Doing Occupational Justice: A Central Dimension of Everyday Occupational Therapy Practice

Difficulties Fulfilling Self-Care Needs Among Family Caregivers: An Observational Study

IMPORTANCE

Assuming the care of a family member with a disability or chronic illness constitutes a health risk factor for caregivers, who frequently overlook their own self-care.

OBJECTIVE

To analyze the self-care activities (SCAs) among caregivers of a family member with a disability or chronic illness and assess the impact on their satisfaction and quality of life (QoL).

DESIGN

Descriptive, cross-sectional, analytic study.

SETTING

Community.

PARTICIPANTS

Five hundred caregivers of family members with a disability or chronic illness in the city of Zaragoza, Spain.

OUTCOMES AND MEASURES

The family caregivers' occupational performance and satisfaction were assessed with the Canadian Occupational Performance Measure, and their QoL was assessed with the World Health Organization-Quality of Life.

RESULTS

In total, 32.8% of family caregivers had difficulty in all activities related to self-care, 46.6% had difficulty sleeping and resting, 31.6% had difficulty receiving health-related treatments, and 31.2% had difficulty with physical exercise. Women and younger family caregivers showed greater impairment in self-care. Occupational performance, satisfaction, and QoL worsened as the number of affected activities increased.

CONCLUSIONS AND RELEVANCE

Caring for a family member with a disability or chronic illness has a negative impact on the SCAs of caregivers, especially among female caregivers and those of younger age. Caregiving is also associated with lower occupational performance, satisfaction, and QoL. Plain-Language Summary: Caring for a family member with a disability or chronic illness can become a health risk for caregivers, who frequently ignore their own self-care. The study results found that women and younger family caregivers showed a greater decline in self-care. This study provides information to help occupational therapists to work with family caregivers to prevent a decline in their self-care and improve their quality of life.

Predictors of Population Mental Health in Montana: An Occupational Justice Perspective

Population-level analyses can demonstrate occupational injustices and their impact on population health. The objective of this article is to examine whether population-level occupational factors are related to the mental health of Montanans. We used linear regression models of the 2021 Montana County Health Rankings to examine the association between occupational justice and mental health, adjusting for covariates. Predictor variables were access to exercise, insufficient sleep, healthy food access, food insecurity, proximal jobs, and social support. Outcome variables were frequent mental health distress and poor mental health days. Adjusted models showed significant associations between both insufficient sleep (β = 0.25, 95% confidence interval [CI] = [0.0.11, 0.40]; Table 2) and food insecurity (β = 0.32, 95% CI = [0.22, 0.43]) and poor mental health days z scores. Adjusted models also showed significant associations between insufficient sleep (β = 0.18, 95% CI = [0.10, 0.26]) and food insecurity (β = 0.19, 95% CI = [0.12, 0.25]) and frequent mental health distress. Future research should study whether targeting sleep and food security can enhance Montanans's mental health.

Transforming Occupational Therapy for the 21st Century PAIRE: Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity

Theories, models, and frameworks provide the foundation for occupational therapy education, research, and clinical practice. While most have a systems approach focus, other factors, such as societal influences and structural inequities, also contribute to health. Using a cross-sectional design, this study identified the gaps in occupational therapy models of practice and presents a novel approach, the PAIRE (Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity) Model. PAIRE is focused on achieving occupational equity through the reciprocal and intersectional impact of the provider/team, the person/people seeking occupational therapy, and the occupation-in-context, with continuous influences of access, context, and justice. We describe the components of PAIRE and illustrate its functionality in education, research, and clinical practice contexts as well as case examples.

Development of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS) Assessment Tool

The objective of this study was to develop an occupation-centered and client-centered assessment tool for refugees and asylum seekers. A preliminary tool outline was produced based on a literature review, while considering previous published tools' strengths and limitations. A qualitative study was undertaken via focus groups to improve on the tool's design and adequacy for its purpose, resulting in the creation of a pilot version of the tool. Convenience sampling included 8 Greek and Cypriot professional and student occupational therapists with experience in the field, 8 international expert occupational therapists, 4 laypeople, 4 humanitarian professionals, and 5 refugees and asylum seekers. Basic qualitative content and thematic analysis led to topics regarding tool modifications that concerned categorization, formation/structure, wording, administration, and assessment scale. Corresponding tool revisions ensued. This study led to the development of the pilot version of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS), which can also be used to identify underlying personal and environmental factors that contribute to self-perceived low satisfaction. A future quantitative study is required to establish the psychometric properties of the tool.

