Realist process evaluation of occupational performance coaching: protocol.

INTRODUCTION: A cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation, health and well-being of children with neurodisability and their caregivers. This protocol presents the realist process evaluation which is occurring in parallel with the trial to allow testing and further refinement of OPC programme theory, as represented in its logic model. The aim of this realist evaluation is to examine what works, for whom, in the implementation of OPC with caregivers of children with neurodisability (in particular, Maori and Pasifika) in current service delivery contexts. METHODS AND ANALYSIS: Guided by OPC programme theory and realist evaluation processes, mixed-methods data collected from the MANA study OPC group will be analysed to elucidate when OPC works (outcomes), for whom, how (mechanisms) and under what circumstances (contexts). This will culminate in the synthesis of Intervention-Actor Context-Mechanism-Outcome configurations. Descriptive analyses will be reported for quantitative measures of treatment fidelity (OPC-Fidelity Measure), caregiver emotional response to OPC (Session Rating Scale) preintervention emotional state (Depression Stress and Anxiety Scale) and client outcomes (Canadian Occupational Performance Measure). Reflexive thematic analysis will be undertaken to analyse realist interviews with therapists who implemented OPC above and below fidelity thresholds and culturally focused interviews with clients of Maori or Pasifika ethnicity, informing understanding of the contexts influencing therapists' implementation of OPC with fidelity, and the mechanisms triggered within therapists or caregivers to elicit a response to the intervention. The MANA study trial outcomes will be reported separately. ETHICS AND DISSEMINATION: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee (20/STH/93). In all participating jurisdictions local area approval was obtained, involving a process of local Maori consultation. Results will be disseminated to all participants, and more broadly to clinicians and policy-makers through conference presentations and peer-reviewed journal publications, which will inform decision-making about resourcing and supporting effective delivery of OPC to optimise outcomes for children and caregivers. TRIAL REGISTRATION NUMBER: ACTRN12621000519853.

Occupational Performance Coaching for Children With Neurodisability: A Randomized Controlled Trial Protocol.

Background. Occupational Performance Coaching (OPC) is a goal-oriented approach in which client agency takes precedence in goal selection, analysis, choice of action, and evaluation of success. The intended outcomes of OPC are improved occupational performance and participation in clients' life situations. Randomized clinical trials are needed to determine the effectiveness of OPC. Purpose. This study protocol outlines a randomized controlled trial (RCT) of OPC compared to usual care with caregivers of children with neurodisability in improving child, caregiver, and family occupational performance. Method. A single-blind, 2-arm parallel-group, cluster RCT of OPC compared to usual care is planned. Therapists delivering the intervention (N = 14) are randomized to "OPC training" or "usual care" groups. The primary outcome is occupational performance improvement in caregiver (N = 84) identified goals. Implications. Findings will provide translational evidence of the effectiveness of OPC and clarify intervention processes. Areas of future OPC research and development will be indicated.

Stakeholder perspectives of the sociotechnical requirements of a telehealth wheelchair assessment service in Aotearoa/New Zealand: A qualitative analysis.

INTRODUCTION: Telehealth is widely proposed to improve access and equity in provision of rehabilitation, including wheelchair assessment, yet the design requirements of telehealth wheelchair assessment that will be accepted and utilised at scale are unclear. Service design that addresses the existing inequities in outcomes for indigenous populations, such as Maori will be critical. The aim of this study was to examine the design requirements of a telehealth wheelchair assessment service from the perspectives of key stakeholders such as wheelchair users and their families, including indigenous (Maori) and health professionals including occupational therapist, and physiotherapist assessors and technicians. METHODS: Within a wider mixed methods design, inductive thematic analysis was applied to focus group and interview data from 23 assessors (19 occupational therapists and four physiotherapist assessors, one of whom was Maori) and 19 wheelchair users (three of whom were Maori). RESULTS: Eight themes were discerned with the final three themes emphasising the experiences of particular concern to Maori: (1) At the mercy of the system; (2) The hurdle of technology; (3) More efficient for all; (4) Lost information and connection; (5) Rights and the right way forward; (6) Cultural safety; (7) Whanaungatanga (relationship building); and (8) Summative disadvantage for Tangata whaikaha (Maori with disabilities). Themes reflected a recognition of risks and uncertainty associated with tele-delivered assessment. Conversely, advantages in access, equity, and professional competency were reimagined. Perspectives of Maori included both risks and advantages as perceived by Maori. CONCLUSION: Substantial dissatisfaction with current wheelchair assessment services among wheelchair users provides context to the impetus for a successful design of a telehealth assessment service. Training in conducting telehealth wheelchair assessment is essential incorporating culturally safe communication practices and support of wheelchair user autonomy while identifying solutions that achieve wheelchair user goals.

