Adolescents' experiences of a school-based health promotion intervention in socioeconomically advantaged and disadvantaged areas in Sweden: a qualitative process evaluation study.

BACKGROUND: Adolescence is a transition period in which positive experiences of physical activity have the potential to last into later adulthood. These experiences are influenced by socioeconomic determinants, leading to health inequalities. This study aims to explore adolescents' experiences and participation in a multi-component school-based intervention in schools located in socioeconomically advantaged and disadvantaged areas in Sweden. METHODS: A qualitative design was used to evaluate how participants experienced the intervention. The intervention was a multi-component school-based intervention. It was conducted in six schools (four control and two intervention schools) with a total of 193 students and lasted one school year. It was teacher-led and consisted of three 60-minute group sessions per week: varied physical activities, homework support with activity breaks, and walks while listening to audiobooks. In total, 23 participant observations were conducted over eight months and 27 students participated in focus groups. A content analysis was conducted. RESULTS: The results describe a main category 'Engaging in activities depending on socioeconomic status' and three generic categories: 1. Variations in participation in PA together with classmates and teachers; 2. Variations in engagement in PA after school; and 3. Differences in time and place allocated to do homework and listen to audiobooks. These categories illustrate how participants looked forward to the physical activities but used the time spent during the walks and homework support differently depending on how busy they were after school. Frequently, those who were busiest after school were also those from the advantaged area, and those who had little to do after school were from the disadvantaged area. CONCLUSION: Socioeconomic factors influence participants' possibilities to engage in the intervention activities as well as how they use their time in the activities. This study showed that it is crucial to support adolescents' participation in physical activities by providing structure and engaging well-known teachers in the activities, especially in schools located in disadvantaged areas.

Stakeholders' Expectations of Return-to-Work After Spinal Cord Injury: A 1-Year Follow-Up.

Understanding the process of return-to-work is key to supporting people's social participation and health after a disability. This phenomenographic study aimed to explore the expectations and ways of understanding return-to-work from the perspectives of three stakeholder types: three workers with spinal cord injuries, their employers, and an occupational therapist coordinator. Participants were interviewed twice, at 6 and 12 months, after having participated in a research-based return-to-work intervention in Sweden. A phenomenographic approach was used to analyze the data. The findings highlight how stakeholders' different expectations prevented them from openly discussing more flexible arrangements to make return-to-work viable and sustainable. The study contributes to occupational therapy practice by raising awareness of the challenges of work reintegration. It also adds to the body of knowledge in occupational science by illuminating how normative social expectations and policy concerning work/productivity influence the return-to-work process.

Occupational balance in parents of pre-school children: Potential differences between mothers and fathers.

BACKGROUND: Parents of young children are a vulnerable group with an increased risk of stress-related health problems compared to adults without children. Low occupational balance has been identified as a risk factor for stress-related disorders. AIM: The study aimed to describe occupational balance in parents of pre-school children and to explore potential differences between mothers and fathers. METHOD: Data were collected by a web-based survey based on the Occupational Balance Questionnaire (OBQ11). A total of 302 working parents (200 mothers and 102 fathers) with at least one child under seven years of age were included in the study. FINDINGS: Mothers reported lower occupational balance than fathers with a median value of 10 for mothers and 12 for fathers (p = 0.029). Mothers rated significantly lower than fathers in three items; 'Balance between work, home, family, leisure, rest and sleep', 'Having sufficient time for doing obligatory occupations' and 'Balance between doing things for others and for oneself'. CONCLUSION: The results indicate that caring for pre-school children may negatively impact both parents, impacting mothers' occupational balance to a greater degree. SIGNIFICANCE: Occupational therapists' knowledge could be utilised to increase awareness of the importance of occupational balance within health services and improve mothers' occupational balance.

Return to work after COVID-19: Experiences and expectations from the first wave of COVID-19 in Stockholm.