Swimming Lessons for Children With Autism: Parent and Teacher Experiences

The occupation of swimming for children with autism is an unexplored field of research in the South African context. This study explores the experiences of swimming teachers and parents of children with autism in the context of swimming lessons. Semi-structured in-depth interviews were utilized with a qualitative, descriptive-phenomenological design. Data analysis utilized Colaizzis's seven-step method. Parents first sought swimming lessons for their children as a survival skill. Although facing barriers to accessing this service, parents experienced swimming as a meaningful occupation with unexpected benefits. Swimming teachers also derived meaning from providing lessons, despite a lack of knowledge. They expressed a need for greater support and training. Swimming is a meaningful occupation for children with autism and their families, but swimming teachers in South Africa are not always equipped to provide this service. Occupational therapists could play a variety of roles in supporting participation for all stakeholders.

Potential roles of occupational therapists in urban planning for age-friendly environments: A Q-methodology

BACKGROUND

Urban planning for age-friendly environments is an important issue, and occupational therapists and occupational scientists could contribute to planning such environments; however, knowledge of the potential roles of occupational therapists is limited.

AIM

To explore the potential roles of occupational therapists in urban planning for age-friendly environments in Japan from the perspectives of occupational therapists and stakeholders.

MATERIALS AND METHODS

A Q-methodology study was conducted to gain viewpoints from occupational therapists and stakeholders regarding their roles in the urban planning of age-friendly environments for older people in Japan. Participants included eight occupational therapists and seven stakeholders who completed the Q-sorting process.

RESULTS

Three viewpoints emerged which are interpreted as roles of occupational therapists: (1) Promote older people's participation in everyday activities in their communities, (2) Advocate for older people towards policy-making to reflect their occupational needs or perspectives, and (3) Arrange neighbourhood environments towards enhancing participation in occupation through adjustments to compensate for functional limitations.

CONCLUSION AND SIGNIFICANCE

Results reveal the potential roles of occupational therapists in urban planning for age-friendly environments in Japan. These roles can be a guide in the continuing professional development of occupational therapists in the fields of urban planning for older people.

Older people's experiences of visiting social day centres: The importance of doing and being for health and well-being

BACKGROUND

Social day centres can support active and healthy ageing amongst older people. However, little is known regarding the importance of social day centres.

AIMS/OBJECTIVES

The aim of this study was to explore how older people visiting social day centres perceive the day centres' social influence on their health and well-being.

MATERIAL AND METHODS

Twenty older persons attending social day centres on a regular basis were interviewed regarding activities at the day centre and their importance for active and healthy ageing. The data were analysed using qualitative content analysis.

RESULTS

The social day centres were described as arenas to provide a structure (and something to do) in the visitor's everyday life. By attending a day centre, the participants created a social context with other visitors. Staff acted as facilitators for visitors, helping them to interact with other visitors and to experience the feeling of being needed by others.

CONCLUSIONS

The findings suggest that social day centres are important arenas for creating a sense of context and belongingness amongst older people.

SIGNIFICANCE

This study provides knowledge on how doing and being contribute to healthy and active ageing.

Using Practice-Based Inquiry to Enact Occupation-Centered, Justice-Oriented Practice in an Acute Mental Health Setting

IMPORTANCE

Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice.

OBJECTIVE

To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States.

DESIGN

Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice.

SETTING

Acute mental health service in a large teaching hospital system.

PARTICIPANTS

Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study.

DATA COLLECTION AND ANALYSIS

Practitioner scholars' experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice.

FINDINGS

The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change.

CONCLUSIONS AND RELEVANCE

For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy's unique contribution to mental health practice, this research provides a valuable tool for practitioners. What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice.

'I'm institutionalised … there's not much I can do': Lived experience of housing related delayed discharge

INTRODUCTION

Delayed discharge from inpatient mental health units is the continued hospitalisation of consumers after being assessed as ready to be discharged. This is common in adult inpatient mental health services and is usually due to a lack of appropriate housing for discharge. Research indicates a range of possible negative impacts, but no studies have explored consumers' perspectives on this issue. This study explores consumers' perspectives of the experience of housing related delayed discharge (HRDD).

