Ann-Britt Ivarsson

Participation by doing: Social interaction in everyday activities among persons with schizophrenia

Schizophrenia impacts on social functioning and participation in everyday life. However, there is limited research describing how persons with schizophrenia interact with others when performing daily activities. The aim of this study is to describe how persons with schizophrenia interact with others while performing everyday activities in different contexts in terms of facilitating and hindering factors. Repeated participant observations of four persons with schizophrenia were conducted in their environment. The observed activities and social interactions were chosen from the participants daily routines. Field notes were taken during the observations. Qualitative content analysis was used to analyse the data. Two themes constitute the main result: Facilitating social interaction in activity performance and Hindering social interaction in activity performance. These two themes serve as headings for sub-themes representing factors influencing social interaction in activity performance. Through a further analysis of the themes the following dichotomous contexts were identified as influential: meaningful/not meaningful activity being performed; attitudes were trusting/lacking trust; and location, at home/outside the home. Conclusion: If the facilitating contextual factors are considered for each individual when planning and performing everyday activities together with others there is a possibility to improve social interaction skills and thereby participation.

Occupational therapists' descriptions of their work with persons suffering from cognitive impairment following acquired brain injury.

The aim of the present study was to investigate how Swedish occupational therapists describe their work with persons suffering from cognitive impairment following acquired brain injury. A qualitative descriptive approach was used and interviews were conducted with 12 occupational therapists working in community and county council care. Qualitative content analysis was used and revealed three main themes: (1) “To make the invisible visible”, (2) “To collaborate—a prerequisite for success”, and (3) “Dilemmas to handle”. The findings showed a complex scenario where the occupational therapists worked to make the cognitive impairments visible to themselves, the clients, and persons close to the client. Collaboration was perceived as a key factor. The dilemmas concerned different aspects in the rehabilitation process, which affected the occupational therapists’ work with the clients. Identified areas in need of improvement are prioritizations and additional education regarding both intervention methods and theory. A reluctance to use standardized assessments was expressed and research that identifies and overcomes those hindrances in clinical practice is needed. Therapeutic use of self was described as important. To understand and illuminate the occupational therapists’ comprehension of the concept further research is required.

Teenagers' struggles with contraceptive use - what improvements can be made?

Objective To study the experiences of teenagers using contraceptives at an out-patient abortion clinic and to explore the reasons behind their choices. Methods Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used. Results One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Factors that influence contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use. Conclusion The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was unsatisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to initiate it. Friends and the Internet were the main sources for acquiring information.

An integrative review combined with a semantic review to explore the meaning of Swedish terms compatible with occupation, activity, doing and task

The aims of this study were to explore the intended meaning of the terms “occupation”, “activity”, “doing”, and “task” used in international occupational therapy literature and from this perspective explore which Swedish terms best capture these meanings. A literature review of occupational therapy-related journals was performed to gain a basic understanding of the term occupation and related terms. In addition, a semantic review was used: English and Swedish dictionaries were reviewed to explore the semantic meaning of the English terms “occupation”, “activity”, “doing”, and “task”, and the Swedish terms “aktivitet”, “syssla/sysselsättning”, “görande”, and “uppgift”. A comparison was also performed by searching for parallels between the results of the literature review, the semantic definitions of the English and Swedish terms and the comprehensive meaning of the Swedish terms aktivitet and syssla/sysselsättning. An overarching idea of the concept of occupation was found in the literature review and for the purposes of this study we have identified this as Occupation for survival. From this overarching idea, three themes were identified: The feature of occupation, Impact of occupation and Occupation an occupational therapy concept. Each theme could be subdivided into sub-themes. The Swedish term aktivitet was found to have more power, strength, and spirit connected to the synonyms found in the semantic analysis than to those connected with the Swedish term syssla/sysselsättning. According to the findings in this study we found that the term “aktivitet” is the best comparable term in Swedish to the English term “occupation”.

Occupation as described by novice occupational therapy students in Sweden: The first step in a theory generative process grounded in empirical data

A core assumption in occupational therapy is that occupation enhances health. This study is one of a series of planned studies carried out in Sweden, with the overall aim to develop a theory, based on empirical grounds, concerning the dimensions of occupation that may be useful in occupational therapy. The specific aim for this study is to examine the dimensions of occupation as generally understood among novice occupational therapy students. Grounded Theory was the chosen method. Data were collected among occupational therapy students. The students wrote down spontaneously what they considered to be included in activity. A preliminary core category “The what, why, and how of occupation” and five other categories emerged from the analysis: (1) The doing and context of occupation; (2) Motive for occupation; (3) Time and place for occupation; (4) Type of participation; and (5) Outcome of occupation. Relationships between the categories were established between the Motive for occupation and Outcome of occupation, which constitute a kind of prerequisite for occupation. The three remaining categories: The doing and context of occupation, Time and place for occupation, and Type of participation established a form for occupation. In conclusion, the study results illuminated the richness of the concept of occupation and support the core assumption in occupational therapy that occupation enhances health.

