Perception of occupational balance by people with mental illness: A new methodology

Aims The aims were to (i) investigate initial construct validity of a tool for assessment of time allocation in occupational balance, and (ii) describe perceived occupational balance and its relationship with socio-demographics, well-being, and personal recovery among people with mental illness. Methods Satisfaction with Daily Occupations and Occupational Balance (SDO-OB) was administered to 226 persons. SDO-OB reflects balance in five occupational domains: work, leisure, home chores, self-care, and overall occupational balance. Indicators for assessing construct validity were: satisfaction with everyday occupations, occupational value, symptom severity, and psychosocial functioning. For the second aim, the data collection included socio-demographics, life quality, self-esteem, self-mastery, and personal recovery. Results Occupational balance ratings indicated the participants were either under-occupied or in balance. Few were over-occupied. Feeling in balance was related to greater well-being and recovery compared with being under-occupied. Risk factors for under-occupation were younger age (in relation to work), and higher education (in relation to overall balance). Conclusions Associations with the indicators suggest initial construct validity. The SDO-OB is promising for assessment of occupational balance among people with mental illness. Being under-occupied was detrimental to well-being and recovery, and this indicates the importance of offering more occupational opportunities for people with mental illness.     

The attendees’ view of quality in community-based day centre services for people with psychiatric disabilities

Abstract

Background/aims: Community-based day centres in Sweden are well-established arenas for psychiatric rehabilitation, but little is known of the attendees’ perception of the quality of the service provided. The aim of the study was thus to describe and investigate the quality of the services in community-based day centre for people with psychiatric disabilities.

Methods: A sample of 218 attendees in 14 community-based day centre services in Sweden completed the Quality in Psychiatric Care – Daily Activities (QPC-DA).

Results: The results showed that people with psychiatric disabilities perceived the quality of community-based day centre services as high. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the centre, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement.

Conclusion/significance: From an occupational science perspective, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the centre.     

Occupational health and safety in hospitals accreditation system: the case of Lebanon

Introduction: Hospital accreditation can be an incentive to improve occupational health and safety (OHS) performance.

Objective: This study assesses the relationship between status of accreditation among private Lebanese hospitals and compliance with OHS accreditation standards.

Methods: A survey was administered to 68 private Lebanese hospitals to assess accreditation status and specific indicators related to each of the 9 OHS codes in the Lebanese accreditation manual. Chi-square, Fisher’s exact test, and independent sample t-tests compared the OHS standards between accredited and non-accredited hospitals.

Results: Fifty-six percent of participating private hospitals were accredited. Accredited hospitals reported statistically better OHS performance than non-accredited hospitals based on the standards outlined in the accreditation manual. However, there was inconsistent performance on numerous OHS indicators among participating hospitals.

Conclusion: The gaps in OHS performance suggest the need for strengthened OHS guidelines in the national accreditation process to safeguard workers’ health. Strategies to fortify OHS performance include tying service reimbursement to OHS compliance and linking OHS standards with national labor legislation.     

Ageing in the right place – a prototype of a web-based housing counselling intervention for later life

Abstract

Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one’s future housing needs.

Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design.

Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n?=?6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n?=?7) served as discussion points.

Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.

Conclusion and Significance: A user-centred design process can result in services that are aligned with older adults’ preferences for obtaining housing information. Services for planning and preparing future housing needs have the potential to increase older adults´ well-being at home as well as reduce costs for care and housing provision by the municipalities.     

Hospital support services and the impacts of outsourcing on occupational health and safety

Background: Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors.

Objectives: This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach.

Methods: Worker’s compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups.

Results: Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P < 0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries.

Conclusions: This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.     

