The Occupational Performance History Interview in community mental health case management: Consumer and occupational therapist perspectives

Background/aim:  This study aimed to explore the use of the Occupational Performance History Interview from the perspectives of mental health consumers and occupational therapist case managers in community mental health settings.
Methods:  This qualitative study, based on naturalistic inquiry, involved 10 participants: four occupational therapists who interviewed six mental health consumers, using the Occupational Performance History Interview. All participants participated in follow-up interviews or in focus groups to gain an understanding of their perspectives of this experience. Transcribed data were analysed using the constant comparative method.
Results:  Consumer participants valued telling their occupational stories. Occupational therapist participants described the interview as supporting them to be more occupationally focused within their case management roles.
Conclusion:  The findings suggest that the Occupational Performance History Interview can potentially enhance client-centred and occupationally focused practice in community mental health case management.     

Leisure and ageing: The leisure experiences of older Italians in an Australian community

Background:   A search of the occupational therapy literature revealed a paucity of research on how older adults make use of their leisure time, what meaning these pursuits have to them, and whether their chosen leisure occupations are health enhancing. Occupational therapy literature on how people of culturally and linguistically diverse backgrounds understood leisure was also lacking.
Aim:   This thesis documented a qualitative research study that aimed to discover how Italians aged 65 years and older living in the City of Greater Geelong, Victoria, Australia engaged in leisure occupations, the meanings that were derived from leisure engagement, and whether such subjective experiences of leisure produced health benefits.
Methods and results:   A phenomenological study design was utilised, and data were collected through semistructured interviews and a reflective journal. Participants engaged in numerous meaningful leisure occupations that directly impacted on positive subjective experiences and health outcomes. The subjective experiences found concurred with current research, and were categorised under the three main constructs of leisure theory: 'intrinsic motivation', 'internal control' and 'suspension from reality'.
Conclusion:   Leisure was found to promote positive subjective experiences, health benefits and successful ageing for the participants. It is suggested that the subjective experiences categorised under the 'intrinsic motivation' construct of leisure theory is the main determinant of positive leisure experiences. Furthermore, culturally meaningful leisure occupations were highlighted, and the 'Leisure Engagement Model' is proposed to demonstrate the power of leisure on people's lives and on their sense of health towards continued leisure engagement and health promotion.     

What older people do: Time use and exploring the link between role participation and life satisfaction in people aged 65 years and over

Objectives:  Data on time use and role participation can provide rich information that can help occupational therapists better understand older people's lives. This study aimed to (i) describe the time use and role participation of community-dwelling people aged 65 years and older, (ii) analyse whether time use and role participation changed with increasing age, and (iii) determine if there is a link between maintenance of role participation and life satisfaction in older age.
Methods:  Using a cross-sectional design, interviews including the Activity Configuration, Role Checklist and Life Satisfaction Index-Z were used to collect data on 195 participants (mean age 75 years, 58.5% female).
Results:  Participants spent most of their time on sleep (8.4 h/day), solitary leisure (4.5 h/day), instrumental activities of daily living (3.1 h/day), social leisure (2.7 h/day) and basic activities of daily living (2.6 h/day). The most common roles were friend (96.4%), family member (95.4%) and home maintainer (87.2%). Participants aged 75 years and older spent significantly more time on solitary leisure and less time on paid work and transport compared to those aged 65–74 years. Role maintenance was significantly related to greater life satisfaction in participants aged 75–84 years.
Conclusion:  Older people's occupations and roles are diverse, and increasing age does not appear to reduce occupational or role engagement. The value of roles is not always reflected in the amount of time devoted to them and facilitating continued participation in valued roles may be important for older people's life satisfaction.     

