Feasibility of Health Promoting Activity Coaching for Mothers of Children With Disabilities: Pilot Nonrandomized Controlled Trial.

IMPORTANCE: Mothers of children with disabilities experience health disparity. Interventions targeting maternal mental health need to be developed. OBJECTIVE: To determine the feasibility and preliminary effectiveness of the Healthy Mothers Healthy Families-Health Promoting Activities Coaching (HMHF-HPAC) intervention for mothers to improve participation in healthy activities and mental health and to evaluate outcome measures. DESIGN: Nonrandomized controlled pilot feasibility study with one group who received HMHF-HPAC and a control group. SETTING: Pediatric occupational therapy service; on site or telehealth. PARTICIPANTS: Twenty-three mothers completed prequestionnaires; of those, 11 mothers participated in the intervention, and 5 did not (7 withdrew). INTERVENTION: Eleven pediatric occupational therapists were trained to deliver six 10-min sessions of HMHF-HPAC to mothers, integrated into their child's therapy session or separately via telehealth. OUTCOMES AND MEASURES: Mixed-design analysis of variance explored changes in scores on the Depression Anxiety Stress Scale-21 Items and the Health Promoting Activities Scale. RESULTS: The intervention group reported, on average, significant reductions in depressive symptoms and stress symptoms and significant increases in participation in health-promoting activity. No significant main effect of time was found for these variables in the control group. CONCLUSIONS AND RELEVANCE: The HMHF-HPAC program is a viable occupational therapy coaching intervention that can be embedded in existing services for families of children with disabilities. Future trials that evaluate the effectiveness of the HMHF-HPAC intervention for mothers of children with disabilities are warranted. What This Article Adds: This article provides support for the feasibility of appropriate and sensitive outcome measures and program content and delivery to implement the novel HMHF-HPAC intervention in further research. Mothers of children with disabilities benefited from integrated HMHF-HPAC delivered by pediatric occupational therapists within the family's existing services.

Cross-Cultural Validation of the Chinese Version of the Health Promoting Activities Scale.

IMPORTANCE: The Health Promoting Activities Scale (HPAS) measures the frequency of participation in health-promoting activities of mothers of children with disabilities. Translation of the HPAS into Chinese and validation of the Chinese version will enable its use with Chinese-speaking mothers of children with disabilities. OBJECTIVE: To translate the HPAS into Chinese and assess its construct validity in relation to measures of well-being, mental health, and activity satisfaction. DESIGN: Cross-cultural validation. SETTING: Community. PARTICIPANTS: Eight bilingual Chinese speakers were involved in the translation. Ethnic Chinese mothers of children with disabilities living in Australia, Singapore, or Taiwan (N = 89) were recruited via purposive snowball sampling. Participants self-selected to complete the Chinese e-survey. OUTCOMES AND MEASURES: Translation was guided by recommended frameworks. The Chinese versions of the Warwick-Edinburgh Mental Well-being Scale (WEMWS), Personal Well-being Index (PWI), and Kessler Psychological Distress Scale-10 (K10) were used to determine construct validity. Internal reliability was investigated. RESULTS: The Chinese version of the HPAS correlated significantly with satisfaction ratings (r = .45, p < .001; n = 87), WEMWS Total score (r = .61, p < .001; n = 85), PWI mean score (r = .44, p < .001; n = 84), and K10 total score (r = -.33, p = .002; n = 81). Internal reliability was moderate (Cronbach's α = .74). CONCLUSIONS AND RELEVANCE: The Chinese version of the HPAS was found to be cross-culturally equivalent to the original HPAS and psychometrically sound for use with Chinese-speaking mothers of children with disabilities. What This Article Adds: This study provides an example of the cross-cultural validation process. The Chinese version of the HPAS is psychometrically sound and could be used as an outcome measure of Chinese mothers' participation in health-promoting activities.

Healthy ageing through participation in community situated activities: A scoping review of assessment instruments to support occupational therapy practice.