Factors influencing subjective perceptions of everyday occupations: Comparing day centre attendees with non-attendees

Abstract

Background: Subjective perceptions of everyday occupations are important for the well-being of people with psychiatric disabilities (PD) and are likely to vary with factors such as attending a day centre or not, activity level, self-mastery, sociodemographic and clinical factors. Aim: To explore differences in subjective perceptions of occupation and activity level between day centre attendees and non-attendees, and to investigate factors of importance for the subjective perceptions of occupations. Methods: The study groups comprised 175 participants: 93 day centre attendees and 82 non-attendees. Data were collected with instruments concerning; subjective perceptions of everyday occupations, activity level, self-mastery, and sociodemographic and clinical factors. Results: Day centre attendees perceived higher levels of occupational value and activity level, while the groups perceived a similar level of satisfaction with daily occupations. For the total sample, self-mastery influenced both valued and satisfying everyday occupations while only value was affected by activity level. Satisfaction with daily occupation increased with age and both value and satisfaction increased with lower levels of psychiatric symptoms. Conclusion: Day centres provide perceptions of occupational value and stimulate activity. Non-differences between the groups regarding satisfaction with everyday occupations implied, however, that day centres might not cover all relevant occupational needs.     

Occupational therapists’ perception of the concept of occupational balance

Introduction: Occupational balance is one of the concepts used by occupational therapists with no consensus on its definition. Literature demonstrates different perspectives when this concept is applied in practice and in its link to other concepts such as health and well-being. This study aims to explore how the concept of occupational balance is perceived and practised by occupational therapy practitioners.

Method: A qualitative methodology was employed. Fourteen occupational therapists volunteered for the study. Nine occupational therapy practitioners were interviewed individually and five attended a focus group. Thematic analysis was applied to analyze the data.

Results: Six themes were identified as follows: (1) occupational balance: what it is; (2) how occupational balance is formed; (3) occupational balance and well-being (4); subjective and objective representations of occupational balance (5); what disrupts/affects occupational balance; and (6) occupational balance/imbalance and occupational therapy practice.

Conclusions: Both objective and subjective experiences of occupational balance need to be considered in order to make an informed decision in practice. The right occupational balance for each individual should be based on his/her values but with consideration of the principal of no harm to others.     

Factors associated with participation frequency and satisfaction among people applying for a housing adaptation grant

Background: People applying for a housing adaptation (HA) grant are at great risk of participation restrictions due to declining capacity and environmental barriers.

Aim: To investigate the association of person-, environment-, and activity-related factors with participation frequency and satisfaction among people applying for a housing adaptation grant.

Material and methods: Baseline cross-sectional data were collected during home visits (n?=?128). The association between person-, environment-, and activity-related factors and participation frequency and satisfaction was analysed using logistic regressions.

Results: The main result is that frequency of participation outside the home is strongly associated with dependence in activities of daily living (ADL) and cognitive impairments, while satisfaction with participation outside the home is strongly associated with self-reported health. Moreover, aspects of usability in the home were associated with frequency of participation outside the home and satisfaction with participation in the home and outside the home alone.

Conclusion: Dependence in ADL, cognitive impairments, self-rated health, and aspects of usability are important factors contributing to participation frequency and satisfaction among people applying for a housing adaptation grant, particularly outside the home.

Significance: Our findings indicate that more attention should be directed towards activity-related factors to facilitate participation among HA applicants, inside and outside the home.     

Exploring occupational balance in adults in Sweden

Abstract

Aim: The aim of this study was to describe the relationship between occupational balance (measured by the occupational balance questionnaire [OBQ]) and self-rated health and life satisfaction. A secondary aim was to explore differences in occupational balance among adults in Sweden. Methods: The 153 participants (63% women), recruited using convenience sampling, answered a questionnaire comprising demographic questions, the OBQ, one item about self-rated health, and one about life satisfaction. The OBQ was analysed for correlation with subjective health and life satisfaction. The OBQ and its individual items were also analysed for correlations with age and for differences between men and women and participants living with children younger than 18 years versus not. Results: The OBQ was significantly positively correlated to self-rated health and life satisfaction, supporting the relationship between occupational balance and health. No significant correlation between age and the total OBQ was identified but some differences in occupational balance, related to whether the participant was living with or without children at home, were revealed. Conclusions: The results should be interpreted with caution due to the nature of the sample and data but they can serve as a point of departure for further studies and hypotheses regarding occupational balance in different populations.     

