Experiences of meaning in garden therapy in outpatient psychiatric care in Sweden. A narrative study.

BACKGROUND: Support has been found for using garden therapy as form of intervention for clients with common mental disorders, but no consensus has been found for what contributes to perceived meaningfulness of garden therapy. AIMS: To investigate whether participants perceived garden therapy as meaningful, and if so, what contributed to the meaningfulness. MATERIAL AND METHODS: Narrative individual interviews were conducted twice with six participants who participated in garden therapy and once with two participants. Data was analysed using narrative methodology. RESULTS: Perceived meanings in garden therapy were associated to the participants' individual needs and prerequisites: to land, just be, relax, go back to basics, understand, verbalise, enhance energy, and socialise. The group leaders had an important role to create safety and trust, and to adapt the activities and use of the environment. The activities, the garden environment and social group contributed to perceived meaning in garden therapy. CONCLUSIONS: Garden therapy offered the participants possibilities to meet their different needs and thereby perceived meaning. To achieve this, the group leaders need to adapt the gardening individually to each participant. SIGNIFICANCE: Various components were perceived as meaningful. The group leaders therefore have to adapt the garden therapy to each participant's needs.

A Turning Point Towards Recovery: An Interview Study with Participants in the Culture and Health Programme for Clients with Long-Term Mental Health Disorders in Sweden.

The study aimed to explore participants' perceptions and experiences of the Culture and Health programme in Sweden for clients with long-term mental health disorders. A qualitative approach with interviews was applied. Grounded Theory guided the analysis and selection of informants. A total of 15 informants were interviewed. A core category 'A turning point in dealing with everyday life beyond the mental illness' with three categories: inner life, social life and occupational life emerged. A theory indicating the importance of asking clients about their expectations, was formulated. Further studies are warranted, including studies of effects.

New way of working: Professionals' expectations and experiences of the Culture and Health Project for clients with psychiatric disabilities: A focus group study.

There is a need for various types of interventions when meeting needs of clients with psychiatric disabilities and complementary interventions may also influence their well-being. The Culture and Health project, based on complementary interventions with 270 clients, was created in a county in Sweden for clients with psychiatric disabilities and for professionals to carry out the interventions. The aim of this study was to investigate the professionals' expectations regarding the project and their clients' possibilities for participating, and to investigate the professionals' experiences of the project after its completion. Focus group data with a total of 30 professionals participating were collected. A qualitative content analysis revealed four categories of the professionals' expectations before entering the project: "Clients' own possibilities and limitations for their development and independence", "Professionals' possibilities for supporting the clients", "Societal prerequisites", and "Expectations of a new way of working". Furthermore, the analysis regarding professionals' experiences after working with the project revealed three categories: "Adopting the challenges", "Having ways of working that function - prerequisites and possibilities", and "Meeting the future - an ambition to continue". CONCLUSION: Working in the Culture and Health project together with the clients in group-based activities was perceived as beneficial, although challenges arose. When implementing cultural activities, support from stakeholder organisations is needed.

Women's perceived work environment after stress-related rehabilitation: experiences from the ReDO project.

PURPOSE: The study aimed to investigate (a) if women's perceptions of their work environment changed during a 16-week rehabilitation period and at a 12-month follow-up; (b) whether such changes were related to outcomes in terms of return to work, well-being and valued occupations. METHODS: Eighty-four gainfully employed women on sick-leave due to stress-related disorders responded to instruments assessing perceptions of the work environment, well-being (self-esteem, self-mastery, quality of life, perceived stress, self-rated health) and perceived occupational value. Data about return to work were collected from registers. Non-parametric statistics were used. RESULTS: The increase in the women's ratings of their work environment was non-significant between baseline and completed rehabilitation but was statistically significant between baseline and the 12-month follow-up. No relationships were found between changes in perceptions of the work environment and outcomes after the rehabilitation. At the follow-up, however, there were associations between perceived work environment changes in a positive direction and return to work; improved self-esteem, self-mastery, quality of life, perceived occupational value and self-rated health; and reduced stress. CONCLUSION: It seems important to consider the work environment in rehabilitation for stress-related problems, and a follow-up appears warranted to detect changes and associations not visible immediately after rehabilitation. IMPLICATIONS FOR REHABILITATION: Work environment Perceptions of the work environment seem important for return to work, although other factors are likely to contribute as well. Perceptions of the work environment are associated with several aspects of well-being. When developing rehabilitation interventions a focus on the clients' perceptions of their work environment seems vital.