Responsibility sharing for adolescents with type 1 diabetes: A scoping review.

BACKGROUND: The term 'Responsibility Sharing', albeit poorly defined, has emerged from the diabetes literature, to describe a distinct mechanism for comprehensively managing the characteristic shift in responsibility that underpins the transition to self-management for adolescents. METHODS: A scoping review, following the PRISMA-ScR guidelines, distilled the literature from seven databases to answer the questions: What is responsibility sharing? Who are the key stakeholders? What factors affect responsibility transaction? What are its recognized outcomes? How is responsibility shared? RESULTS: Responsibility sharing is a transactional arrangement between youth and their caregiver/s that functions to repeatedly and flexibly apply ownership to the management of diabetes care tasks, across the course of adolescence. In the main, responsibility sharing was associated with better metabolic and/or psychosocial outcomes. Effective responsibility sharing was seen as being responsive to adolescent capacity and driven by autonomy supportive, sustained communication patterns that enable mutually agreeable responsibility assumption by all stakeholders. CONCLUSION: Different perspectives on responsibility sharing for adolescents with Type 1 diabetes, and the lack of a universal definition, have led to discordance within the literature about its operationalization and measurement. This paper proposes a definition of responsibility sharing for future researchers to apply.

A qualitative study exploring high school students' understanding of, and attitudes towards, health information and claims.

BACKGROUND: Exposure to health claims, particularly in the media and social media, is pervasive, and the information conveyed is often inaccurate, incomplete or misleading. Some young people of high school ages are already making decisions about using readily available health interventions (such as sports drinks and beauty products).Although previous research has assessed adults' understanding of health claims, no research has examined this issue in young adults who are attending high school. OBJECTIVE: To explore high school students' understanding of, and attitudes towards, concepts relevant to assessing health information and claims. DESIGN: A qualitative study involving semi-structured interviews with 27 Australian high school students. Responses were recorded, transcribed and a thematic analysis performed. Three themes emerged as follows: (i) Variability in sources of health information and claims, and general understanding of their creation and accuracy of content, (ii) The use of substitute indicators to assess health information and claims and make judgements about their trustworthiness, (iii) Uncertainty about, and literal interpretation of, the language of health claims. Despite general scepticism of health claims and admitted uncertainty of research terminology, many students were generally convinced. Students had poor understanding about how health claims are generated and tended to rely on substitute indicators, such as endorsements, when evaluating the believability of claims. CONCLUSION: School students' lack of awareness of basic health research processes and methods of assessing the accuracy of health information and claims makes them vulnerable to distorted and misleading health information. This restricts their ability to make informed health decisions - a skill that increases in importance as they become adults.

"Not just a normal mum": a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss.

