Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography.

BACKGROUND: Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed. AIM: Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach. MATERIAL AND METHODS: The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data. RESULTS: Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied. CONCLUSION AND SIGNIFICANCE: The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

A concept analysis of creative activities as intervention in occupational therapy.

Background: This article is based on a common understanding of the concept of creative activities as intervention, as described in occupational therapy literature. Historically, creative activities have been used as intervention in occupational therapy. There is, however, a lack of clarity in descriptions of the concept.Aims/Objectives: To investigate and clarify the concept of creative activities as intervention (CaI) and to validate the findings in occupational therapy practice.Material and methods: A selection of articles according to PRISMA resulted in 15 articles, analysed with concept analysis. The results were validated by a reference panel of seven occupational therapists using a questionnaire and data was analysed by descriptive statistics.Results: Five attributes defined CaI: (1) Often consisting of elements of art and craft using mind and body, (2) Being experienced as meaningful, (3) Creating creative processes, (4) Developing skills, enhancing occupational performance and managing everyday life, and (5) Being easy to modify individually or in groups with different approaches. Three cases were generated from the attributes to illustrate the integrity of the analysis.Conclusions and significance: The results led to a description of CaI that could facilitate future research communication and common definition in occupational therapy practice.

Joining, belonging, and re-valuing: A process of meaning-making through group participation in a mental health lifestyle intervention.

BACKGROUND: Balancing Everyday Life (BEL), a new group-based intervention for mental health service users, was implemented in Sweden. Mental health service users often experience group interventions as meaningful, but knowledge of the process of meaning-making in a group is lacking. AIM: To explore participants' perceptions of the group in the Balancing Everyday Life (BEL) lifestyle intervention; specifically, personal experiences of what brings meaning when participating in a group. METHODS: This qualitative Grounded Theory study included 26 interviews with 19 BEL participants. RESULTS: A process of meaning-making in a group was constructed: Joining with others: from feeling alone to connected, A sense of belonging: mutual support and understanding, and Re-valuing Self: respect and self-worth. No longer feeling alone contributed to meaning. Peers and group leaders were considered important parts of the group, and participants appreciated feeling understood, respected, and helping others. CONCLUSION: The proposed process of meaning-making, as well as 'Joining' as a unique step, seems to be new contributions which could help practitioners when organizing groups. Overcoming fear of joining could break a cycle of isolation and lead to connecting and belonging. The value of participants finding purpose through helping others should be further explored.

Experiences of meaning of occupation at day centers among people with psychiatric disabilities.

BACKGROUND: There is a need for intervention studies of persons with psychiatric disabilities who attend day centers (DCs). AIM: The aim of this study was to investigate how people living with psychiatric disability experience and describe the meaning of occupation at DCs after taking part in an intervention. METHODS: An interpretative phenomenological approach was used and 11 participants in the intervention were interviewed. RESULTS: The superordinate theme describing the experienced meaning at the DC was As a substitute for work, and the sub-themes were; A feeling of belonging to a subculture; Flexibility and adaptation of occupation in accordance with the individual's needs and recovery process; and Influence. CONCLUSIONS: The results indicated that the intervention played an important role for the creation of meaning at the DC's for the participants in their daily lives and appeared to promote their well-being. Activities that promoted structure and were experienced as work-like as well as activities that promoted social belonging and influence at the DC were experienced as meaningful. Further intervention studies are needed to gain more knowledge about how to tailor different approaches and activities at DCs in the municipalities that could be experienced as meaningful by their members.

Adding quality to day centre activities for people with psychiatric disabilities: Staff perceptions of an intervention.

AIM: To evaluate an intervention aimed at enriching day centres for people with psychiatric disabilities by exploring staff experiences from developing and implementing the intervention. METHOD: Each staff group developed a tailor-made intervention plan, following a manual, for how to enrich the day centre. They received supervision and support from the research team. The study was based on focus-group interviews with a total of 13 staff members at four day centres. Narrative analysis with a thematic approach was used. A first round resulted in one narrative per centre. These centre-specific narratives were then integrated into a common narrative that covered all the data. RESULTS: A core theme emerged: User involvement permeated the implementation process and created empowerment. It embraced four themes forming a timeline: "Mix of excitement, worries and hope", "Confirmation and development through dialogue, feedback and guidance", "The art of integrating new activities and strategies with the old", and "Empowerment-engendered future aspirations". CONCLUSION: The users' involvement and empowerment were central for the staff in accomplishing the desired changes in services, as were their own reflections and learning. A possible factor that may have contributed to the positive outcomes was that those who were central in developing the plan were the same as those who implemented it.

