An international study of diversity in occupational therapy research- A bibliographic review of English research literature.

BACKGROUND: The cornerstone of a strong profession is the research that supports its knowledge base and practice. However, little is known about the range of international occupational therapy research. OBJECTIVE: To explore the range and diversity of the international occupational therapy research from published peer reviewed literature in English during the year 2018. METHODOLOGY: Limited to 2018, a review was conducted of sources from i) health-related search engines using search terms associated with occupational therapy practice, and ii) content pages of occupational therapy publications. Articles were excluded if they i) had no occupational therapy author, ii) were not peer reviewed, iii) not in English, and iv) did not include primary data collection (e.g., opinion pieces, position statements, study protocols). Of articles selected for analysis, data were extracted and synthesized according to the study's origin country, publishing research journal, the characteristics of the represented research, and its alignment with World Federation of Occupational Therapists research priorities. RESULTS: A total of 4,169 articles were retrieved from the search (i.e., 3,459 from health-related search engines and 710 through a manual search of occupational therapy journals). After exclusions, 2,345 articles were included for analysis. CONCLUSION: The review identified English published research was predominantly conducted in economically privileged countries. In addition, it revealed several research priorities that need further development such as evaluating the effectiveness of occupational therapy interventions.

Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study.

BACKGROUND: Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders' needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. OBJECTIVE: This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. METHODS: A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study's findings. RESULTS: The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users' strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. CONCLUSIONS: Stakeholders' experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources.

Work conditions as predictors of Swedish occupational therapists' occupational balance.

BACKGROUND: There is little knowledge of how organizational and social work environmental conditions impact workers' perceptions of occupational balance. The aim of the present study was to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists' perceptions of occupational balance. MATERIALS/METHODS: This prospective study collected data twice, with a one-year interval, and used a web survey. The present study included 1835 participants. Logistic regression analysis was used to analyze the work predictors of occupational balance. RESULTS: A reasonable workload, high control, and high reward predicted high occupational balance. Having no children living at home, a satisfactory financial situation, and being physically active also predicted high occupational balance. CONCLUSION: A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists. SIGNIFICANCE: This knowledge can support occupational therapists in the development of interventions at the work place, with focus on the workload and the resources (control and reward), to promote employees' occupational balance.

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model.

Background: Flexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model? Methods: Digital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis. Results: The following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload. Conclusions: Rural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model.

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams.

Introduction: To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration. Methods: Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis. Results: Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams' way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system. Conclusion: The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.

Swedish occupational therapists' considerations for leaving their profession: Outcomes from a national survey.

BACKGROUND: Occupational therapists are an essential healthcare profession and play a vital role in rehabilitating patients in the activities of daily life. Nevertheless, many occupational therapists in Sweden are leaving the profession and this jeopardises occupational therapy services. OBJECTIVE: To explore factors that cause occupational therapists to seriously consider leaving their profession. MATERIAL AND METHODS: As part of a larger national study of Swedish occupational therapists' health and work environment, qualitative content analysis with a summative approach was applied to explore the reasons for considering leaving their profession among 1279 Swedish occupational therapists. RESULTS: Three themes emerged: (1) facing work environment deficiencies, (2) pursuing own development and (3) Personal factors and external constraints. The largest category, belonging to theme 1, was stress and high work pressure given 344 times as a reason to consider leaving the profession. CONCLUSIONS AND SIGNIFICANCE: This article provides new and important insights on the reasons why occupational therapists may seriously consider leaving their profession. The results are significant for managers and employing organizations to consider in order to prevent a shortage of occupational therapy services.

Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study.

The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.

Changes in rehabilitation actors' mental health literacy and support to employers: An evaluation of the SEAM intervention.

BACKGROUND: Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention. OBJECTIVE: To evaluate the impact of SEAM on rehabilitation professionals' knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process. METHODS: In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics. RESULTS: SEAM significantly increased rehabilitation professionals' knowledge of mental health (T1-T2: z = -2.037, p = 0.042; T2-T3: z = -5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50-60%) also estimated that they had increased their use of supporting strategies towards service users and employers. CONCLUSIONS: The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users' resources and work ability, as well as on employers' support needs.

