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.

Engaging with 'less affluent' communities for food system transformation: a community food researcher model (FoodSEqual project)

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with socio-demographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet are often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project is a research consortium that aims to 'co-produce healthy and sustainable food systems for disadvantaged communities'. The project focusses on innovating food products, supply chains and policies, placing communities at the centre of the change. Tackling the above issues requires new ways of working. Creative approaches in food research are known to empower a wider range of individuals to share their 'lived food experience' narratives, building relationships and corroborating co-production philosophies, thus promoting social justice, and challenging more traditional positivist/reductionist 'biomedical' approaches for nutrition and food studies. This review paper critiques the use of community-centric approaches for food system transformation, focusing on one, a community food researcher model() as an exemplar, to highlight their utility in advocating with rather than for less affluent communities. The potential for creative methods to lead to more equitable and lasting solutions for food system transformation is appraised, consolidating the need for community-driven systemic change to foster more progressive and inclusive approaches to strengthen social capital. The paper closes with practice insights and critical considerations offering recommendations for readers, researchers, and practitioners, enabling them to better understand and apply similar approaches.

Participatory food events as collaborative public engagement opportunities

There is an urgent need to ‘get creative’ with the way we tackle social and nutritional inequalities. The Food as a Lifestyle Motivator (FLM) project has explored the use of creative participatory approaches to engage ‘harder to reach’ communities in dialogues to improve their well-being and life skills. Preliminary findings have confirmed that food can be a powerful catalyst for social inclusion with the potential to empower ‘marginalised’ individuals. Part of this exploratory study has involved two participatory food events (November 2015 and November 2016) run in a local day centre for drug and alcohol rehabilitation. The aim of these events was to bring together key stakeholders (from the service user and provider communities) to exchange food-based knowledge, using collaborative and co-creative participatory approaches. Following ethical clearance, a range of data were collected at the events to assess their ‘social impact’. These consisted of (1) audio interviews (service providers and users), (2) oral surveys (service users and key workers) and (3) observations of social cooking and eating engagement, and creative visual arts (photography, collage, food games and quizzes). In this article, we detail how the range of creative approaches used has successfully engaged individuals (average attendance: n = 80, service users: n = 32) to participate in these food-themed events. We reflect on the overarching themes from data capture of the social and therapeutic aspects of food (activities). We also reflect on the collation (and curation) of findings, systematically critiquing the approaches used, including consideration of ethics, and drivers for engagement. Finally, we consider how the utility of such creative approaches can optimise public engagement activities, not only to enhance research impact but also to inform collaborative developments with and between service users, service providers and other stakeholders, with the potential to lead to transformative food-related changes.

Understanding the meaning and use of occupational engagement: Findings from a scoping review

Introduction

It is theorized that occupational therapy practice is underpinned by the construct of occupational engagement, with a focus on examining the subjective meaning of occupation. The theoretical definition of occupational engagement presents significant challenges to its use, evaluation, and measurement within evidence-based contemporary occupational therapy practice.

Method

A scoping review was conducted to examine how occupational engagement is defined within occupational therapy literature and how occupational engagement is evaluated.

Results

Twenty-six journal articles were identified. Definitions were fragmented and inconsistent across studies. Key themes relating to definitions of occupational engagement included active involvement in occupation, finding value and meaning, balanced engagement, subjective experience of engagement, developing identity through occupation, and social and environmental interactions. Measures seeking to understand occupational engagement were varied across studies, with a consistent measure applied only in the area of mental health.

Conclusion

The lack of consistency in definitions and measurement of occupational engagement presents significant issues for occupational therapy practice and evaluation. There is a need for a common definition of occupational engagement to be applied in the literature. Outcome measures seeking to understand occupational engagement are also required; however, these rely on a clearly defined construct.

Exploring the lived experience of homelessness from an occupational perspective

BACKGROUND

Working in homelessness is a growing area of practice for occupational therapists, however, there is limited literature on the lived experiences of homelessness and occupational engagement Study aim: To explore the lived experience of homeless men in relation to how they engaged in day-to-day occupations when sleeping rough or hostel dwelling Methods: Data were gathered from five men residing in a homeless hostel in the UK. Data collection included semi-structured interviews and photographic diaries. Data were analyzed using Interpretative Phenomenological Analysis Results: Participants described their experiences of occupational engagement whilst sleeping on the streets which included engaging in survival occupations, the significance of apparently ordinary occupations and moving beyond survival occupations. The homeless hostel provided opportunities for occupational engagement that the men perceived in an idiosyncratic manner. The men described benefits of engaging in novel occupations and reengaging in known occupations. Occupational injustices were a common theme that occurred throughout participants experiences Conclusion: This study has highlighted the diversity of occupational engagement for 'roofless' or 'houseless' participants and how different individuals experience occupational adaption Significance: This study has furthered understandings of the concept of 'survival occupations' and the importance of community resources to facilitate occupational engagement whilst homeless.