Understanding children's motivation from a self-determination theoretical perspective: Implications for practice

Background:  This paper investigates three human psychological needs — autonomy, competence and relatedness — within the context of self-determination theory (SDT). Meeting these needs in therapeutic environments is congruent with principles of client-centred practice.
Aims:  A key objective is to describe how SDT can increase understanding of children's motivation and their willingness to engage in occupations. An additional objective is to investigate commonalities between SDT and specific client-centred approaches such as cognitive orientation to daily occupational performance (CO-OP).
Method and Results:  Literature about SDT is reviewed and a model of motivation based on self-determination and flow theory is presented. Clinical examples are used to highlight theoretical principles.
Conclusions:  It is proposed that understanding theories of motivation, such as SDT and flow, can further occupational therapists' understanding of the psychological processes involved in client-centred practice, particularly when working with children. This information has the potential to enhance clinical knowledge about activity choices to promote children's participation.     

Reliability and validity of the Leisure Satisfaction Scale (LSS--short form) and the Adolescent Leisure Interest Profile (ALIP)

This study aimed to evaluate the reliability and validity of the Leisure Satisfaction Scale (LSS – short form) and the Adolescent Leisure Interest Profile (ALIP). The LSS and the ALIP are instruments that occupational therapists can use to evaluate the leisure activities that clients enjoy. Evaluation of leisure interest and participation will assist in creating goals for therapy to maximize a client's ability to participate in leisure activities. This study examined the test–retest reliability and concurrent validity of the LSS and the ALIP using a sample of 37 adolescents between the ages of 13 and 17 with no known impairments. The assessments were administered individually or in small groups 7 to 17 days apart. Cronbach's alpha was used to determine the internal consistency. Pearson product moment correlations were calculated to examine the test–retest reliability of the 60 subscales and the six question totals of the ALIP, as well as for the 6 subscales and total score of the LSS. Concurrent validity was evaluated between the ‘How often?’ question of the ALIP and the LSS (short form). Based on the study results, the ALIP and the LSS seem to have good test–retest reliability levels when used with adolescents with no known physical or mental impairments. The concurrent validity between the two instruments was not supported, with many of the scores indicating only weak or no association to each of the subscales, suggesting that the assessments differ in some fundamental way. However, the evidence of some relationships between subscales may indicate some areas where the ALIP and the LSS are similar. Copyright © 2002 Whurr Publishers Ltd.     

Comparison of time use, role participation and life satisfaction of older people after stroke with a sample without stroke

Background/aims:  This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1–3 years post-stroke and living in the community. The results of this study were compared with a published study on the time use, role participation and life satisfaction of older Australians who had not experienced stroke.
Methods:  Twenty-three participants with stroke (mean age 74.2 years, 69.6% men) were interviewed using measures of time use, role participation and life satisfaction.
Results:  Participants with stroke spent most of their time in sleep (7.2 h/day), solitary leisure (7.0 h/day), social leisure (3.0 h/day), and basic activities of daily living (2.9 h/day). Compared to the sample without stroke, participants with stroke spent significantly less time in sleep, instrumental activities of daily living, and volunteer work, and significantly more time at home, with others, and engaged in solitary leisure. Similar to the sample without stroke, the most common roles for participants with stroke were family member, friend, and home maintainer. Participants with stroke engaged in fewer roles than participants without stroke. Unlike the sample without stroke, role loss was not correlated with life satisfaction for participants with stroke; however, having more roles was correlated with greater life satisfaction.
Conclusion:  Experiencing a stroke can affect the configuration of older people's time use and reduce their role participation. Facilitation of older people's role participation after stroke may enhance their life satisfaction.     

Pilot study exploring quality of life and barriers to leisure-time physical activity in persons with moderate to severe multiple sclerosis