Health and Safety Adoption from Use of a Risk Assessment Document on Irish Farms

ABSTRACT

Objectives: This article describes levels of implementation of occupational health and safety (OHS) controls on a sample of Irish farms following completion of a risk assessment document (RAD) made available as part of a statutory code of practice (COP) for the agriculture sector. The article describes the legislation mandating the COP and the operation of a prevention initiative (PI) among key stakeholders to develop and promote farmer use of the COP and RAD. Methods: RADs were collected for farmers (N = 475) and the number and type of OHS controls listed for action were tabulated. A farm audit of OHS standards and of implementation of controls listed for action in the RAD was undertaken among a randomly selected sample of farms (N = 94) where the RAD was completed. Results: The study data indicates that farmers used the RAD to a limited extent, and that their focus in its use was on identifying physical rather than organizational controls. An association was found between farmers who actively implemented controls and positive OHS standards. Farm OHS standards were also associated with farmer attitude to OHS, farm enterprise, farmer age category, and work time needed to operate the farm. Conclusions: Overall, the study data suggests that standards of farm management are a crucial determinant of OHS standards. The study data also indicates that having knowledge of required OHS controls does not ensure implementation. Development of social learning in groups is considered as a significant means of increasing OHS farm adoption.     

Everyday occupational problems perceived by participants in a pain rehabilitation programme

Abstract

Background: Knowledge of the diversity of occupational problems perceived by people with chronic pain is insufficient. Aims: To describe everyday occupational problems among patients with musculoskeletal pain enrolled in a pain rehabilitation programme, and to compare subgroups based on participant characteristics. Methods: The sample consisted of 152 men and women. Occupational performance was assessed with the Canadian Occupational Performance Measure (COPM). Other data were obtained from forms including sociodemographic variables and pain diagnoses. Major findings: The participants reported 706 prioritized everyday occupational problems categorized as self-care (37%), productivity (32%), and leisure (31%). Household management was the largest sub-category. Working, sitting, and cleaning the house were the specific occupational problems reported most frequently. Women reported significantly more occupations related to productivity and men reported more self-care occupations. Principal conclusion: Patients with pain have a wide range of occupational problems that need to be addressed, along with gender-specific needs.     

Housing adaptations from the perspectives of Swedish occupational therapists

Abstract

Aim: The aim of this study was to investigate how occupational therapists in Sweden administer housing adaptation cases, how they perceive the housing adaptation process, and which improvements they consider necessary. Methods: A total of 1 679 occupational therapists employed by the county councils or the local authorities (and involved in housing adaptations) participated in a web-based survey. The survey targeted issues related to referral and needs identification, assessment, certification, case progress feedback, and evaluation. Results: Less than half of the occupational therapists systematized the assessment prior to intervention and very few conducted any evaluation afterwards. Feedback from workmen or grant managers to the occupational therapists on each case's adaptation progress was often asked for but rarely given. The majority of the participants were satisfied with the housing adaptation process in general, while at the same time they indicated a need for further improvements in the process. Differences between occupational therapists related to employer and year of graduation were found on the majority of the targeted issues. Conclusions: To conclude, to a very large extent housing adaptations seem to be based on non-standardized procedures for assessment, and only a few of them are evaluated systematically.     