METHOD

Using a grounded theory approach, in-depth interviews were conducted with 10 consumers. All consumers were experiencing HRDD from inpatient mental health units in one Sydney local health district. The data were analysed using constant comparative analysis.

FINDINGS

A lack of choice and control was the central theme that characterised participants' experiences. The combined experience of being delayed in hospital and being homeless led to a lack of choice and control over the basics in life, how consumers spent their time and with whom, and their futures. This lack of autonomy was shaped by the features of the hospital and participants' personal circumstance. The hospital features included rules and routines, physical and social environments, resources, and support from staff. Personal circumstances included individual situations, social networks, and support from community organisations. Participants described a variety of impacts, including reduced mental and physical well-being, and anticipated difficulty transitioning back into the community.

CONCLUSION

This study is the first of its kind and provides consumer perspectives on the impacts of HRDD on their well-being and recovery. The inability to participate in meaningful and necessary occupations is an occupational injustice and implies the need for occupational therapists to advocate for both the prevention of HRDD through government investment in affordable and readily available housing and the mitigation of its effects through modified hospital environments and practices.

Type of Findings Generated by the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis

Occupational therapists are needed to meet the health and occupational needs of the global population, but we know little about the type of findings generated by occupational therapy workforce research conducted worldwide. We aim to synthesize these findings and their range of content to inform future investigations. A scoping review with content analysis was used. Six scientific databases, websites of official institutions, snowballing, and key informants were used for searches. Two independent reviewers took selection decisions against the eligibility criteria published a priori in the review protocol. Of the 1246 unique references detected, 57 papers were included for the last 25 years. A total of 18 papers addressed issues of attractiveness and retention, often in Australia, and 14 addressed the issues of supply, demand, and distribution, often in the US. Only these two categories generated subtopics. Many workforce issues were rarely addressed as a main topic (e.g., race/ethnic representation). Cross-national, cross-regional, or cross-professional studies generated more actionable findings. Overall, we found few discernable trends, minimal evidence of research programs, and various gaps in content coverage or in the use of contemporary research approaches. There is a need for a coordinated strengthening of the occupational therapy workforce research worldwide.

Being an academic retiree: a qualitative, follow-up study of women academics in the Republic of Ireland

Purpose

Retirement is a complex process that can impact daily lives and relationships. While some gender differences in academic retirement experiences have been noted, few studies have focused exclusively on women academics’ retirement experiences. This follow-up study aims to explore the meaning of retirement and its impact on retired women academics' daily lives and relationships over time from an occupational perspective.

Design/methodology/approach

Using a qualitative, longitudinal descriptive design, semi-structured interviews (n = 11) were completed with women retirees from one university and an academically linked university-level, college of education and liberal arts, in the Republic of Ireland (n = 11). This paper presents the findings of follow-up interviews conducted one year later (n = 10). Data were analysed using Braun and Clarke’s six-phase thematic analysis. A longitudinal analysis was then undertaken using a recurrent cross-sectional approach (Grossoehme and Lipstein, 2016) to enable discussion of changes and continuity that had occurred over time in their daily lives.

Findings

The analysis yielded four themes: (i) continuing to navigate occupational identity challenges, (ii) structuring free time, (iii) appreciating health and well-being and (iv) continuing meaningful professional relationships and activities. Participants described on-going occupational identity challenges linked with contextual factors and experiences of occupational injustices of lack of recognition, lack of inclusion and a lack of choice to continue working in their paid academic employment.

Originality/value

These findings suggest that occupational therapists advocate for older adults, so that meaningful choices in retirement timing can be offered to all equally and so that older people are acknowledged for their contributions to society.

Mapping the occupational therapy workforce research worldwide: Study protocol for a scoping review

BACKGROUND

Human Resources for Health (HRH) research informs the development of evidence-based, population-centered HRH policies and practices. Occupational therapists are key human resources for meeting the health, rehabilitation, and occupational needs of the population worldwide. Yet, the global status of the occupational therapy workforce research remains unchartered.

OBJECTIVES

This study protocol depicts the methods to map out and synthesize the occupational therapy workforce research worldwide.

METHODS

Six scientific-literature databases and key international institutional websites will be systematically searched, complemented by snowballing searches and recommendations from key global, regional, or national representatives of the World Federation of Occupational Therapists. Two independent reviewers will screen titles-and-abstracts and then full-texts against the eligibility criteria, e.g., 10 categories of workforce research. Educational research, non-empirical papers, and papers (or their summaries) not available in English, Spanish or Portuguese are excluded. Data extraction (e.g., methods, geographies, aims, key findings) will be conducted by one author and fully verified by another. The extracted data will be computed as well as subject to content analysis to provide quantitative map of the literature and of the contents addressed, e.g., per inclusion category.