BackgroundWe sought to assess how impairment (physiological/psychological) and disability (social/environmental) are associated with physical and leisure/recreation activity levels and quality of life (QOL) in people with moderate/severe multiple sclerosis (MS). We conducted a cross-sectional survey at the MS Comprehensive Care Center, Stony Brook University Hospital, Stony Brook, NY, of a convenience sample of 43 people (50 eligible) with MS and Expanded Disability Status Scale scores of 6.0 to 8.0. The main outcome measures were QOL measured by MSQOL-54, physical activity measured by Physical Activity Disability Scale, and leisure/recreation activity measured by Nottingham Leisure Questionnaire. We analyzed the canonical correlations among physical and leisure/recreation activity levels and (1) impairment and (2) QOL.ResultsHigher levels of physical and leisure/recreation activity were associated with lower levels of apathy and depression and higher levels of cognition, self-efficacy, and QOL (physical and mental). Major barriers reported included fatigue, lack of motivation, and cost.ConclusionImpairments and social/environmental disabilities create barriers to physical and leisure/recreation activity. Additional research is needed to determine, for people with MS, what supports might increase participation in physical and leisure/recreation activities and whether this increase yields improved QOL.     

Movement skills proficiency and physical activity: A case for Engaging and Coaching for Health (EACH)–Child

Background/aim:  Supporting children's participation in health-enhancing physical activities is an important occupational goal for therapists. Fundamental movement skills (FMS) are thought to underpin and enable many activity options. This study had two goals: first, to examine the relationship between fundamental movement skills (FMS) and physical activity, and second, to use this and existing evidence to inform strategies whereby children's motivation for and engagement in physical activity can be supported.
Methods:  A cross-sectional investigation of 124 children, aged 6–12 years, was undertaken. FMS were assessed using the Movement Assessment Battery for Children (M-ABC) and physical activity by pedometer step counts.
Results:  A weak but significant association was found between weekend physical activity and balance skills for girls. Correlations between physical activity and ball skills or manual dexterity were not significant for either gender, however, having age appropriate ball skills did result in greater but not significant levels of physical activity for all children when grouped together.
Conclusions:  Findings from this study question the magnitude of the relationship between children's FMS and physical activity as measured by pedometers. If the goal of health enhancement through physical activity engagement is to be realised, it is proposed that community, occupation-based approaches may offer more potential than skills-based interventions at increasing activity participation. The concept of Engaging and Coaching for Health (EACH)-Child is introduced to this end. Occupational therapists are encouraged to work collaboratively with school and community organisations to assist children to find the physical activities that best accommodate their interests, abilities and offer opportunities for lifelong engagement.     

Development of the activity card sort--Australia

Aims:   To develop the Activity Card Sort (ACS) — Australia as a tool to measure participation in activities of daily living for older adults.
Methods:   Secondary data analysis of activity diaries of older Australians in Brisbane and Adelaide were utilised for item generation. Survey of older adults and cluster analysis was used for item selection and determination of domains for the ACS-Australia.
Results:   The final ACS-Australia is comprised of 82 activity items, falling under the three domains of household activities, social/educational activities and leisure activities.
Conclusions:   The ACS-Australia has robust properties, wide application and provides a culturally relevant tool to measure participation of older Australians, thus will facilitate rigorous clinical and population-based research.     

Subjective leisure experiences of older Australians

Background:  Previous studies into leisure have employed methodologies that may understate the significance of experiential components. This exploratory study investigated the leisure experiences of retired Australians over 65 years of age.
Methods:  Five semistructured interviews were used to explore the leisure experience of older people from metropolitan Adelaide. Data were coded and analysed thematically.
Results:  Relaxation and engrossment emerged as commonly expressed experiences, yet were found to emerge as a result of engagement in occupations predefined as leisure. Experiences of freedom from both necessary duties and a sense of obligation were discussed as potential determinants of leisure consciousness.
Practice implications:  This study highlights a need for therapists to actively access clients' subjective leisure experiences to enable engagement in personally meaningful leisure occupations.     

Reflections of occupational therapists working as members of a research team

Aim:  This qualitative study explored the effects of clinician participation in a randomised clinical trial on subsequent practice.
Method:  Eight occupational therapists responded to open-ended questions delivered by email about their reflections on participating in clinical research and its impact on their practice. Qualitative analysis uncovered therapists' motivation to participate in research, what they felt that they gained, and if and how research participation influenced practice.
Results:  Clinicians learned about research, practice, and their own clinical biases through their participation in clinical research.
Conclusion:  Our findings suggest that participation in research may contribute to shrinking the research-practice gap.     