BACKGROUND: In Stockholm (Sweden) a substantial number of persons who were infected with SARS-CoV-2 during spring 2020, and received intensive care followed by rehabilitation due to COVID-19, were of working age. For this group, return to work (RTW) is an important part of the rehabilitation, however this is an area that thus far has received little scholarly attention. The Aim of this study was two-fold. First, to descriptively look at self-reported work ability over time using the Work Abilty Index among working age adults who recovered from severe COVID-19, and secondly, to explore experiences and expectations concerning RTW among working age adults who recovered from severe COVID-19. METHODS: Focus group interviews and qualitative thematic analyses were utilized. In addition, the study populations' self-reported work ability index was recorded over one year. FINDINGS: Qualitative analysis of data resulted in 5 themes: a) Initial experiences after discharge from in-patient rehabilitation, b) Disparate first contact with work, c) Uncertainties about own role in RTW process, d) Working situation for those who had started getting back to work, and e) A need to reprioritize expectations for work in the context of everyday life. There were no statistical differences in work ability index scores between 18 and 52 weeks after discharge from an in-patient rehabilitation unit. CONCLUSION: RTW after COVID-19 can require systematic support for several months as well as be initiated earlier in the rehabilitation process. Further research in the area is needed.

Engagement in Everyday Activities for Prevention of Stroke: Feasibility of an mHealth-Supported Program for People with TIA.

Most of the risk factors for stroke are modifiable, yet incorporating and sustaining healthy lifestyle habits in daily life that reduce these risk factors is a major challenge. Engaging everyday activities (EEAs) are meaningful activities that are regularly performed that have the potential to contribute to the sustainability of healthy lifestyle habits and reduce risk factors for stroke. The aims of this study were (1) to investigate the feasibility and acceptability of a digitally supported lifestyle program called "Make My Day" (MMD) for people at risk for stroke following a transient ischemic attack, and (2) to describe participants' stroke risk and lifestyle habits pre- and post-intervention. A multiple case study design using mixed methods was utilized (n = 6). Qualitative and self-reported quantitative data were gathered at baseline, post-intervention, and 12 months post-baseline. The results indicate that MMD can support lifestyle change and self-management for persons at risk for stroke following a TIA. The findings indicate a high acceptability and usability of MMD, as well as a demand for digital support provided via a mobile phone application. Self-management with digital support has the potential to increase participation in EEAs for persons at risk for stroke following a TIA.

Challenges in enacting occupation-based social transformative practices: A critical dialogical study.

BACKGROUND.: Globally, occupational therapists are taking up the transformative potential of occupation to mobilize the profession's commitment to social change. PURPOSE.: This study examined ideal constructions of occupation-based social transformative practices and challenges that may arise when enacting these practices. METHOD.: Five participants with experiences developing practices aligned with social transformative goals in diverse locations were recruited. In this critical dialogical study, three dialogical interviews were conducted with each participant. Critical reflexivity was enacted through the exchange of transcripts and critical reflections with participants. A critical discourse analysis was conducted to examine how such practices are shaped within discourses and other contextual features. FINDINGS.: The findings address constructions of ideal practice and three threads that provide critical insights into ways discourses shape possibilities to enact social transformation through occupation. IMPLICATIONS.: This study brings together experiential and theoretical knowledge to advance social transformative practices by problematizing underexamined discourses in occupational therapy.

Critical dialogical approach: A methodological direction for occupation-based social transformative work.