Empowerment and occupational engagement among people with psychiatric disabilities.

BACKGROUND: Empowerment is essential in the rehabilitation process for people with psychiatric disabilities and knowledge about factors that may play a key role within this process would be valuable for further development of the day centre services. OBJECTIVE: The present study investigates day centre attendees' perceptions of empowerment. The aim was to investigate which factors show the strongest relationships to empowerment when considering occupational engagement, client satisfaction with day centres, and health-related and socio-demographic factors as correlates. METHODS: 123 Swedish day centre attendees participated in a cross-sectional study by completing questionnaires regarding empowerment and the targeted correlates. Data were analysed with non-parametric statistics. RESULTS: Empowerment was shown to be significantly correlated with occupational engagement and client satisfaction and also with self-rated health and symptoms rated by a research assistant. The strongest indicator for belonging to the group with the highest ratings on empowerment was self-rated health, followed by occupational engagement and symptom severity. IMPLICATIONS: Occupational engagement added to the beneficial influence of self-rated health on empowerment. Enabling occupational engagement in meaningful activities and providing occupations that can generate client satisfaction is an important focus for day centres in order to assist the attendees' rehabilitation process so that it promotes empowerment.

Time use among individuals with persistent mental illness: identifying risk factors for imbalance in daily activities. Previously published in Scandinavian Journal of Occupational Therapy 2008; 15: 23-33.

The aim of this study was to investigate associations between time use in daily activities and sociodemographic and clinical factors in order to identify individuals with persistent mental illness at risk of having an imbalance in daily activities, as reflected in their time use and daily rhythm. Participants (n=103) were selected from a psychiatric outpatient unit using a randomized stratified selection procedure. The main findings indicated that time spent in daily activities increased with age, and that older individuals more often had a beneficial daily rhythm. Women and individuals living with children spent more time on self-care/self-maintenance than men and individuals living without children. Individuals with a diagnosis of psychosis spent less total time in daily activities than individuals with non-psychosis. In conclusion, general psychiatric symptoms, such as self-blame, anxiety, and difficulties in cooperating with others, explained most of the risk of spending little time in work/education as well as the risk of spending long periods asleep and having an adverse daily rhythm. A diagnosis of psychosis and high levels of general symptoms together explained most of the risk of having low total time use in activity. Factors such as age and living with children or not seemed to be important factors in relation to time use and daily rhythm.

Effectiveness of an intervention to improve day centre services for people with psychiatric disabilities.

BACKGROUND/AIM: Day centres for people with psychiatric disabilities need to be evaluated for effectiveness in order to provide the best possible support. This study aimed at investigating the effectiveness of a tailor-made intervention to improve day centre services for people with psychiatric disabilities. METHODS: The intervention was devised to bridge identified gaps in the services and lasted for 14 months. Eight centres were allotted to the intervention (55 attendees) or comparison condition (51 attendees). Fidelity to the intervention and major events in the day centres were assessed. The outcomes were degree of meaningfulness found in the day centre occupations, satisfaction with the rehabilitation received, satisfaction with everyday occupations and quality of life. RESULTS: The fidelity to the intervention was good, but more positive events, such as new occupational opportunities, had taken place in the comparison units. No differences were identified between the intervention and the comparison group regarding changes from baseline to the 14-month follow-up in perceived meaningfulness among day centre occupations, satisfaction with everyday occupations or quality of life. CONCLUSIONS: The intervention seemed ineffective, but the positive events in the comparison group resembled the measures included in the tailor-made interventions. This first intervention study in the day centre context has hopefully helped to generate hypotheses and methods for future research.

Social interaction among people with psychiatric disabilities--does attending a day centre matter?

