Occupational science: academic innovation in the service of occupational therapy's future

Using the Theory of Affordances to Understand Environment-Play Transactions: Environmental Taxonomy of Outdoor Play Space Features-A Scoping Review

IMPORTANCE

The transactions between the physical environment and children's play have not been well studied. The theory of affordances provides a way to better understand how environmental characteristics offer opportunities for play occupation.

OBJECTIVE

To investigate the relationship between environmental characteristics of outdoor play spaces and children's outdoor play and to develop an environmental taxonomy to support the analysis of play affordances in community play spaces.

DATA SOURCES

Peer-reviewed literature (1974-2023) was sourced from a previously published scoping review (Morgenthaler, Schulze, et al., 2023). The Academic Search Complete, Avery Index to Architectural Periodicals, CINAHL, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched using the keywords and synonyms of playground, environmental qualities, and children with and without disabilities.

STUDY SELECTION AND DATA COLLECTION

A secondary analysis of the previously published scoping review was conducted. Included studies were those that provided descriptions of physical environment-play activity transactions.

FINDINGS

A qualitative content analysis of 45 articles was conducted and used to form an environmental taxonomy. This taxonomy consisted of 14 space and object categories defined by their functional qualities and linked to play affordances. An array of 284 play occupations were identified in different forms. Play affordances of spaces and object categories and their functional environmental qualities were subsequently identified.

CONCLUSIONS AND RELEVANCE

This study provides evidence to support the understanding of how the physical environment shapes children's outdoor play occupations. Plain-Language Summary: The study authors developed the Environmental Taxonomy of Outdoor Play Space Features as a tool that occupational therapists can use to better understand and describe how the physical environment shapes opportunities for play. The tool could also be useful to justify environmental intervention in schools and public playgrounds to create spaces that support more play for a diversity of children.

Applying Concepts of Curriculum Design and Cultural Adaptation: Collaborating on a Dual-Degree Occupational Therapy Program in Mainland China

Occupational therapy is a profession with origins rooted in Western values. As culture plays an important role in shaping theory and practice, the curriculum design of academic programs that train future rehabilitation professionals should reflect the local context. As part of an international partnership, a dual-degree graduate program in occupational therapy was established between a Chinese and an American university. A team composed of members from both institutions collaborated on culturally adapting an entry-level master's program in occupational therapy for China, based on a U.S. program, which welcomed its first cohort in September 2019. This article details the timeline and process of program design and adaptation from conception, through implementation to evaluation and revision, with the aim of offering a framework for curriculum adaptation of other academic programs in the U.S. and internationally. The adapted curriculum includes the program mission, vision, and philosophy; the curriculum model with program outcomes and threads; the program scope and sequence; materials and resources; and course-specific objectives, learning activities, and assessments. The authors also share lessons learned through this experience of international collaboration as well as next steps for program evaluation and sustainability. The detailed overview of this international collaboration offers suggestions for individuals and institutions seeking to develop global partnerships and adapt curricula across cultural contexts.

Acquired brain injury (ABI) survivors' experience of occupation and activity during their inpatient stay: a scoping review

PURPOSE

This review aimed to characterise and map: (1) what type of evidence and what dominant study characteristics are available regarding acquired brain injury (ABI) survivors' experience of occupation and activity in hospital? (2) How are occupation and activity conceptualised in the literature? (3) How are ABI survivors experiencing occupation and activity while in hospital? (4) What factors create barriers or opportunities for engagement in occupations or activity in hospital? (5) Are there any knowledge gaps identified?

MATERIALS AND METHODS

A scoping review was conducted examining literature published between 2017 and 2022. Relevant studies were systematically retrieved from electronic databases.

RESULTS

Thirty-four publications were included. There were more quantitative studies (n = 18). Much of the research has been conducted outside of the UK. The populations studied were principally stroke (n = 22). The concept of activity rather than occupation predominates. Patients spend their time alone and inactive. Structural and contextual barriers for engaging in activity are identified. Qualitative study designs exclude ABI survivors with communication or cognitive impairment.

CONCLUSIONS

There is a paucity of research with ABI survivors in hospitals in the UK. Alternative methodological approaches such as ethnography would ensure those with communication or cognitive impairment are not excluded from research. Implications for rehabilitationRehabilitation professionals, especially occupational therapists, need to lead acquired brain injury (ABI) research in acute hospital settings in the UK.Conceptualisation of meaningful activity and occupation needs a clearer focus in ABI research.Qualitative studies frequently exclude participants with cognitive or communication impairments so methodologies that are more inclusive and representative of brain injury survivors are needed.

