Mapping Effectiveness Studies of Occupational Therapy in Africa: A Scoping Review.

Background: Contextual relevance is an important consideration for evidence-based practice, especially in low- and middle-income countries where the nature of practice may differ from high-income countries. Resources and access to rehabilitation are constrained, and service-users face a range of intersecting challenges to activity and participation. Aim: To evaluate the body of evidence for the effectiveness of occupational therapy in Africa, and to determine if systematic reviews with meta-analysis and/or meta-synthesis are feasible. Methods and Analysis. We conducted a systematic scoping review of published and grey literature by following PRISMA-ScR guidelines across 13 databases and through personal contact with occupational therapists across Africa. Covidence software was used to manage a blind review process by at least three reviewers per included article. The McMaster Quantitative Review Form, NHMRC levels of evidence, the Cochrane PROGRESS-Plus health equity criteria, and the TIDieR checklist informed data extraction using Microsoft Forms. Results: The search yielded 4199 articles, of which 45 were included. Evidence in six fields of practice included paediatrics, mental health, physical rehabilitation, hand therapy, work practice, and community development, although the evidence was largely limited to South Africa (93% studies). Levels of evidence varied but included 13 RCTs. In all, 1957 participants were included, ranging in age from 25 days to 99 years, with a wide range of health conditions. Most studies reported a positive outcome for occupational therapy. Conclusion: Findings suggest a moderate body of evidence to support occupational therapy in Africa. Systematic review with meta-analysis, assessment of risk of bias, and in-depth analysis of specific areas of practice are now required. All effectiveness studies in occupational therapy should include measures of occupational performance or participation, minimum reporting standard checklists should be used more consistently, and effect sizes should be consistently calculated and reported in effectiveness research.

Workplace-Based Interventions for Mental Health in Africa: A Scoping Review.

Mental health problems are one of the leading contributors to the global burden of disease. Workplaces provide a valuable and accessible setting for interventions to improve worker health. However, little is known about mental health interventions on the African continent, particularly those based in the workplace. This review aimed to identify and report on the literature about workplace-based interventions for mental health in Africa. This review followed the JBI and PRISMA ScR guidelines for scoping reviews. We searched 11 databases for qualitative, quantitative and mixed-methods studies. The grey literature was included, and no language or date limits were applied. Title and abstract screening and full text review, were completed independently by two reviewers. A total of 15 514 titles were identified, of which, 26 titles were included. The most common study designs were qualitative studies (n = 7) and pre-experimental, single-group, pre-test, post-test studies (n = 6). Workers with depression, bipolar mood disorder, schizophrenia, intellectual disability, alcohol and substance abuse, stress and burnout were included in the studies. The participants were mostly skilled and professional workers. A wide variety of interventions were offered, of which, most were multi-modal. There is a need to develop multi-modal interventions in partnership with stakeholders, particularly for semi-skilled and unskilled workers.

The Impact of an Evidence-Informed Spinal Cord Injury Activities of Daily Living Education Manual (SADL-eM): Protocol for a Randomized Controlled Trial.

BACKGROUND: Spinal cord injury (SCI) is a catastrophic injury associated with functional loss and life-threatening complications. Many people with SCI in the Gaza Strip of Palestine are discharged from inpatient rehabilitation to the community while still lacking many daily life skills. This randomized controlled trial (RCT) seeks to test the impact of the Spinal Cord Injury Activities of Daily Living Education Manual (SADL-eM)-an evidence-based occupational therapy patient educational intervention-on rehabilitation outcomes. OBJECTIVE: The proposed trial aims to evaluate the SADL-eM intervention compared with standard treatment among people with SCI. METHODS: This is a parallel RCT with two study arms: intervention and control. A total of 90 patients treated in inpatient rehabilitation settings will be randomly allocated to two study groups. Both groups will receive standard care. The intervention group will also use the SADL-eM with their treating occupational therapist during rehabilitation. The SADL-eM is a comprehensive activities of daily living (ADL) educational tool that was codeveloped with people with SCI and stakeholders across Gaza. The self-report version of the Spinal Cord Independence Measure will be used on admission (ie, baseline measure) and after 6 weeks as the primary outcome measure. Secondary outcomes include the third version of the Spinal Cord Independence Measure, the Private Religiousness Practices Scale, the Organizational Religiousness Short-Form, additional ADL domains covered by the education manual, and adherence to the intervention. The effect of the intervention will be determined using repeated-measures analysis of variance. RESULTS: This study will be conducted from April 2021 through December 2022, with results expected to be available in January 2023. CONCLUSIONS: If the SADL-eM is demonstrated as clinically effective, this will have significant implications for occupational therapy interventions in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT04735887; https://clinicaltrials.gov/ct2/show/NCT04735887.