INTRODUCTION: The occupational therapy profession has an essential role to play in healthy ageing that includes enabling participation, a construct that according to The International Classification of Functioning, Disability and Health (ICF), incorporates an environmental context. Environmental barriers and enablers of participation in community-situated activities for people over the age of 65 have been identified. To support practice, occupational therapists require assessments with demonstrated content validity including comprehensive coverage of the construct. The purpose of this scoping review study was to investigate what instruments are available to assess community participation for people over the age of 65 that included environmental factors. METHODS: A scoping review of the literature was conducted, utilising the Joanna Briggs Institute (JBI) scoping review methodology. The evidence source was review articles and inclusion criteria were that they reviewed instruments to assess participation that could be used for people over the age of 65. Items extracted from included instruments were evaluated against a preset list of community-participation and environment categories that had been developed from the ICF. RESULTS: Twenty-three review studies met inclusion criteria and from these 240 instruments were extracted. Twenty instruments were retained after exclusions and from these, 540 instrument items were extracted. Of these, 280 (47%) were coded as community-participation, and only 20 (3.4%) as environment items. Fourteen of the instruments included no environment items. CONCLUSIONS: No instrument was identified that comprehensively assessed community participation including the related environmental factors. Such an instrument is required to enable occupational therapy practitioners to support healthy ageing. The development of such an instrument will strengthen the profession's capacity to develop new ways of delivering services to older adults in line with emerging ways that aged care will be delivered and to advance its essential role in healthy ageing.

Maternal and child factors associated with the health-promoting behaviours of mothers of children with a developmental disability.

BACKGROUND/AIM: Mothers caring for their child or adult with a developmental disability can experience mental health disparity. Protective factors such as healthy behaviours are under-researched. This study investigated relationships between mental health, healthy behaviours, and disability factors. METHODS: The cross-sectional online survey included: Depression Anxiety Stress Scales (DASS); Family Empowerment Scale (FES); Health Promoting Activities Scale (HPAS); and a measure of childhood quality of life (QoL). RESULTS: All mothers were raising offspring (aged 3-36 years) with a developmental disability. Fifty-two percent of mothers (N = 81) had a mental health diagnosis. DASS scores were elevated for depression (58 %), anxiety (52 %) and stress (68 %). Mothers participated in health promoting activities infrequently and reported low satisfaction with community health-supporting facilities. Depressive symptoms, maternal empowerment and two indicators of child-related QoL explained 29.7 % of the variance in healthy behaviours. Depressive symptoms were the most important predictor of lack of health promoting behaviours. CONCLUSIONS: Better mental health predicted more frequent participation in health promoting behaviour. Future research might explore the extent to which health promoting behaviours protect mental health. Service changes including family health focused services, and custom designed health promotion or coaching programs may improve the health behaviours of mothers with high care responsibilities.

Initial psychometric evaluation of the Hartley Knows Writing Shapes Assessment Version 2 with typically developing children between the ages of 4 and 8.

INTRODUCTION: Despite advances in technology, handwriting still remains an important part of the school curriculum. Especially during the early years of schooling, handwriting difficulties have been shown to negatively affect academic success. Consequently, occupational therapists rely on sound psychometric tools to assess a child's visual motor abilities and implement appropriate strategies to facilitate their handwriting outcomes. The Hartley Knows Writing Shapes Assessment Version 2 (HKWSA-V2) evaluates knowledge of writing shapes, ability to replicate writing shapes and knowledge of handwriting concepts used in the Hartley Knows Writing Program (HKWP). The current study describes the initial development and psychometric evaluation of the HKWSA-V2. METHOD: Typically developing children (N = 50) between 4 and 8 years old, completed two visual motor assessments: the HKWSA-V2 and the Beery Buktenica Developmental Test of Visual Motor Integration 6th Ed. (Beery VMI). Guided by the COnsensus-based standards for the Selection of health Measurement INstruments, statistical analysis was conducted using various non-parametric tests to assess the internal consistency, construct, and criterion validity of the HKWSA-V2. RESULTS: The internal consistency of the HKWSA-V2 ranged between adequate and excellent (Cronbach's α = 0.61-0.88). Construct validity as hypothesised, was supported with strong correlations found between groups of children who had and had not been involved in the HKWP. Statistically significant differences were also found in HKWSA-V2 scores based on the child's chronological age (r = .51, p < .01; r = .34, p < .05) and year level (p = .00). Criterion validity was substantiated with moderate to strong correlations found between all HKWSA-V2 scales and subscales and the Beery VMI subscales (ρ = 0.06-0.53). CONCLUSION: Evaluation of the tool provides promising initial psychometric findings. The tool allows professionals and clinicians to evaluate a child's visual motor abilities according to concepts learnt within the HKWP. Further development of the HKWSA-V2 is warranted.

