Melinda Suto

A scoping review of the Photovoice method: implications for occupational therapy research.

Background. Photovoice is a participatory action research method combining photography and group work to give people an opportunity to record and reflect on their daily lives. Purpose. To review the use of Photovoice in health research and consider the implications for occupational therapy research. Methods. Literature review, guided by a scoping framework, reveals the purposes, rationales and populations with whom Photovoice has been used. Findings. From 351 documents retrieved, 191 original studies were surveyed; 68% were peer-reviewed. The majority of studies (76%) occurred within the public health domain and a smaller percentage (24%) with individuals experiencing a specific illness and/or disability, with very few (2%) documented in the occupational therapy literature. Implications. Photovoice provides a useful framework to apply a participant-centred research approach on occupational participation. It is important to consider and further examine ethical and methodological issues related to stigma, physical and cognitive capacities, mobility and technical accessibility related to using this method.

‘It’s something that I manage but it is not who I am’: reflections on internalized stigma in individuals with bipolar disorder

Bipolar disorder (BD) is a complex chronic condition associated with substantial costs, both at a personal and societal level. Growing research indicates that experiences with stigma may play a significant role in contributing to the distress, disability, and poor quality of life (QoL) often experienced in people with BD. Here, we present a sub-set of findings from a qualitative study of self-management strategies utilized by high functioning Canadian individuals with BD. Specifically, we describe a theme relating to participants’ experiences and understandings of internalized stigma. Descriptive qualitative methods were used including purposeful sampling and thematic analysis. High functioning individuals with BD type I or II (N = 32) completed quantitative scales to assess symptoms, functioning and QoL, and participated in an individual interview or focus group to discuss the self-management strategies that they use to maintain or regain wellness. Thematic analysis identified several themes, including one relating to internalized stigma. Within this, four additional themes were identified: stigma expectations and experiences, sense of self/identity, judicious disclosure, and moving beyond internalised stigma. One of the more unique aspects of the study is that it involves a participant sample that is managing well with their illness, which differs from the norm in biomedical research that typically focuses on pathology, problems and dysfunction.

What works for people with bipolar disorder? Tips from the experts

OBJECTIVES Little is known about how patients successfully manage their bipolar disorder (BD). This is a remarkable gap in the BD literature, given that current treatments are inadequate and information about beneficial self-management strategies could have clinical and theoretical implications. Here, we present results from a study of self-management strategies used by a sample of high-functioning individuals with BD. METHODS The objectively rated Multidimensional Scale of Independent Functioning (MSIF) was used to confirm high functioning status (score <3) amongst a sample of individuals self-described as functioning well with BD type I or II (N=32). Participants completed quantitative scales to assess psychiatric history, current symptoms, functioning and quality of life, and underwent either an individual interview or focus group to answer open questions about the self-management strategies they used to maintain or regain wellness. RESULTS Wellness strategies fell into the following themes: 1) Sleep, rest, exercise and diet; 2) Ongoing monitoring; 3) Enacting a plan; 4) Reflective and meditative practices; 5) Understanding BD and educating others; 6) Connecting with others. CONCLUSIONS The wellness strategies described by the current sample have substantial overlap with those identified in the sole comparable qualitative study. They are also broadly consistent with, and serve to elaborate on proposed mechanisms of therapeutic action in adjunctive psychosocial interventions for BD. The findings constitute hopeful stories for people affected by the disorder and suggest further research to confirm and refine mechanisms of beneficial effect in BD.

Meanings of well-being from the perspectives of youth recently diagnosed with psychosis.

Abstract Background: The phenomenon of well-being has attracted a surge of attention in mental health policy, clinical practice and research internationally. Yet, the definitions of well-being remain elusive, and there is limited understanding on its meanings from the perspectives of youth mental health service users. Objective: This study explored the meanings of well-being from the perspectives of youth mental health service users diagnosed with psychosis in the past 3 years. Methods: Using a qualitative approach, we conducted semi-structured interviews and participant-photography elicited focus groups with 17 youth recruited from an early intervention program for psychoses and a mental health program specializing in the delivery of psychiatric services to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Findings: The findings illustrate five key themes in participants’ conceptualizations of well-being: multidimensionality; active oriented states; social environment; identity; and normality. Dimensions of well-being identified in participants’ accounts include: psychological, physical, emotional, moral/virtuous, financial/material, spiritual, and social aspects. Conclusions: Our heuristic framework for conceptualizing well-being, grounded in the narrative accounts of youth participants, can inform the future planning and design of interventions, research, and outcome measures pertaining to the well-being of youth recently diagnosed with psychosis.

