Nadine Larivière

“Do-Live-Well” A Canadian framework for promoting occupation, health, and well-being

Background. Occupational therapists can bring a unique and valuable perspective to the national dialogue on health promotion. Current approaches have a narrow focus on diet and exercise; a broader focus on occupation has the potential to enrich understanding regarding forces that contribute to health and well-being. Purpose. A new “Do-Live-Well” framework will be presented that is grounded in evidence regarding the links between what people do every day and their health and well-being. Key Issues. Elements of the framework include eight different dimensions of experience and five key activity patterns that impact health and well-being outcomes. Personal and social forces that shape activity engagement also affect the links to health and well-being. Implications. The framework is designed to facilitate individual reflection, community advocacy, and system-level dialogue about the impact of day-to-day occupations on the health and well-being of Canadians.

Multifaceted impact evaluation of a day hospital compared to hospitalization on symptoms, social participation, service satisfaction and costs associated to service use

Abstract Objective. This study compared clinical and functional changes, satisfaction with services and costs associated to service use, in participants treated in a day hospital for adults and seniors organized by diagnostic groups, with clients hospitalised. Methods. A quasi-experimental design was used. The experimental group was composed of clients (N = 40) treated in a day hospital. The comparison group included clinically and demographically similar clients hospitalised in the same institution (N = 13). Outcomes were symptoms, social participation, self-esteem, service satisfaction, utilization and associated costs. Results. During the index intervention, the level of improvement was significantly greater in the day hospital group regarding symptoms (P = 0.047), self-esteem (P = 0.01) and social participation (accomplishment: P = 0.02; satisfaction: P = 0.008). Following discharge, there was no significant difference in the level of change between the two groups on all variables. Day hospital participants were significantly more satisfied of several dimensions of services (P ≤ 0.01). Comparison of total mean costs of services used 6 months before and after index treatment showed a cost reduction of 38% in the day hospital group and 7% in the hospitalisation group. Conclusions. Day hospitals organized by diagnostic groups lead to positive clinical and economical outcomes over time.

Who benefits the most from psychiatric day hospitals? A comparison of three clinical groups.

Comparison of the effects of psychiatric day hospital programs between homogenous clinical groups is an important issue that requires more attention. One group of day hospital patients who have not been included in most studies are people with cluster B personality disorders. The purpose of this study was to compare clinical and social participation outcomes in three groups of individuals treated in a psychiatric day hospital: patients with psychotic disorders, patients with mood and anxiety disorders, and patients with cluster B personality disorders. A pre-experimental, pre-test post-test design was used. During the first and last week of treatment, as well as 6 months after discharge, 20 participants in each group completed questionnaires on severity of symptoms, distress, accomplishment, satisfaction with social participation, and self-esteem. During the intervention, there was significant improvement in all groups on all variables, except for self-esteem in people with psychotic disorders, which remained stable. The patients with psychotic disorders showed significantly less improvement than the two other groups in severity of symptoms, distress, and self-esteem. Following discharge, the degree of change was comparable in the three groups on all variables based on between-groups analyses. However, based on within-group analyses, patients in the mood and anxiety disorders group continued to show significant improvement over time after discharge on self-esteem, accomplishment, and satisfaction with social participation, while no significant changes were seen in the other two groups. Although all three clinical groups made significant gains during their participation at the day hospital and maintained these gains after discharge, those with mood and anxiety disorders benefited the most from their day hospital experience.

Exploring Social Participation of People with Cluster B Personality Disorders

This study aimed to describe the impact of living with a cluster B personality disorder in an acute phase on social participation. A descriptive cross-sectional design was used. During their first week in a day hospital or inpatient admission, 31 participants completed the Assessment of Life Habits, examining the quality of social participation in 77 daily activities and social roles (life habits). The participants presented significantly more difficulties and dissatisfaction in realizing social roles than daily activities. Areas of life perceived to be the most problematic to accomplish were leisure, school, and work. Interpersonal relationships and fitness were the least satisfying. Personal care was the least disrupted and most satisfying life habit. Life habits that could be prioritized in psychiatric rehabilitation interventions with people with cluster B personality disorders included leisure activities, work and school, fitness, and interpersonal relationships.