Controlled choice, not choice and control: Families' reflections after one year using the National Disability Insurance Scheme.

INTRODUCTION: At least 40 percent of children with cerebral palsy and their families rely on access to allied health services, assistive technology, and require funding and expertise to achieve skills and participate in daily life. Implementation of the National Disability Insurance Scheme (NDIS) has resulted in a shift to public funding and emphasis on choice and control of services, support and assistive technology to promote social and economic participation. Families of children with cerebral palsy are invested in scheme success and their subjective experiences require consideration if the NDIS is to meet participation targets. OBJECTIVE: The aim of this research was to explore the experiences of families with a child with cerebral palsy, who have been in receipt of the NDIS for 12 months, comparisons to previous funding systems, and recommendations for the NDIS going forward. METHODS: Purposive sampling was utilised within one specialised paediatric setting. All families received occupational therapy intervention for their child. A qualitative approach using semi structured interviews was employed. Braun and Clarke's six phases of thematic analysis was utilised to analyse the data and explore participants lived experiences. FINDINGS: Eight (n = 8) mothers of children with cerebral palsy were interviewed. Three overarching themes were derived from the data: Equipment impacts on all areas of life; Frustration navigating the National Disability Insurance Scheme; and Gratitude, hope and suggestions. CONCLUSION: Families reported challenges navigating the NDIS including administrative challenges and extensive wait times for assistive technology, as well as gratefulness for increased opportunities for support. Occupational therapists and other allied health professionals can assist by: being proactive in service delivery and advocating for the needs of individual families and children; and finding ways to increase the preparedness of the NDIS to better understand the needs of children with cerebral palsy and their families.

The impact of carer status on participation in healthy activity and self-reported health among Australian women over 50 years.

BACKGROUND/AIM: Occupational therapists frequently work with carers and their family member who requires direct services. In Australia, women provide the majority of informal care. Carer status is determined by the provision of informal help or supervision to an older person, or a person with a disability or long-term health condition. Caregiving responsibilities can impact mental and physical health and reduce women's participation in leisure activities and the labour force. The aim of the study was to examine differences in the participation of Australian women, aged 50 years and over, with and without caregiving responsibilities, in self-selected health promoting activities, self-reported mental health and participation in physical activity. METHODS: This cross-sectional study investigated Australian women (N = 157) who completed a survey comprising demographic questions, the Depression Anxiety Stress Scales-21 (DASS-21), International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Health Promoting Activities Scale (HPAS). Differences between carers and non-carers in participation in health promoting activities, mental health, physical activity and labour force participation were investigated using Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Carers reported significantly lower participation in health promoting activities (P < 0.001), vigorous physical activity (P = 0.001) and moderate physical activity (P = 0.009). Carers also reported significantly higher responses than non-carers, in symptoms of depression, anxiety and stress (P < 0.001). Carers were significantly more likely than non-carers to be engaged in part-time employment, with 37% of carers employed part-time and 44% of carers not working. CONCLUSION: These findings indicate significant differences between women with and without caregiving responsibilities and their participation in health promoting activities, self-reported mental health, participation in physical activity and the labour force. Carers may benefit from occupational therapy that recognises the important role of carers in the life of their family member and supports carer's health and participation in health promoting activities.

Systematic review of the economic impact of cerebral palsy.