Occupation as described by academically skilled occupational therapists in Sweden: a Delphi study.

Abstract The aim of this study was to continue the process of exploring and understanding the concept of occupation in a Swedish occupational therapy context and from an expert perspective. Thirteen eligible occupational therapists active in Sweden, all academically skilled and who had published articles concerning the concept of occupation or activity, were invited to take part in the study. Eight were willing to participate representing different parts of Sweden. A three-round Delphi study was conducted in which the participants reflected on 46 statements derived from a core category and five categories concerning the concept of occupation, extracted from previous studies in this project. The participants gave 124 comments on 44 of the 46 statements. Results revealed new statements, mainly concerning the intentional aspect of occupation and occupation in a structural hierarchy. Comments also contributed with rephrased statements promoting clarity. A total of 54 statements were then ranked on a four-point Likert scale of which 47 reached consensus among participants. Seven statements were not supported to a level of consensus. Four of them dealt with how and if values and individual judgements influence what are viewed as occupations. To continue the developing process, studies in occupational therapy praxis have to be performed.

Occupation as described by occupational therapy students in Sweden: A follow-up study

This study is the second in a series of studies carried out in Sweden concerning the dimensions of the concept occupation. The specific aim of this study was to explore new and confirm previously found dimensions of the concept of occupation in the context of occupational therapy. Occupational therapy students, a few weeks from their completion of studies, were asked to write down spontaneously what they personally considered to be occupation. Forty-two women and three men, aged between 25 and 33 years, participated. Grounded theory with the constant comparative method was used to analyse the data. A coding scheme of 40 codes was used to compare new data with previously found data concerning the concept of occupation as described by occupational therapy students. Six new codes concerning occupation expanded the dimensions of the concept. Five of those were found within the doing and context dimensions. These codes defined occupation as something that depends on who is performing the occupation and where the occupation is performed. Thus, occupation is not a permanent state but also very much depends on subjective experience. Additional studies with experienced occupational therapists have been planned to further expand these findings and aim to give a stronger foundation to the concept of occupation built on empirical grounds.

Quality of community-based day centre services for people with psychiatric disabilities: psychometric properties of the Quality in Psychiatric Care - Daily Activities (QPC-DA).

Abstract Background/aims The aim of the present study was to test the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care – Daily Activities (QPC–DA) and to briefly describe the day centre attendees’ perception of the quality at community-based day centre services. Methods A sample of 218 attendees from 14 community-based day centre services in seven municipalities in Sweden participated in the study. Results Confirmatory factor analysis revealed that the QPC–DA consists of six dimensions and has a factor structure that to a large extent corresponds to that found in other studies of quality in psychiatric care settings, such as inpatient, outpatient, forensic inpatient, and housing support for people with psychiatric disabilities. The internal consistency of the factors was satisfactory and thus the QPC–DA showed adequate psychometric properties. The attendees’ ratings of quality of community-based day centre services were generally high. The highest rating was for the encounter dimension and the lowest for the participation and the secluded environment dimensions, indicating areas for improvement. Conclusion/significance The QPC–DA includes important aspects of the attendees’ assessment of quality of community-based day centre services and offers a simple and inexpensive way to evaluate quality from their perspective.

An investigation of the housing environment for persons with asthma and persons without asthma.

Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons’ well-being. An important issue in occupational therapy is to improve the relationship between a persons functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n = 49) and persons without asthma (controls, n = 48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmental medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-family houses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person–environment relationship for persons with asthma, focusing on their ability to perform daily activities.

Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury

Abstract Primary objective: To describe Swedish occupational therapist practice patterns for clients with cognitive impairment following acquired brain injury. Research design: A cross-sectional stratified random sample of 462 occupational therapists. Methods: An online questionnaire was used to collect data. Main results: The predominant practice pattern was the use of ADL-activities for assessment and therapy regardless of whether limitations in occupational performance or cognitive function were assessed or whether the approach was remedial or compensatory. For assessment, general ADL-instruments were used more often than instruments that assessed cognitive function. Instruments were used less often within municipal rehabilitation facilities compared to regional, county and primary care facilities. The most common focus of the therapies was in regard to abilities related to executive functioning. Another prominent practice pattern was a collaborative approach involving clients, relatives and other staff. The theories used in practice were, to a large extent, general in nature and did not focus specifically on cognitive functioning. Conclusions: Swedish occupational therapy practice for clients with cognitive impairments following acquired brain injury focuses highly on occupational performance. Therapies targeting executive functioning seem particularly important in practice and a collaborative approach involving clients, relatives and other staff is a prominent feature in practice.