BACKGROUND: Calls for embracing the potential and responsibility of occupational therapy to address socio-political conditions that perpetuate occupational injustices have materialized in the literature. However, to reach beyond traditional frameworks informing practices, this social agenda requires the incorporation of diverse epistemological and methodological approaches to support action commensurate with social transformative goals. AIM: Our intent is to present a methodological approach that can help extend the ways of thinking or frameworks used in occupational therapy and science to support the ongoing development of practices with and for individuals and collectives affected by marginalizing conditions. METHOD: We describe the epistemological and theoretical underpinnings of a methodological approach drawing on Freire and Bakhtin's work. RESULTS: Integrating our shared experience taking part in an example study, we discuss the unique advantages of co-generating data using two methods aligned with this approach; dialogical interviews and critical reflexivity. DISCUSSION: Key considerations when employing this approach are presented, based on its proposed epistemological and theoretical stance and our shared experiences engaging in it. SIGNIFICANCE: A critical dialogical approach offers one way forward in expanding occupational therapy and science scholarship by promoting collaborative knowledge generation and examination of taken-for-granted understandings that shape individuals assumptions and actions.

Occupational therapists' perceptions of the need to enact health promotion in community development through occupational justice / Percepções dos terapeutas ocupacionais sobre a necessidade de implementar a promoção da saúde no desenvolvimento comunitário por meio da justiça ocupacional

Abstract Introduction Social determinants of health underlie and contribute to health inequalities. Stigma, poverty, and unequal access to health care are examples of social determinants that affect people's well-being and participation in society. Although occupational therapists use occupation to promote health and well-being, they rarely consider how to address the reduction of health inequalities in their practice. Objective The study aimed to explore how occupational therapists perceive the need to enact health promotion in community development through occupational justice. Method Following critical participatory action research principles, group discussions were conducted by six professionals from across France. Occupational justice frameworks and public health reports were used to prompt a group dialogue over four months. A content analysis of the discussion was conducted, guided by the theory of practice architectures to understand how the therapists' practices were shaped by discursive, economic, and socio-political circumstances. Results Four themes reflected the professional needs to undertake community development: 'the professional skills needed to enact the community's own know-how and self-expertise', 'the importance of seeing the 'whole' picture and reaching out to other sectors', 'the need for occupational justice to understand the complexity of community development', and 'the need to move beyond body functions in education'. Conclusion Community development offers unique opportunities to work in the complex context of everyday living. Reasoning informed by occupational justice concepts enables occupational therapists to consider health outcomes caused by social determinants. Occupational therapy education must train students for complex reasoning on how occupational injustices are rooted in everyday social contexts.

Resumo Introdução Os determinantes sociais da saúde fundamentam e contribuem para as desigualdades em saúde no mundo. Estigma, racismo, pobreza e acesso desigual aos cuidados de saúde são exemplos de determinantes sociais que afetam o bem-estar e a participação das pessoas na sociedade. Embora os terapeutas ocupacionais usem a ocupação para promover a saúde e o bem-estar, raramente consideram seu potencial para lidar com a redução das desigualdades em saúde. Objetivos Explorar como os terapeutas ocupacionais percebem a necessidade de implementar promoção de saúde no desenvolvimento comunitário por meio da justiça ocupacional. Método Seguindo os princípios críticos da pesquisa-ação participativa, as reuniões do grupo foram conduzidas por seis profissionais de diferentes regiões da França. Enquadramentos de justiça ocupacional e relatórios nacionais de saúde pública foram usados para estimular um diálogo durante quatro meses. Uma análise de conteúdo foi conduzida, guiada pela teoria das arquiteturas da prática, para entender como as práticas dos terapeutas ocupacionais foram moldadas por circunstâncias discursivas, econômicas e sociopolíticas. Resultados Quatro temas refletiram as necessidades profissionais para praticar o desenvolvimento comunitário: as habilidades profissionais necessárias para decretar o próprio know-how da comunidade; e auto perícia, a importância de ver o quadro "por inteiro" e de alcançar outros setores; a necessidade da justiça ocupacional para compreender a complexidade do desenvolvimento comunitário; e a necessidade de ir além das funções do corpo na formação. Conclusão O desenvolvimento comunitário oferece oportunidades únicas para trabalhar no complexo contexto da vida cotidiana. O raciocínio informado pela justiça ocupacional permite aos terapeutas ocupacionais considerarem melhor os efeitos dos determinantes sociais sobre a saúde. A formação em terapia ocupacional deve abordar a realização de raciocínios complexos sobre como as injustiças ocupacionais estão enraizadas nos contextos sociais cotidianos.

