Barry Trentham

Participatory action research: integrating community occupational therapy practice and research.

Participatory action research (PAR) is a form of collaborative research particularly concerned with power inequities of marginalized communities. With this approach, occupational therapists can work with clients and communities to address issues of access, inclusion, equity and collaboration in practice and research. This paper begins with a summary of key concepts and controversies related to participatory action research. Two examples from occupational therapy experience are used to demonstrate the initial steps and key principles of PAR projects and to highlight the conceptual links between PAR and community-based, client-centred occupational therapy. One project involved a group of mental health consumers, the other a community group of older adults. Several challenges and potential outcomes in PAR projects are highlighted in this examination of the complexity of PAR processes. The paper concludes by identifying possibilities and obstacles to the further use of PAR in occupational therapy.

Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis

Objective Our aim was to develop evidence-informed recommendations for rehabilitation with older adults living with HIV. Design We conducted a knowledge synthesis, combining research evidence specific to HIV, rehabilitation and ageing, with evidence on rehabilitation interventions for common comorbidities experienced by older adults with HIV. Methods We included highly relevant HIV-specific research addressing rehabilitation and ageing (stream A) and high-quality evidence on the effectiveness of rehabilitation interventions for common comorbidities experienced by older adults ageing with HIV (stream B). We extracted and synthesised relevant data from the evidence to draft evidence-informed recommendations for rehabilitation. Draft recommendations were refined based on people living with HIV (PLHIV) and clinician experience, values and preferences, reviewed by an interprofessional team for Grading of Recommendations Assessment, Development, and Evaluation (GRADE) (quality) rating and revision and then circulated to PLHIV and clinicians for external endorsement and final refinement. We then devised overarching recommendations to broadly guide rehabilitation with older adults living with HIV. Results This synthesis yielded 8 overarching and 52 specific recommendations. Thirty-six specific recommendations were derived from 108 moderate-level or high-level research articles (meta-analyses and systematic reviews) that described the effectiveness of rehabilitation interventions for comorbidities that may be experienced by older adults with HIV. Recommendations addressed rehabilitation interventions across eight health conditions: bone and joint disorders, cancer, stroke, cardiovascular disease, mental health challenges, cognitive impairments, chronic obstructive pulmonary disease and diabetes. Sixteen specific recommendations were derived from 42 research articles specific to rehabilitation with older adults with HIV. The quality of evidence from which these recommendations were derived was either low or very low, consisting primarily of narrative reviews or descriptive studies with small sample sizes. Recommendations addressed approaches to rehabilitation assessment and interventions, and contextual factors to consider for rehabilitation with older adults living with HIV. Conclusions These evidence-informed recommendations provide a guide for rehabilitation with older adults living with HIV.

Social media and senior citizen advocacy: an inclusive tool to resist ageism?

With population aging, interest groups demand that governments act to prevent a perceived financial crisis. Senior citizens remain frustrated in their efforts to influence the response of policy-makers. In an effort to strengthen their voice, one group of senior citizens, engaged in a participatory action research project, questioned how online social media could be used in their advocacy efforts. This query led to an examination of the literature with the primary objective of determining what is known about the use of social media by senior citizens for the purposes of social advocacy. The outcomes of the review revealed that very few studies specifically examined this question. Senior citizen online roles were depicted as consumers of health information or socializers with family and friends. Ageist assumptions informed the design of computer hardware, online formats and norms for social engagement. Senior citizens have concerns about the trustworthiness of social networking sites and while social media can exclude senior citizens from public debate, the authors conclude that the pressing issue is to focus on age-friendly design and supports. With these in place, social media can provide a venue for senior citizens to challenge ageism and influence public policy discourses.