Match between needs and services for participation of older adults receiving home care

Purpose – This paper aims to explore the match between needs and services related to participation for frail older adults receiving home care. Design/methodology/approach – A qualitative multiple case study was conducted with 11 triads each involving an elder, a caregiver and a healthcare provider working in a Health and Social Services Centers (HSSCs). Findings – Although HSSCs in Quebec are supposed to promote social integration and participation of older adults, services provided to the older adults in this study focused mainly on safety and independence in personal care, dressing, mobility and nutrition, without fully meeting older adults’ needs in these areas. Discrepancies between needs and services may be attributable to the assessment not covering all the dimensions of social participation or accurately identifying older adults’ complex needs; older adults’ and their caregivers’ difficulties identifying their needs and accepting their limitations and the assistance offered; healthcare providers’ l...

A qualitative exploration of a community-based singing activity on the recovery process of people living with mental illness:

Introduction This study first aims to qualitatively explore the benefits of a community-based singing activity taking place in Montreal, Canada. The second aim is to identify the activity’s essential components that potentially explain these benefits. Method An exploratory evaluative design involving qualitative descriptive methods was used. Thirteen individuals with various mental illnesses, the voice teacher and the activity coordinator participated in a group interview. Findings Four main benefits emerged from the participants’ interviews: (1) rediscovering identity and gaining self-confidence; (2) resuming and engaging in meaningful occupations and projects; (3) learning to collaborate with others and improving social skills; (4) improving physical condition and cognitive skills. The essential components of the activity were identified as: a normalizing environment and the absence of stigma; high expectations and support for participants; teacher-led stress relief exercises and activities; the use of singing as an activity to express emotions and stimulate cognitive functions. Conclusion This community-based singing activity appears to have contributed to the recovery process of its participants. There is a clear role for occupational therapists to promote, facilitate and support such activities outside traditional mental health services, since the participants were looking for occupational participation opportunities in normalizing community contexts.

What you do every day matters: A new direction for health promotion

Canadian health promotion campaigns directed towards healthy living have traditionally emphasized discrete behaviours that influence health and well-being, such as diet, physical activity and smoking. Although this traditional approach is important and supported by evidence, it does not account for broader determinants of health. The purpose of this commentary is to propose an innovative health promotion approach that expands the healthy living discourse through a focus on patterns of daily activity. We highlight four key public health messages derived from a synthesis of existing research evidence. The messages are based on the premise that what you do every day has an important impact on health and well-being. Rather than being prescriptive or outlining minimum requirements, this approach invites reflection on various experiences and activity patterns that shape the health and well-being of individuals and communities. This broader and more inclusive approach to healthy living reflects diverse needs and experiences, making it relevant and attainable for people of all ages and abilities. Future efforts directed at operationalizing the key messages for individuals and communities hold much promise for populations that may be at risk of activity patterns believed to contribute to poor health and well-being.RésuméLes campagnes canadiennes de promotion de la santé axées sur les modes de vie sains portent en général sur les comportements distincts qui influencent la santé et le bien-être, comme le régime alimentaire, l’activité physique et le tabagisme. Cette démarche classique est importante et appuyée par des données probantes, mais elle ne tient pas compte des grands déterminants de la santé. Le but de notre commentaire est de proposer une démarche de promotion de la santé novatrice qui va au delà du discours sur les modes de vie sains en s’intéressant aux schémas d’activité quotidiens. Nous faisons ressortir quatre messages de santé publique essentiels dérivés d’une synthèse des données de recherche existantes. Ces messages reposent sur l’hypothèse selon laquelle ce que l’on fait tous les jours a un effet important sur la santé et le bien-être. Au lieu d’être prescriptive ou de définir des exigences de base, une telle démarche invite à réfléchir aux diverses expériences et aux schémas d’activité qui façonnent la santé et le bien-être des personnes et des communautés. Cette façon plus large et plus globale d’aborder les modes de vie sains reflète la diversité des besoins et des expériences, ce qui la rend pertinente et atteignable pour des gens de tous âges et de toutes capacités. Les efforts futurs de cette démarche pour opérationnaliser les messages essentiels en fonction des personnes et des communautés sont très prometteurs pour les populations risquant d’avoir des schémas d’activité qui contribuent à réduire leur santé et leur bien-être.