The combination of psychosocial working conditions, occupational balance and sociodemographic characteristics and their associations with no or negligible stress symptoms among Swedish occupational therapists - a cross-sectional study.

BACKGROUND: The numbers of people who are on sick leave due to mental health problems, such as exhaustion disorder, are increasing in Sweden. One of the most affected groups is healthcare professionals. In order to develop preventive strategies to promote a sustainable working life for occupational therapists, there is a need to understand the associations between psychosocial working conditions, occupational balance and no or negligible stress symptoms. To the best of our knowledge, neither the combination of these factors nor the salutogenic perspective, have been taken into consideration when exploring factors associated with stress symptoms among occupational therapists in previous research. METHODS: Purposeful sampling was used. All currently working members of the Swedish Association of Occupational Therapists were invited to take part in the present study in 2018. The final sample was 3658 (48% response rate). A web-survey with questions about signs of exhaustion, psychosocial working conditions, occupational balance and sociodemographic characteristics was used. Logistic regression analyses were used in order to calculate associations between psychosocial working conditions, occupational balance, sociodemographic characteristics and no or negligible signs of exhaustion. RESULTS: Experiencing high occupational balance, low workload, high control, high sense of community and high justice, were associated with no or negligible stress symptoms. Furthermore, a satisfying financial situation, having children living at home, being married and long professional experience were significant in this model. CONCLUSIONS: It seems important to consider not only psychosocial working conditions, but also occupational balance to prevent exhaustion disorder among occupational therapists in Sweden. Organisational programmes, which reduce the workload, strengthen the control and sense of community and facilitate occupational balance, seem to be important areas for health promotion in this group.

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers.

BACKGROUND: Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. METHODS: Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. RESULTS: The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. CONCLUSIONS: The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.

Perceived job strain among Swedish occupational therapists with less than 10 years of work experience.

BACKGROUND: Occupational therapists with less than 10 years of work experience have been shown to be at higher risk of work-related stress. There is a need for further research on the level of job strain they perceive. AIMS: To investigate the perceived level of job strain among Swedish occupational therapists with less than 10 years of work experience and differences between groups who have worked for 0-5 years and 6-10 years. MATERIAL AND METHODS: In this cross-sectional study, a web-based survey was sent to 345 occupational therapists with less than 10 years of work experience, with 252 responding. Data was collected using the Swedish Demand-Control-Support Questionnaire and questions on job strain and sociodemographics. RESULTS: The participants scored 19.68 points on the control scale and 20.01 points on the support scale, indicating high levels of control and support, and 13.33 points on the demand scale (high demand ≤ 14 points). Twelve percent worked in high strain jobs. Most (75%) worked in low strain and active jobs. CONCLUSIONS AND SIGNIFICANCE: The participants reported low levels of job strain. However, to prevent mental health problems, employers need to identify those in active jobs to ensure that they have time to exercise control over their work situation.

Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups.

BACKGROUND: Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. OBJECTIVE: The aim of this study was to examine stakeholder groups' perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. METHODS: A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. RESULTS: The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers' concern of legislation incompatibility with innovative technology, and RTW professionals' concern of the possibility that digital solutions may replace them to a certain extent. CONCLUSIONS: This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.

An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study.

BACKGROUND: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. METHODS: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). RESULTS: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. CONCLUSION: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. TRIAL REGISTRATION: NCT04083404 Registered 05 September 2019 (retrospectively registered).

Occupational Health among Swedish Occupational Therapists: A Cross-Sectional Study.