From domestication to imperial patronage: Deconstructing the biomedicalisation of occupational therapy

Occupational therapy knowledge emerged in the 19th century as reformist movements responded to the industrialisation of society and capitalist expansion. In the Global North, it was institutionalised by State apparatuses during the First and Second World Wars. Although biomedicine contributed to the rapid expansion and establishment of occupational therapy as a health discipline, its domestication by the biomedical model led to an overly regulated profession that betrays its reformist ideals. Drawing on the work of Deleuze and Guattari, our aim in this article is to deconstruct the biomedicalisation of occupational therapy and demonstrate how resistance to this process is critical for the future of this discipline. The use of arts and crafts in occupational therapy may be conceptualised as a 'nomad science' aesthetically resisting the domination of industrialism and medical reductionism. Through the war efforts, a coalition of progressive nurses, social workers, teachers, artisans and activists metamorphosed into occupational therapists. As it did with nursing, biomedicine proceeded to domesticate occupational therapy through a form of 'imperial' patronage subsequently embodied in the evidence-based movement. 'Occupational' jargon is widely used today and may be viewed as the product of a profession trying to establish itself as an autonomous discipline that imposes its own regime of truth. Given the symbolic violence underlying this patronage, the future of occupational therapy should not mean behaving according to biomedicine's terms. As a discipline, occupational therapy must resist the appropriation of its 'war machine' and craft its own terms through the release of new creative energy.

Optimizing Occupations, Habits, and Routines for Health and Well-Being With Lifestyle Redesign®: A Synthesis and Scoping Review

IMPORTANCE

Lifestyle Redesign® originated as a preventive occupational therapy intervention for healthy older adults, and it was found to be both effective and cost effective in the Well Elderly Studies initiated in the 1990s. Building on that empirical foundation, the scope of Lifestyle Redesign has been greatly expanded as a general intervention framework addressing prevention and chronic condition management in a wide range of populations, settings, and conditions. Yet until now, its full scope, defining characteristics, and supporting evidence have not been clearly and succinctly described, limiting its potential reach and impact.

OBJECTIVE

To outline the definition and key characteristics of Lifestyle Redesign, provide a scoping review of its evidence base and future directions for research, describe its current applications, and make recommendations for its use in clinical practice.

EVIDENCE REVIEW

We searched PubMed and CINAHL, tables of contents of 10 occupational therapy journals, and citations in two seminal Lifestyle Redesign publications to identify articles published in 1997-2020 that described quantitative outcomes (for n ≥ 20) of interventions meeting the defining characteristics of Lifestyle Redesign.

FINDINGS

Our scoping review yielded 12 publications providing supportive evidence for Lifestyle Redesign's positive impact on a range of health and well-being outcomes among both well populations and those with chronic conditions.

CONCLUSIONS AND RELEVANCE

Lifestyle Redesign has the potential to meet a growing need in clinical and community settings for health care services that address prevention, health promotion, and chronic disease management. What This Article Adds: Current evidence supports the use of Lifestyle Redesign to improve health and well-being for a range of client populations. This review outlines its defining characteristics and current applications to improve its implementation in clinical practice and expand related research efforts.

Exploring dating as an occupation for young heterosexual women in Ireland

Purpose

Dating is a meaningful occupation for many single people. The occupation of dating has transformed considerably in Ireland due to recent changes in Irish culture and the advent of online dating technology. The purpose of this study was to explore the complexities and intricacies of dating in an Irish context.

Design/methodology/approach

A qualitative research approach was used and data were collected using semi-structured interviews with ten heterosexual women (age 24‐34) living in urban areas of Ireland. Data were analysed using inductive thematic analysis (Braun and Clarke, 2006).

Findings

Dating did not fully resonate with their experience, but they did not have an alternative term. The form of dating was influenced by cultural, temporal, physical and virtual contexts. Beliefs about dating, fluctuating emotions and feelings of mortification because of the stigma of online dating created meaning for participants and influenced their use of strategies to improve resilience. While dating was not a preferred occupation for participants because of its arduous nature and fluctuations in emotion, it was seen as essential to fulfil the function of finding a romantic partner or partner in occupation. Connections between participant experiences and occupational science are discussed to address the lexicon of dating and the form, function and meaning of dating.

Originality/value

This study contributes to occupational science knowledge by revealing the occupational understandings of dating as an emerging and dynamic occupation in a rapidly changing culture of Ireland.

What If Deliberately Dying Is an Occupation?

In some legal and societal circumstances, people freely and capably plan, organize, and precipitate their own death. Drawing on published literature, we critically reflect on how deliberately ending one's own life fits with the current definitions of the concept of occupation. Using an occupational science and occupational therapy theoretical reflection, we argue that deliberately dying can for some people be considered a purposeful and meaningful occupation. Implications for such an occupational therapy practice are discussed: attending to the occupational needs of specific groups of people, reconsidering definitions and conceptual work, advocating for occupational justice in ending life activities, reflecting on ethical conundrums around self-harm activities within the scope of practice, and exploring deliberate death as a purposeful and meaningful occupation. Because deliberately dying is something that some people do, in this article we aim to open a dialogue within the field of occupational science and occupational therapy about this sensitive and potentially controversial issue.

Who is safe at work? Problematizing employment volatility during the 2008-2018 Spanish socioeconomic crisis from a critical occupational perspective

Abstract Introduction The Spanish socioeconomic crisis context has impacted on the population’s work conditions, which generates instability and workers’ fear of losing their job. Despite the recent research which addresses the work as an occupation in Critical Occupational Therapy and Science, little is known about the volatility of employment in relation to the job instability resulting from contextual changes. Objectives To explore the relationship between employment volatility, participation in daily occupations, and the health and wellbeing of workers during the Spanish socioeconomic crisis. Method A narrative qualitative methodology was conducted. Two open interviews and a personal diary were used as data generation methods. Two experiences were analyzed by adopting a thematic analysis. Results Three thematic categories illustrate how workers orchestrate their occupations in a context of employment volatility and they situate the multidimensional context of work in such circumstances as restrictive of occupational opportunities. Uncertainty generates a normalized instability in the daily life of workers, which impact occupational choices, health, and wellbeing. In addition, participants reflect on future perspectives of work associated with precarity and resignation. Conclusions The study of the employment volatility contributes to broadening the conceptualization of work as an occupation and contribute to the development of occupational justice-based practices.