BACKGROUND: Engaging in social interaction has, for people with psychiatric disabilities, been shown to enhance well-being and the experience of meaning and to generally prevent the worsening of mental illness. AIM: The aim of the study was to investigate how day centre attendees differed from non-attendees regarding different aspects of social interaction and to investigate how occupational factors, including day centre attendance, and previously known predictors were related to social interaction in the study sample as a whole. METHODS: A total of 93 day centre attendees and 82 non-attendees with psychiatric disabilities were examined regarding social interaction, subjective perception of occupation, activity level, sense of self-mastery and socio-demographic and clinical variables. Data were analysed with non-parametric statistics, mainly logistic regression. RESULTS: Social support was mainly provided by informal caregivers such as family members. The day centre attendees had more social relations but did not experience better quality or closeness in their relationships than non-attendees. Important factors for social interaction were subjective perceptions of daily occupation, being married/cohabiting, self-mastery and severity of psychiatric symptoms. CONCLUSION: Alternative ways of enhancing social interactions in the community is needed, targeting the group's feeling of satisfaction and value in daily life together with self-mastery.

Factors influencing subjective perceptions of everyday occupations: comparing day centre attendees with non-attendees.

BACKGROUND: Subjective perceptions of everyday occupations are important for the well-being of people with psychiatric disabilities (PD) and are likely to vary with factors such as attending a day centre or not, activity level, self-mastery, sociodemographic and clinical factors. AIM: To explore differences in subjective perceptions of occupation and activity level between day centre attendees and non-attendees, and to investigate factors of importance for the subjective perceptions of occupations. METHODS: The study groups comprised 175 participants: 93 day centre attendees and 82 non-attendees. Data were collected with instruments concerning; subjective perceptions of everyday occupations, activity level, self-mastery, and sociodemographic and clinical factors. RESULTS: Day centre attendees perceived higher levels of occupational value and activity level, while the groups perceived a similar level of satisfaction with daily occupations. For the total sample, self-mastery influenced both valued and satisfying everyday occupations while only value was affected by activity level. Satisfaction with daily occupation increased with age and both value and satisfaction increased with lower levels of psychiatric symptoms. CONCLUSION: Day centres provide perceptions of occupational value and stimulate activity. Non-differences between the groups regarding satisfaction with everyday occupations implied, however, that day centres might not cover all relevant occupational needs.

Test-retest reliability of two instruments for measuring public attitudes towards persons with mental illness.

BACKGROUND: Research has identified stigmatization as a major threat to successful treatment of individuals with mental illness. As a consequence several anti-stigma campaigns have been carried out. The results have been discouraging and the field suffers from lack of evidence about interventions that work. There are few reports on psychometric data for instruments used to assess stigma, which thus complicates research efforts. The aim of the present study was to investigate test-retest reliability of the Swedish versions of the questionnaires: FABI and "Changing Minds" and to examine the internal consistency of the two instruments. METHOD: Two instruments, fear and behavioural intentions (FABI) and "Changing Minds", used in earlier studies on public attitudes towards persons with mental illness were translated into Swedish and completed by 51 nursing students on two occasions, with an interval of three weeks. Test-retest reliability was calculated by using weighted kappa coefficient and internal consistency using the Cronbach's alpha coefficient. RESULTS: Both instruments attain at best moderate test-retest reliability. For the Changing Minds questionnaire almost one fifth (17.9%) of the items present poor test-retest reliability and the alpha coefficient for the subscales ranges between 0.19 - 0.46. All of the items in the FABI reach a fair or a moderate agreement between the test and retest, and the questionnaire displays a high internal consistency, alpha 0.80. CONCLUSIONS: There is a need for development of psychometrically tested instruments within this field of research.

Measuring perceived meaningfulness in day centres for persons with mental illness.

RATIONALE: As support in leading a meaningful and active life, a person with mental illness is often given the opportunity to attend a day centre. However, few studies have investigated the meaningfulness perceived by the person visiting a day centre. For such a purpose, a self-report instrument was developed. AIMS: To explore whether perceived meaningfulness, as expressed in the recently developed instrument Evaluation of Perceived Meaning in Day Centers (EPM-DC), could be viewed as one dimension and also to investigate the psychometric properties of this instrument. METHODS: Persons with mental illness attending five day centres in Sweden participated and completed the questionnaire. The data were analysed by Rasch analysis. MAJOR FINDINGS: The study showed that the concept captured in the instrument could be viewed as unidimensional and the result gave preliminary evidence for sound psychometric properties. PRINCIPAL CONCLUSION: The results indicate promising signs of validity and reliability, but the suitability of self-reporting may be questioned.

