Inclusivity in Occupational Participation: Life Stories of Bangladeshi With Spinal Cord Injury.

This research aimed to describe the process of occupational participation among persons with spinal cord injury (SCI) discharged from the only SCI rehabilitation hospital in Bangladesh. We analyzed seven participants' interview transcripts and observations using the trajectory equifinality model. Study participants demonstrated the following occupational participation trajectories: (a) employing a strategy or difficulty in occupational participation; (b) performing solidarity or experiencing deprivation; (c) creating identity or divergence; and (d) being included in or excluded from everyday life. There are four pathways: (I) discouraging conditions that minimized daily performance; (II) reinforcing obligatory connections to optimization of daily performance; (III) reciprocity to facilitate social activities; and (IV) manipulating mastery in occupational participation. Occupational therapists can consider the trajectory phases and pathways of occupational participation when facilitating the inclusion of service users after discharge from the hospital.

Experience of Occupational Participation Among Persons With Spinal Cord Injury: Life Story Analysis With Trajectory Equifinality Model (TEM)Persons with spinal cord injury (SCI) in Bangladesh demonstrated inadequate skills in community integration because of limited access to health care follow-ups and unfavorable sociocultural conditions. This research focuses on occupational participation experiences among seven persons with SCI living in the community. We used trajectory equifinality model (TEM) to analyze semi-structured interview and observation data to understand human experiences in an irreversible timeline from a starting point to an endpoint. Data analysis revealed a conceptualization of four periods of occupational participation and four common types of non-linear pathways. Participants optimized shared occupational participation and used mastery over occupations to minimize the experience of occupational deprivation. These findings could assist in developing independent peer-led occupation-based health care programs with few skilled occupational therapists and limited financial resources. These 3 years of interviews and follow-up reports with participants who were selected purposively do not necessarily reflect how actual participation unfolded over time.

Habit Formation Intervention to Improve Type 2 Diabetes Self-Management Behaviors: A Feasibility Study.

IMPORTANCE: Self-management of lifestyle behaviors is the recommended focus for interventions to address Type 2 diabetes. Habit formation is an effective approach to changing personal behaviors, but evidence of success for Type 2 diabetes is limited. OBJECTIVE: To examine the feasibility and preliminary effectiveness of occupation-based habit formation interventions for improving diabetes self-management behaviors. DESIGN: Single-subject design with multiple participants providing 4 wk of baseline data followed by 10 wk of intervention data. SETTING: Individual telehealth sessions. PARTICIPANTS: Eight adults (ages 29-75 yr) with Type 2 diabetes, who had access to a telephone and who were not involved in other diabetes-related education or interventions voluntarily, enrolled into the study. INTERVENTION: Participants engaged in 10 wk of habit formation intervention focused on four diabetes self-management domains: nutrition, blood glucose monitoring, medication management, and physical activity. OUTCOMES AND MEASURES: Data gathered included findings on measures of diabetes self-care behaviors and habit formation. RESULTS: There was a significant change in self-care behaviors for 6 of the 8 participants (p < .05 for 1 participant, and p < .01 for 5 participants). Group changes were statistically significant (p < .001). Habit strength significantly improved for all areas of diabetes self-management (p < .001 for nutrition, blood glucose monitoring, and medication management and p = .001 for physical activity). CONCLUSIONS AND RELEVANCE: Findings suggest that the occupation-based intervention was feasible and showed promise for developing self-management behaviors. What This Article Adds: Habits are considered foundational to occupations, yet application of the science of habit formation is often not well understood by occupational therapists. This study considered the theoretical components of habit formation that have been neglected by prior studies and demonstrates the feasibility and preliminary effect estimates of a habit formation intervention when used with people with Type 2 diabetes.

Occupational therapy gender imbalance; revisiting a lingering issue.

BACKGROUND: Recently, it has been suggested that gender disparity in Occupational Therapy has to do with segregated gendered job norms that position female dominated professions as a 'step down' for many males. Interestingly, this suggestion was not underpinned by experiences of males in the profession. AIMS AND METHODS: Thirteen male Occupational Therapists with a variety of backgrounds were invited to this Round Table research, focussing on the broader issue of the existing gender imbalance in Occupational Therapy. RESULTS: Two themes emerged: 'The core values of the profession', and 'Broadening the scope of the profession'; none of them suggesting that male/female imbalance was necessarily the most pressing issue. CONCLUSIONS: A gender-unrelated approach to everyday problem-solving was put forward to achieve increased diversity in Occupational Therapists' backgrounds, better reflecting the people they serve. By broadening the scope and the way the profession is presented, and encouraging innovative and more entrepreneurially driven approaches, diversity in the workforce could be further facilitated. These findings are discussed within the context of 'The mutual constitution of cultures and selves' model. SIGNIFICANCE: Diversity in the Occupational therapy workforce could be further facilitated with a shift in focus away from the male/female perspective to an intersectional approach.