“¿Quién está seguro en el trabajo?” Problematizando la estabilidad laboral durante la crisis socioeconómica española 2008-2018 desde una perspectiva ocupacional crítica

Resumen Introducción El contexto de crisis socioeconómica en España ha repercutido en las condiciones laborales de la población, generando situaciones de incertidumbre y miedo a perder el empleo por parte de los/as trabajadores/as. A pesar de las emergentes líneas de investigación que abordan el empleo como ocupación en Terapia y Ciencia de la Ocupación crítica, poco se sabe sobre la volatilidad del empleo en relación a la amenaza de pérdida del mismo derivada de cambios contextuales. Objetivos Explorar la relación entre la amenaza de pérdida de empleo, derivada de cambios contextuales, y la participación en ocupaciones cotidianas, la salud y el bienestar durante la crisis socioeconómica en España. Metodología Se llevó a cabo un estudio cualitativo exploratorio con diseño narrativo. Las técnicas de generación de datos fueron dos entrevistas semiestructuradas en profundidad y un diario personal. Se analizaron las experiencias de dos participantes mediante análisis temático. Resultados Emergieron tres categorías temáticas que ilustran cómo los/as trabajadores/as orquestan sus ocupaciones en un contexto de empleo volátil y sitúan el trabajo en un contexto multidimensional que restringe sus posibilidades ocupacionales. La inseguridad laboral genera una inestabilidad normalizada en la vida diaria, lo cual impacta en las elecciones ocupacionales, salud y bienestar de trabajadores/as. Los/as participantes reflexionan sobre sus perspectivas futuras de trabajo asociadas a la precariedad y resignación. Conclusión El estudio de la situación de amenaza de pérdida de empleo permite ampliar la conceptualización del trabajo como ocupación y contribuir en el desarrollo de prácticas basadas en la justicia ocupacional.

Alcohol use during pregnancy in rural Lesotho: "There is nothing else except alcohol"

OBJECTIVE

Reducing alcohol use during pregnancy is a pressing public health priority in Sub-Saharan Africa, but insight into the factors that influence prenatal drinking practices is lacking. This study investigated perceptions of, and motivations for, alcohol consumption during pregnancy and associated practices in a rural district of Lesotho.

METHODS

A combination of purposive and snowball sampling methods were used to identify pregnant women and mothers with young children from the general community, as well as from alcohol-serving venues. Between September 2016 and March 2017, a trained data collector conducted in-depth interviews with 40 women on reasons why pregnant women drink, what they know about the risk of drinking alcohol during pregnancy, and perceptions of women who drink during pregnancy.

RESULTS

Sixty-five percent of women (n = 26) reported that they consumed alcohol during pregnancy. Findings were clustered into four themes: 1) alcohol use in daily and cultural life; 2) alcohol as relief from stress and hunger; 3) alcohol's effect on the baby; and 4) access to information about alcohol consumption. Our data suggest that alcohol use was a prominent feature of daily life and a key part of traditional events and ceremonies. Other than potentially harming the baby through falling on their stomachs while inebriated, women did not mention other risks associated with prenatal alcohol use. Rather, there were prominent beliefs that drinking alcohol - home-brewed alcohol in particular - had cleansing or protective benefits for the baby. Experiences of food insecurity were prominent, and women reported that alcohol helped curb their hunger and allowed them to save food to give to their children.

CONCLUSIONS

Within this context of chronic poverty and food insecurity, alcohol use during pregnancy will continue to represent a valid, though tragic choice if the structural conditions and current social arrangements that facilitate prenatal alcohol use remain unchanged.

Association between apathy and satisfaction with meaningful activities in older adults with mild cognitive impairment: A population-based cross-sectional study

OBJECTIVES

This cross-sectional study aimed to clarify the relationship between apathy, meaningful activities, and satisfaction with such activities of older adults with mild cognitive impairment (MCI).

METHODS

We analyzed 235 older adults with MCI (≥65 years, mean age: 76.9 ± 6.4 years, women: 63.4%) who participated in a community-based health check survey (Tarumizu Study 2018). MCI was defined as at least 1.5 SD below the reference threshold (age- and education-adjusted score) on one or more of the computerized cognitive test including memory, attention, executive functions, and processing speed. Apathy symptoms were assessed using three of the 15 items of Geriatric Depression Scale. Participants selected meaningful activities from the 95 activities of the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance.

RESULTS

Apathy in MCI was prevalent by 23.8%. The categories of meaningful activities revealed no difference, with, or without apathy. Logistic regression analysis showed that activity satisfaction was significantly associated with apathy after adjusting for age, sex, education, instrumental activities of daily living, depressive symptoms, and MCI subtype (OR, 0.62; 95% CI, 0.44-0.88, p = 0.008).

CONCLUSIONS

Satisfaction with the activities that are deemed meaningful is associated with apathy among community-dwelling older adults with MCI.