Workplace-based occupational therapy for mental health in Africa: a scoping review protocol.

INTRODUCTION: Although mental health at work is a pressing and growing concern, mental healthcare accounts for less than 2% of global healthcare, with marked inequality across continents. Africa has the smallest proportion of mental health service providers, and the highest rate of out-of-pocket expenditure for mental health service users. Poor mental health at work results in costs to workers, employers and the economy. This review aims to collaborate with stakeholders to identify literature on workplace-based occupational therapy interventions supporting the mental health of workers in Africa. METHODS AND ANALYSIS: We will search Medline (PubMed), EBSCOhost (Academic Search Premier, AfricaWide Information, CINAHL, Health Source: Nursing/Academic), Scopus, Web of Science, Sabinet, Cochrane and OTSeeker for qualitative and quantitative primary research studies. Grey literature will be searched via Sabinet and ProQuest. No language or date restrictions will be applied. Title and abstract screening as well as full-text screening will be done independently by two reviewers. Data extracted will include information about the articles, characteristics of studies and interventions, and findings. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting results. Three groups of stakeholders will be consulted during the review process: service users/workers, employers and service providers/occupational therapists. ETHICS AND DISSEMINATION: This scoping review does not require ethics approval. Findings of the review will be disseminated through stakeholder engagements, peer-reviewed publications and conference presentations.

Optimizing a Halfway House to Meet Mental Health Care Users' Occupational Needs.

Background. Halfway houses (HwH) may support community reintegration of mental health care users and can be effective in meeting occupational needs of residents. However, they are not optimally used in South Africa. Purpose. This study aimed to improve the functioning of a HwH so that it better meets occupational needs of the resident mental health care users. It draws on Doble & Santha (2008); seven occupational needs. Method. A four-phase Participatory Action Research methodology was used. We conducted thematic analysis to describe met and unmet needs within PAR phases. Findings. Occupational needs of accomplishment, renewal, pleasure and companionship were being met. However, coherence, agency and affirmation needs were not being met. An additional occupational need for interdependence, based on the African ethic of Ubuntu, was identified. Implications. HwH functioning affected residents' experiences of health and wellbeing. Engagement in collective occupations can contribute to meeting the occupational need of interdependence.

Embedding graduate attributes during occupational therapy curriculum development: A scoping review and qualitative research synthesis.

INTRODUCTION: Graduate attributes are the personal qualities, skills and competencies, and values that students develop during their time at university to prepare them for work, and enable them to contribute to their communities. Occupational therapy education may foster well-rounded individuals if the development of graduate attributes is embedded within curriculum design and delivery. METHODS: This study identifies and synthesises existing knowledge on how graduate attributes are embedded in occupational therapy curricula. We conducted a scoping review following PRISMA extension for scoping review guidelines, and a qualitative research synthesis to reach a new conceptual understanding of the process of developing desired graduate attributes during occupational therapy curriculum development. RESULTS: Ten discipline-specific occupational therapy graduate attributes were identified. Three themes from the analysis of 15 papers explained how these attributes are embedded in curricula: Using a theoretical framework, a Graded process of active learning, and Collaborative curriculum design. CONCLUSION: Occupational therapy education is enhanced by being explicit about the desired graduate attributes that underpin curriculum design and delivery. Further work is needed to understand the benefits of including service users' perspectives and the value of clinical fieldwork education.

Eclectic Application of Theoretical Models in Occupational Therapy: Impact on Therapeutic Reasoning.

We investigated the impact of an eclectic framework for combining theoretical conceptual practice models on occupational therapists' theoretical reasoning using concurrent mixed methods with repeated measures and grounded theory designs. Study participants (n = 9) attended two workshops to review select occupational therapy theoretical conceptual practice models and learn how to use the eclectic framework. We assessed skills in eclectic combination of theoretical conceptual practice models using the Theory Application Assessment Instrument. The skills improved significantly [χ2(2, 9) = 7.09, p = .02], a finding that was corroborated by the qualitative findings indicating that the eclectic framework may potentially help improve theoretical reasoning among occupational therapists.

The Immediate Effect of African Drumming on the Mental Well-Being of Adults With Mood Disorders: An Uncontrolled Pretest-Posttest Pilot Study.

