Lena-Karin Erlandsson

Meaningfulness in work – Experiences among employed individuals with persistent mental illness

The aim of the present study was to investigate how people with persistent mental illness, with various types of work and employment conditions, experience and describe the meaningfulness of work. The study had a qualitative approach and twelve informants living in the community were purposefully selected and interviewed according to overarching themes. The interviews were analysed using qualitative content analysis, and all of the authors were involved in the analysis process. The findings resulted in four main themes: 1) work per se has certain characteristics, 2) participation in different contexts gives a feeling of normality, acceptance, belonging and fulfilment of norms and values, 3) work affords structure, energy and a balanced daily life, and 4) work increases well-being and strengthens ones identity. A tentative model is described concerning perceived meaningfulness in work among individuals with persistent mental illness, in which the first three aspects of meaning are a prerequisite for meaning in terms of increased well-being and strengthened identity. Furthermore, it seems important that work has to bring the just right challenge to the individual in order for him or her to perceive the identified aspects of meaningfulness.

Occupational value among individuals with long-term mental illness.

Purpose. The study compared the perceived value of occupation among a sample of individuals with long-term mental illness to a sample of people not diagnosed with mental illness. As well, it investigated whether diagnostic and demographic factors were related to perceived occupational value among the individuals with mental illness. Finally, the study examined the relationship between occupational value and ratings of health and well-being. Method. One hundred and three individuals with mental illness and 28 healthy individuals were recruited for the study. Results. Overall occupational value among the individuals diagnosed with mental illness differed only marginally from the healthy group, indicating that perceived occupational value was by and large not related to mental illness. Among the individuals with mental illness, having children living at home was related to occupational value. There were moderate to strong associations between occupational value and measures of health and well-being. Practice Implications. This study provides important insights into occupational value among individuals with persistent mental health problems and provides some preliminary evidence in support of the Value, Meaning and Occupation Model.

Meaningfulness in daily occupations among individuals with persistent mental illness

This study investigated how people with persistent mental illness who work or study, attend a community‐based activity centre or have no regular activities, experience and describe the meaningfulness of their daily occupations. Data were gathered from 102 randomly selected individuals who were interviewed regarding their daily occupations and perceived meaningfulness using a ‘yesterday activity diary’. Content analysis revealed five main themes of meaningfulness: 1) Connection with others and the world around them, 2) Enjoyment and fun in life, 3) Being productive and having a sense of achievement, 4) Being occupied and having routines and projects in the stream of time and 5) Taking care of oneself to maintain health. Their connections, enjoyment and fun, and taking care of oneself were the aspects of meaningfulness that occurred most frequently. Participants who worked or studied more frequently identified connections, and made fewer statements about taking care of their health. The findings contribute to the knowledge of perceived meaningfulness in daily occupation, showing that despite different occupational structures and settings, all themes of meaningfulness were represented in the three groups. Thus, people with persistent mental illness create and find meaning within their daily occupations, although the occupations that generate these aspects of meaningfulness may differ.

Value dimensions, Meaning and Complexity in Human Occupation: A tentative structure for analysis

In occupational therapy and occupational science, it is important to clarify the perspective from which the analysis of occupation is addressed. The purpose of this paper is to present a tentative structure for describing occupation, allowing for analysis in a lifelong panorama as well as for the immediate experience a person acquires from performing a single occupation. The concept of occupational value is introduced as a prerequisite for meaning, defining three different dimensions: concrete, symbolic, and self-reward value. A dynamic categorisation of single occupations is presented, considering each unique occupational performance viewed from a macro, meso, and a micro perspective, inspired by dynamic systems theory. It is proposed that all occupations are meaningful if they are integrated parts of a persons occupational continuity, and that it is the interaction between the mentioned three perspectives that determines their meaningfulness. With an explicit focus on value and meaning as perceived by the unique person, occupational therapists will become more skilled in designing meaningful occupational therapy interventions. This paper is a contribution to the development of occupational science as well as to occupational therapy, but the theoretical framework presented must be empirically tested in order to demonstrate its validity.In occupational therapy and occupational science, it is important to clarify the perspective from which the analysis of occupation is addressed. The purpose of this paper is to present a tentative structure for describing occupation, allowing for analysis in a lifelong panorama as well as for the immediate experience a person acquires from performing a single occupation. The concept of occupational value is introduced as a prerequisite for meaning, defining three different dimensions: concrete, symbolic, and self-reward value. A dynamic categorisation of single occupations is presented, considering each unique occupational performance viewed from a macro, meso, and a micro perspective, inspired by dynamic systems theory. It is proposed that all occupations are meaningful if they are integrated parts of a persons occupational continuity, and that it is the interaction between the mentioned three perspectives that determines their meaningfulness. With an explicit focus on value and meaning as perceived by the unique person, occupational therapists will become more skilled in designing meaningful occupational therapy interventions. This paper is a contribution to the development of occupational science as well as to occupational therapy, but the theoretical framework presented must be empirically tested in order to demonstrate its validity.