Perceptions of Occupational Therapy Educators about the Educational Preparation of Occupational Therapists for Designation as Qualified Mental Health Professionals.

This study investigated educators' perspectives on whether occupational therapists were educationally prepared for designation as Qualified Mental Health Professionals (QMHPs) using a cross-sectional survey design followed by interviews to gather qualitative data. Fifty-two educators responded to an electronic survey questionnaire. Six of the 52 participants volunteered for follow-up interviews. Most educators (64.58%) thought that occupational therapists were prepared for designation as QMHPs (p=.04). Interview data indicated that educational programs prepared students for psychosocial practice using various content delivery methods. Occupational therapists need to advocate for recognition as significant contributors to the treatment of people with mental health challenges.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

Education for sustainable health care: From learning to professional practice.

A number of planetary boundaries, including climate change as a result of greenhouse gas emissions, has already been exceeded. This situation has deleterious consequences for public health. Paradoxically, 4.4% of these emissions are attributable to the healthcare sector. These problems have not been sufficiently acknowledged in health professions curricula. This paper addresses two main issues, humanistic learning and the application of knowledge acquisition to clinical practice. Humanistic learning principles can be used to emphasize learner-centered approaches, including knowledge acquisition and reflection to increase self-awareness. Applying humanistic principles in everyday life and clinical practice can encourage stewardship, assisting students to become agents for change. In terms of knowledge and skills application to clinical practice, an overview of varied and novel approaches of how sustainable education can be integrated at different stages of training across several health care professions is provided. The Health and Environment Adaptive Response Taskforce (HEART) platform as an example of creating empowered learners, the NurSusTOOLKIT, a multi-disciplinary collaboration offering free adaptable educational resources for educators and the Greener Anaesthesia and Sustainability Project (GASP), an example of bridging the transition to clinical practice, are described.

Eclectic Application of Theoretical Models in Occupational Therapy: Impact on Therapeutic Reasoning.

We investigated the impact of an eclectic framework for combining theoretical conceptual practice models on occupational therapists' theoretical reasoning using concurrent mixed methods with repeated measures and grounded theory designs. Study participants (n = 9) attended two workshops to review select occupational therapy theoretical conceptual practice models and learn how to use the eclectic framework. We assessed skills in eclectic combination of theoretical conceptual practice models using the Theory Application Assessment Instrument. The skills improved significantly [χ2(2, 9) = 7.09, p = .02], a finding that was corroborated by the qualitative findings indicating that the eclectic framework may potentially help improve theoretical reasoning among occupational therapists.

Designing and implementing a physiology course for a new doctoral occupational therapy program with student feedback.

Recently, the Occupational Therapy Department requested a custom-designed medical physiology course for the students in the new occupational therapy doctoral program. The first author, a physiologist with extensive experience in teaching both undergraduate preprofessional and medical students in human physiology, was recruited to design and implement the course. The course was designed to be consistent with the constructivist philosophy that guides the occupational therapy curriculum. The course was offered for the first time during fall/spring 2015/2016 and included both first- and second-year occupational therapy doctoral students. A number of anonymous assessment tools were used to evaluate students' perceptions regarding the effectiveness of various pedagogies used in the course in enhancing their learning. A summative course assessment survey with comments was used at the end of the course. This paper describes the model of course design and the student feedback, which generated some suggestions for improvement of the course. This approach in designing a new course for a new disciplinary group of students should be helpful to other faculty involved in developing courses for health career programs populated by students with variable physiology backgrounds and different educational needs. The final relevant feedback from the course would be to have the students evaluate the usefulness of the course to their future careers immediately following their certification examinations in a year or two and during their subsequent clinical experiences; however, that information will likely be more difficult to obtain.

Clinical Effectiveness of Occupational Therapy in Mental Health: A Meta-Analysis.

OBJECTIVE: The purpose of this study was to estimate the effectiveness of theory-based occupational therapy interventions in improving occupational performance and well-being among people with a mental health diagnosis. METHOD: The meta-analysis included 11 randomized controlled trials with a total of 520 adult participants with a mental health diagnosis. Outcomes were occupational performance, well-being, or both. We conducted meta-analyses using Comprehensive Meta-Analysis software (Version 3.0) with occupational performance and well-being as the dependent variables. RESULTS: Results indicated a medium effect of intervention on improving occupational performance (mean Hedge's g = 0.50, Z = 4.05, p < .001) and a small effect on well-being (mean Hedge's g = 0.46, Z = 4.96, p < .001). CONCLUSION: Theory-based occupational therapy interventions may be effective in improving occupational performance and well-being among people with a mental health diagnosis and should be an integral part of rehabilitation services in mental health.