BACKGROUND: Cerebral palsy (CP) and its associated conditions can pose a significant economic burden on families, the health care system and the general economy. The boundary for inclusion of costs in research can vary substantially across studies. AIMS: To summarize the evidence for burden of disease for CP including the impacts on the health system, the community and carers. METHODS: Literature was identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library. The search was restricted to articles published in English between 1970 and April 2016. All costs were converted to $USD 2016 price. RESULTS: Twenty-two articles were included. Studies varied from snapshot cost descriptions to more complex lifetime estimates, from prevalence-based to incidence-based studies, and from inclusion to exclusion of non-medical costs. There was a strong positive relationship between CP severity and expenditure. Significant costs were incurred by families and the welfare system to facilitate school and community engagement. CONCLUSION: Facilitating participation for people with CP involves substantial expense. The size, nature and distribution of the economic burden emphasises the importance of finding effective strategies to reduce the risk and severity of CP, together with how it is financed.

Descriptive profile of the academic integrity of Australian occupational therapy students.

BACKGROUND: Academic integrity is the moral code of academia. Students who demonstrate trustworthiness in an academic setting are more likely to be dependable in a clinical setting. It is, therefore, important for occupational therapy academic and fieldwork educators to know the academic integrity profile of their students and to address any areas of academic dishonesty in curriculum design and delivery. To date, there has been no baseline description of the academic honesty profile of Australian occupational therapy students. AIM: To establish a baseline of academic integrity and academic dishonesty among occupational therapy undergraduate and graduate-entry masters students in a cohort of Australian students. METHODS: Seven hundred and one students from five Australian universities completed a self-report questionnaire comprising demographic questions and six standardised scales measuring academic integrity. RESULTS: Overall, occupational therapy students reported high levels of academic and fieldwork integrity; however, some areas of concerns exist. Students report copying material without citations at least once during their studies (55%), obtaining test questions at least once during their studies (42.6%) or padding out a bibliography (39.5%). CONCLUSION: Occupational therapy education needs to continue to emphasise the importance of academic and fieldwork integrity. Students need to be explicitly taught what academic honesty and dishonesty is and be provided with the resources and time to complete academic work to reduce the risk of academic dishonesty.

Patients' and healthcare professionals' perceptions of self-management support interactions: Systematic review and qualitative synthesis.

Objective To review studies examining the experience of self-management support in patient-provider interactions and the shaping of goals through interactions. Methods We undertook a systematic review and thematic synthesis of the qualitative literature. We searched six databases (2004-2015) for published studies on the provision of self-management support in one-to-one, face-to-face, patient-provider interactions for obesity, type 2 diabetes mellitus and chronic obstructive pulmonary disease, with 14 articles meeting inclusion criteria. Results Themes identified from studies were (1) dominance of a traditional model of care, encompassing the provision of generic information, exclusion of the psychosocial and temporal nature of interactions and (2) a context of individual responsibility and accountability, encompassing self-management as patients' responsibility and adherence, accountability and the attribution of blame. Interactions were constrained by consultation times, patient self-blame and guilt, desire for autonomy and beliefs about what constitutes 'effective' self-management. Discussion Encounters were oriented towards a traditional model of care delivery and this limited opportunity for collaboration. These findings suggest that healthcare professionals remain in a position of authority, limiting opportunities for control to be shared with patients and shared understandings of social context to be developed.

Validity of the Assistance to Participate Scale with Parents of typically developing Australian children aged three to eight years.