BACKGROUND: Following previous perinatal loss, women in a subsequent pregnancy may experience heightened emotions, such as anxiety and fear, with a range of longer-term implications. To support these women, the Mater Mothers' Bereavement Support Service in Brisbane, Australia, developed a Pregnancy After Loss Clinic (PALC) as a specialised hospital-based service. The present study investigated the experiences of mothers with previous perinatal loss in relation to: (a) their subsequent pregnancy-to-birth journey, and (b) the PALC service. Such research seeks to inform the ongoing development of effective perinatal services. METHOD: A qualitative interview-based research design was employed with a purposive sample of 10 mothers who had previously experienced perinatal loss and who attended the Mater Mothers' PALC during their subsequent pregnancy in 2015. All mothers had subsequently delivered a live baby and were in a relationship with the father of the new baby. Women were aged between 22 and 39 years, primiparous or multiparous, and from a range of cultural backgrounds. Semi-structured interviews, conducted either at the hospital or by telephone by an experienced, independent researcher, lasted between 20 min and one hour. All interviews were audio-recorded and transcribed verbatim, with participant names changed. Interviews were analysed using content analysis by two researchers who were not involved in the service delivery or data gathering process. RESULTS: Seven themes were identified from the interview material: The overall experience, The unique experience of first pregnancy after loss, Support from PALC, Experiences of other services, Recommendations for PALC services, Need for alternative services, and Advice: Mother to mother. CONCLUSIONS: Participants spoke positively of the PALC services for themselves and their families. Anxieties over their subsequent pregnancy, and the desire for other health professionals to be more understanding were frequently raised. Recommendations were made to extend the PALC service and to develop similar services to support access for other families experiencing perinatal loss.

Contribution of speech and language difficulties to health-related quality-of-life in Australian children: A longitudinal analysis.

PURPOSE: The trajectory of health-related quality-of-life (HRQoL) for children aged 4-9 years and its relationship with speech and language difficulties (SaLD) was examined using data from the Longitudinal Study of Australian Children (LSAC). METHOD: Generalized linear latent and mixed modelling was used to analyse data from three waves of the LSAC across four HRQoL domains (physical, emotional, social and school functioning). Four domains of HRQoL, measured using the Paediatric Quality-of-Life Inventory (PedsQL™), were examined to find the contribution of SaLD while accounting for child-specific factors (e.g. gender, ethnicity, temperament) and family characteristics (social ecological considerations and psychosocial stressors). RESULT: In multivariable analyses, one measure of SaLD, namely parent concern about receptive language, was negatively associated with all HRQoL domains. Covariates positively associated with all HRQoL domains included child's general health, maternal mental health, parental warmth and primary caregiver's engagement in the labour force. CONCLUSION: Findings suggest that SaLD are associated with reduced HRQoL. For most LSAC study children, having typical speech/language skills was a protective factor positively associated with HRQoL.

Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

Health-related quality-of-life of children with speech and language difficulties: a review of the literature.

A review of the literature has been undertaken to examine health-related quality-of-life (HRQoL) of children and adolescents with speech and language difficulties (SaLD), with a particular focus on evidence regarding the domains of HRQoL most affected by SaLD. Twelve electronic databases were searched for articles on this topic published from 1966 to January 2011. Seven studies suitable for inclusion were identified. These papers were reviewed in relation to their participants, sample size, study design, and outcome measures, which differed considerably across studies. From the studies reviewed, there is emerging evidence that HRQoL can be compromised for children and adolescents with SaLD relative to their peers, and some consensus that the social domain of HRQoL is most impacted. Overall, the review highlights a paucity of research in this area and recommendations are made as to how research may advance. Most importantly, studies examining the effect of child and family factors in mediating or moderating the relationship between SaLD and HRQoL are required. This knowledge will support the identification of children with SaLD at risk of poorer HRQoL outcomes and inform intervention strategies through the identification of relevant risk and protective factors.

Evaluating an online occupational therapy community of practice and its role in supporting occupational therapy practice.

