Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography

BACKGROUND

Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed.

AIM

Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach.

MATERIAL AND METHODS

The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data.

RESULTS

Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied.

CONCLUSION AND SIGNIFICANCE

The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

Psychosocial Working Conditions and Social Participation. A 10-Year Follow-Up of Senior Workers

Social participation is important for health, and it is well known that high strain jobs impact negatively on mental and physical health. However, knowledge about the impact of psychosocial working conditions on social participation from a long-term perspective is lacking. The purpose of this study was to investigate the associations between different job types and social participation from a long-term perspective. A comprehensive public health questionnaire "The Scania Public Health Survey", was used, and psychosocial working conditions were measured with a Swedish translation of the Job Content Questionnaire. Based on data from 1098 working respondents aged 55 at baseline and a 10-year follow-up when the respondents were not working, the analyses revealed that social participation varied by job type. Jobs with high decision latitude, as in active and relaxed jobs, seem to predict high social participation, even after cessation of employment. Besides that, the result suggests that high social participation during working life is a predictor of high social participation from a long-term perspective which promotes healthy aging. Incentives for working longer are strongly related to good working conditions. A supportive work environment with possibilities for employees to participate in decision making, i.e., high control, is vital for a sustainable working life. This may contribute to an extended working life and may also support social participation prior to retirement as well as after retirement and thus to healthy aging.

Prerequisites and driving forces behind an extended working life among older workers

BACKGROUND

Reforms are changing pension systems in many European countries, in order to both restrict early retirement and force people to extend their working life. From occupational therapy and occupational science perspectives, studies focusing on aspects of working life that motivate the older worker is urgent.

AIM

The aim was to describe incentives behind an extended working life among people over age 65.

METHOD

Focus group methodology was used, with participants ages 66-71, from varying work fields: construction and technical companies and the municipal elderly care sector.

FINDINGS

Work was considered important and valuable to the degree of how challenging work was, the possibilities for inclusion in a team of colleagues and the chances for better personal finances. Amongst all, the participants expressed a feeling of a strengthened identity by being challenged and having the opportunity to manage working tasks.

CONCLUSION

The finding showed the actual reasons behind an extended working life among older workers. However, a risk of rising social inequity may appear with increased working life if older people are forced to extend their working life due to a difficult financial situation as a pensioner. A variety of retirement options and initiatives in order to support older workers are justified.

Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study

BACKGROUND

Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method.

METHODS

In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed.

RESULTS

The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone.

CONCLUSIONS

Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

Occupational Therapy targeting Physical Environmental Barriers in Buildings with Public Facilities

The main aim of this study was to evaluate an occupational therapy based intervention aimed at increasing the accessibility to buildings with public facilities in a Swedish town centre, which targeted physical environmental barriers. The intervention was occupational therapy advice based on the environmental assessments of each facility, given to the facility owners in order to ease the removal of environmental barriers. Another aim was to elucidate the attitudes towards and the practical obstacles to the implementation of accessibility measures among public facility owners. Systematic on-site observations of environmental barriers were administered in five buildings with different facilities, at baseline and at follow-up 18 months later, and were complemented by semi-structured interviews with the facility owners at follow-up.

At baseline, environmental barriers were found in all five facilities, such as at entrances, and at follow-up only minor improvements were identified. Two of the facility owners had made use of the occupational therapy advice, but the results also revealed scarce knowledge of or negative attitudes towards accessibility measures. Much remains to be done when it comes to attitudes towards the inclusion of people with disabilities. Active occupational therapy, as described in this study, can influence the situation only to a limited extent. Nevertheless, the results demonstrate that there is knowledge to be gained through this kind of approach.

Very old people's experience of occupational performance outside the home: Possibilities and limitations

To support occupations outside the home for older people with functional limitations it is important to understand how the person, environment, and occupations influence performance. Therefore the purpose of this study was to describe how very old people experience occupational performance outside the home. Twenty-one single-living, very old persons, above 80 years, were strategically selected and interviewed. A phenomenographic approach was used for this study and the interviews were analyzed using contextual analysis. The findings showed a variation in the experience of occupational performance described in three referential aspects: keeping on doing as before, drawing on available resources, and living in constrained circumstances. Referring to everyday occupations the participants described how they continued to do what they had done before, but decline in functional capacity made it more difficult to overcome environmental barriers. They also described how they sometimes could put functional limitations aside and use their utmost capacity to reach their goals. When they could not do that any more, they had to find possibilities for occupations close to home. In order to support very old people's occupational performance outside the home, outdoor mobility has to be facilitated, including the design of the physical environment as well as possibilities for social interaction.

"Let's go for a walk!": identification and prioritisation of accessibility and safety measures involving elderly people in a residential area

By emphasising the involvement of elderly people in a project applying a mixed-method approach, the overriding objective of this study was to identify and prioritise concrete measures aimed at increasing accessibility and safety in the outdoor pedestrian environment within a residential area of a Swedish town. Measures generally given priority were: the separation of pedestrians/cyclists, lower speed limits, better maintenance and specific measures in pedestrian walkways such as wider sidewalks, curb levels and form and more even surfaces on pavements. Definition of these priorities offered knowledge to the highway department concerning the importance of small details in relation to the larger infrastructure. The elderly people in the study district found new ways to communicate with and influence those within the community who are responsible for these matters.

Very old people's use of the pedestrian environment: functional limitations, frequency of activity and environmental demands

Due to decreased functional capacity as well as high environmental demands there is a risk of diminishing activity outside home in very old age (age 80+). In order to explore differences according to functional limitations (FL) among very old people with respect to frequency of activity, perceived health, overall perception of neighbourhood environment, and perceived problems in the pedestrian environment, data derived from a postal questionnaire survey to very old people living in an urban area in Sweden were used. This explorative study is based on the sub-sample of people aged 80+ who reported outdoor activities (n = 97). Four groups of respondents with different types of FL were identified: with no FL (n = 23), with only movement-related FL (n = 26), with only perception/cognition-related FL (n = 16), and with both movement- and perception/ cognition-related FL (n = 32). The majority of the respondents reported rather high frequency of activity outside home. When examining differences between the four groups, the analysis indicated how the complexity of FL and perceived problems in the pedestrian environment impacted on their activity performance. Persons with both movement- and perception/cognition-related FL were less satisfied with their frequency of activity, experienced their health more negatively and experienced more problems in the pedestrian environment than in the other groups. The findings from this study indicate the importance of considering combinations of FL in creating supportive environments for activity and health.