A practice research study concerning homeless service user involvement with a programme of social support work delivered in a specialized psychological trauma service

ACCESSIBLE SUMMARY

Homeless persons are known to be highly vulnerable to psychological trauma, in events triggering periods of homelessness and the considerable social isolation and adversity suffered when homeless. This study provides an account of how mental health support work is experienced by homeless service users when it is informed by a person-centred, non-directive approach and implemented by trainee health and social care professionals under the auspices of a specialized psychological trauma service. The study draws upon material gathered from interviews with service users domiciled in supported housing for homeless persons and support workers who practiced on the programme. The service users who participated in the study valued support work that combined practical and relational elements, but would have preferred a longer-term involvement. They also spoke of feelings of disconnection and estrangement from others including their peers in supported housing. The support worker participants valued the flexibility they had when working on the programme to tailor their intervention to service users' individual needs. Practice implications of the study are discussed. These include the need to minimize barriers to accessing support, facilitate informal time between professionals and homeless service users, and manage intervention endings sensitively when temporary staffing arrangements are in place.

ABSTRACT

Homeless people are a population known to be highly vulnerable to trauma, in triggering events to becoming homeless and the considerable social isolation, discrimination, and adversity suffered when homeless. Currently, there is a paucity of research into mental health service delivery to homeless persons and the influence it imparts in individual lives. This article presents a qualitative 'practice research' study into a pilot programme of social support work delivered in a specialized psychological trauma service to homeless service users. The programme was grounded in a non-directive, person-centred approach and staffed by student social workers. The study aim was to explore the support work programme as it was received by service users domiciled in supported housing for homeless persons, encompassing experiencing the programme, worker-service user engagement and contextual influences bearing upon positive outcomes. Narrative interviews gathered the impressions of service users and support workers and the data arising from these interviews was analysed thematically. Service user participants valued support work that combined practical and relational elements, but would have preferred a longer-term involvement. They also spoke of feelings of disconnection and estrangement from their peers in the supported accommodation and their families. The worker participants valued the flexibility of person-centred work tailored to service users' individual needs and echoed service user concerns around the short-term nature of their involvement. Psychiatric nurses carrying out, or supervising, mental health support work with homeless service users should be mindful of the potential impact of temporary staffing arrangements on continuity of care. They should also consider how working from a person-centred perspective and addressing client's practical needs may aid in developing rapport and trust with homeless service users.

Exploring the occupations of homeless adults living with mental illnesses in Toronto / Explorer les occupations d’adultes sans-abri atteints de maladies mentales vivant à Toronto

Background.

The nature of occupational engagement for homeless people living with mental illnesses is not well understood, and there are few studies to date that examine the occupational lives of these individuals.

Purpose.

This research study seeks to understand how this group of individuals engages in occupations. The central question is ‘‘What is the nature of occupational engagement by homeless adults living with mental illnesses in Toronto?’’

Method.

A constant comparative method of analysis was used in a secondary analysis of 60 interviews with homeless adults experiencing mental illness.

Findings.

Four themes emerged that describe the nature of occupational engagement for this group: occupations as enjoyment, occupations as survival/risk, occupations as passing time, and occupations as self-management.

Implications.

This research informs occupational therapy interventions aimed at optimizing engagement, health, and well-being for homeless adults living with mental illnesses.

An Occupational Therapy Intervention Service to Hostels for Homeless People: An Overview

This evaluation of an Occupational Therapy Intervention Service within homeless persons' hostels in Bristol, England, highlights the efficacy of occupational therapy with this service user group and reflects on the practicalities of delivering such a service in an inter-agency context.

Occupational therapy engaged homeless individuals with complex needs who were often defended against change in their own lives. Over 7 months an Occupational Therapy Intervention Service provided an individual service for 16 residents and made a further 542 contacts through group work. The creation of psychosocial microenvironments within hostels allowed individuals to experience themselves differently and contemplate the possibility of change. The importance of collaborative working between occupational therapists and hostel staff is examined in the light of the psychologically informed environments agenda.