Sociodemographic Determinants of Leisure Participation Among Elderly in Malaysia

Leisure participation has been proven to be beneficial and has a positive link to successful ageing. This study aims to explore the sociodemographic determinants of leisure participation among the Malaysian elderly. A cross-sectional study was conducted among persons aged 60 years and above, purposively selected from eight health clinics in the state of Selangor. Leisure participation was measured using a validated Leisure Participation Questionnaire specific for Malaysian elderly, consisting of 25 activities, categorized into 4 categories, namely recreational (physical), cognitive, social and productive. Frequency of such participation was measured on a 6-point scale. Its association with sociodemographic variables was examined using inferential and regression analysis. 268 participants were involved in this study (response rate = 100%). The most common daily leisure activities were having conversations while relaxing (78.7%), watching television (74.6%) and reading (63.4%). The least frequently done leisure activities were from the recreational and cognitive categories. The activities were weakly correlated to each other, reflecting the lack of diversity of leisure activities among respondents. Education was the main predictor for leisure participation among elderly, with higher educational level is associated with high RAS (B = 1.020, P < 0.05), CAS (B = 1.580, P < 0.05) and SAS (B = 1.276, P < 0.05). Education level, marital status and locality were important determinants of leisure participation among elderly, with education being the main predictor. Further studies exploring the effective method of educating the ageing society are recommended.     

Exploration of Australian and New Zealand indigenous people's spirituality and mental health

Background:  Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models.
Methods and Results:  To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems.
Conclusion:  The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered.     

Development of the Assistance to Participate Scale (APS) for children's play and leisure activities

Aim   This paper describes the development and psychometric evaluation of the Assistance to Participate Scale (APS). The APS measures the assistance that a school-aged child with a disability requires to participate in play and leisure activities from the primary carer's perspective.
Method   Mixed methodology using an instrument design model was used to complete two studies. First, a qualitative research design was used to generate items and scoring criteria for the APS. Second, a quantitative study evaluated the instrument using data collected from 152 mothers with children aged 5–18 years. Statistical analysis assessed the underlying structure, internal consistency and construct validity of the APS.
Results   Exploratory factor analysis revealed two correlated components, reflecting home-based and community-based play activities. Both subscales and the total APS scale showed good internal consistency. The APS correlated as predicted with individual domains and overall scores for other validated measures (Pediatric Evaluation of Disability Inventory caregiver scales and Pediatric Quality of Life Inventory) with correlations ranging from rho = 0.42 to rho = 0.77. The APS was able to discriminate between groups of children based on type of schooling (regular or segregated), need for equipment/assistive devices, frequency of lifting and disability.
Conclusions   The APS provides professionals with a brief psychometrically sound tool that measures the amount of caregiver assistance provided to a child with a disability to participate in play and recreation. The APS may be used as an outcome measure and to evaluate and predict the amount and type of additional assistance families need to facilitate their child's participation in an important aspect of the child's daily life and development: play and recreation.     

Achieving a restorative mental break for family caregivers of persons with Alzheimer's disease

Background/Aim:  This phenomenological exploration of how caregivers of persons with Alzheimer's disease achieve a mental break defined them as distinct periods of freedom from caregiving concerns and conceptualised them as the essence of respite and as a restorative occupation.
Methods:  Four in-depth interviews each with 15 family caregivers revealed two categories.
Results:  Factors associated with achieving a mental break included: social support, traditional respite, relief-enhancing conditions, techniques for momentary stress reduction, and respite impediments. Achieving a mental break included mental break techniques and experiencing a mental break.
Conclusions:  Restorative mental breaks are often within caregiver control, are achievable independent of formal respite services, and involve both rest and engagement in absorbing activities. Restorative breaks are often pleasurable, support productivity, may be entwined with caregiving activities, and importantly, do not compromise care recipient well-being.     