International Occupational Therapy Research Priorities.

Occupational therapy is a global profession represented by the World Federation of Occupational Therapists (WFOT). International research priorities are needed for strategic guidance on global occupational therapy practice. The objective of this study was to develop international research priorities to reflect global occupational therapy practice. A Delphi study using three rounds of electronic surveys, distributed to WFOT member organizations and WFOT accredited universities, was conducted. Data were analyzed after each round, and priorities were presented for rating and ranking in order of importance. Forty-six (53%) out of 87 WFOT member countries participated in the Delphi process. Eight research priorities were confirmed by the final electronic survey round. Differences were observed in rankings given by member organizations and university respondents. Despite attrition at Round 3, the final research priorities will help to focus research efforts in occupational therapy globally. Follow-up research is needed to determine how the research priorities are being adopted internationally.

Empowering people to change occupational behaviours to address critical global issues.

BACKGROUND: The greatest threat to human well-being in this century is climate change and related global issues. PURPOSE: We examined the effectiveness of the Modified Instrumentalism in Occupational Therapy model as a framework for facilitating occupational behaviour change to address climate change and related issues. METHOD: Eleven individuals participated in this mixed-methods single-subject-design study. Data were gathered using the Modified Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy and Daily Occupational Inventories. Quantitative data were analyzed using two- and three-standard deviation band methods. Qualitative data were analyzed using heuristic phenomenological procedures. FINDINGS: Occupational performance changed for five participants. Participants' feelings shifted from frustration and helplessness to empowerment and a desire for action. They felt empowered to find occupation-based solutions to the global issues. IMPLICATIONS: Occupation-based interventions that increase personal awareness of the connection between occupational performance and global issues could empower people to be agents for action to ameliorate the issues.

Instructing occupational therapy students in use of theory to guide practice.

We investigated the effectiveness of instructing students in occupational therapy practice models to facilitate their competence in applying theory in clinical practice. Course evaluation data were gathered and analyzed retrospectively. We found that perceived understanding of theory and its application improved significantly after instruction. The students' perceived competence in theory use predicted their level of confidence in their assessment and intervention skills. We concluded that emphasis on instruction of students in the use of occupational therapy practice models could be a viable method of improving practice through consistent use of theoretical guidelines in clinical reasoning.

The validity of occupational performance assessments: a validity generalization meta-analysis.

The purpose of this meta-analysis was to determine sample weighted mean validity effect sizes for occupational performance assessments, and their generalizability from research to clinical settings. The bare-bones Validity Generalization (VG) guidelines developed by Hunter and Schmidt ( 2004 ) augmented by Maximum Likelihood (ML) procedures were used to complete the meta-analysis. The sample consisted of 27 studies in which convergent, divergent, and predictive validity estimates of occupational performance assessments were investigated. The mean coefficients of assessments validated in the studies constituting the sample for this meta-analysis ranged from medium to large. Further meta-analysis with complete dis-attenuation of observed mean validity coefficients is indicated.

Ikiugu's eclectic method of combining theoretical conceptual practice models in occupational therapy.

BACKGROUND/AIM: Occupational therapists are often reluctant to use single theoretical conceptual practice models to guide practice because they recognise the limitation of individual models in addressing clients' occupational performance issues. However, there is a dearth of eclectic methods of guiding theoretical model combination in the profession. The effectiveness of one such newly developed method in guiding combination of models by students working on a case study was investigated. METHODS: This was a mixed methods study with experimental and phenomenological designs in which forty-three occupational therapy students participated. RESULTS: There was increased confidence in ability to apply theory in a case study for all research participants. The improvement was significantly higher for participants in the experimental group, who had been introduced to the eclectic method. Participants in the experimental group were more capable of combining models systematically in a case study compared with those in the control group. CONCLUSIONS: Adopting Ikiugu's eclectic method of combining theoretical conceptual practice models may help students learn how to combine them systematically and increase their likelihood of using theory effectively to guide clinical practice in their future as occupational therapists.

Interrater, intra-rater and internal consistency reliability of the Theory Application Assessment Instrument.