Describing Patterns of Daily Occupations— A Methodological Study Comparing Data from Four Different Methods

The importance of patterns of daily occupations to health has been emphasised ever since occupational therapy was founded, but little is known about this relationship. The aim of this study was to describe in detail one womans pattern of daily occupations as an initial step in developing strategies for further studies of patterns of daily occupations. Four different methods were used, one on each of four days. Three types of occupations were discerned; main occupations, hidden occupations, and unexpected occupations, which intertwined and formed an occupational pattern. The occupations were, in turn, composed of actions. Using the diary method gave an overall picture of main occupations during a whole day. Direct observation and video-recorded observation added additional information about the actions that were the building blocks of the occupations, as well as about hidden and unexpected occupations. The fourth method, a variant of the experience sampling method, gave deeper knowledge about the informants reflections when performing an occupation. It was assumed that a detailed description of patterns of occupation is needed to understand its relationship to health. Therefore, if the diary method is used, it has to be combined with a subsequent interview. Direct observation was the single method that best captured the complexity of the pattern of daily occupations as captured in this study.

Rasch analysis of an instrument for measuring occupational value : implications for theory and practice

This study investigated psychometric properties of an instrument for assessing perceived occupational value, the 26-item OVal-pd. Data from 225 Swedish subjects with and without known mental illness were analysed regarding fit to the Rasch measurement model (partial credit model), differential item functioning (DIF), and functioning of the OVal-pd four-category response scale. The reliability (index of person separation, analogous to Cronbachs alpha) was good (0.92) but there were signs of overall and item level (six items) misfit. There was DIF between people with and without mental illness for three items. Iterative deletion of misfitting items resulted in a new 18-item DIF-free scale with good overall and individual item fit and maintained reliability (0.91). There were no disordered response category thresholds. These observations also held true in separate analyses among people with and without mental illness. Thus, the first steps of ensuring that occupational value can be measured in a valid and reliable way have been taken. Still, occupational value is a dynamic construct and the aspects that fit the construct may vary between contexts. This has implications for, e.g., cross-cultural research and calls for identification of a core set of culture-free items to allow for valid cross-cultural comparisons.

Occupational value and relationships to meaning and health: Elaborations of the ValMO-model.

Abstract This study investigates the theoretical assumption of the Value and Meaning in Occupations model. The aim was to explore the relationship between occupational value, perceived meaning, and subjective health in a sample of individuals of working age, 50 men and 250 women. Frequency of experienced values in occupations was assessed through the Occupational Value instrument with pre-defined items. Perceived meaning was operationalized and assessed by the Sense of Coherence measure. Subjective health was estimated by two questions from the SF-36 questionnaire. The analyses implied descriptive analyses, correlations, and logistic regression analyses in which sociodemographic variables were included. The findings showed highly significant relationships between occupational value and perceived meaning and when belonging to the high group of occupational value the likelihood was tripled of belonging to the high group of perceived meaning. When married or cohabitating there was double the likelihood of belonging to the high group of perceived meaning. Although perceived meaning was found to be positively associated with subjective health, working full time was the most important factor in explaining subjective health, compared with working less than full time. The results confirm assumptions in the ValMO-model, and the importance of focusing on occupational value in clinical practice is highlighted.