Illustrating the Importance of Critical Epistemology to Realize the Promise of Occupational Justice.

This article argues that it is vital to embrace critical reflexivity to interrogate the epistemological beliefs and principles guiding occupation-based scholarship to move away from frameworks that are incongruent with calls for occupational justice. For this purpose, we describe an epistemic tension between the stated intentions to demonstrate that occupation-based work can be a means to create a more just society and the epistemological beliefs that have historically dominated occupation-based scholarship. To exemplify the potential implications of this tension, a critical analysis of Creswell's social justice/transformative design is presented, illustrating that work that expresses a commitment to social justice while relying on positivist/postpositivist assumptions often risks perpetuating injustices through neglecting their sociopolitical construction. Drawing upon critical social theory, we highlight how engagement with critical epistemological assumptions can facilitate addressing the sociopolitical "roots" of occupational injustices and highlight directions for social transformation.

Precarious work as situated occupation: exploratory study of workers' experiences in the context of the Spanish economic crisis / El trabajo precario como ocupación situada: estudio exploratorio de experiencias de trabajadores en el contexto de crisis económica española / O trabalho precário com a ocupação implantada: estudo exploratório de experiências de trabalhadores no contexto da crise econômica espanhola

Introduction: From an occupational perspective, employment or work is conceived as a positive and significant occupation in the life of human beings. Throughout the development of the profession, work has been conceptualized as a goal and a means for recovering, focusing on its potential for (re)integrating people with physical and mental disabilities into the labor market. However, there is a gap in knowledge regarding work as an occupation when it is precarious. Objective: Adopting a critical and occupational justice perspective, the aim of this study is to explore and problematize the relationship between precarious work, health, and well-being, based on the experience of four individuals. Method: Participants' experiences of precarious work were gathered through two semi-structured interviews with each participant. Data was analyzed using a qualitative exploratory design, constant comparison techniques, and applying a kaleidoscope metaphor. Results: The findings describe the context of precarious work, its effects on the health and well-being of the participants, and the meanings that participants attribute to their work. Conclusion: This study problematizes the positive and significant relationship between work, health, and well-being implicit in the occupational therapy literature. This research contributes to the development of more complex understandings of work as an occupation that not only involves personal experiences, but also interrelates with socio-economic and political contexts.

Introducción: Desde la terapia ocupacional, el trabajo es concebido como una ocupación positiva y relevante en la vida de los seres humanos. A lo largo del desarrollo histórico de la profesión, el trabajo ha sido conceptualizado como un objetivo y medio curativo, centrándose en su potencial para la (re)integración laboral de personas con discapacidades físicas y mentales. Sin embargo, existe una laguna de conocimiento en referencia al trabajo como ocupación cuando este es precario. Objetivo: El objetivo de este estudio es explorar y cuestionar la relación entre trabajo precario, salud y bienestar a partir de la experiencia de cuatro individuos desde una perspectiva crítica y de justicia ocupacional. Método: Se analizaron las experiencias de cuatro trabajadoras/es, utilizando un diseño cualitativo exploratorio, técnicas de análisis de comparación constante, y aplicación de la metáfora de caleidoscopio. Para recoger los datos se utilizó una entrevista semiestructurada, realizando dos entrevistas por participante. Resultados: Los resultados describen el contexto del trabajo precario, los efectos del trabajo en la salud y bienestar de los participantes, y los significados que los participantes le otorgan a sus trabajos. Conclusión: En este estudio se cuestiona la relación positiva y significativa entre trabajo, salud y bienestar implícita en la literatura de terapia ocupacional. Esta investigación contribuye al desarrollo de entendimientos más complejos del trabajo como ocupación que van más allá de experiencias individuales, situando el trabajo en relación a contextos socioeconómicos y políticos.