Addition of Occupational Therapy to an Interdisciplinary Concussion Clinic Improves Identification of Functional Impairments

BACKGROUND

Concussions, or mild traumatic brain injuries, are prevalent among youth and young adults. These injuries may disrupt a person's daily activities (occupations) including school, physical activity, work, and socialization. Rehabilitation professionals, such as occupational therapists (OTs), are experts in providing individualized intervention to address these temporary life changes during recovery.

OBJECTIVE

This article aims to identify the benefit of having an occupational therapy practitioner on an interdisciplinary treatment team when providing intervention to patients with concussion.

SETTING

Concussion clinic at an academic institution.

PARTICIPANTS

Participants ages 12 to 24 years with a reported history of mild traumatic brain injury or concussion were evaluated by a physician, or by a physician and OT, in an initial evaluation appointment.

DESIGN

A single researcher (OT) with training in concussion qualitatively compared reported impacted occupational domains as defined in the Occupational Therapy Practice Framework, using both a retrospective and a prospective cohort. The prospective group differed from the retrospective group in that an OT was present, and participated in the initial evaluation.

RESULTS

The domains of performance patterns (P = .007) and performance skills (P ≤ .001) were identified significantly more often when an occupational therapy practitioner participated in the initial evaluation.

CONCLUSIONS

Rehabilitation professionals, such as OTs, play an important role in identifying impacted domains after a concussion, which can help optimize patient care.

The Relationship Between Meaningful Occupation and Self-Rated Health in Japanese Individuals: The Wakayama Study

In this study, we conducted a quantitative cross-sectional evaluation of the relationships between self-related health and occupational form, occupational performance, and occupational satisfaction. The participants were 675 community-dwelling subjects (283 men, 392 women) who completed a self-administered questionnaire. From this data, we performed a multiple logistic regression analysis using the high and low values of self-rated health as the dependent variables and the characteristics of occupational form, occupational performance, and occupational satisfaction as the independent variables. There were three analysis models: Model 1, which mutually adjusted for all the independent variables; Model 2, with adjustment of the basic attributes, in addition to the first model; and Model 3, which was based on Model 2, but also adjusted for diseases. In all three models, high self-rated health was significantly correlated with high occupational performance scores. These findings confirmed that supporting occupational performance improvement is useful for improving self-rated health.

Associations between Depressive Symptoms and Satisfaction with Meaningful Activities in Community-Dwelling Japanese Older Adults

The aim of this cross-sectional study was to investigate relationships between individuals' ratings of satisfaction and performance of activities that they found meaningful and depressive symptoms. Data was obtained from 806 older adults (mean age 74.9 ± 6.3 years, women = 63.0%) who participated in a community-based health check survey (Tarumizu Study 2018). Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Non-linear logistic regression analyses were used separately by gender to examine the association between satisfaction and performance of meaningful activities and depressive symptoms. The prevalence of depressive symptoms was 15.8%. We found no significant difference between meaningful activity choice between older adults with depressive symptoms and those without, in both men and women. After adjusting for potential covariates, satisfaction was associated with depressive symptoms in both men (OR 0.52, 95% CI 0.35-0.77) and women (OR 0.67, 95% CI 0.49-0.91), but performance was limited in women (OR 0.87, 95% CI 0.77-0.99). Our findings suggest that depressive symptoms are associated with satisfaction in meaningful activities regardless of activity categories.

Household Waste Sorting and Engagement in Everyday Life Occupations After Migration—A Scoping Review

The aim of this scoping review was to gain an overview of the current state of the literature on the engagement in waste sorting post migration from an occupational perspective, in the light of two aspects sustainability efforts currently face: Increased human migration and environmental degradation. Both the resource recovery and occupational science literature were reviewed and analyzed. However, despite the current lack on studies on how migrants’ transition into waste sorting schemes at the household level, this scoping review was able to provide a broad picture of the engagement in daily activities that support sustainability, such as household waste sorting. Given the current initiatives to develop efficient resource recovery from waste, such knowledge contributes to efforts to engage households with different cultures and experiences in waste sorting. The results highlight the importance of future research to better understand how people who are new to waste management schemes experience these, and study the way that engagement in waste sorting shifts and transforms. This is because providing such knowledge can contribute to raising awareness of the environmental impact of waste sorting, and inform policies aimed at sustainable waste management.

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.

Effect of Animal-Assisted Therapy on Patients in the Department of Long-Term Care: A Pilot Study

Long-term hospital stays might have a negative psychosocial impact on our patients. One way to positively activate hospitalized patients is to introduce animal-assisted therapy (AAT). A total of 72 individuals participated in this research. The experimental group comprised 33 patients (8 males, 25 females), while the control group contained 39 patients (11 men, 28 women). The participants in the control group were aged from 58 to 100 years and the experimental group featured participants aged from 51 to 95, for whom AAT was included alongside standard care. Blood pressure, heart rate, Barthel index, and general mood were measured in both groups. Results did not reveal any changes in blood pressure, heart rate, or Barthel index in comparison between groups. A great influence was noted in assessment of the mood of the patients. The inclusion of AAT did not affect physiological parameters, but it exerted a significant effect on the psychological well-being of the patients.

