A Pilot Study of the ¡Vivir Mi Vida! Lifestyle Intervention for Rural-Dwelling, Late-Midlife Latinos: Study Design and Protocol

Occupational Therapy in Primary Health Care for Underserved Populations: A Scoping Review

The aim of this scoping review was to identify what current and potential opportunities exist for occupational therapy in primary healthcare for underserved populations. Search phrases were utilized across several databases and Occupational Therapy specific journals were hand searched. Nineteen articles met inclusion criteria: English, 2009-2021, services delivered by occupational therapy practitioners or supervised students, for underserved populations/individuals, in community-based care, and primary health care settings. Five synergistic themes emerged from the literature are discussed: Client-centered, team collaboration, holistic and preventative health and wellness, evidence-based program evaluation, and innovative service delivery.

Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services

INTRODUCTION

Rural communities contribute to national wellbeing, identities, economies, and social fabrics yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about non-urban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focussed services are more commonly discussed. Understanding intentions expressed in publications about non-urban service design may identify assumptions/limitations to current approaches and contribute to improved future services.

METHODS

Each of 117 publications identified in a scoping review was read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes. The first author reinterrogated the publications and coded data to identify relevant examples to support the identified themes.

RESULTS

Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes (i) Extension of urban practice and (ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme (iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focussed on developing non-urban communities and promoting justice.

CONCLUSION

The hegemonic paradigm links occupational therapy services with neoliberal notions of individualism, private provision of care, and efficiency/market value, rather than the occupational therapy values for justice. The profession must consider our role in perpetuating injustice for non-urban people and consider if and how more contextually tailored counter hegemonic place-based paradigms can be developed from and with regional, rural, and remote practice.

Life Domains and Lifestyle of Older Adults Living in a Nursing Home: A Pilot Study

Although the preventive occupational therapy intervention program Lifestyle Redesign® has proven to be effective in maintaining and improving the health and quality of life of older adults, a similar program has not yet been culturally adapted to the Spanish population. As a preliminary step in developing a lifestyle intervention tailored to healthy Spanish older adults living in a nursing home (Lifestyle Choice; originally in Spanish "Elección de Estilo de Vida"), we aimed to identify and describe the life domains of this population and determine overlap with content areas addressed in the Lifestyle Redesign® program. An observational cross-sectional study was carried out using quantitative methods, including 30 healthy older adult residents in the "Virgen del Prado" nursing home in Talavera de la Reina (Toledo), based on the development of a questionnaire and a survey. Six life domains were identified: self-care, sleep and rest, mobility, personal safety, health maintenance, spirituality, and free time usage. The results of this study reveal important overlaps with content areas of Lifestyle Redesign®, suggesting that it may be feasible to develop a lifestyle intervention ("Elección de Estilo de Vida") tailored to the sociocultural features of the healthy Spanish population over 65 years old living in nursing homes.

Lifestyle Redesign® with independent living older adults in countries other than the USA

BACKGROUND

Health promotion services need to be developed to respond to the needs of an ageing population. Lifestyle Redesign^® (LR^®) is an occupational therapy intervention that has been addressed as cost-effective in the USA.

AIMS/OBJECTIVES

This scoping review aimed to identify how the LR^® has been implemented and what the results have been with older adults living independently in countries other than the USA.

MATERIAL AND METHODS

Sixteen studies were included. Quantitative results were interpreted through the numeric data and qualitative results through inductive thematic analysis.

RESULTS

The delivery of the LR^® shared both similarities and differences with the original LR^®, and the variations concerned interventions length, facilitators, and the outcome measures used. In the quantitative results, there was often a positive trend in intervention groups' health-related quality of life, mental health, and occupational performance; in qualitative results, there was improvement in self-esteem and possibilities in building new communities.

CONCLUSIONS AND SIGNIFICANCE

The original LR^® was often transferrable into cultural settings other than the USA and many positive outcomes in the health and well-being of older adults were addressed. However, to understand the feasibility and effectiveness of the LR^®, scientific research and publications need to be enhanced.

Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care

Importance: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs.

Objective: To evaluate patients’ long-term health-related outcomes after lifestyle intervention.

Design: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up.

Setting: Rural, community-based primary care.

Participants: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr.

Intervention: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care.

Outcomes and Measures: Self-reported and physiological outcomes: symptom–well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants’ lives.

Results: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom–well-being dimensions (Cohen’s d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention’s sustained positive effect on their wellness.

Conclusions and Relevance: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos.

What This Article Adds: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.

Evaluation of ¡Vivir Mi Vida! to improve health and wellness of rural-dwelling, late middle-aged Latino adults: results of a feasibility and pilot study of a lifestyle intervention

AimThe aim of this study was to determine the feasibility and efficacy of a culturally tailored lifestyle intervention, ¡Vivir Mi Vida! (Live My Life!). This intervention was designed to improve the health and well-being of high risk late middle-aged Latino adults and to be implemented in a rural primary care system.

BACKGROUND

Rural-dwelling Latino adults experience higher rates of chronic disease compared with their urban counterparts, a disparity exacerbated by limited access to healthcare services. Very few lifestyle interventions exist that are both culturally sensitive and compatible for delivery within a non-metropolitan primary care context.

METHODS

Participants were 37 Latino, Spanish-speaking adults aged 50-64-years-old, recruited from a rural health clinic in the Antelope Valley of California. ¡Vivir Mi Vida! was delivered by a community health worker-occupational therapy team over a 16-week period. Subjective health, lifestyle factors, and cardiometabolic measures were collected pre- and post-intervention. Follow-up interviews and focus groups were held to collect information related to the subjective experiences of key stakeholders and participants.FindingsParticipants demonstrated improvements in systolic blood pressure, sodium and saturated fat intake, and numerous patient-centered outcomes ranging from increased well-being to reduced stress. Although participants were extremely satisfied with the program, stakeholders identified a number of implementation challenges. The findings suggest that a tailored lifestyle intervention led by community health workers and occupational therapists is feasible to implement in a primary care setting and can improve health outcomes in rural-dwelling, late middle-aged Latinos.