BACKGROUND/AIM: Networking, together with knowledge acquisition and resource sharing, are key components of occupational therapists' professional development. To enhance the connectedness and clinical support available to occupational therapists, OT AUSTRALIA Queensland developed an online community of practice (CoP). No research regarding the use of online CoPs by occupational therapists has been conducted. This study aimed to explore occupational therapists' perceptions of the benefits of, barriers to, and reasons for using or not using the online CoP. METHODS: Two focus groups were conducted, one with therapists who had used the CoP (n = 5) and the other with therapists who had not used it (n = 9). Participant responses to focus group questions informed the development of a survey asking therapists about their use of the CoP, its benefits and reasons for using/not using it, which was sent via email to all OT AUSTRALIA Queensland members. RESULTS: Motivation to use the CoP, technology, workload management impacts, potential benefits and time considerations emerged as themes from the focus groups. Of the 55 survey respondents, 58.2% were aware of the CoP but only 32.7% had accessed it. Potential benefits of the CoP identified by participants included time efficiency, structural flexibility, networking capabilities and mentoring opportunities. Reasons for not accessing and/or participating in the CoP included access difficulties, usability difficulties, personal communication preferences and perceived irrelevance of available information. CONCLUSION: The findings of this study suggest that the CoP is still in the early stages of development; however, it has the potential to be further embraced by therapists if further promotion, training and minor usability modifications are undertaken.

Fundamental movement skills and self-concept of children who are overweight.

OBJECTIVE: Differences in fundamental movement skills and self-perceptions of physical ability and physical appearance of overweight and non-overweight children were investigated. METHOD: Overweight (n = 89, mean age = 8.75 ± 1.4 years, BMI z-score = 2.22, SD = 0.46, 46% male) and non-overweight (n = 27, mean age = 8.25 ± 1.5 years, BMI z-score = 0.03, SD = 0.73, 62.1% male) participants enrolled in the KOALA (Kinder Overweight Activity Lifestyle Actions) project were included. The overall objective of the KOALA project was to determine in a randomized controlled trial the effect of a Triple P (Positive Parenting Program), and a family 'Eat Well Be Active' Scouts Camp program on BMI in overweight children. Baseline between-group differences on measures of fundamental movement skills and self-concept perceptions were analyzed using independent samples t-tests. Relationships between BMI and these variables were investigated with multiple linear regression. RESULTS: Overweight children had lower scores on Bruninks-Oseretsky Test of Motor Performance-2 subtests (Bilateral Coordination, Upper Limb Coordination, Strength, Balance, and Running Speed and Agility), and Physical abilities self-concept than non-overweight children. CONCLUSIONS: Children who were overweight had significant fundamental movement skill difficulties, as well as having poorer Physical abilities self-concept perceptions compared to non-overweight children. The association between increasing BMI and poor performance of gross motor tasks has potential implications for physical activity participation. Future research is needed to determine if fundamental movement skill difficulties and low physical ability self-concept are predisposing factors for children who are overweight or associated outcomes.

Physical activity and depressive symptoms in American adolescents.

This study employed ordinal logistic regression analyses to investigate the relationship between American adolescents' participation in physical activity and depressive symptomatology. Data were drawn from the second Child Development Supplement to the Panel Study of Income Dynamics (CDS II), which was conducted over 2002-2003. Fewer than 60% of adolescents were found to accumulate 60 min of moderate-to-vigorous physical activity (MVPA) outside of school hours on week or weekend days. Accumulated duration of MVPA was not, however, significantly associated with severity of depressive symptoms for either gender. Males who were not involved in sporting clubs or lessons were more likely than males who were highly involved to experience greater severity of depressive symptoms (OR = 3.24, CI = 1.33, 7.87). Results highlight gender variability in the psychosocial correlates of sporting participation and prompt further investigation of the relevance of current physical activity guidelines for mental health in adolescence.

Play preferences and behavior of preschool children with autistic spectrum disorder in the clinical environment.

The play of children with autistic spectrum disorder (ASD) is a valuable medium for assessment and intervention, and its analysis has the potential to aid diagnosis. This study investigated spontaneous play behavior and play object preferences for 24 preschool children with ASD in a typical occupational therapy clinical environment. Play behavior was rated and choice of play object noted at 10-second intervals from a 15-minute video recording of unstructured play. Statistical analyses indicated that play behavior was consistent with descriptions in the literature. In addition, the children demonstrated clear preferences for play objects in the form of popular characters (e.g., Thomas the Tank Engine) and those with sensorimotor properties. We propose that the inclusion of preferred play objects in a clinical environment may increase intrinsic motivation to play, and thereby enhance assessment and intervention.