OBJECTIVE: This pilot study is the first to examine the effects of an occupational therapist-led African drumming group on mental well-being among adult psychiatric inpatients with mood disorders. METHOD: We used a quasi-experimental, uncontrolled, one-group, pretest-posttest design. We collected data for six different drumming groups (N = 13) using the Stellenbosch Mood Scale, the Primary Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, and the Enjoyment of Interaction Scale. RESULTS: Participants significantly improved on all six domains of the Stellenbosch Mood Scale, with a large clinical effect. Participants with higher self-reported anxiety and depression benefited the most. According to the Enjoyment of Interaction Scale results, all the participants enjoyed the drumming "a great deal." CONCLUSION: Our positive findings suggest that drumming may be an effective intervention for adults with acute mood disorders. We recommend further research that uses a control intervention.

Reconsidering the "Asphalt Identikit".

Background/Aim The "asphalt identikit" theory suggests that driving cessation inevitably leads to feelings of incompetence and dependency. This article challenges this proposition by investigating the driving-related possible selves of British older adults living in West London. Methods Thematic analysis of data from 19 of 39 interviews in which older adults participating in a larger study talked about driving in the context of their grocery shopping. Results Three themes were evident: "I can drive - that makes a huge difference," "Expecting to lose my license," and "I gave up my license." Discussion Driving cessation is not a dreaded possible self for all older adults. Older adults may use a variety of identity maintenance processes to retain their positive sense of self. Conclusions Mental well-being can be maintained during driving cessation by finding ways to compensate for the loss of a license and finding alternative ways of achieving hoped-for possible selves.

Food Activities and Identity Maintenance Among Community-Living Older Adults: A Grounded Theory Study.

OBJECTIVE: Engaging in food activities and maintaining identity are each important for productive aging. This study explored the role of food activities in identity maintenance among community-living older adults. METHOD: We used a grounded theory approach to analyze data collected in semistructured interviews with 39 predominantly White, British older adults living in West London. RESULTS: Two lifelong food identities-"food lover" and "nonfoodie"-were maintained in the processes of participation and maintenance and threat and compensation. The process change in meaning and identity explained the development of a third food identity-"not bothered"-when participants experienced being alone at the table, deteriorating health, and worry about the cost of food. CONCLUSION: Food activities that are a pleasurable and important part of daily life contribute to the maintenance of important identities and mental well-being in older adults.

Food activities and identity maintenance in old age: a systematic review and meta-synthesis.

OBJECTIVES: Services provided to older people should be developed based on active ageing policies. Nutrition is one aspect of active ageing, but little is known about how food activities contribute to psychological well-being in later life. This is a systematic review of qualitative and quantitative research that answers the question 'What is known about the relationship between food activities and the maintenance of identities in old age?'. METHODS: We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and used quality assessment parameters to complete a systematic review and narrative synthesis. Academic Search Premier, MEDLINE, CINAHL Plus, and PsycINFO databases were searched. RESULTS: We initially identified 8016 articles, of which 167 full-text articles were screened for inclusion. Twenty-two articles were included in the review. There was moderate evidence from nine qualitative and two quantitative studies, of variable quality, that food activities contribute to the maintenance of women's gendered identities, the ethnic identities of men and women, and community identities. There was moderate evidence from 10 qualitative studies, of variable quality, that a change in food choice and deteriorating health changed food activity participation. These changes threatened identities. Most studies included both younger adults and older adults. CONCLUSION: In later life, there are many life experiences leading to change. Further research is needed to develop understanding of how identity and mental well-being are maintained, despite changes in everyday activities like cooking and eating. This may enable health care professionals to meet psychological needs alongside biological needs during nutritional interventions.

Libraries of life: using life history books with depressed care home residents.

Depression is a common, and often undetected, psychiatric disorder in geriatric care home residents. Reminiscence, an independent nursing therapy used by a variety of health and social care professionals, can prevent or reduce depression. This practice development project explored the use of reminiscence life history books as an interpersonal therapeutic tool with 3 depressed care-home residents living in residential care and skilled nursing facilities. The process of choosing to produce a book, assessment of capabilities, and methods of construction are described using 3 illustrative case studies. Three themes emerged: reviewing the past, accepting the present, and dreaming of an alternative future. This project demonstrated that life history books, tailored to individual needs and abilities, can facilitate reminiscence and reduce depression by increasing social interaction. The benefits to residents, their families, and care staff are discussed and the relevance to nursing practice highlighted.