Psychometric properties of a Swedish version of the Pearlin Mastery Scale in people with mental illness and healthy people

Background: Mastery refers to the degree to which people perceive that they can control factors that influence their life situation, and has been found important for peoples quality of life and well-being. It is thus essential to be able to measure mastery in a valid and reliable way. Aim: This study aimed at using the Rasch measurement model to investigate the psychometric properties of a Swedish version of the Pearlin Mastery Scale (Mastery-S). Methods: A sample of 300 healthy individuals and 278 persons with mental illness responded to the Mastery-S. Item responses were Rasch analysed regarding model fit, response category functioning, differential item functioning (DIF) and targeting, using the partial credit model. Results: The Mastery-S items represented a logical continuum of the measured construct but one item displayed misfit. Reliability (Person Separation Index) was 0.7. The response categories did not work as expected in three items, which could be corrected for by collapsing categories. Three items displayed DIF between the two subsamples, which caused a bias when comparing mastery levels between subsamples, suggesting the Mastery-S is not truly generic. Conclusions: The Mastery-S may be used to obtain valid and reliable data, but some precautions should be made. If used to compare groups, new analyses of DIF should first be made. Users of the scale should also consider exempting item 6 from the scale and analyse it as a separate item. Finally, rewording of response categories should be considered in order to make them more distinct and thereby improve score reliability.

Return to Work Outcomes of the Redesigning Daily Occupations (ReDO) Program for Women with Stress-Related Disorders: A Comparative Study : a comparative study focusing on return to Work

Stress-related disorders are a frequent cause for sick leave, with consequences such as great distress and adverse economic effects for the affected person and substantial costs for society. Identifying effective interventions that facilitate return to work is thus important. The aim of this study was to evaluate the effectiveness of the 16-week Redesigning Daily Occupations program as a work rehabilitation method for Swedish women with stress-related disorders. The authors of this study hypothesized that, compared to women who got Care as Usual, 12 months after completed rehabilitation a larger proportion of the Redesigning Daily Occupations women would have returned to work, and they would have less sick leave, perceive less stress, and have greater self-esteem. Forty-two women entered the Redesigning Daily Occupations intervention and a matched comparison group received Care as Usual. The data, collected between 2007 and 2010, consisted of registry information and questionnaires targeting socio-demographics, perceived stress, and self-esteem. The findings partly verified the hypotheses. A larger proportion of the Redesigning Daily Occupations women returned to work and they decreased their sick leave and increased their self-esteem more than the Care as Usual group, but the groups did not differ in stress reduction. Thus, the Redesigning Daily Occupations seems to be a promising work rehabilitation method for women with stress-related disorders.

Levels of complexity in patterns of daily occupations: relationship to women's well-being

Abstract The study builds on a previous study of the everyday occupations of 100 women who worked at home and in the paid workforce. Their pattern of daily occupations was depicted using time‐occupation graphs inspired by the time geography method, whereby the womens pattern of occupations were categorised and clustered according to complexity. For each woman, the level of complexity was operationalised as the frequency of shifting between three categories of occupation (main, hidden, and unexpected) and sleep, along with the frequency of unexpected occupations and whether shifts in type of occupation were concentrated in limited parts of the day, e.g., the mornings. The study had two aims. First, to test the hypothesis that among women who work at home and in the paid workforce, those with low‐complex patterns of daily occupations would rate their health and well‐being higher than women having medium‐complex patterns. As well, those with medium‐complex patterns would rate their health and well‐being better than women with high‐complex patterns. Secondly, the study aimed to investigate differences among these subgroups in relation to sociodemographic factors. The hypothesis was partly confirmed. Increasing complexity was associated with lower levels of self‐rated health, but not with lower levels of sense of coherence and well‐being. With respect to sociodemographic factors, the women in the three subgroups differed in terms of level of education. The results tentatively confirm theoretical assumptions of a link between patterns of daily occupations and experiences of health, and provide an incentive for further research on this relationship.