Occupational science: a renaissance of service to humankind through knowledge

Unveiling human-nature interaction: Qualitative exploration of perceived benefits of urban gardening

The study seeks to provide insights into the subjective experiences and perceived benefits of urban gardening by gardeners in the city of Belgrade. It encompassed several forms of urban gardens, both collective and individual. The study involved conducting semi-structured interviews with 44 gardeners, supplemented by field observations. Thematic analysis revealed seven key themes of benefits. The findings slightly diverged from studies in developed countries, demonstrating less emphasis on the social aspects of urban gardening, as participants did not view social interaction as a primary motivation. Also, there was a stronger focus on the productive and economic aspects of gardening among the retired low-income population of home gardeners with previous experience in agriculture.

An Occupational Perspective on Psychedelic Therapy: A Scoping Review

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

“Jardins das ocupações”: estratégias de cuidados diante de perdas ocupacionais e luto

Resumo Situações vivenciadas como estressoras, tais como a morte de entes queridos, perda de emprego, sonhos, projetos e outros têm afetado direta ou indiretamente as ocupações rotineiras das pessoas, resultando em rupturas, mudanças e afastamentos das preferências ocupacionais diárias, tanto as externas como as realizadas no ambiente doméstico, o que pode impactar a pessoa e a maneira como se ocupa e participa da vida social. O presente artigo apresenta uma proposta de intervenção e cuidados nas condições de perdas significativas e luto e fomenta reflexões a esse respeito sob uma perspectiva ocupacional, correlacionando conceitos da Ciência da Ocupação, Logoterapia e Análise Existencial de Viktor Frankl. Para tanto, baseia-se na estratégia interventiva de cuidado no luto, denominada “Jardim de Ocupações”, a qual emprega elementos como a metáfora e o desenho como possibilidades para criar aproximações com a fundamentação teórica ancorada na Ciência Ocupacional, sob a ótica da tensão existencial e valores de sentido de Viktor Frankl. Considera-se a proposta interventiva “Jardins de Ocupações” como um instrumento participativo, reflexivo, com potencial para aprofundar reflexões e compreensões sobre os sentidos de vida e o engajamento em ocupações ante às perdas sofridas.

“Garden of occupations”: care strategies in the face of occupational losses and mourning

Abstract Situations experienced as stressful, such as the death of loved ones, loss of jobs, dreams, projects and others, have directly or indirectly affected people's routinely occupations, resulting in disruptions, changes and withdrawals from daily occupational preferences - both externally and the ones carried out in the domestic environment - which can impact the person and the way in which they engage and participate in social life. This article presents a proposal for intervention and care in the conditions of significant loss and mourning and promotes reflections on this subject from an occupational perspective, correlating concepts from Occupation Science, Logotherapy and Existential Analysis by Viktor Frankl. Therefore, it is based on the interventional strategy of care in mourning, called “Garden of occupations”, which uses elements such as metaphors and drawing as possibilities to create approximations with the theoretical foundation anchored in Occupational Science, from the perspective of existential tension and values of meaning by Viktor Frankl. The interventional proposal “Garden of occupations” is considered a participatory, reflective instrument, with the potential to deepen reflections and understandings about the meanings of life and engagement in occupations in the face of losses suffered.

Securing occupational rights by addressing capabilities: A professional obligation

BACKGROUND

The World Federation of Occupational Therapists asserts that all occupational therapists are obligated to promote occupational rights, and has highlighted the importance of Amartya Sen's concept of 'capabilities' to the work of securing the occupational rights to which all are equally entitled.

AIMS

To outline the capabilities approach and highlight its relevance and importance for the occupational therapy profession.

MATERIAL & METHODS

Drawing from Sen's work, and that of other scholars who have critiqued and adapted his capabilities approach, this paper describes the foundational components of the capabilities approach and identifies important overlaps with issues of concern to occupational therapy.