Highly Cited Occupational Therapy Articles in the Science Citation Index Expanded and Social Sciences Citation Index: A Bibliometric Analysis

OBJECTIVE

A bibliometric analysis was completed of highly cited occupational therapy literature and authors published from 1991 to 2014 and accessible in the Science Citation Index Expanded (SCI-Expanded) and Social Sciences Citation Index (SSCI) databases.

METHOD

Data were obtained from the SCI-Expanded and SSCI. Articles referenced >100 times were categorized as highly cited articles (HCA).

RESULTS

Of 6,486 articles found, 31 were categorized as HCA. The American Journal of Occupational Therapy published the largest number of HCA (n = 8; 26%). The 31 HCA were distributed across seven countries: United States (20 articles), Canada (3), United Kingdom (3), Australia (2), the Netherlands (1), New Zealand (1), and Sweden (1). The three authors with the highest Y-index were S. J. Page, F. Clark, and W. Dunn.

CONCLUSION

A latency period of 4 to 5 yr post-publication appears to be needed for a journal article to gain citations.

A Bibliometric Analysis of Highly Cited and High Impact Occupational Therapy Publications by American Authors

A bibliometric analysis was completed of peer-reviewed literature from 1991-2015, written by American occupational therapists, to examine US high impact scholarship with "occupational therapy" and "occupational therapist(s)" used as keywords to search journal articles' publication title, abstract, author details, and keywords. Results included 1,889 journal articles from 1991-2015 published by American occupational therapists as first or corresponding author. Sixty-nine articles attained a TotalCitation₂₀₁₅ ≥ 50 and 151 attained a Citation₂₀₁₅ ≥ 5 indicating that they were the most highly cited literature produced in this period. Although the majority (58%) of this literature was published in occupational therapy-specific journals, 41% was published in interdisciplinary journals. Results illustrate that the volume of highly cited American occupational therapy peer-reviewed literature has grown over the last two decades. There is need for the profession to strategize methods to enhance the publication metrics of occupational therapy-specific journals to reduce the loss of high quality publications to external periodicals.

Woman-to-woman rape and sexual assault, and its impact upon the occupation of work: Victim/survivors' life roles of worker or student as disruptive and preservative

BACKGROUND

Woman-to-woman rape and sexual assault globally remains largely unknown and unaddressed. Expectedly, victim/survivors often cope alone, or with limited support, in the traumatic aftermath of their sexual victimisation. Work is one occupation that is impacted upon at this time.

OBJECTIVE

The study explored the perceived impacts of woman-to-woman rape and sexual assault, the subsequent experience of disclosure, reaction, and support, and the consequences for victim/survivors' subjective experience of occupation.

METHODS

The study combined a sociological auto/biographical approach with an occupational science perspective. A web-based survey generated initial data, and was also used as a sampling tool; subsequently, 10 respondents were interviewed face-to-face, in various UK locations. An eleventh respondent shared her story through correspondence.

RESULTS

Four key themes emerged: 1) Identity; 2) Emotion; 3) Survival; and 4) Occupation. The latter, occupation, incorporated study and work.

CONCLUSIONS

For these victim/survivors, work or education can be experienced as either: disrupted (triggering) or as preservative (maintenance). Their life roles as worker or student were impacted by feelings that they could have performed better and achieved more. Occupational therapists and other relevant service providers could work with sexually victimised people in order to participate more satisfactorily and healthily in the occupation of work.

Expectations of choice: an exploration of how social context informs gendered occupation

Purpose

Occupational choice describes the process that leads to occupational engagement as a result of intrinsic and extrinsic influences. There has been a considerable amount of research concerning occupational choice, gender and adolescence. However, this has largely focused on the areas of career choice and engagement in risky health behaviours. This paper aims to expand on the literature by providing a broader scope of occupation more aligned with the concept associated with occupational science. Furthering this, the researcher aims to examine the influence of gender as an extrinsic influence on occupational choice. The researcher aims to explore how contextual influences inform gendered occupational choice.

Design/methodology/approach

An exploratory qualitative approach was used in the current study. Incorporating photographs as a means of elucidating conversation during the interview process, photo-elicitation interview techniques were used as part of the data collection. This involved using a collection of photographs to prompt participants to discuss their interpretations of various occupations. Six adolescent boys and girls aged 11-14 years participated in the study. Participants were recruited from mixed-gendered sports clubs in the West of Ireland. Thematic analysis was used to analyse the data. An occupational justice perspective was used to interpret the data.

Findings

Responses suggest that gender informs occupational choice through different mechanisms. These included social systems, physical and institutional opportunities as well as expectations participants held of themselves and others they considered to be within their social grouping. Social systems included groups such as friends and family. The ease of access to physical and institutional resources was another factor that informed choice. Participants projected views of expectations they perceived others held for them informed how the participants made their choices. These factors varied across gender. Despite opportunities being available to both sexes, choices were often restricted to particular occupations.

Originality/value

The findings suggest that factors informing the occupational choices of adolescents included a combination of intrinsic factors such as gender and perspectives, as well as external factors including peers, family and opportunities in the local community. Practical applications of this involve acknowledging and further understanding the contextually situated nature of choice to provide more equitable practice. The results of the study may provide more insight into the factors that enable and inhibit occupation. A further understanding of these influences can redirect how we view adolescent occupations in a way that promotes health.

