Exploring the implementation of an educational film within antenatal care to reduce the risk of cytomegalovirus infection in pregnancy: A qualitative study

BACKGROUND

Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neuro-disability in childhood. In the absence of a licensed vaccine, adoption of hygiene-based measures may reduce the risk of CMV infection in pregnancy, however these measures are not routinely discussed with pregnant women as part of National Health Service (NHS) antenatal care in the United Kingdom (UK).

METHODS

An exploratory qualitative study was conducted, underpinned by Normalization Process Theory (NPT), to investigate how an educational intervention comprising of a short film about CMV may best be implemented, sustained, and enhanced in real-world routine antenatal care settings. Video, semi-structured interviews were conducted with participants who were recruited using a purposive sample that comprised of midwives providing antenatal care from three NHS hospitals (n = 15) and participants from professional colleges and from organisations or charities providing, or with an interest in, antenatal education or health information in the UK (n = 15).

FINDINGS

Midwives were reluctant to include CMV as part of early pregnancy discussions about reducing the risk of other infections due to lack of time, knowledge and absence of guidance or policies relating to CMV in antenatal education. However, the educational intervention was perceived to be a useful tool to encourage conversations and empower women to manage risk by all stakeholders, which would overcome some identified barriers. Macro-level challenges such as screening policies and lack of official guidelines to legitimise dissemination were identified.

DISCUSSION

Successful implementation of education about CMV as part of routine NHS care in the UK will require an increase in awareness and knowledge about CMV amongst midwives. NPT revealed that 'coherence' and 'cognitive participation' between service members are vital to imbed CMV education in routine practice. 'Collective action' and 'reflexive monitoring' is required to sustain service changes.

Climate Change and Occupational Therapy: Meeting the Urgent Need for Adaptation, Mitigation, and Resilience

Climate change may be the most pressing existential threat to human health and wellbeing in the twenty first century. In this paper, the authors provide context and critique on barriers to climate action in the United States and other high-income countries, including the profit-driven approach to health, consumerism, and the climate change countermovement. The reciprocal connections between occupational engagement and climate damage are examined from a lens of collective and irresponsible occupations and subsequent accountability. The authors propose the United Nations' Sustainable Development Goals as a basis for recommendations occupational therapy practitioners could implement within the priorities of adaptation, mitigation, and resilience.

Valuing home modifications: The street-level policy work of occupational therapists in Australian home modification practice

INTRODUCTION

Occupational therapists recommending home modifications in Australia are often required by funding bodies to consider 'value' and 'value for money' (VFM); however, clear guidance on how to define and apply these concepts is not always provided. This paper reports on a qualitative study examining how the concepts of value and VFM are currently understood and operationalised by occupational therapists in Australian home modification practice, with the aim of positively contributing to both policy and practice in this area.

METHODS

The study utilised constructivist grounded theory to collect and analyse qualitative data from 20 occupational therapists who were currently working across Australia and had professional experience in home modifications.

FINDINGS

The grounded theory that was derived from the analysis highlights the unique position that occupational therapists occupy in home modification work as they strive to align the values of different stakeholders to create solutions that all consider to be valuable. In the absence of consistent frameworks or methods for determining value and VFM, evidence also emerged of occupational therapists using a range of individual approaches such as using formal and informal care as metrics, cheapest option approaches, and comparative costing.

CONCLUSION

In addition to a clear need for consistent and transparent approaches to understanding and operationalising VFM in home modifications, there is also a need for further investigation into the value systems that underpin this work. A conceptualisation of occupational therapists as street-level policy agents has proven useful here as it highlights the position occupational therapists occupy, enacting, making, and, at times, challenging policy in day-to-day practice as they work to align the values of the various stakeholders.

Rethinking Driving Against Medical Advice: The Situated Nature of Driving After Stroke

Background: As stroke can result in functional impairments that impact driving ability, many jurisdictions mandate a 30-day period of driving restriction post-stroke. However, between 26% and 38% of clients drive against medical advice during this period. Purpose: Informed by critical reflexivity of the literature and the first author's practice, this critical analysis paper (1) explicates and critiques how adherence to guidelines regarding driving after stroke in the first 30 days is conceptualized in individualistic, biomedically centred research and (2) argues for expanded understandings of driving based on a transactional occupational perspective. Key Issues: Individualistic, biomedical perspectives view driving against medical advice as an individually located phenomenon, generating partial understandings and individually focused solutions. Re-conceptualizing driving after stroke as a transactional occupational choice provides a productive basis for understanding and addressing driving within practice and research. Implications: Concepts from occupational science can generate new insights for research and client-centred practice regarding driving following stroke.

The (dis)obedient occupational therapist: A reflection on dissent against disciplinary propaganda

Abstract Introduction Despite struggling to establish itself as an autonomous profession, occupational therapy remains extensively regulated and controlled by discursive authorities inside and outside the discipline. After overcoming the profession’s reformist ideals, the military governance that supported its rapid expansion morphed into civil institutions but both were based on similar grounds: occupational therapists should obey a strict set of rules while disobedience and dissent are consistently repressed or silenced. Objective The objective of this article is to deconstruct dominant (consensual) discourses that shape the status quo in occupational therapy and envision alternative paths for the development of the discipline. Method Drawing on the work of Erich Fromm and Jacques Rancière, we propose a (critical) theoretical analysis of the concepts of disobedience and dissensus as they apply to occupational therapists. Results The concepts of disobedience (Fromm) and dissensus (Rancière) can be used to revisit the consensus shaped by discursive authorities inside and outside occupational therapy and expose the political nature of such processes. We argue that remaining oppressive forces similar to those of a warfare regime persist in regulating occupational therapy practice and knowledge by enacting a form of ‘disciplinary propaganda.’ Rather than threatening the development of the discipline, disobedience and dissensus constitute critical responses to disrupt dominant discourses and give rise to healthier concepts. Conclusion The use of politically charged terms such as disobedience or dissensus can be seen as controversial and unsettling for a profession like occupational therapy but we believe they are necessary for the future of our discipline.

Centering the Complexity of Long-Term Unemployment: Lessons Learned from a Critical Occupational Science Inquiry

Inquiries that rely on temporal framings to demarcate long-term unemployment risk generating partial understandings and grounding unrealistic policy solutions. In contrast, this four-phase two-context study aimed to generate complex understandings of post-recession long-term unemployment in North America. Grounded in a critical occupational perspective, this collaborative ethnographic study also drew on street-level bureaucracy and governmentality perspectives to understand how social policies and discursive constructions shaped people’s everyday ‘doing’ within the arena of long-term unemployment. Across three phases, study methods included interviews with 15 organizational stakeholders who oversaw employment support services; interviews, participant observations, and focus groups with 18 people who provided front-line employment support services; and interviews, participant observations, time diaries, and occupational mapping with 23 people who self-identified as being long-term unemployed. We draw on selected interviews and mapping data to illustrate how participants’ definitions and experiences of long-term unemployment reflected and moved beyond dominant temporally based framings. These findings reinforce the need to expand the dominant conceptualizations of long-term unemployment that shape scholarly inquiries and policy responses. Reflections on the benefits and challenges of this study’s design also reinforce the need to use multiple, flexible methods to center the complexity of long-term unemployment as it is experienced in everyday life.