Introdução: A partir da terapia ocupacional, o trabalho é concebido como uma ocupação positiva e relevante na vida dos seres humanos. Ao longo do desenvolvimento histórico da profissão, o trabalho tem sido conceituado como um alvo e meio de cura, concentrando-se em seu potencial para a (re)integração laboral de pessoas com deficiências físicas e mentais. No entanto, existe uma lacuna no conhecimento em referência ao trabalho como uma ocupação, quando esta é precária. Objetivo: O objetivo deste estudo é explorar e questionar a relação entre o trabalho precário, saúde e bem-estar com base na experiência de quatro indivíduos a partir de uma perspectiva crítica e da justiça ocupacional. Método: Foram analisadas as experiências de quatro trabalhadores, usando um desenho qualitativo exploratório, técnicas de análise de comparação constante e aplicação da metáfora do caleidoscópio. Para a coleta de dados, foi utilizada uma entrevista semiestruturada, realizando duas entrevistas por participante. Resultados: Os resultados descrevem o contexto do trabalho precário, os efeitos do trabalho na saúde e no bem-estar dos participantes, e os significados que os participantes dão aos seus empregos. Conclusão: Neste estudo, é questionada a relação positiva e significativa entre trabalho, saúde e bem-estar implícita na literatura em terapia ocupacional. Esta pesquisa contribui para o desenvolvimento de entendimentos mais complexos de trabalho como uma ocupação que vá além de experiências pessoais, colocando o trabalho em relação aos contextos socioeconômicos e políticos.

Estudio de alcance de terapia ocupacional y drogodependencias: reflexiones críticas de los contextos, prioridades y miradas en la investigación / A scoping review of occupational therapy literature on drug addiction: critical reflections on contexts, priorities and research perspectives

Introducción: El consumo problemático de drogas representa uno de los problemas de salud más significativos a nivel mundial. La terapia ocupacional es uno de los actores sociales que promueve la participación en la comunidad, mediante la ocupación, contribuyendo a la justicia ocupacional. Sin embargo, se desconoce qué perspectivas y prioridades se están utilizando en la investigación de la terapia ocupacional, lo cual es clave para desarrollar una práctica reflexiva y crítica. Objetivo: Actualizar, identificar y sintetizar las prioridades y perspectivas en la producción científica existente relacionada al consumo de drogas y terapia ocupacional. Método: Se realizó una revisión de la literatura siguiendo el marco de referencia para “Scoping Review” desarrollado por Arksey y O’Malley. Se buscó en las siguientes bases de datos electrónicas: CINAHL, Cochrane Library Plus, Dialnet, EMBASE, ISI Web of Science, OTseeker y Scopus. Se empleó el método descriptivo analítico y la triangulación de investigadores para realizar el análisis de los datos. Resultados: Del análisis de la literatura emergieron tres categorías: “Contextualización”, “Prioridades de investigación” –relación entre el desempeño ocupacional y la calidad de vida, instrumentos de evaluación e intervenciones de terapia ocupacional– y “Miradas teóricas en la investigación” (una mirada positivista: la neurociencia como sustento de la intervención; una mirada empoderadora: construyendo el camino hacia la inclusión, y una mirada sistémica: centrada en la familia como base de la intervención). Conclusión: Es preciso continuar investigando acerca de la problemática del consumo de drogas desde la terapia ocupacional, empleando una perspectiva crítica basada en la ciencia de la ocupación.