The Satisfaction with Daily Occupations (SDO-13) Scale: Psychometric Properties among Clients in Primary Care in Sweden.

This article describes the results to expand and develop the use of the Satisfaction with Daily Occupations (SDO-13) Scale. Data were collected in primary care before (I) and after intervention (II) among clients with stress-related disorders and musculoskeletal pain. The Cronbach's alpha values of the SDO-13 Scale were 0.80 and 0.88. Convergent validity was assessed against global occupational satisfaction and general health, resulting in rs = -0.65 (p < 0.001) and rs = -0.46 (p < 0.001). The SDO-13 Scale could not discriminate between the primary care sample and a psychiatric sample (p = 0.15), whereas number of current occupations could (p < 0.001). The SDO-13 was not sensitive to change (p = 0.92). Future studies need to explore criterion and construct validity based on more dissimilar samples and more standardized interventions. Applications of these results to practice are discussed.

A longitudinal study of the working relationship and return to work: perceptions by clients and occupational therapists in primary health care.

BACKGROUND: The working relationship between client and therapist can be important to enhance outcomes from vocational rehabilitation for women with stress-related disorders in primary health care. The aim was to investigate the working relationship, as perceived by clients and therapists in the Redesigning Daily Occupations (ReDO™) program, and its relationships to return to work and satisfaction with the rehabilitation. Another aim was to compare the ReDO™ group and a "care-as-usual" (CAU) group regarding perceptions of the working relationship with the social insurance officer. METHOD: Forty-two ReDO™ clients and 42 matched controls receiving CAU participated. The study included four measurements (baseline, after 16 weeks rehabilitation and follow-ups after 6 and 12 months). 37 + 37 clients completed. Return to work data was obtained from the Social Insurance Offices (SIO), and the working relationship and client satisfaction were assessed by self-report questionnaires. RESULTS: The clients rated the working relationship higher than the therapists (mean rating 101.1 vs. 93.9; p < 0.001). The therapists' rating showed a statistically significant association with return to work at the 12-month follow-up, and the clients' perceptions were statistically significantly related to how they rated satisfaction with the rehabilitation received. The ReDO™ and the CAU groups did not differ regarding how they rated the relationship with the SIO officer (mean ratings 83.9 vs. 77; p = 0.189). The working relationship with the SIO officer was not related to return to work, but an association (rs = 0.70, p < 0.001) to client satisfaction at 16 weeks appeared in the CAU group alone. CONCLUSION: The working relationship as perceived by clients and therapists seemed to be partly separate phenomena, the client perceptions being linked with satisfaction with the rehabilitation and the therapist perceptions with the clients' return to work. The relationship to the SIO officers was of no importance to return to work but was of some significance for satisfaction with the rehabilitation among the CAU clients. Therapists should strive to improve the relationship with clients to whom they feel the relationship is fragile since that might enhance the chances for those clients to return to work. TRIAL REGISTRATION: Registered at ClinicalTrials.gov (identifier NCT01234961) 2 November 2010.

Work outcomes and their predictors in the Redesigning Daily Occupations (ReDO) rehabilitation programme for women with stress-related disorders.