RESULTS

Sen's capabilities approach employs a contextualised view of human wellbeing; attending to whether people have the abilities to do the things they would value doing, and whether their circumstances actually provide the real opportunities to choose to do what they would value doing.

CONCLUSIONS

The capabilities approach, with its attention to abilities and actions, options and opportunities, empowerment and choice, justice and participation, has clear relevance for occupational therapists.

SIGNIFICANCE

A capabilities perspective provides a valuable framework for occupational therapists striving towards equalising people's opportunities, possibilities and choices - their capabilities - to secure their occupational rights.

An exploration of occupational choices in adolescence: A constructivist grounded theory study

BACKGROUND

Adolescence is a critical period within the life course, for developing adult occupational competencies and health behaviours. Few studies have considered how 16-17 year olds choose activities and behaviours from an occupational perspective.

AIM AND OBJECTIVES

To explore how adolescents aged 16-17 years old make choices about their daily occupations to inform a theoretical model of occupational choice.

MATERIALS AND METHODS

About 27 secondary school students aged 16-17 years attended one of six focus groups. Transcripts were analyzed using constructivist grounded theory, informing the iterative development of a theoretical model of occupational choice.

RESULTS

Adolescent occupational choice occurred in response to experiencing needs, and was characterized by 'weighing up' and 'juggling' the following four key domains: 'Appraising values and priorities', 'Interacting with the situational context', 'Exploring skills and occupational repertoire' and 'Considering time factors'. A developing sense of responsibility and autonomy for occupational choices was described, leading to the development of the future occupational self.

CONCLUSIONS AND SIGNIFICANCE

A theory illuminating how adolescents make choices was developed. The theory aligns with existing developmental literature and provides unique insights, from an occupational science perspective, on the conscious process by which adolescents make, develop and adapt choices about the occupations they do considering contextual and individual opportunities and constraints.

'Choice' in occupational therapy theory: A critique from the situation of patriarchy in India

Background: Dominant occupational therapy theories assert that people choose their daily occupations, and participate in occupations as autonomous agents; yet scholars insist that choices are socially-structured and inequitably available.Aim: To critically review the concept of choice in occupational therapy theory through an exploration of patriarchy in India.Material and methods: Drawing from scholarly work that addresses patriarchy in India, we employ the commonly-used occupational categories of self-care, productivity and leisure as a framework to explore the real availability of occupational choices for women.Results: Patriarchal ideology perpetuates inequitable power dynamics within Indian society. As a consequence, women, children and non-dominant men have few opportunities to make or enact occupational choices that impact their wellbeing and their lives.Conclusions: The examples provided in this paper challenge those occupational therapy theories that portray occupational engagement as the product of individual volition and unconstrained choice.Significance: Dominant occupational therapy theories are informed by specific Western assumptions that may have little relevance to people in other contexts. Critical approaches to professional assumptions are essential to avoid the imperialistic imposition of irrelevant theories, and the development and delivery of services that may be oppressive for clients who have few opportunities to make occupational choices.

Early Hour, Golden Hour: an Exploration of Slovenian Older People's Meaningful Occupations

People are occupational beings and enabling older people to engage in meaningful occupations contributes to their health and well-being. Experiences of engagement and meaning in an occupation may differ in different socio-cultural contexts. The aim of this study was to explore Slovenian older people's individual experiences of engagement in occupation, with a particular emphasis on their meaningful occupations. The study employed a phenomenological research approach. Semi-structured interviews were conducted with ten Slovenian older adults, living independently in their home environment. Interpretative Phenomenological Analysis was used to approach and analyze the data. The findings highlighted that meaningful occupations and daily rituals represented an important part of the participants' identities. The meanings they attached to their occupations were informed by Slovenian socio-cultural, historical and physical context. A range of people and places were identified as significant in generating and maintaining these meanings. Participants gave particular significance to the role of productive, health-promoting and family-related occupations. The study contributes new occupational science knowledge and the findings support the case for increased recognition of the importance of meaningful occupation for older people.