Resource Seeking as Occupation: A Critical and Empirical Exploration

Occupational therapists and occupational scientists are committed to generating and using knowledge about occupation, but Western middle-class social norms regarding particular ways of doing have limited explorations of survival occupations. This article provides empirical evidence of the ways in which resource seeking constitutes an occupational response to situations of uncertain survival. Resource seeking includes a range of activities outside formal employment that aim to meet basic needs. On the basis of findings from 2 ethnographic studies, we critique the presumption of survival in guiding occupational therapy documents and the accompanying failure to recognize occupations that seem at odds with self-sufficiency. We argue that failing to name resource seeking in occupational therapy documents risks alignment with social, political, and economic trends that foster occupational injustices. If occupational therapists truly aim to meet society’s occupational needs, they must ensure that professional documents and discourses reflect the experiences of all people in society.

Some Factors influencing Occupational Engagement for People with Schizophrenia Living in the Community

With the emergence of occupational science, there has been renewed interest in the health benefits of occupational engagement and a call for more research into the occupational nature of humans. Engaging in occupations is known to have a positive effect on an individual's health and sense of wellbeing. A common feature of people with schizophrenia, however, is a decrease in volition and a reduction in the occupations performed. This study explored some of the influences on occupational engagement for people with schizophrenia living in the community.

A qualitative approach was chosen, using semi-structured interviews. Four male and four female participants, aged 23 to 49 years, described the influences on their occupational engagement. Content analysis, primarily using coding and memoing, was employed to categorise the data. Four main themes emerged: health, routine, external factors and internal factors. Some specific factors identified within these themes were medication, daily schedules, staff, family, work, self-concept and challenges. The implications of the results are discussed, with particular reference to assisting occupational therapists to enable clients with schizophrenia to engage more successfully in occupations.

Occupational Therapy: A Critical Overview, Part 1

This article provides an overview of occupational therapy by analysing those philosophical aspects that are generally held in high regard by the profession. It attempts to demonstrate that current professional beliefs and related models of practice may be flawed and may have a far greater negative Influence on the profession than is generally acknowledged.

Part 1 challenges some of the core philosophical ideas of occupational therapy, in particular concepts related to health through occupation, the meaning of occupation, purposeful activity and occupational dysfunction.

Efficacy and the Self

Psychoanalytic theory concerning efficacy is reviewed from a historical perspective together with the work of the more recent writers, Daniel Stern and Joseph Lichtenberg. The contribution of the early caregiver and the impact of upbringing on the experience of efficacy is considered. Some psychoanalytic ideas are applied to the practice of activity-based therapy.

Understanding ‘Occupation’ as the Founders Did

The term ‘occupation’ is both ambiguous and encompassing. This term was adopted by the founders of the profession as a means of incorporating a variety of perspectives on the profession. Interrelating concepts deriving from pragmatism and the mental hygiene movement offer a rationale for understanding occupation. Terms used to describe occupation are egocentricity (mind/body elements), exocentricity (time/space elements) and consensuality (social elements). The integration of these aspects in occupation offers an explanation for the holism advanced by the profession at its outset and today.

An Overview of Occupational Therapy in the Context of the American Influence on the Profession: Part 1

This article presents an overview of the genesis of the beliefs and values about occupational therapy as they emerged in the USA, reviews some of the factors associated with these developments, and questions the professional relevance of the concept of occupation as promulgated in the model of human occupation. Part 1 provides the background: it offers an historical outline of the beginning of occupational therapy in the USA, reflects on the meaning of occupation, and evaluates the concept of occupation as therapy. Part 2 considers the scientific aspects of occupation from a paradigmatic perspective, and concludes with suggesting that the concept of competence, rather than occupation, has provided and will continue to provide the philosophical underpinning for occupational therapy.

Mental Health Clients Confirm the Motivating Power of Occupation

Most occupational therapists, like the founders of the profession, believe that engagement in meaningful occupation is fundamental in helping to overcome the effects of disability. This paper describes the method and one of the resulting themes of a study that investigated the value, related to personal meaning, of occupation from the perspective of people with enduring mental health problems.

Qualitative research methods were used in two mental health day service settings: a workshop, where woodwork was provided as a medium for creative therapy, and a drop-in facility. Clients were asked about their motivation, their occupational experiences and any benefits that engagement in occupation might have had for them. Participant observation was undertaken over 10 sessions and six in-depth interviews were conducted. The findings emerged through content and inductive analysis, as well as analytical triangulation of the data.

Occupation was identified as a means for generating intrinsic motivation. By providing a sense of purpose and a structuring of time, within an empowering environment, engagement in occupation was seen to be of value and had personal meaning for the clients. However, more research needs to be undertaken to augment the findings. Such evidence will support increased provision of occupation for people whose lives have been severely disrupted by mental health problems.

The Most Important Activity and the Reasons for That Experience Reported by a Danish Population at Age 75 Years

The aim of the study was to describe the activities that 75-year-old men and women indicate as most important and to reveal why they find them important.

The data were derived from a cross-sectional study of 748 Danish 75-year-old men and women, born in 1914. The people were interviewed at home by means of a questionnaire. The most important activity was revealed by an open-ended question: what is your most important activity? The answers were classified into three qualities: type, site and social relations. The participants were asked if the activity was important because it gave enjoyment, self-confidence, challenges, company, cooperation, usefulness, new skills and/or new experiences.

