Heather Fritz

Don't Think Paralysis Takes Away Your Womanhood: Sexual Intimacy After Spinal Cord Injury.

Sexuality and intimacy are important components of health and well-being. Issues surrounding sexuality and intimacy are equally important for men and women living with physical disabilities, including spinal cord injury (SCI). Yet, womens sexuality after SCI remains largely unexamined. This article presents the findings from an in-depth qualitative investigation of the sexual and reproductive health experiences of 20 women with SCI in or around Detroit, MI. Findings echo existing literature documenting the sexual consequences of life after SCI and suggest new areas of inquiry important for better addressing sexual concerns across the lifespan. Specifically, findings suggest a need to consider the variable effects of SCI on sexual intimacy in relation to a persons developmental trajectory, the appropriate timing of sexual education, the need to expand conceptualizations of sexual intimacy, and the ways SCI may affect sexuality in later life.

I see it now: Using photo elicitation to understand chronic illness self-management

Background. How people integrate self-management into daily life remains underexamined, and such processes are difficult to elicit through traditional approaches used to understand human occupation. Purpose. This paper will provide a brief overview of one visual research method, photo elicitation, that holds promise for studying self-management of health behaviours and will present findings from an analysis of how the use of photo elicitation interviews contributed additional insights into self-management beyond those generated from the data collected through the other methods used in the study. Method. A qualitative, multiple-methods, multiple-case study was conducted with a purposive sample of 10 low-income women ages 40 to 64 with type 2 diabetes. Findings. The photo elicitation interviews contributed insights beyond those generated from other study methods about how individuals viewed their self-management behaviours and how occupations changed across time. Implications. Photo elicitation is a valuable research method for better understanding clients’ chronic illness self-management practices. Description. Les processus par lesquels les gens intègrent l’autogestion dans leur vie quotidienne ont été peu étudiés; ces genres de processus sont difficiles à susciter à l’aide des approches utilisées traditionnellement pour comprendre l’occupation humaine. But. Cet article présentera un bref aperçu de la photo-interview, une méthode de recherche visuelle prometteuse pour l’étude de l’autogestion des comportements en matière de santé. L’article présente également les résultats d’une analyse de la façon dont l’usage de la photo-interview a permis d’obtenir des réflexions introspectives sur l’autogestion allant au-delà de celles provenant des données recueillies à partir des autres méthodes utilisées dans l’étude. Méthodologie. Une étude de cas multiple et qualitative à méthodes multiples a été menée à l’aide d’un échantillon choisi à dessein de 10 femmes ayant un faible revenu, âgées de 40 à 64 ans et atteintes de diabète de type 2. Résultats. Les entrevues menées à l’aide de la photo-interview ont permis de recueillir des réflexions introspectives au-delà de celles qui avaient été produites à l’aide des autres méthodes de recherche, en ce qui concerne la façon dont les individus percevaient leurs comportements d’autogestion et la façon dont les occupations changeaient au fil du temps. Conséquences. La photo-interview est une méthode de recherche utile pour mieux comprendre les pratiques d’autogestion des clients face à leurs maladies chroniques.

Integrating the science of habit: Opportunities for occupational therapy

Chronic diseases are the leading causes of early morbidity and mortality in the United States. Because personal behaviors are the primary risk factors for developing chronic diseases, developing effective strategies to modify personal behaviors remains a national imperative. Occupational therapy can help address this problematic situation through interventions based on an understanding of habit and principles of habit modification. The objective of this paper is to provide an evidence-based argument for occupational therapy research and practice targeting health-promoting lifestyle behaviors as habits. We discuss empirical research conducted over the previous decade with a focus on the role of habit in daily behavior, key evidence-based strategies for changing existing habits and developing new habits, and recent advances in habit measurement in relation to issues of intervention design. Understanding habit development, function, and change offers a novel orientation for occupational therapy toward practice and research on many complex health problems.

Learning to do Better The Transactional Model of Diabetes Self-Management Integration

In this article I examine the process by which low-income (mostly minority) women develop the skills to integrate diabetes self-management into daily life and the conditions that affect the process. I present and describe a multimethod approach, including semistructured interviews, photo elicitation, time geographic diaries, and a standardized assessment which were used to collect data from 10 low-income women with type 2 diabetes, ages 40 to 64 years, between July and December 2012. I describe the grounded theory approach to data analysis which facilitated the development of the Transactional Model of Diabetes Self-Management (DSM) Integration. The model depicts the theorized process whereby low-income women accept aspects of diabetes education and training as congruent with their circumstances, act on them, and practice with them until they become integrated into daily life. Inquiry and practice play key roles in assimilating DSM. I discuss the study’s implications for facilitating better health-management programs.