AIM: To investigate the interrater, intra-rater and internal consistency reliability of the Theory Application Assessment Instrument, a tool for testing competency in combining multiple theoretical conceptual practice models in client evaluation and treatment planning. METHODS: The assessment was administered to 27 graduate students in two phases. The principal investigator rated the participants on the assessment scale on two separate occasions. RESULTS: Interrater and intra-rater reliability were good for Phase 2 data. Internal consistency reliability for Phase 2 data was in the 'questionable' range. CONCLUSION: The instrument shows promise of being an efficient tool. However, this was an exploratory study with a small sample. Its replication with a larger more representative sample is needed to increase external validity.

Analyzing and Critiquing Occupational Therapy Practice Models Using Mosey's Extrapolation Method.

Over time, there has been a persistent gap between theory and practice in occupational therapy. In this paper, it is suggested that this gap could be decreased by enhancing therapists' knowledge and understanding of the nature of theory. Mosey's (1996a) 9-step extrapolation method of developing theoretical conceptual practice models is proposed as one way of improving clinicians' understanding of the structure of theoretical conceptual practice models and knowing how to analyze and critique them to determine their usefulness in specific clinical contexts. This understanding will hopefully translate into increased utilization of theoretical conceptual practice models to guide every day practice.

A framework for combining theoretical conceptual practice models in occupational therapy practice.

BACKGROUND: Occupational therapists find it difficult to use theoretical conceptual practice models to guide practice because no single model can address all of a client's occupational performance issues. PURPOSE: This paper presents a proposed framework for combining conceptual practice models to guide both collaborative assessment and intervention planning to address clients' occupational performance issues. The framework was designed as a tool not only to help therapists use theoretical models more easily, but also to help them better defend their intervention decisions. KEY ISSUES: The framework provides a systematic method of combining a variety of theoretical conceptual practice models to address a client's issues more comprehensively thereby making theory appealing to therapists. IMPLICATIONS: The framework may be useful in helping occupational therapists combine multiple theoretical models to address clients' occupational performance issues and in defending their clinical decisions effectively.

An argument for pragmatism as a foundational philosophy of occupational therapy.

BACKGROUND: In 1986, Estelle Breines argued that occupational therapy identity problems could be resolved by acquiring tools that enable therapists to analyze their profession in a sophisticated manner. Breines identified philosophical inquiry as one of these tools. PURPOSE: This study examined how pragmatism can provide a philosophical framework for occupational therapy practice and knowledge. METHOD: An analysis of a sample of occupational therapy literature, philosophy of pragmatism literature, and Slagle lectures delivered between 1955 and 1995 was completed. Themes underlying the assumptions, principles, and values articulated in the literature and the Slagle lectures were identified and compared. RESULTS: Findings of the analysis indicate that some of the core assumptions, principles, and values of occupational therapy as identified in occupational therapy literature and the Slagle lectures are conceptually consistent with those of the philosophy of pragmatism. PRACTICE IMPLICATIONS: Pragmatism may provide a philosophical framework to organize the knowledge and practice of occupational therapy and assist with clarifying the profession's identity.

Understanding the occupational human being as a complex, dynamical, adaptive system.

The purpose of this pilot study was to investigate whether the complex occupational human being may be understood using constructs derived from chaos theory such as dependence on initial conditions, fractality, and attractor conditions (Bassingthwaighte, Liebovich, & West, 1994; Buell & Cassidy, 2001; Fraser & Greenhalgh, 2001). Quantitative and qualitative data consisting of daily activities engaged in for 21 days by nine students at the University of Scranton, Scranton, Pennsylvania, was collected using activity inventories. Data analysis revealed that although the findings need to be interpreted with caution due to a small, homogeneous sample, there are indications that the above mentioned constructs from chaos theory may be used to understand the complex occupational human being.

Facilitating professional identify in occupational therapy students.

The purpose of this study was to explore how a graduate course in occupational therapy theory can help prepare students to develop a professional identity. Thirty students participated in the study. The course included content on the history of occupational therapy, models of practice and the social, philosophical, political and economic factors that impact on occupational therapy. The students were divided into groups of four or five where they discussed issues assigned by the instructor. An electronic blackboard was used to share the discussion with the class. Surveys of the students' opinions were used to collect data on what the students viewed as the strengths and weaknesses of the course. The students felt that the class discussions were the strongest part of the course. They felt that the course improved their critical thinking and problem solving significantly. It was concluded from the results that the course facilitated their professional identity through the connection made between theory and practice. There is a recognized need to explore the issue of developing a professional identity in occupational therapy students through courses integrating philosophical topics and clinical practice. Specifically, it is recommended that further research be carried out in educational settings with larger samples, using comparison groups and other methodologies to evaluate the issue of facilitating professional identity in occupational therapy students.