The making of occupation-based models and diagrams: History and semiotic analysis

BACKGROUND.

Models provide a structure for organizing knowledge and facilitating learning and are upheld by occupational therapy as epitomizing the cornerstones of its practice.

PURPOSE.

This article briefly examines the scientific history of occupation-based model development in the 1950s before addressing the process of conceptual model making in occupational therapy. Using the theory of semiosis, it explains and takes a critical perspective on conceptual model building in occupational therapy.

KEY ISSUES.

Since the surge of development in the mid-1970s, models have grown and undergone some revision. However, while the profession has often contested the definitions of its core terms, it has not challenged the accepted models and diagrams that present the constituents of practice.

IMPLICATIONS.

Examining the processes of conceptual model development from a critical, semiotic point of view foregrounds models in the historico-theoretical literature and brings into scrutiny a model's relevancy in current practice.

Principal Approaches to Understanding Occupation and Occupational Science Found in the Chilean Journal of Occupational Therapy (2001-2012)

Background

The progression of occupational science in Chile is documented in the main scientific publication of the field, the Chilean Journal of Occupational Therapy (RChTO).

Objective

Identify approaches to understanding and applying occupation and occupational science as elucidated in the RChTO.

Methodology

A systematic qualitative review of the journal (2001–2012) identified articles elucidating an approach to understanding and application operationally defined as references to specific authors, theories, models/paradigms, definitions, and other fields that support approaches to O/OS.

Results

The study identified two main approaches. The first considers occupation/occupational science from a practical perspective or as a means to explain human behavior; the second considers occupation/occupational science as an object of study. Each approach is further divided into categories.

Conclusion

This study provides a novel perspective on regional use of occupational science concepts. These findings contribute to our understanding of this science in context and to recognition of the cultural relevance of these scientific concepts.

The pan occupational paradigm: development and key concepts

BACKGROUND/AIM

Wilcock's Occupational Perspective of Health (OPH) aligns with the profession's re-discovery of its holistic, occupationally focused roots. Its dimensions of occupation-doing, being, becoming and belonging - resonate strongly with therapists on an intuitive, implicit level. However, its documented use in practice to date has been sparse, and several barriers to its implementation have been identified. The aim of this article is to present a renewal of the OPH - the Pan Occupational Paradigm (POP). Method of development: POP was developed using critical analysis, reflection and a comprehensive literature review. Each stage of development is described in detail, including the POP's inherent assumptions. Key concepts: POP retains the four dimensions of occupation, and shows their interdependent role within occupational entities (e.g. individuals, groups or communities). An entity can be approached by occupational therapy at any point and all the dimensions (either directly or indirectly) can be engaged. Occupational entities move along a continuum of wellbeing, and this movement can be in both positive and negative directions over a lifespan.

CONCLUSION AND SIGNIFICANCE

POP is a distillation of occupational therapy's unique way of knowing about occupation and the promotion of wellbeing. It is put forward as an updated paradigm for occupational therapy in the 21st century.

Occupational Balance: What Tips the Scales for New Students?

The open question, ‘What prevents you from reaching occupational balance?’, was posed within a questionnaire aimed at exploring the meanings of occupation, health and wellbeing with a cohort of first-year occupational therapy students during their initial few weeks at university. Their written responses to the question about occupational balance were analysed and are discussed in this paper. Not surprisingly, occupational balance appeared to be achieved by only a few and more by chance than design.

People, time and money factors were identified as the main impediments to achieving occupational balance, with psychological and emotional pressures being at the forefront. Interestingly, despite these barriers, the overall educational benefit of considering the occupational balance question in this way raised the students' awareness of its relationship to health and wellbeing. This increased awareness might have longer-term health benefits, both personally and professionally, which would be worthy of further research.