Long-term community reintegration: Concepts, outcomes and dilemmas in the case of a military service member with a spinal cord injury

Abstract Purpose: Despite growing knowledge about medical and functional recovery in clinical settings, the long-term issue of community reintegration with a spinal cord injury (SCI) in the military context remains virtually unexamined. Thus, the U.S. Department of Defense created the SCI Qualitative Research Program to advance knowledge about service members’ reintegration into civilian life. The purpose of this paper is to better characterize the long-term outcomes related to the community participation experienced and desired vis-à-vis a case study of a military veteran who suffered a service-related traumatic SCI. Methods: An in-depth anthropological interview was used with Jake, a 28-year old marine with a service-related C5/C6 SCI. Data were analyzed using content analysis. Findings: Three significant themes were identified: opportunities for better engaging socially meaningful others may not be adequately included in so-called “client-centered” interventions; how management of the social self in inter-personal interactions and public spaces is critical to gaining broader societal acceptance; and how meaningful age normative relationships and activities are essential to establish lasting inclusive social connections. Conclusions: Jake’s case challenges existing models of rehabilitation predominantly focused on physical capacity building. Study findings point to the need for rehabilitation to invest more resources in efforts to address the existential and social elements of long-term social reintegration. Implications for Rehabilitation Both the veteran with SCI and their meaningful support network face challenges socially reintegrating after injury and rehabilitation. Empowering clients to envision future possibilities in terms of family, intimate relationships, and meaningful work are important to successful long-term social reintegration. Addressing the existential desires and social capacities of the individual may be as important as addressing physical functioning skills after SCI.

Characterizing Pain Flares From the Perspective of Individuals With Symptomatic Knee Osteoarthritis.

Although pain in knee osteoarthritis (OA) commonly affects activity engagement, the daily pain experience has not been fully characterized. Specifically, the nature and impact of pain flares is not well understood. This study characterized pain flares as defined by participants with knee OA. Pain flare occurrence and experience were measured over 7 days.

Robotic exoskeletons for reengaging in everyday activities: promises, pitfalls, and opportunities

Abstract Purpose: Media images and marketing materials suggest a future in which individuals with spinal cord injury (SCI) can utilize robotic exoskeletons to reengage in everyday activities, yet these narratives may not align with the current technological realities. The purpose of this paper is to present and describe the current use of robotic exoskeletons in rehabilitation and home settings and discuss the benefits and limitations of the devices. Materials and methods: We provide an overview of the features and limitations of the four robotic exoskeleton products (EKSO Bionics, ReWalk, Rex Bionics, and Indego) that are currently being used in in the United States in rehabilitation settings. We follow by suggesting ways that these devices fall short of fulfilling the promise of reengage in everyday activities in real-world life contexts. Results and discussion: Available devices appear to be better suited for rehabilitation settings than for home use. Device weight, the need for upper extremity supports, supervision requirements, and a limited range of movements are all issues that limit functionality and restrict opportunities for using such devices in real-world contexts. Designing the next generation of exoskeletons to be more useful in everyday life will require further collaboration among engineers, clinicians, and patients. Implications for Rehabilitation Exoskeletons offer the promise of allowing individuals with neurological injury to reengage in everyday activities from a standing position. Several exoskeleton devices are currently available for use in the United States. Weight of exoskeleton devices, the need for upper extremity supports, supervision requirements of hone units, and a limited range of movements are issues that restrict opportunities for using such devices in real-world contexts. Further development of exoskeleton technologies is warranted to improve the devices for real-world use.

Diabetes self-management among Arab Americans: patient and provider perspectives.

BackgroundArab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers.MethodsQualitative content analysis was used to analyze five focus groups–two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients.ResultsFour distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships.ConclusionsFindings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

Using a Smartphone-Based Ecological Momentary Assessment Protocol With Community Dwelling Older African Americans

Objectives Little is known about the feasibility of smartphone-based Ecological Momentary Assessment (EMA) approaches to collect psychosocial data from older populations, especially disadvantaged older populations. In response to this gap, this report provides evidence of the feasibility and utility of a smartphone-based EMA approach for real-time assessment with older African Americans. In addition, we share lessons learned about how to improve utility. Methods Ninety-seven older African Americans ages 55 and older (range: 55-95 years) used an Android smartphone loaded with an EMA application to provide data about their everyday activities and stress four times per day for seven consecutive days. Results Exit interviews early in the study suggested enhancements to the EMA interface. Adherence was demonstrated with response completion rates of 92-98% on EMA measures and no participant attrition based on the EMA protocol. Discussion Our findings suggest using a smartphone-based EMA approach for data collection is feasible and has utility with older African Americans. We most likely enhanced adherence by testing, training, monitoring, and adapting the EMA protocol using input from older adults early in the EMA design process.

The transactional perspective on occupation: A way to transcend the individual in health promotion interventions and research

ABSTRACT Ten years after its introduction, the role of the transactional perspective in occupational science has grown. Although the perspective has been used for a variety of purposes, application remains primarily associated with qualitative modes of inquiry and within the domain of occupational science. We argue that the perspective has broader potential in empirical occupational science as well as in the fields of population health, health promotion, and intervention science. In this paper, we present one such opportunity for the transactional perspective to contribute substantially to science, namely, the problem of how best to theorize and ground empirical research on health behavior change and maintenance. The science of health behavior change and maintenance has suffered from a reliance on theories that privilege individual agency while neglecting how contextual influences shape health behavior. In this paper, we discuss how the issue of health behavior change and maintenance is a relevant problem for occupational science, especially if using a transactional perspective. We provide an overview of the perspective inclusive of key principles—continuity and change, habits, problematic situations and inquiry. We follow by suggesting how the perspective provides the theoretical tools to better connect persons and situations in the context of health behavior change and maintenance and how it can inform intervention design. We conclude with a discussion of potential challenges of applying the perspective to health behavior change and maintenance, and about the significance of these potentialities for the larger project of occupational science and transdisciplinary contributions.