Introduction: Drug abuse is one of the most complex global health issues. Occupational therapy is one of the socialactors that promotes community participation, using occupation as a means to contribute to occupational justice. However, it is unknown what theoretical perspectives are being used in occupational therapy research. This knowledge is essential for developing a critical and reflexive practice. Objective: This study aims to update, identify and synthesize the priorities and perspectives employed in the existing scientific literature of occupational therapy related with problematic use of drugs. Method: A scoping literature review based on the methods described by Arksey and O’Malley (2005) was conducted. Literature was identified using the following electronic databases: CINAHL, Cochrane Library Plus, Dialnet, EMBASE, ISI Web of Science, OTseeker, and Scopus. To analyse the data, a descriptive-analytic method and triangulation were used. Results: The literature reviewed reveals information regarding three categories: “Contextualization”, “Research Priorities” –the relationship between occupational performance and quality of life, assessment tools, occupational therapy intervention and “Theoretical Research Perspectives” (a positivist view: neuroscience as base for intervention, an empowering view: paving the way for inclusion, and a systemic view: family as base for intervention). Conclusion: Further research is needed regarding the role of occupational therapy in the field of problematic drug use using a critical perspective based on occupational science.

La formación de pregrado de terapia ocupacional en Chile vista desde la perspectiva de los estudiantes: ¿cuál es la percepción de necesidades que tienen los estudiantes de terapia ocupacional en relación a su proceso de formación? / Occupational therapy undergraduate education in Chile seen from the students' perspective: what are the students' perceptions of their undergraduate education?

Introducción: la comprensión de la percepción que tienen los estudiantes de terapia ocupacional hacia su formación de pregrado representa una parte esencial en el desarrollo y mejoramiento curricular de la profesión. Objetivo: explorar las percepciones que tienen los estudiantes de terapia ocupacional hacia los contenidos y la formación de pregrado en Chile. Metodología: en este estudio cualitativo y fenomenológico, los datos se recolectaron a través de cuestionarios electrónicos autoaplicados. Los cuestionarios fueron suministrados a través de las tecnologías de la información y comunicación, en donde los entrevistados respondieron y remitieron sus respuestas anónimamente a través de internet. Los participantes son estudiantes de la carrera de terapia ocupacional de distintas universidades a lo largo del país, de ambos géneros y pertenecientes al rango entre los 18-40 años de edad. En correlación con el enfoque interpretativo-descriptivo de este estudio, el análisis de los datos se realizó a través del método de comparación constante propuesto por Glaser y Strauss y el software ATLAS.ti 5.0. Resultados: como resultado de los hallazgos de esta investigación, 3 temáticas fueron identificadas; (1) malla curricular y programas, (2) metodologías docentes y (3) relación entre docentes-estudiantes. Discusión: una mayor participación de los estudiantes en su propia formación de pregrado facilitaría su comprensión de los contenidos y objetivos curriculares, así como les proporcionaría una mejor visión de éstos y sus conexiones a través de los años de estudio de la profesión. Además de proporcionarles una mirada reflexiva y crítica acerca de los contenidos aprendidos y de las herramientas que necesitan desarrollar para la adquisición de éstos.

Introduction: understanding the occupational therapy students’ perception of their undergraduate training is an essential part for the development and improvement of the program. Aim: to explore the occupational therapy students’ perception of the content and undergraduate education in Chile. Methodology: in this phenomenological and qualitative study, data were collected through self-administered electronic questionnaires. The questionnaires were provided using information and communication technology, where the respondents submitted their answers anonymously through Internet. The participants are occupational therapy students between 18-40 years old of both genders from various universities across the country. In correlation with the interpretive-descriptive approach of this study, data analysis was performed using the constant comparison method proposed by Glaser and Strauss and the software ATLAS.ti 5.0. Results: as a result of the findings of this research, three themes were identied: (1) programme of study, (2) teaching methods, and (3) student-teacher relationship. Discussion: a greater student participation in their own undergraduate education could facilitate the understanding of the content and program aims, as well as provide a better view of the connections between them through the years of study. In addition, this study aims to provide the students with a reactive and critical thinking about the learning contents and the tools that they need to develop in order to reach the learning goals of the program. Relevance for the OT: the results of this study aim to open a dialogue and discussion between students and scholars from different universities regarding the needs of the undergraduate programs as perceived by students of different years of study. Furthermore, this study aims to discuss the methodologies and teaching methods used to provide the set of courses to the students in order to encourage the development and review of these...