BACKGROUND/AIM: The Assistance to Participate Scale (APS) measures the assistance parents provide to children with disability to participate in play and leisure. The primary aim of this study was to extend the psychometric development of the APS through application to a typically developing sample. METHODS: Parents (N = 125) of typically developing Australian children aged three to eight years completed an online questionnaire comprising the APS, Pediatric Evaluation of Disability Inventory (PEDI), Pediatric Quality of Life Scale (PedsQL) (caregiver scales) and demographic questions. Guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), structural validity of the APS was investigated using principal components analysis; internal consistency reliability through calculation of Cronbach's α; construct validity through convergence with previously validated measures of paediatric occupational performance and quality of life (PEDI, PedsQL) and investigation of five research hypotheses developed a priori. RESULTS: Structural validity of the APS was confirmed. Internal consistency (Cronbach's α = 0.76) was good for this unidimensional scale. Construct validity was substantiated by moderate correlations with the PEDI and PedsQL (physical), and data that supported all research hypotheses. Statistically significant differences were found in APS scores based on sex (P = 0.018), age (P < 0.001), school attendance (P < 0.001) and elder sibling (P = 0.006). CONCLUSIONS: Results of this study indicate the APS is a valid and reliable measure of the parental role in a typically developing child's play. Validation upon a typically developing sample offers preliminary guidelines regarding the normative pattern of assistance provided to children during play. Further research in line with the COSMIN is required.

Intrarater Reliability and Other Psychometrics of the Health Promoting Activities Scale (HPAS).

OBJECTIVE: The Health Promoting Activities Scale (HPAS) measures the self-rated frequency with which adults participate in activities that promote health. We evaluated the internal consistency, construct validity, and intrarater reliability of the HPAS with a cohort of mothers (N = 56) of school-age children. METHOD: We used an online survey that included the HPAS and measures of mental and physical health. Statistical analysis included intraclass correlation coefficients (ICCs), measurement error, error range, limits of agreement, and minimum detectable change (MDC). RESULTS: The HPAS showed good internal consistency (Cronbach's α = .73). Construct validity was supported by a significant difference in HPAS scores among participants grouped by physical activity level; no other differences were significant. Results included a high aggregate ICC of .90 and an MDC of 5 points. CONCLUSION: Our evaluation of the HPAS revealed good reliability and stability, suggesting suitability for ongoing evaluation as an outcome measure.

Facilitators and barriers to social and community participation following spinal cord injury.

BACKGROUND/AIM: One of the factors known to contribute to a 'good life' following an acquired disability is making connections with others, often achieved through participation in activities outside the home. The majority of outcomes research following SCI has focussed on impairments and activity limitations with less emphasis on participation. This paper reports part of a larger study that explored the experience and meaning of social and community participation following SCI. The research question guiding the part of the study reported in this paper was: What are the facilitators and barriers to social and community participation following acquired SCI? METHODS: Semi-structured interviews were conducted with 17 adults with traumatically acquired spinal cord injury living in the community. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Three main themes and 11 subthemes were identified. The main themes were: Resources and environmental accessibility impact social participation; other people influence community engagement; health issues affect social participation. Adequate financial resources and social support (from friends and family, and from peer mentors) were found to assist social participation, while the physical environment, unsupportive social attitudes and mental health issues were identified as barriers to community participation. CONCLUSIONS: This study contributes to the evidence base regarding outcomes following SCI. Enabling engagement in meaningful activities in the community must be at the forefront of occupational therapy intervention, both at an individual client level and through advocacy and policy involvement, to improve the quality of life of people with SCI living in the community.

Complementary, Alternative, and Mainstream Service use Among Families with Young Children with Multiple Disabilities: Family Costs to Access Choices.

ABSTRACT Families raising a young child with multiple disabilities are charged with significant responsibilities such as learning about their child's condition and navigating mainstream and alternative services. Aim: Describe service choices, costs, out of pocket expenses, and the impact on families. Methods: Survey design using a custom questionnaire was used to collect extensive retrospective and current data. Purposive sampling (N = 29) occurred from one early intervention facility specialized in servicing children with cerebral palsy (CP) and, or multiple disabilities in Australia. Descriptive statistics were used for analysis of data. Results: Twenty-three (79%) families reported caring for a child with CP. Twenty-three families reported using at least one complementary/alternative intervention. Out-of-pocket amounts were reported including: chiropractic services (10 families); naturopathy (9 families); point percussion therapy (7 families), and Chinese medicine (6 families). Expenses resulted in families reporting forgoing clothing items, family entertainment, recreation/hobbies for parents (55%); family holidays (59%); time for parents alone (66%); and health services for parents (38%). Conclusions: Families of young children with multiple disabilities select a wide range of services for their child, with consequential out of pocket expenses. Early intervention professionals can be an important resource for families as they evaluate their choices and select interventions for their child.