A majority of the participants reported physical and individual activities as the most important and the reasons given by most participants for stating their activity as most important were work enjoyment and usefulness. It was concluded that attention should be paid to older people's possibilities for having important activities.

Occupational Therapy: A Critical Overview, Part 2

Part 2 of this article continues the evaluation of philosophical concepts that began in part 1. It concludes by suggesting that the foundation of the profession does not rest on the dictum ‘health through occupation’ but on the field related to the learning and teaching of skills, and stresses the importance and potential that this field has for the future viability of occupational therapy. In this context, the need for recognising the distinction that exists between the inherent competence of Individuals, as closed systems, and their observable behaviour as they openly interact with the environment is emphasised.

True to Our Philosophy? Sexual Orientation and Occupation

Occupational science and occupational therapy suggest that people engage in occupations that are meaningful and relevant to them on personal and cultural levels. Sexual orientation is one theme of meaning in a person's life which influences his or her choice of occupations and the meaning and relevance those occupations hold. Sexual orientation, as it is conceptualised here, encompasses far more than a person's choice of sexual partner and is, therefore, an important area for an occupational therapist to consider. It is, however, an often neglected area in both curricula and the literature.

This paper presents the results of a qualitative study which investigated the perspectives of basic grade occupational therapists regarding working with clients of gay, lesbian or bisexual sexual orientation. Six basic grade occupational therapists were interviewed using a semi-structured format and four themes emerged. The findings included that the basic grade occupational therapists interviewed did not consider occupation in its complexity and so did not appreciate how sexual orientation might be expressed in a person's occupations. The interviews also indicated that the subject of sexuality is still taboo in occupational therapy.

Models for Practice in Occupational Therapy: Part 2, What Use are They?

The second part of this article presents arguments for the value of models for practice in occupational therapy and suggests some of their limitations. The article concludes by inviting readers to reflect on these two positions.

Latino Families' Experiences With Autism Services: Disparities, Capabilities, and Occupational Justice

This article examines six cases of publicly funded Applied Behavior Analysis (ABA) therapy for Latino children with autism spectrum disorder (ASD) to contribute to thinking about occupational justice. In this ethnographic study of six Latino families of children with ASD in Los Angeles County, all families were offered ABA for their children, but five families experienced occupational challenges leading them to insist on modifications of ABA or to opt out of the service. We consider in each case (a) how the families' experiences can be understood occupationally, (b) how ABA affected the functionings and capabilities of the children and their families, and (c) how the parents' accounts relate to occupational justice. Applying the capabilities approach can help operationalize the concept of occupational justice as a tool to evaluate social policy across cases.

The Concepts of Habit and Routine: A Preliminary Theoretical Synthesis

Although a number of diverse research areas underscore the importance of habit and routine, there has been little theoretical coherence to this work considered as a whole. Varying definitions of habit and routine, as well as the extremely broad range of phenomena to which they apply, have hampered the ability to develop any overarching synthesis. In connection with a recent conference sponsored by the American Occupational Therapy Foundation, this article offers a preliminary theoretical synthesis of habit and routine with respect to definitional issues, relation to quality of life, and potential benefits to consumers with disabilities.

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.

An Occupational Perspective of the Weil-Being of Maya Women in Southern Belize

A study was designed to explore the relationship between occupation and the well-being of indigenous Maya women living in a rural village in the Toledo District of southern Belize. Using a qualitative multiple methods approach, data were collected through participant observation, interviews, a focus group, and document review. Subjects were Maya women, 18 years or older, living in a rural village in southern Belize. The women demonstrated similarities in daily physical and social routines at the river and in their homes, reflecting occupational patterns and routines that are deeply imbedded in their culture and play a critical role in the formation of self-identity. Several themes emerged describing the women's definitions of health and well-being. Each woman interpreted her life in relation to her occupations and well-being differently. This seemed to vary depending on individual life experiences, routines, and contexts.

The Activity Card Sort: A Factor Analysis

This study was conducted to examine the utility of the Activity Card Sort (ACS) as a unique assessment tool for measuring adult human occupation and level of activity. Factor analysis was used to determine whether the picture items of the ACS empirically cluster into four categories of human occupations (instrumental activities, low-demand leisure activities, high-demand leisure activities, and social activities), as well as to compare young and elderly people's classifications of activities on the ACS instrument. The study sample consisted of 184 participants who were divided into two groups (53 students and 131 elderly people). Factor analysis revealed five factors for student activities and four factors for elderly people's activities. The analysis of variance revealed that students were involved primarily in leisure activities and secondarily in independent activities of daily living (IADL), whereas elderly people were mostly involved in IADL. Pearson correlations showed the five student categories to be distinctive, whereas substantial overlapping among categories was obtained for elderly people. The use of the ACS as an important research instrument may serve to advance our understanding of the categorization of human occupations among different age groups by identifying underlying dimensions of occupational performance and assessing intensity of involvement in different occupational categories. In addition, this instrument highlights the interaction between occupational performance, person factors (various age and gender groups), and environment factors (e.g., culture).