Does a Falls Prevention Program Impact Perceived Participation in Everyday Occupations? A Pilot Randomized Controlled Trial

This study aimed to evaluate the effectiveness of a multi-disciplinary, client-centered, fall prevention program on the experiences of participation and autonomy in everyday occupations among community-dwelling older adults. In total, 131 older adults (65+) were included and randomly allocated into two groups. Intention-to-treat analysis was used. Results of this pilot study showed that the program had a limited effect on the subjective experiences of participation and autonomy in everyday occupations among the participants. However, a trend of increased perceived participation and a decrease in the experience of perceived problems with participation among the participants in the intervention group was shown. Perceived participation and autonomy seem to be subjective experiences, and they seem to vary depending on the individual. To properly understand the impact of fall prevention interventions on participation and autonomy, measurements that capture both subjective and objective experiences are essential to use.

Participation in Occupational Performance: Reliability and Validity of the Activity Card Sort

The Activity Card Sort (ACS) is a comprehensive instrument for assessing participation in occupational performance of instrumental, social-cultural, and leisure activities. The purpose of the study was to determine the reliability and validity of the ACS within different adult and older adult groups. The study included 263 participants comprising 5 groups of 61 healthy adults, 61 healthy older adults, 40 spouses or caregivers of individuals with Alzheimer's, 45 individuals with multiple sclerosis, and 56 individuals 1 year after having a stroke. The ACS was adapted to the Israeli culture in a previous study with the author's permission. The final version that was used in this analysis included 88 picture cards of adults performing instrumental, social-cultural, and low and high physical leisure activities that the clients sort into five categories. The ACS provides a “retained activity level” score that is the percentage of activities in which a person is currently engaged divided by those with whom he or she was involved in the past. In addition, comparisons between all groups of current activity levels were analyzed. The ACS had high internal consistency (Cronbach alpha in each area) for instrumental activities of daily living (IADL) and social-cultural activities (.82, .80), and lower for low and high physical leisure activities (.66, .61). A one-way analysis of variance (ANOVA) that compared groups of participants on total retained activity level and individual activity areas showed a significant group effect on all comparisons (p<.000) that support construct validity. Post hoc Scheffe tests revealed significant differences between most groups. The same results were found for current activity level. The results support the reliability and validity of the ACS and provide a basis for its clinical use.

Occupation-Based Intervention for Addictive Disorders: A Systematic Review

Addictive disorders disrupt individuals' occupational lives, suggesting that occupational therapists can play a crucial role in addiction rehabilitation. Occupation-based interventions are those in which an occupation is performed, and occupations are defined as those activities a person engages in to structure time and create meaning in one's life. This review asked: In persons with addictive disorders, are occupation-based interventions more effective than treatment as usual in improving short and long-term recovery outcomes? A systematic literature search was performed by a medical librarian in Ovid MEDLINE, PsychINFO, Social Work Abstracts, OTSeeker, HealthSTAR, CINAHL, and ACPJournalClub. Authors screened 1095 articles for inclusion criteria (prospective outcome studies examining the effectiveness of an occupation-based intervention with a sample primarily consisting of a diagnosis of a substance-related or addictive disorder and with at least five participants), and two authors appraised the resulting 66 articles using a standard appraisal tool, yielding 26 articles for qualitative synthesis and 8 with shared outcome measures for quantitative analysis. Occupation-based interventions in the areas of work, leisure, and social participation were found to have been used to treat addictive disorders. Occupation-based interventions in the area of social participation all elicited better outcomes than their respective control/comparison groups. Not all occupation-based interventions in the area of leisure elicited better outcomes than their comparison group, but in the eight articles with shared outcome measures, quantitative analysis demonstrated leisure interventions produced larger effect sizes than social participation interventions.