The Swedish public sector is facing great challenges in recruiting and retaining healthcare professionals, due to increasing sick leave numbers. The aim of this study was to describe Swedish occupational therapists' occupational health in terms of risk factors in the social and organizational work environment, occupational balance, and work-related mental health problems. A web survey was emailed to all working members of the Swedish Association of Occupational Therapists (n = 7600) and 3658 answered the survey. The web survey included questions on sociodemographic characteristics, social and organizational environment, occupational balance, and work-related health. The occupational therapists in general rated their workload as high, which was described as leading to increased stress, difficulties doing a good job, and increased job turnover. They also reported having difficulties maintaining occupational balance. Almost a fifth reported having symptoms related to mild incipient exhaustion or a pronounced exhaustion disorder. Almost 60 percent reported having, during the last year, seriously considered seeking new employment as an occupational therapist and 35 percent had seriously intended to leave their profession. In conclusion, there is an urgent need to improve the work situation of occupational therapists. If not, increases in mental health problems, sick leave and job turnover rates may seriously jeopardize the welfare system by eroding healthcare.

Psychometric properties of the WHOQOL-BREF among next of kin to older persons in nursing homes.

BACKGROUND: The worries of next of kin about their older loved ones in nursing homes can be extensive and can adversely affect their subjective experiences of their own physical, mental and social well-being. It is thus of utmost importance to measure the quality of life of next of kin in a valid and reliable way. METHODS: The design is a cross-sectional study with psychometric evaluation based on classical test theory in preparation for a planned educational intervention study on palliative care. An abbreviated version of the World Health Organization's quality-of-life self-assessment instrument WHOQOL, the Swedish WHOQOL-BREF, was completed by 254 next of kin of older persons in 30 nursing homes. Data quality was assessed via the mean, median, item response, missing values, and floor and ceiling effects. Reliability was estimated using Cronbach's alpha and corrected item-total correlations. Construct validity was estimated by Spearman's rank correlation, and model fit was assessed using confirmatory factor analysis. RESULTS: The rate of missing data was low (less than 2%). Ceiling effects ranged from 11 to 43% and were above 20% for 21 of 24 items. The corrected item-total correlations varied between 0.35 and 0.68 and were thus well above the lower limit of 0.30. Cronbach's alpha was 0.83, indicating satisfactory internal consistency. The confirmatory factor analysis indicated a fair to close model fit (comparative fit index 0.93, root mean squared error of approximation 0.06). CONCLUSIONS: The findings suggest that the WHOQOL-BREF may constitute a reliable and valid measure of quality of life for use among next of kin to older persons in nursing homes. When interpreting the results, it is important to assess the ceiling effect, as it may restrict the ability of the WHOQOL-BREF to detect true positive changes in quality of life over time. TRIAL REGISTRATION: NCT02708498.

Exploring the service and knowledge gap between rehabilitation professionals and employers in the return-to-work process of people with mental health problems in Sweden.

BACKGROUND: Research is needed on how to optimize the return-to-work process for persons with mental health problems. OBJECTIVE: To develop a model that explains how employer and rehabilitation professional mental health literacy may influence strategies used in the return-to-work of persons with mental health problems. METHODS: A grounded theory study design was used to collect and analyse interview data from 23 employers and 22 rehabilitation professionals. RESULTS: The analysis resulted in four categories, illustrated in a conceptual process model: 1) seeing mental health problems through past experiences; 2) separating understandable and incomprehensible mental health problems; 3) balancing safeguarding one's personal interest with providing adequate support; and 4) facing conflicts and uncertainty in employee/service user return-to-work. A positional map of employer/rehabilitation types was created based on level of negative attitudes and uncertainty in supporting employees/service users and the employer in relation to the level of comprehensive understanding of mental health problems. CONCLUSIONS: Professional mental health literacy needs to be increased. Interventions need to be developed that provide employers with targeted support and knowledge in mental health literacy. Education on how to prevent and detect common mental health problems in the workplace is needed.

Critical factors for the return-to-work process among people with affective disorders: Voices from two vocational approaches.