Further validation of the Health Promoting Activities Scale with mothers of typically developing children.

BACKGROUND/AIM: The Health Promoting Activities Scale (HPAS) measures the frequency that mothers participate in self-selected leisure activities that promote health and wellbeing. The scale was originally validated on mothers of school-aged children with disabilities, and the current article extends this research using a comparative sample of mothers of typically developing school-aged children. METHOD: Australian mothers (N = 263) completed a questionnaire containing the HPAS, a measure of depression, anxiety and stress (DASS-21) and questions concerning their weight, height, sleep quality and demographics. Statistical analysis assessed the underlying structure, internal consistency and construct validity of the HPAS. Inferential statistics were utilised to investigate the construct validity. RESULTS: Exploratory factor analysis supported the unidimensionality of the HPAS. It showed good internal consistency (Cronbach's alpha = 0.78). Significantly lower HPAS scores were recorded for women who were obese; had elevated levels of depression, anxiety and stress; had poor quality sleep or had heavy caring commitments. The mean HPAS score in this sample (M = 32.2) was significantly higher than was previously reported for women of children with a disability (M = 21.6: P < 0.001). CONCLUSIONS: Further psychometric evaluation of the HPAS continues to support the HPAS as a sound instrument that measures the frequency that women participate in meaningful occupation that is associated with differences in mental health and wellbeing and other health indicators.

Predicting mental health among mothers of school-aged children with developmental disabilities: the relative contribution of child, maternal and environmental factors.

AIM: Many mothers of children with developmental disabilities are known to experience high levels of stress, and compromised mental health. Research is crucial to better understand and assist mothers with compromised mental health, and ultimately better service families raising and supporting a child with a disability. METHOD: Data were collected using cross sectional mail-out survey with follow up phone call. Instruments included the Short Form 36 version 2 (SF-36v2) and instruments that measured maternal, child and environmental factors. Descriptive statistics examined characteristics of participants. Correlation, t-tests, and multiple regression analyses were used to identify factors associated with mothers' mental health. RESULTS: Mothers (N=152) cared for a school-aged child (aged 5-18 years) with high care needs and developmental disabilities including autism spectrum disorder (n=94); cerebral palsy (n=29); attention deficit hyperactivity disorder (n=19). Factors associated with maternal mental health included the child's psychosocial health (r=.36) and challenging behaviour (r=-.33); maternal empowerment (r=.40); maternal participation in health promoting activities (r=.43); and the child's unmet service needs (r=-.29). The strongest predictors of maternal mental health in this cross sectional study were maternal participation in healthy activity and empowerment, the child's emotional functioning and unmet service needs. CONCLUSION: This study identified maternal factors as the most important influence on self reported mental health among this sample of mothers. Findings suggest that service changes that provide mothers with information about their own health and need for health enhancing activities, as well as education that empowers mothers to manage and master their child's disability and needs, may contribute to maternal mental health and well being.

Melbourne Assessment of Unilateral Upper Limb Function: construct validity and correlation with the Pediatric Evaluation of Disability Inventory.

The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) is an evaluation tool that objectively measures upper-extremity function in children with cerebral palsy (CP). This study investigates how well performance on the Melbourne Assessment relates to the child's actual performance in functional tasks. Eighteen children with CP (5 to 14 years of age; nine males, nine females) were assessed using the Melbourne Assessment and the Pediatric Evaluation of Disability Inventory (PEDI). Five children had spastic quadriplegia, eight had spastic diplegia, two had spastic hemiplegia and diplegia, two had athetosis, and one had hypotonic quadriplegia with mobile ventilator dependence. Children's performances were statistically correlated using Spearman's rho to establish the relation between these tools. Very high correlation coefficients were calculated between the Melbourne Assessment and self-care (0.939) and mobility domains (0.783) of the PEDI and the overall functional skills section of the PEDI (0.718). The Melbourne Assessment demonstrates excellent construct validity for upper limb functioning.