing group, how participants perceived self-managing everyday life after group attendance, and their reflections on unmet needs that could enhance self-management of everyday life with fatigue.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 10 participants who had attended an activity-pacing group. Thematic analyses were conducted.

FINDINGS

Prior to group attendance, the participants expressed an awareness of their lack of knowledge of fatigue. Through group attendance, they increased their understanding of fatigue and their ability to apply strategies to better manage everyday life. Participants found it difficult to balance their energy use and realised that implementing activity-pacing strategies takes time. Therefore, they requested follow-up sessions with the activity-pacing group. They also desire that rheumatologists pay more attention to and acknowledge fatigue.

CONCLUSIONS AND SIGNIFICANCE

Enhancing the understanding of fatigue and how to manage everyday life with fatigue, appears to be important. Group interventions led by occupational therapists and with a focus on activity-pacing may be a suitable approach. Follow-up sessions are recommended.

The motives of people who delay retirement: An occupational perspective

BACKGROUND

Increasing numbers of people are delaying retirement. Studies of their motives are scarce and biased to Western contexts.

AIMS

The aim was to explore internal and external motives of older Slovenians who continue to work after becoming eligible for retirement.

METHODS

Nine workers, aged 59-72, were interviewed. The interviews were analysed using thematic analysis.

FINDINGS

Three main themes were extracted. The 'Foundations' described the prerequisites for continued work engagement that were often non-negotiable. The 'Rewards' included the benefits of working and suggested a strong pull towards the non-material aspects of work. 'Negotiating occupational challenges' summarized an internal crisis that was experienced when faced with a potential occupational void of retirement.

CONCLUSIONS

Although the participants' motivations were not homogenous, we identified a pattern in the way they constructed their motives in relation to the occupational life trajectories and contextual factors. Based on our findings and multidisciplinary theories, we proposed a hierarchy of motives for prolonged work activity.

SIGNIFICANCE

The study offers an occupational perspective of the phenomenon of delayed retirement and argues that the efforts of the discipline of occupational therapy should be directed at different levels of motives, including empowering people to nurture higher level occupational motives.