Visuomotor Organization and Thinking Operations Performance of School-Age Ethiopian, Bedouin, and Mainstream Israeli Children

In this study, the cognitive performance, specifically visuomotor organization and thinking operations, of new immigrant children (Ethiopian) and children from a minority group (Bedouin) was compared to the performance of mainstream Israeli children in two age groups. By assessing the cognitive performance of children from different cultural contexts, a more basic understanding can be gained of the child's ability to perform in school, in daily self-care, and in play/leisure tasks. Furthermore, knowledge of information-processing development that influences occupation in different cultures will advance occupational science. The findings suggest that cultural context as well as schooling have a powerful impact on children's cognitive performance. The findings may have implications for various diverse populations, and therefore it is recommended to study the cognitive performance of school-age children in other populations and to use a dynamic assessment to explore the learning potential of children. It is recommended to develop preventive intervention programs in populations from diverse cultural contexts.

Enabling Empowerment: Using Simulations versus Real Occupations

This study shows how the organization of occupational therapy determines occupational therapists' potential and limits for enabling the empowerment of adults who attend mental health day programmes. Drawing from the full ethnography, this paper shows how the organization of practice determines invisibly whether occupational therapists are more likely to involve people in simulations or in the real occupations of their everyday world. The study explores the use of simulations versus real occupations by tracing everyday practice to the locations, facilities, and scheduling context in which practice occurs. Practice is further traced to the philosophic and funding context of programmes. The final part of the analysis outlines how the use of simulations versus real occupations is shaped by particular ideas about mental health, professional practice, health services, welfare, and the market place. The analysis of an institutional ethnography offers a blueprint for change.

Developmental Dyspraxia and the Play Skills of Children With Autism

OBJECTIVE

This study sought to investigate the impact of developmental dyspraxia on the play skills of children with autism spectrum disorder (ASD).

METHOD

The praxis abilities of 32 children with ASD (mean age=7.5 yr) were assessed using two subtests of the Sensory Integration and Praxis Tests and the Planning and Ideas domain of the Sensory Processing Measure Home Form. Play and leisure skills were measured with the Vineland Adaptive Behavior Scales, Second Edition. Utilizing correlation coefficients, we investigated the relationship between developmental dyspraxia and the play skills of children with ASD.

RESULTS

Children with ASD demonstrated definite dysfunction in imitative praxis abilities, the generation of ideas, and participation in age-appropriate play and leisure activities.

CONCLUSION

Praxis problems in children with ASD greatly affect their successful participation in play and leisure activities.

Treating Depressive Symptoms in Psychosis: A Network Meta-Analysis on the Effects of Non-Verbal Therapies

AIMS

The aim of this study was to examine whether non-verbal therapies are effective in treating depressive symptoms in psychotic disorders.

MATERIAL AND METHODS

A systematic literature search was performed in PubMed, Psychinfo, Picarta, Embase and ISI Web of Science, up to January 2015. Randomized controlled trials (RCTs) comparing a non-verbal intervention to a control condition in patients with psychotic disorders, whilst measuring depressive symptoms as a primary or secondary outcome, were included. The quality of studies was assessed using the 'Clinical Trials Assessment Measure for psychological treatments' (CTAM) scale. Cohen's d was calculated as a measure of effect size. Using a Network Meta-analysis, both direct and indirect evidence was investigated.

RESULTS

10 RCTs were included, of which three were of high quality according to the CTAM. The direct evidence demonstrated a significant effect on the reduction in depressive symptoms relative to treatment as usual (TAU), in favor of overall non-verbal therapy (ES: -0.66, 95% C.I. = -0.88, -0.44) and music therapy (ES: -0.59, 95% C.I. = -0.85, -0.33). Combining both direct and indirect evidence, yoga therapy (ES: -0.79, 95% C.I. = -1.24, -0.35) had a significant effect on depressive symptoms, and occupational therapy (ES: 1.81, 95% C.I. = 0.81, 2.81) was less effective, relative to TAU. Exercise therapy did not show a significant effect on depressive symptoms in comparison to TAU (ES: -0.02 95% C.I. = -0.67, 0.62). Due to inconsistency of study evidence, the indirect effects should be interpreted cautiously.

CONCLUSIONS

Non-verbal therapies appear to be effective in reducing depressive symptomatology in psychotic disorders, in particular music therapy and yoga therapy.

Occupational Consciousness

Occupational consciousness refers to ongoing awareness of the dynamics of hegemony and recognition that dominant practices are sustained through what people do every day, with implications for personal and collective health. The emergence of the construct in post-apartheid South Africa signifies the country's ongoing struggle with negotiating long-standing dynamics of power that were laid down during colonialism, and maintained under black majority rule. Consciousness, a key component of the new terminology, is framed from post-colonial perspectives - notably work by Biko and Fanon - and grounded in the philosophy of liberation, in order to draw attention to continuing unequal intersubjective relations that play out through human occupation. The paper also draws important links between occupational consciousness and other related constructs, namely occupational possibilities, occupational choice, occupational apartheid, and collective occupation. The use of the term 'consciousness' in sociology, with related or different meanings, is also explored. Occupational consciousness is then advanced as a critical notion that frames everyday doing as a potentially liberating response to oppressive social structures. This paper advances theorizing as a scholarly practice in occupational science, and could potentially expand inter or transdisciplinary work for critical conceptualizations of human occupation.