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.     

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.     

The association between leisure motivation and recovery: A pilot study

Background and aims:  Recovery from mental illness may be facilitated by participation in activities that provide meaning and purpose in the lives of consumers. Leisure participation can be a major source of enjoyment as well as mental and physical well-being.
Methods and results:  This study examined the association between consumers' motivation to engage in leisure and their self-reported perception of recovery in a sample of 44 Clubhouse members. The Leisure Motivation Scale and the Recovery Assessment Scale were used to measure the association between leisure motivation and recovery. The results indicated a statistically significant association between leisure motivation and recovery.
Conclusion:  These findings have implications for service delivery within mental health settings, as occupational therapists may be able to design leisure-based programs more effectively if they can understand the needs and motives for participation. More emphasis should be placed on supporting consumers to re-integrate and be socially included within the community through leisure-based initiatives.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

Integrated Community Policy Uptake Model: responding to select Manitoba and Saskatchewan rural women's experiences of health reform/renewal

Objective:  To explore the impacts and implications of health reform/renewal for rural women in Saskatchewan and Manitoba, Canada.
Design:  The study was a multiple case study approach using mixed methods of focus groups, individual interviews, and trends/utilization analysis.
Setting:  Three rural communities – two in Saskatchewan; one in Manitoba.
Participants:  Rural women; non-health providers.
Interventions:  None.
Outcome Measures:  None.
Results:  This paper presents a four phase Integrated Community Policy Uptake Model which is derived from the experiences of rural women during the operationalizing of health reform policy. The model depicts a four phase integration of the health reform or renewal policy; specifically, 'Taking In', 'Taking On', 'Taking Over', and 'Taking Beyond'. The Integrated Community Policy Uptake Model is firmly rooted in the perceptions and opinions of rural women, and is informed by their understanding of health policy.
Conclusion:  The involvement of rural women in the policy process is necessary. The model proposed potentially encourages women to become more directly engaged in future health policy making and planning. There is also significant potential for this model to inform decision makers of the perceptions, needs, and solutions offered by stakeholders such as rural women.     

Promoting mental health care in a rural paediatric unit through participatory action research

Objective:  To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research.
Design:  A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research.
Setting:  A 16-bed paediatric unit of a rural general hospital.
Participants:  A purposive convenience sample of all paediatric nursing staff ( n =  20; of 24 nurses).
Outcome measures:  In the first phase of this study, focus groups were conducted to explore the experiences of nurses.
Results:  Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment.
Conclusions:  There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority.     

Developing a worker role: Stories of four people with mental illness

Background and Aims:  Work plays an important role in adults' well-being, irrespective of health status. Vocational rehabilitation can enable people with mental illness to return to open employment. A narrative approach was used to explore how individuals with a mental illness made sense of their work-related experiences.
Methods and Results:  Four Clubhouse members in open employment for at least 6 months completed in-depth, semistructured interviews, from which narratives were created to reveal events, significant persons and actions that assisted these individuals to resume work. Woven into the participants' stories were four 'impelling forces' contributing to a sense-of-self as a worker. These impelling forces were: support from significant others, the personal meaning of work, experiences within the Clubhouse programme, and the ongoing struggle with illness. Implications for occupational therapy practice are discussed.
Conclusion:  The findings of this study urge occupational therapists and others to provide opportunities to provide on-going support to people with a mental illness who seek paid employment.     

Satisfaction with Daily Occupations: Construct validity and test–retest reliability of a screening tool for people with mental health disorders

Background/Aim:  In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self-care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care.
Methods:  The SDO was administered on two occasions with a 1-week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self-rated health were collected on the first of these occasions.
Results:  In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; r _s   = 0.84 for the satisfaction score and r _s   = 0.92 for the activity level.
Conclusions:  The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self-rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self-defined problems. The instruments may therefore supplement each other.     

Key considerations in delivering appropriate and accessible health care for rural and remote populations: Discussant overview

Objective:  To provide an overview of papers discussing optimal service delivery models for rural and remote Australia.
Design:  A synthesis of overarching considerations guiding rural and remote health service policies.
Setting:  Small rural and remote communities in Australia.
Participants:  Invited delegates attending the Inaugural Rural and Remote Health Scientific Symposium in Brisbane 2008.
Main outcome measures:  Key issues underpinning health service provision for small rural and remote communities.
Results:  The formulation and implementation of effective health service provision policies must be underpinned by overarching health goals, agreed health service requirements, recognition of how rural and remote health contexts impact upon health service provision and the constraints limiting health service responses.
Conclusion:  Systemic change is required in order to ensure equitable access to health care services in small rural and remote communities.     

Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals

Objective:  This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs.
Design:  This study used a multivariate, longitudinal research design.
Research setting:  A cross-sectional survey was the setting for this study.
Participants:  The participants were rural or urban hospitals in the United States.
Main outcome measures:  The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location.
Results:  Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information.
Conclusions:  This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations.     

‘A lot better than medicine’ - Self-organised ocean swimming groups as facilitators for healthy ageing

Exercise, spending time in nature and feeling part of a supportive community all contribute to better physical and mental health and to healthy ageing. This focused ethnography investigates how participation in self-organised ocean swimming groups contributes to healthy ageing amongst older men and women in the Australian coastal city of Perth. It explores the ways marine life, personal experiences and social connectedness mediate their group use of public blue space, and highlights that group membership promotes participants’ enhanced health and wellbeing, and supports development of self-efficacy and resilience. These findings suggest that more inclusive access to ocean swimming and other forms of active or adventure-based leisure activities should be advocated from a public health perspective.     