CONCLUSION

The results of this review can inform wide consultation processes and strategic, concerted local and global developments of the occupational therapy workforce.

Collaborative Relationship-Focused Occupational Therapy: Evolving Lexicon and Practice

BACKGROUND.

Client-centred practice has been part of occupational therapists' identity for several decades. However, therapists have begun to question whether the term obstructs critical relational aspects of therapy.

PURPOSE.

The purpose of this article is to summarize critiques of the use of the term client-centred and propose an expanded descriptor and a fundamental shift in how occupational therapists engage with individuals, families, groups, communities, and populations.

KEY ISSUES.

Three themes summarize critiques of how client-centred practice has been envisioned: (a) the language of client-centred, (b) insufficient appreciation of how the therapist affects the relationship, and (c) inadequate consideration of the relational context of occupation. We propose collaborative relationship-focused practice that has key relational elements of being contextually relevant, nuanced, and safe, and promotes rights-based self-determination.

CONCLUSION.

We argue that these essential relational elements, along with a focus on occupations, are required to promote occupational participation, equity, and justice.

Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

People with disabilities may be disproportionally affected by the COVID-19 pandemic. We synthesize the literature on broader health and social impacts on people with disabilities arising from lockdown-related measures.

METHODS

Scoping review with thematic analysis. Up to mid-September 2020, seven scientific databases and three pre-print servers were searched to identify empirical or perspective papers addressing lockdown-related disparities experienced by people with disabilities. Snowballing searches and experts' consultation also occurred. Two independent reviewers took eligibility decisions and performed data extractions.

RESULTS

Out of 1026 unique references, 85 addressed lockdown-related disparities experienced by people with disabilities. Ten primary and two central themes were identified: (1) Disrupted access to healthcare (other than for COVID-19); (2) Reduced physical activity leading to health and functional decline; (3) From physical distance and inactivity to social isolation and loneliness; (4) Disruption of personal assistance and community support networks; (5) Children with disabilities disproportionally affected by school closures; (6) Psychological consequences of disrupted routines, activities, and support; (7) Family and informal caregiver burden and stress; (8) Risks of maltreatment, violence, and self-harm; (9) Reduced employment and/or income exacerbating disparities; and (10) Digital divide in access to health, education, and support services. Lack of disability-inclusive response and emergency preparedness and structural, pre-pandemic disparities were the central themes.

CONCLUSIONS

Lockdown-related measures to contain the COVID-19 pandemic can disproportionally affect people with disabilities with broader impact on their health and social grounds. Lack of disability-inclusive response and emergency preparedness and pre-pandemic disparities created structural disadvantages, exacerbated during the pandemic. Both structural disparities and their pandemic ramifications require the development and implementation of disability-inclusive public health and policy measures.

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.

Occupational justice health questionnaire: reflections on its application

ABSTRACT Introduction Occupational justice concept is defined as the equal access and participation in all occupations, including the resources required for participation and opportunities for social inclusion. Occupational justice not only remains conceptually ambiguous for occupational therapy practice but also lacks critical examination of its applicability to non-Western cultures. Objective This article describes the reflexive process exercised by the researchers during and after using the Occupational Justice Health Questionnaire (OJHQ) as an occupational therapy tool in a substance addiction rehabilitation setting in the Philippines. Method This qualitative study gathered transcriptions from field notes and focus group discussions of the authors. These transcriptions were characterized by the authors’ reflections on their experiences using the OJHQ on four distinct periods: 1) OJHQ translation, 2) pilot testing, 3) OJHQ-Filipino version administration, and 4) project conclusion. Data were analyzed through thematic analysis. Results Qualitative data revealed four themes: tool usefulness; administration guidelines; contextualized use of the tool; and nuances of occupational injustices in substance addiction and rehabilitation setting. Conclusion Findings expanded OJHQ’s purpose to enhance clinical reasoning, promote justice-oriented health care, activate reflective practice, and recognize the interweaving and evolving nature of injustices. This article offers an understanding of how reflections can facilitate cultural adaptation of practice tools used in occupational therapy and justice practice.