Moving from China to Canada: Occupational Transitions of Immigrant Mothers of Children with Special Needs

Introduction: Chinese immigrants to Canada bring a set of values and beliefs that influence the way they experience the world. Some are mothers with children with special needs. These women face the difficult process of transitioning into a new culture and society along with caring for a child with special needs. Objectives: To gain an in-depth understanding of the experiences and occupations of Chinese mothers of children with special needs who have immigrated to Canada. Methods: This descriptive phenomenological study used semi-structured interviews as the principal means of collecting data from three immigrant mothers with children with special needs who were born in China or Hong Kong. Results: Three themes were identified: 1) Change in types of caregiving occupations and stressors with immigration, 2) Parenting responsibilities shape personal and family life and occupations, and 3) Occupational changes associated with caregiving and immigration influence personal and family well-being. Conclusion: Occupational choices and engagement were based on the sense of duty and responsibility to their children. Chinese immigrant mothers made significant life changes regardless of their own and their familys well-being in the interest of their childrens development and quality of life.

A Critical Reframing of Play in Relation to Indigenous Children in Canada

In this paper, we explore the implications of applying critical perspectives to the play occupations of Indigenous children in Canada, and of reframing play as an occupational determinant of health. First we consider the normalizing construction of play in early child development. We then apply critical perspectives to discuss the implications of reframing play as an occupational determinant by exploring how Indigenous childrens play can be shaped by broader historical, political and socio-economic structures that may otherwise remain obscured. We propose that a critical reframing of play as an occupational determinant of health may be important in fostering health equity for Indigenous children.

Well-Being and Engagement in Valued Activities: Experiences of Young People with Psychosis

The purpose of this study was to understand how engagement in valued activities contributes to the well-being of young people diagnosed as having psychosis within the past 3 years. Using a qualitative approach, the authors conducted semi-structured interviews and photography-elicited focus groups with 17 participants between the ages of 18 and 24 years who were recruited from an early intervention program for psychoses and a psychiatric service specializing in providing care to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Participants derived six well-being enhancing experiences from engaging in highly valued activities: making meaning; expressing thoughts and emotions; changing physical, emotional, and cognitive states; cultivating skills, strengths, and virtues; connecting and belonging; and making a contribution. These findings highlight the importance of identifying activities that young people perceive as being valuable to their well-being, the meanings and experiences derived from these activities, and how best to support engagement in them.

Growing Older With Cerebral Palsy: Insidersʼ Perspectives

Purpose: Research has shown that adults with cerebral palsy (CP) lose functional abilities earlier than persons who are able-bodied. Because CP is a lifespan disability, developmental therapists should be aware of these changes. Methods: We used descriptive phenomenology to understand the unique, lived experiences of adults growing older with CP. Data were gathered through in-depth, semistructured interviews. Open-ended questions asked what it was like to age with CP, how these experiences were understood, how strategies were used to cope with changes, and what are the meanings of these experiences. Results: A theme, Awareness, Acceptance, and Action, emerged from the data analysis. Participants were aware that their bodies were deteriorating quicker than those of peers who are able-bodied. They developed acceptance that hastened actions toward improving their quality of life. Conclusions: These findings provide insights for pediatric therapists who work with children with CP about what may be important to their clients as they grow older.

Directions for advancing the study of work transitions in the 21st century

OBJECTIVES The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Religious and/or Spiritual Practices: Extending Spiritual Freedom to People with Schizophrenia:

Background. It continues to be a challenge to define and utilize spirituality in client-centred occupational therapy practice. Dialogue about spirituality is especially problematic for occupational therapists working with people with schizophrenia. Purpose. To explore the meaning of religion and/or spirituality for people living with a diagnosis of schizophrenia. Methods. Nine community-based individuals with schizophrenia engaged in interviews about the meaning of religion and/or spirituality and demonstrated self-defined spiritual practices. Phenomenology, hermeneutic theory, and a symbolic interactionism framework provided methodological and analytic guidance. Findings. Participants employed religious and/or spiritual practices to cope with schizophrenia symptoms and make meaning of their lives. Individuals used multiple systems of meaning to explain their experiences. Religious and/or spiritual agency, an individuals sense of freedom to choose among the spiritual options, renewed their sense of empowerment. Implications. Therapists can engage in spiritual negotiation with clients by using well-worded empowering questions toward a common goal of life enhancement.