Identifying Occupational Performance Issues with Older Adults: Therapists’ Perspectives:

Background Identifying occupational performance issues is an essential component of the occupational therapy process. Little attention has been paid to therapists’ management of this aspect of geriatric practice. Purpose This study explored therapists’ approach to identifying occupational performance issues (OPI) with older adults. Methods Information gathered from semi-structured interviews was analyzed using Polkinghornes (1995) analysis of narrative method. Findings The study demonstrated how therapists prepare clients to engage in the OPI identification process; use interviewing strategies to build trust; and tap into client narratives to foster hope in occupational possibilities. Implications Findings suggest that therapists require a complex set of highly skilled strategies to engage clients in OPI identification through tapping into aspects of the clients motivational influences, occupational histories, therapy expectations, and generational attitudes about aging. Further study is required to identify ways to overcome structural barriers to more occupational and narrative-based approaches to identifying occupational performance issues.

Elucidating a Goal-Setting Continuum in Brain Injury Rehabilitation

For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organization-determined goals (e.g., “the goal is discharge”) and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice.

Educating Tomorrow’s Practitioners: Influences on Community Mental Health Occupational Therapy Education

Abstract The World Health Organization has identified mental health problems, mental illnesses, and the promotion of mental health as major issues currently facing the global population. This paper identifies several influences in the field of community mental health and explores how influences such as changing demographics, increasing diversity, a recovery paradigm, and workplace mental health issues are influencing the education of occupational therapy students. The authors present examples from the occupational therapy Masters Curriculum of the University of Toronto, Ontario, Canada to stimulate discussion on how internationally recognized frameworks, such as mental health promotion and the International Classification of Functioning can be incorporated in occupational therapy education to prepare students for practice in dynamic, shifting, and new practice environments.

Exercising senior citizenship in an ageist society through participatory action research: A critical occupational perspective

ABSTRACT This paper analyses the experiences of a group of senior citizens living in a large Canadian city as they engaged in advocacy focused on home care services. The methodology used was participatory action research (PAR); data were collected over a 2-year period. Findings are considered within an understanding of citizenship as an occupational role, an occupational possibility constrained by conventional ageist views on ageing as reinforced and informed by successful ageing concepts situated within a neo-liberal political context. Key themes emerging from the analysis were naming, exposing and resisting ageism; identifying oneself as a senior citizen; balancing occupational demands in light of age-related changes; and social media as an exclusionary or enabling tool for advocacy. The PAR project is described as it was experienced around several political social actions including letter writing campaigns, political dispositions, and the development of informational materials on ageism. As a socio-cultural condition constraining occupational possibilities for older adults, findings highlight how ageism shapes how senior citizens exercise their citizenship through resistance to normalizing influences. The study illustrates a transformative approach to occupational science research aimed at creating knowledge that leads to social change.

The Environmental Production of Disability for Seniors with Age-Related Vision Loss

RÉSUMÉ:À ce jour, l’attention portée aux causes environnementales d’infirmité parmi les personnes âgées ayant une perte de vision liée à l’âge a été limitée. Cette étude ethnographique critique visait à révéler les façons dont les barrières environnementales ont produit ou perpétué l’invalidité chez 10 personnes âgées atteintes de PVLA. Une version modifiée de l’approche en cinq étapes de l’ethnographie critique de Carspecken a été adoptée en utilisant trois méthodes de collecte de données, notamment une entrevue narrative, une séance d’observation participante et une entrevue semistructurée en profondeur. Les résultats ont révélé comment l’invalidité est façonnée pour les personnes âgées avec PVLA quand ils rencontrent des caractéristiques environnementales intégrées d’une société ageiste et invalidante. Ces résultats sont illustrés par la présentation d’analyses de trois activités couramment discutées: faire de shopping, manger et déplacement dans la communauté. Notre discussion suggère que la prise en compte de la production environnementale de l’infirmité nécessite une politique sociale inclusive, le plaidoyer et un accent sur l’éducation afin de développer et de maintenir des environnements favorables au vieillissement et à la faible vision.To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken’s five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-visionfriendly environments.