Well-being and occupational rights: An imperative for critical occupational therapy

Abstract

Background: One of occupational therapy's core assumptions is that engagement in occupations influences well-being. Because occupational engagement is integral to human well-being, and because well-being is integral to human rights, this paper contends that the ability and opportunity to engage in occupations is an issue that concerns rights. Aims: To outline well-being and its centrality to human rights; to explore the relationships between well-being and occupation and between well-being and occupational rights; and to highlight the consequent imperative to engage in critical occupational therapy. Key issues: The World Federation of Occupational Therapists asserts that all people have the right to participate in a range of occupations that enable them to flourish, fulfil their potential, and experience satisfaction congruent with their culture and beliefs; and further asserts the human right to equitable access to participation in occupation. Conclusions: If occupational therapists are to take seriously their espoused commitment to enabling equitable access to participation in occupation, the inequitable conditions of people's lives will need to be addressed. Critical occupational therapy is a committed form of practice which acknowledges that well-being cannot be achieved solely by enhancing individuals' abilities, and that consequently endeavours also to address the conditions of people's lives.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

Residential environment impact scale: Utilization of the Swedish version

Abstract

Background: The Residential Environment Impact Scale (REIS) is an assessment and consulting instrument designed to examine the impact of the residential environment on its residents and to develop recommendations for adapting this environment. Since REIS is new for occupational therapists in Sweden it is important to evaluate its utilization potential.

Aim: The aim was to examine the utility of the Swedish version of the Residential Environment Impact Scale (REIS-S) for adults living in residential settings.

Material and methods: Twenty-two occupational therapists conducted 28 REIS-S assessments in residential settings including 92 older persons and persons with disabilities. In total, 44 questionnaires were answered before and after conduction of the assessment. The data was analyzed using qualitative methods of analysis.

Results: The REIS-S showed both positive and negative dimensions of utility among occupational therapists working in residential settings. It provided support for making recommendations and contributed to effective assessments but was found time-consuming. The clinical relevance with REIS-S was positive since it met the needs expressed by the occupational therapists.

Conclusions: REIS-S seems promising according to utility in Swedish residential settings for adults. However, psychometrically testing is required for further establishing the utilization of the instrument.     

Experiences of meaning of occupation at day centers among people with psychiatric disabilities

Abstract

Background: There is a need for intervention studies of persons with psychiatric disabilities who attend day centers (DCs).

Aim: The aim of this study was to investigate how people living with psychiatric disability experience and describe the meaning of occupation at DCs after taking part in an intervention.

Methods: An interpretative phenomenological approach was used and 11 participants in the intervention were interviewed.

Results: The superordinate theme describing the experienced meaning at the DC was As a substitute for work, and the sub-themes were; A feeling of belonging to a subculture; Flexibility and adaptation of occupation in accordance with the individual’s needs and recovery process; and Influence.

Conclusions: The results indicated that the intervention played an important role for the creation of meaning at the DC’s for the participants in their daily lives and appeared to promote their well-being. Activities that promoted structure and were experienced as work-like as well as activities that promoted social belonging and influence at the DC were experienced as meaningful. Further intervention studies are needed to gain more knowledge about how to tailor different approaches and activities at DCs in the municipalities that could be experienced as meaningful by their members.     

Comparing the effectiveness of different types of supported housing for patients with chronic schizophrenia

This longitudinal study assessed the effectiveness of different types of supported housing recently established for patients with chronic schizophrenia in the East German region of Dresden. Survey data covering a 2-year period are reported for five patient subgroups (n=244) living in a psychiatric nursing home, in social therapeutic hostels, in sheltered community residential care, at home with family and alone in their own homes. Psychopathological symptoms, social disabilities, subjective quality of life, and normative individual needs for care were the relevant outcome domains assessed. For all subgroups, changes in the outcome parameters were rather small, from a clinical perspective, demonstrating deterioration, particularly for the older and more severely disabled group living in the nursing home. Results from linear variance analytical statistical models showed that group assignment played a significant role only for the baseline-controlled development of social disabilities and subjective quality of life. Contrasts between the groups outlined the disadvantage of homes and hostels in terms of subjective quality of life and the advantage of maintaining integration in family life in terms of social disabilities. These results support health policy decisions that would invest more deliberately in forms of supported housing that endeavour to improve patients’ autonomous functioning in their own flats, as well as providing assistance to families taking care of patients with chronic schizophrenia.