BACKGROUND/AIM: Previous research has shown that the Redesigning Daily Occupations programme reduced the degree of sick leave and increased return to work rates among women on sick leave for stress-related disorders when compared with "care as usual". To further investigate the Redesigning Daily Occupations intervention, this study explored changes in the work situation from baseline to a 12-month follow-up in the Redesigning Daily Occupations group compared with the "care as usual" group and analysed any predictors of change. METHODS: A matched-control design was used and 84 women were recruited. Objective (return to work and sick leave) and subjective work outcomes (perceptions of the worker role and the work environment) were explored. Potential predictors were clinical and demographic variables and an anxiety-depression factor. RESULTS: In both groups, large positive effect sizes from baseline to follow-up were found regarding the objective outcomes, a moderate positive effect size was found for perceived work environment, whereas perceived worker role remained unaffected. Previous work rehabilitation predicted objective work outcomes in both groups. Higher education and older age were predictors of subjective outcomes in the Redesigning Daily Occupations group, whereas a more severe anxiety-depression rating was negative for work environment ratings in the "care as usual" group. CONCLUSIONS: Return to work seemed possible without a change in the women's perceptions of the worker role; rather they renegotiated their view of the work environment. The Redesigning Daily Occupations programme was found to be promising, with a positive effect on return to work and sick leave reduction. It seemed more suitable for the higher educated and older women.

Client perceptions of a work rehabilitation programme for women: the Redesigning Daily Occupations (ReDO) project.

AIM: The Redesigning Daily Occupations programme (ReDO) is a Swedish work rehabilitation programme for women on sick leave due to stress-related disorders. The aim of the study was to investigate the participants' perceptions of taking part in the work rehabilitation programme. METHODS: Seven of the 38 women who completed ReDO were interviewed during and after the programme. The interviews were analysed by manifest and latent content analysis. RESULTS: The informants were satisfied with the content of the programme and the support they received in the programme and when returning to work. The women thought they had become more aware of what they did during a day and how they performed their daily activities, which helped them to change their ways of performing them. The result highlighted different parts of their rehabilitation process which constituted four sub-themes: "Perceptions of the ReDO", "The intrinsic process", "Person-related changes", and "Perceptions of returning to work", and formed the core theme "Critical parts of the rehabilitation process". CONCLUSIONS: The findings may not be generalized to other settings and future research should further investigate work rehabilitation for the target group.

The Work Environment Impact Scale - Self-Rating (WEIS-SR) evaluated in primary health care in Sweden.

OBJECTIVE: To develop a self-report alternative to the Work Environment Impact Scale (WEIS). PARTICIPANTS: First the novel instrument was used and evaluated by ten occupational therapists and 45~clients in primary health care. Then the instrument was used by 26~clients who participated in a rehabilitation programme in another primary health care district. METHODS: The instrument was investigated in two steps. First content validity and utility were investigated through a questionnaire addressed to occupational therapists and their clients respectively. The response distribution was calculated by frequencies. Internal consistency was investigated. In the second step, a revised version of the instrument was investigated for test-retest reliability and internal consistency. The test-retest reliability was calculated by weighted kappa. The internal consistency of the WEIS-SR was calculated by means of Cronbach's alpha. RESULTS: In step one the content validity was good to moderately good, the utility was good, and the internal consistency was satisfactory (0.72). In step two the internal consistency was good (0.88/0.89) and the test-retest reliability was mostly good to moderate (0.35-0.78, median 0.61). CONCLUSIONS: The instrument will be further investigated in other populations and take into consideration additional psychometric properties such as sensitivity to change, predictive validity, and concurrent validity.

Psychometric properties of the Worker Role Self-assessment instrument used to evaluate unemployed people in Sweden.

The aim was to determine the psychometric properties of the new Worker Role Self-assessment (WRS) instrument. The content validity, utility, test-retest reliability, sensitivity to change, and predictive validity of the WRS were investigated in two subject samples, which were selected at work and pain rehabilitation clinics, respectively. One of these groups consisted of 23 clients and four occupational therapists, and the other comprised 83 clients. All clients in both samples were unemployed. The results showed that both the clients and the occupational therapists perceived the content validity and the utility of the WRS as good. The test-retest reliability showed mostly good to moderate agreement, and the internal consistency was satisfactory. One of the items showed predictive validity for work capacity, and the same item was sensitive to change. However, a ceiling effect reduced the utility and the sensitivity to change. Our findings indicate that the WRS is promising as a tool that clinicians can use to evaluate the capacity for return to work and for planning interventions, although some revisions are needed to counteract the ceiling effect.