Environmental Restrictors to Occupational Participation in Old Age: Exploring Differences across Gender in Puerto Rico

Many older adults face challenges that prevent them from accomplishing common daily activities such as moving around, home maintenance, and leisure activities. There is still a need to examine and understand how environmental factors impact daily participation across gender. This study sought to make a qualitative comparison of gender differences regarding environmental barriers to participation in daily occupations from the perspectives of older adults who live alone in Puerto Rico. Twenty-six Hispanic older adults, 70 years or older participated in this study. We used a descriptive qualitative research design in which researchers administered an in-depth interview to each participant. The results elucidated that women were more likely than men to experience restricted participation due to lack of accessibility of the built environment and transportation systems. The findings could help with the development of tailored, occupation-based, preventive interventions that address gender specific environmental barriers and promote greater participation among both women and men. Further research is required to explore whether these environmental barriers to occupational participation remain consistent across living situations, socioeconomic status and ethnicity.

The Integrating Theory, Evidence and Action (ITEA) Method: A Procedure for Helping Practitioners Translate Theory and Research into Action

Introduction

The aim of this article is to describe and explain a new method for integrating theory and evidence that enables practitioners to translate evidence into action applied in their practice.

Method

A new multiple methods procedure called the Integrating Theory, Evidence and Action method is described. It is a mixed method that progresses through seven distinct steps: clinical question, framework, identification, deconstruction, analysis, reconstruction, and transfer/utilization. An example of using this method to review evidence around occupational therapy with people recovering from alcohol misuse and/or abuse is provided.

Findings

This method highlights the importance of theory, tests the empirical strength of theories, includes diverse forms of evidence, and encourages the integration of knowledge within clinical practice.

Conclusion

The Integrating Theory, Evidence and Action method is accessible and useful to practitioners and will support their efforts to make their practice evidence based. Current methods of evidence-based practice focus mostly on research evidence (particularly quantitative evidence); however, research is only one of the ways of knowing that practitioners draw upon to guide their practice. This method enables occupational therapists to integrate theory, evidence, and practice in a coherent and translatable way.

Occupational therapy students' perceptions of occupational therapy

BACKGROUND/AIMS

An understanding of students' perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students' perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia.

METHODS

Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose-designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed.

RESULTS

Students' responses were categorised as 'what' occupational therapists do; 'how' they do it; 'why' they do it; and 'who' they work with. In 'what' occupational therapists do students frequently described 'helping' people. Both undergraduate and graduate entry masters students used the term 'rehabilitation' to describe how occupational therapy is done, with graduate entry students occasionally responding with 'through occupation' and 'modifying the environment'. Students perceived the 'why' of occupational therapy as getting back to 'everyday activities', with some students emphasising returning to 'normal' activities or life. Regarding the 'who' category, students also thought occupational therapists worked with people with an 'injury' or 'disability'.

CONCLUSIONS

Students entered their occupational therapy programmes with perceptions consistent with the general public's views of occupational therapy. However, graduate entry students exposed to a pre-reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.

Transpersonal Identity and Human Occupation

Transpersonal experiences may have an impact on existing ego/identity boundaries, which can initiate a process of psychospiritual development. The prefix ‘trans’, as in transpersonal, can mean ‘transcending’, such as going beyond existing parameters of identity; or it can mean ‘transforming’, such as a shift in awareness from one state to another. The effects of transpersonal experiences can often lead to different ways of ‘knowing’, which can have a direct impact upon ways of ‘being’ and ‘doing’. This opinion piece considers how developments in transpersonal studies are applicable to human occupation. The human potential that could be explored through the interface between transpersonal identity and occupational identity is discussed.

Occupation for Mental Health and Social Inclusion

Social inclusion and occupational science sit well together and there is a strong case for occupational therapists to take more of a lead with socially inclusive practice. The implications and challenges for occupational therapy roles in mental health services are explored and inclusive practice is discussed in the light of policy that is designed to broaden professional roles. It is argued that if occupational therapists in mental health are going to meet the social inclusion agenda with an occupational focus, they need a political and social awareness in their work with service users and mental health teams.