A Facilitator of Leisure Activities for Stress-Related Growth Experience Among Middle-Aged Korean Women With Depression

Leisure may serve as a coping resource following negative life events that facilitate positive changes. Previous studies on leisure have mainly focused on stress-related growth among individuals living in Western cultures. This study aimed to capture the role of leisure involvement as a facilitator of stress-related growth among middle-aged Korean women with depression. Three main themes were identified as an outcome of participation in leisure activities: (a) strengthening meaningful relationships, (b) improving positive emotions, and (c) facilitating personal strength. By participating in leisure activities, individuals with depression may develop the ability to cope with stress and experience positive changes.     

The meaning of leisure for well-elderly Italians in an Australian community: implications for occupational therapy

Aim:  This paper documents a study that aimed to discover the meaning of leisure experiences for an ageing Italian community in a large regional centre in Victoria, Australia.
Methods:  This qualitative investigation used a phenomenological study design, and data were collected through semistructured interviews with 10 well-elderly Australian Italians.
Results:  Participants engaged in numerous leisure occupations that were meaningful to them and directly impacted on positive subjective experiences and health outcomes.
Conclusion:  This paper adds to an understanding of how leisure impacts on the health of well-elderly Australians and how occupational therapists can use leisure effectively in interventions for successful ageing.     

Rural carers online: a feasibility study

Objective:  To test the feasibility (for a potential randomised controlled trial) of a computer intervention for improving social interaction and promoting the mental health of rural carers.
Design:  The study combined pre- and post-intervention measures with interviews to determine the feasibility of the intervention and the acceptability of the study design to participants. The intervention consisted of providing 14 rural carers with computers and a 4-week training program on basic computer skills, using email and the Internet.
Setting:  The study was conducted in a rural community setting.
Participants:  The carers were 12 women and two men, aged from 50 to 81 years, with an average of 65.5 years.
Main outcome measures:  Measures of social isolation (UCLA Loneliness Scale), depression (Geriatric Depression Scale), carer burden (Zarit Burden Interview) and computer confidence were taken at baseline and at a 3-month follow-up. Interviews were completed at follow-up to discuss outcomes of the study. A focus group discussion was conducted with 11 participants to discuss the study and resolve computer issues.
Results:  Most carers reported increased confidence in email and Internet use. There was improvement for most participants in depressive symptoms and social isolation, but little change in carer burden. Participants identified many social benefits associated with the computer intervention, such as intergenerational connection, community building, skills and confidence and preparation for the future.
Conclusion:  The intervention was found to be practical and acceptable for a group of older carers. It was concluded that it would be feasible to conduct a large randomised controlled trial of the intervention.     

Paths to leisure physical activity among adults with intellectual disabilities: self-efficacy and social support

PURPOSE: This study tested a path model that included perceptions of social support and self-efficacy for leisure physical activity and leisure physical activity participation among adults with intellectual disabilities. DESIGN: A cross-sectional design was used. Data was collected via oral interview. SETTING: Community-based group, supported-living settings in one Midwestern state. SAMPLE: A total of 152 adults with mild to moderate intellectual disabilities, which provided a 39% response rate. MEASURES: Self-efficacy and social support (from family, residential staff and peers with disabilities) for leisure physical activity were assessed using self-reported scales. Leisure physical activity participation was measured with a self-reported checklist of the frequency of leisure physical activity participation. ANALYSIS: Path analysis was conducted for the entire sample and was repeated for younger and older age groups. RESULTS: The hypothesized model fit the data from each group. Social support and self-efficacy predicted physical activity participation, and self-efficacy served as a mediator between social support and physical activity. Significant sources of social support differed between groups; among younger participants, social support from family predicted physical activity, whereas, for the older group, social support from staff and peers predicted physical activity. CONCLUSION: Self-efficacy and social support for leisure physical activity are related to leisure physical activity participation among adults with intellectual disabilities who are receiving supported-living services. The results provide information to guide health promotion programs for this group.