BACKGROUND: Depression is among the major causes of disability with a negative impact on both daily life and work performance. Whilst depression is the primary cause of sick-leave and unemployment in today's workplace there is a lack of knowledge of the needs of individuals with depression regarding their return-to-work (RTW) process. OBJECTIVE: To explore which factors are of critical importance for people suffering from depression and who also are unemployed in their RTW-process and to explore the impact of two vocational approaches on the service users' experiences. The study included participants in two vocational rehabilitation approaches; Individual Enabling and Support (IES) and Traditional Vocational Rehabilitation (TVR). METHOD: Qualitative methods were applied to explore critical factors in the RTW-process. Individuals with affective disorders including depression and bipolar disorder were included.RESULTSThree themes emerged as critical factors; Experiencing hope and power, professionals' positive attitudes, beliefs and behaviours, and employing a holistic perspective and integrating health and vocational service.CONCLUSIONThis study has demonstrated critical factors for the return-to-work process as experienced by persons with depression. To experience hope and power, to meet professionals that believe "you can work", who use a person-centred and holistic service approach, are such factors necessary for gaining a real job. In particular, professionals in TVR need to embrace this understanding since their services were not experienced as including these elements.

Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden.

BACKGROUND: Flexible Assertive Community Treatment (Flexible ACT) has been implemented in Sweden during recent years due to increasing interest in integrated services for people with severe mental illness. To date, few studies have been done on Flexible ACT effectiveness. AIMS: The overall aim of this study was to explore the extent to which clients assigned to the Flexible ACT board for ACT intensive care were stabilized with improved everyday functioning, social outcomes, and changes in healthcare use. METHODS: Ninety-three participants with psychosis, in need of ACT from six newly started Flexible ACT teams, were included. Data were collected using the Social Outcome Index scale (SIX), Practical and Social Functioning Scale, and a healthcare usage questionnaire. RESULTS: There was a significant positive change in everyday functioning and in the SIX-item 'friendship' at 18-months follow-up. A positive correlation was also found between everyday functioning and the SIX-item 'friendship' and a negative correlation between duration of ACT and everyday functioning. A significant increase in number of inpatient hospital days and psychiatric outpatient visits also occurred. CONCLUSION: Clients with psychosis who need ACT may benefit from Flexible ACT through improved social functioning. Being involved in meaningful activities and supported by others are key aspects of recovering from mental illness and are enhanced by Flexible ACT.

Occupational therapy student experiences of a university mental health course based on an integrated application of problem-based and team-based learning.

BACKGROUND: The goal of problem-based and team-based learning (PBL/TBL) is to maximize student engagement and encourage interactive learning. Combining these methods in course design is described as a win-win situation that optimizes student learning, professional development, and uses varied teaching approaches that fit well within health science. More research is needed in the effectiveness of such a hybrid approach. OBJECTIVES: The aim of this study was to explore student experiences of a newly developed mental health course based on an integrated application of PBL and TBL in a university occupational therapy program in Sweden. METHODS: In this grounded theory study data were collected through logbooks (n = 13) and supplemental open-ended interviews (n = 7) at the end of the course. RESULTS: The analysis resulted in two core categories: 1) learning is facilitated by a course design based on the integrated application of PBL and TBL, a current topic, and teachers who are perceived as engaging, and 2) a perceived safe setting facilitates learning and creates a good study environment. There were six related sub-categories. CONCLUSIONS: Combining elements of PBL and TBL may have a range of benefits in promoting student learning and professional development. Other aspects may also have a role to play.

Occupational engagement and cognitive functioning among persons with schizophrenia: an explorative study.

BACKGROUND: Cognitive functioning may have implications for engagement in daily occupations among people with schizophrenia. OBJECTIVES: This cross-sectional study explores relationships between time use assessed occupational engagement and cognitive functioning among persons with schizophrenia. METHODS: Thirty-nine participants from four mental health care services in Sweden participated. The Profile of Occupational Engagement among persons with Severe mental illness (POES) and a cognitive test battery was used. RESULTS: Higher attention and psychomotor speed and higher scores in information processing speed, immediate and delayed verbal recall, and immediate and delayed visual recall were significantly correlated with higher scores in occupational engagement. Regression analyzes revealed that information processing speed and delayed visual recall best explained the variance in occupational engagement (R2 = 0.36). CONCLUSIONS: Cognitive functioning has implications for occupational engagement, and thus the ability to perform daily occupations in a balanced rhythm within various social and physical environments.