Adjustment to community residential settings over time among older adults with serious mental illnesses.

This exploratory cross-sectional study examined adjustment over time of three groups of seniors with serious mental illnesses (N=33), who were transferred from a psychiatric hospital to a community residential facility from 1995-1998. The study participants had lived in the community for 6-41 months. Outcomes included measures of global, social, cognitive and ADL functioning, quality of life and rehospitalizations. Analyses revealed no significant deterioration in symptomatology, cognitive and ADL functioning between groups and a significant change in social functioning. Five participants were readmitted for short hospitalizations. Participants in all groups expressed a positive quality of life in their current community residence.

Traduction et validation du questionnaire ergothérapique l’Inventaire de l’équilibre de vie: Translation and validation of the Life Balance Inventory: An occupational therapy questionnaire

Description. Malgré l’intérêt que le concept de l’équilibre de vie suscite, aucun questionnaire n’est actuellement disponible en français pour bien le mesurer. But. Cette étude visait à traduire le Life Balance Inventory (objectif 1) et à vérifier la validité convergente de cette version française (objectif 2). Méthodologie. Une validation transculturelle a d’abord été réalisée, suivie d’une étude descriptive transversale auprès de 152 adultes âgés de 40 ans et plus, avec ou sans incapacité physique. Des questionnaires ont permis de mesurer les variables suivantes : équilibre de vie, stress, santé et qualité de vie. Résultats. Un meilleur équilibre de vie est associé à un degré inférieur de stress (r = –0,36; p < 0,01), ainsi qu’à une santé physique (r = 0,42; p = 0,01), une santé mentale (r = 0,36; p = 0,01) et une qualité de vie (r = 0,54; p < 0,01) supérieures. Conséquences. L’Inventaire de l’équilibre de vie est un questionnaire valide pour aider les ergothérapeutes à évaluer l’emploi du temps de leurs clients.BACKGROUND Despite the interest in the concept of life balance, no questionnaire is currently available in French to measure it well. PURPOSE This study aimed to translate the Life Balance Inventory (Objective 1) and to verify the convergent validity of the French version (Objective 2). METHOD A cross-cultural validation was first carried out, followed by a cross-sectional descriptive study, with 152 adults ages 40 and over, with and without physical disabilities. Questionnaires were used to measure the following variables, life balance, stress, health, and quality of life. RESULTS A better life balance is associated with a lower degree of stress (r = -.36; p < .01) as well as higher physical health (r = .42; p = .01), mental health (r = .36; p = .01), and quality of life (r = .54; p < .01). IMPLICATIONS The French version of the Life Balance Inventory is a valid questionnaire to assist occupational therapists when assessing time use of their clients.

Social Participation During Transition to Adult Life Among Young Adults With High-Functioning Autism Spectrum Disorders: Experiences From an Exploratory Multiple Case Study

This study aimed to explore the social participation of young adults with high-functioning autism spectrum disorders (HFASD) during their transition to adult life. A multiple case study was conducted using semi-structured interviews with a purposive sample of 10 participants (n = 10) composed of three adults with HFASD, their caregivers, and two representatives of community organizations. Four themes emerged: (1) access to services, (2) orientation to integrated life goals, (3) engagement in meaningful activities, and (4) gap in services before reaching independent living. Properly preparing and orienting the families could help them have a more satisfying social participation.