Increasing the occupational therapy mental health workforce through innovative practice education: A pilot project

Aim:  This paper describes the evaluation of a pilot trial of two innovative placement models in the area of mental health, namely role emerging and collaborative supervision. The Queensland Occupational Therapy Fieldwork Collaborative conducted this trial in response to workforce shortages in mental health.
Method:  Six occupational therapy students and eight practice educators were surveyed pre- and post-placements regarding implementation of these innovative models.
Results:  Students participating in these placements reported that they were highly likely to work in mental health upon graduation, and practice educators were positive about undertaking innovative placements in future. An overview of the placement sites, trials, outcomes and limitations of this pilot trial is provided.
Conclusion:  Though limited by its small sample size, this pilot trial has demonstrated the potential of innovative placement models to provide valuable student learning experiences in mental health. The profession needs to develop expertise in the use of innovative placement models if students are to be adequately prepared to work with the mental health issues of the Australian community now and in the future.     

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.     

Developing referral and reassessment criteria for drivers with dementia

Background and Aims:  Determining if a person with dementia should be referred for a driver assessment, at what stage of the illness and how often to repeat this are difficult decisions for health professionals. The aims of this study were to develop criteria for driver assessment referral and to explore the value of routine reassessment for drivers with dementia.
Methods and Results:  Twenty participants with a diagnosis of dementia were recruited from a memory clinic and underwent a standard occupational therapy driver assessment and reassessment 6 months later. Fifteen failed the initial assessment but 10 went on to pass local area assessments. Some participants in the early stages of the disease failed. Five of the nine participants suitable for reassessment at 6 months also failed.
Conclusion:  The results confirmed that routine referral following the diagnosis of dementia is appropriate. Change in performance was noted at reassessment, confirming that 6 months between assessments is an appropriate timeframe.     

Learning style preferences of Australian occupational therapy students

Background/aim:  The learning styles and teaching implications for nursing and health science students have been well researched in other countries. Less research has considered the learning styles and implications for occupational therapy students. The current study examines the learning styles of occupational therapy students at one Australian university.
Methods:  The learning style preferences of first year undergraduate occupational therapy students ( n  = 120) were investigated. The students completed the Kolb Learning Style Inventory (LSI) and Fleming's VARK (Visual, Aural, Read/Write, and Kinaesthetic) Questionnaire in the first weeks of their course.
Results:  The response rate was 97% ( n  = 116). Learning style preferences as determined by the Kolb LSI were spread over all four Kolb LSI learning styles with 'diverging' (30.2%) and 'converging' (28.4%) being the most preferred. Instructional preference as measured by the VARK Questionnaire was kinaesthetic learning (33%), followed by the multimodal preference VARK (18.1%). Visual and aural categories were these students' least preferred methods of learning.
Conclusions:  The results of the current study support previous research indicating a range of teaching methods should be utilised to accommodate for the variability of students' learning styles within educational programs. To accommodate the range of learning experiences encountered in fieldwork and later in professional practice, students need to strengthen their capacities to use a variety of learning styles. This paper proposes that student learning for evidenced-based practice be facilitated by a range of learning opportunities including practical experiences.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

Associations of self-rated health with different forms of leisure activities among ageing people

Summary Objectives:  This study examined associations between self-rated health and specific forms of leisure activities – i. e. singing in a choir, art painting, playing music; art exhibitions, theatre, movies, concerts; religious events; studying and self-development; voluntary work – and investigated how confounding factors contribute to these associations among ageing people in Finland. Methods:  A postal survey was conducted in 2002 among men and women born in 1926–30, 1936–40 and 1946–50. The final 2,815 participants represented 66% of the original sample drawn, stratified by age, gender, and municipality. Logistic regression analyses were used to investigate associations between specific forms of leisure activities and self-rated health. Results:  Going to art exhibitions, theatre, movies, and concerts among women and studying and self-development among men were significantly positively related to self-rated health, even after adjusting for socioeconomic status (SES), other sociodemographic variables, obesity, and health behaviours. Among women, active participation in religious events and voluntary work were negatively associated with self-rated health. Conclusions:  The association of leisure activities and good self-rated health may differ for genders due to their nature or meaning. Partial support was found for the assumption that leisure activities go together with better self-rated health among ageing people. Submitted: 14 December 2006; Revised: 04 July 2007; Accepted: 02 April 2008     

Racial, Ethnic, and Sex Differences in the Associations Between Violence and Self-Reported Health Among US High School Students

BACKGROUND:  Involvement in interpersonal violence or suicidal behaviors can have a significant impact on an adolescent's physical health. Similarly, previous research has suggested that lived experiences, more than the presence or absence of physical ailments, can significantly influence self-assessed health status among adolescents. The purpose of this study was to examine the cross-sectional associations between involvement in violence and poor or fair self-reported health among US high school students.
METHODS:  Data were obtained from the 2005 national Youth Risk Behavior Survey (n = 13,953). Logistic regression analyses were conducted to determine the associations between violence-related measures and self-reported health while controlling for demographic characteristics and potential confounders. Analyses are presented for students overall and stratified by sex and race/ethnicity.
RESULTS:  Overall, 7.2% of students reported fair or poor self-rated health. Having been in a physical fight, having been injured in a physical fight, having attempted suicide, and having not gone to school because of safety concerns were significantly associated with fair or poor self-rated health after controlling for demographic characteristics and other potential confounders. Differences associated with race/ethnicity and sex are identified.
CONCLUSIONS:  Four of the 5 violence-related measures included in these analyses were significantly associated with fair or poor self-rated health. Future studies should consider the impact of involvement in violent behaviors and perceptions of both physical and mental well-being.