Client perceptions of the Tree Theme Method™: a structured intervention based on storytelling and creative activities.

The Tree Theme Method (TTM) is an intervention based on sessions involving creative activities and life storytelling/story-making, in which the client paints trees representing various periods of his/her life. The aim of this study was to investigate clients' experiences of participating in a TTM intervention and their perceptions of the therapeutic relationship. Thematic interviews were undertaken. Twenty clients attending general outpatient mental healthcare units were recruited after having participated in the intervention. A qualitative content analysis resulted in six categories: "From feeling a pressure to perform to becoming focused and expressive", "Expressing oneself and one's life situation led to awakening of memories and feelings", "New perspectives of self-image, everyday life and relations to others", "Story-making led to shaping and reconstructing one's life story", "Interaction was of importance when reconstructing one's life story" and, finally, "The attitude of the occupational therapist was of importance for the development of the therapeutic relationship". There seemed to be a close association between the intervention and the therapeutic relationship in starting a process of opening up new perspectives on everyday life, but there is a need for further studies including therapists' experience of using the TTM and their perception of the client­therapist relationship.

Meaningfulness in work - experiences among employed individuals with persistent mental illness.

The aim of the present study was to investigate how people with persistent mental illness, with various types of work and employment conditions, experience and describe the meaningfulness of work. The study had a qualitative approach and twelve informants living in the community were purposefully selected and interviewed according to overarching themes. The interviews were analysed using qualitative content analysis, and all of the authors were involved in the analysis process. The findings resulted in four main themes: 1) work per se has certain characteristics, 2) participation in different contexts gives a feeling of normality, acceptance, belonging and fulfilment of norms and values, 3) work affords structure, energy and a balanced daily life, and 4) work increases well-being and strengthens one's identity. A tentative model is described concerning perceived meaningfulness in work among individuals with persistent mental illness, in which the first three aspects of meaning are a prerequisite for meaning in terms of increased well-being and strengthened identity. Furthermore, it seems important that work has to bring the just right challenge to the individual in order for him or her to perceive the identified aspects of meaningfulness.

Attitudes towards mental illness among health care students at Swedish universities--a follow-up study after completed clinical placement.

The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.

Time use among people with psychiatric disabilities: implications for practice.

TOPIC: This paper reviewed the current literature regarding time use among people with psychiatric disabilities. PURPOSE: The purpose was to investigate what characterizes time use, occupational balance and occupational patterns among people with psychiatric disabilities, how time use relates to health in this group, and how time use can be used in research designs and addressed in assessments and interventions. SOURCES: The databases CINAHL and PubMed were searched, by combinations of terms such as: time use, time geography, occupational balance, occupational pattern, assessment, intervention, occupational therapy, lifestyle redesign, well-being, and mental health. CONCLUSIONS: Time use for people with psychiatric disabilities is often restricted to sleeping, eating, caring for oneself, and performing quiet activities. The target group is at risk of being both over- and under-occupied, and occupational imbalance may be regarded as an expression of the disability, thus shaped by a misfit between the person's capacities and environmental opportunities and demands. Several time-use methods exist for the study of daily occupations in people with psychiatric disabilities, but no intervention based on time use was found. Principles for a time-use based intervention are discussed. However, such an intervention needs to be investigated for relevance and effectiveness in future research.

Time use among individuals with persistent mental illness: identifying risk factors for imbalance in daily activities.

The aim of this study was to investigate associations between time use in daily activities and sociodemographic and clinical factors in order to identify individuals with persistent mental illness at risk of having an imbalance in daily activities, as reflected in their time use and daily rhythm. Participants (n = 103) were selected from a psychiatric outpatient unit using a randomized stratified selection procedure. The main findings indicated that time spent in daily activities increased with age, and that older individuals more often had a beneficial daily rhythm. Women and individuals living with children spent more time on self-care/self-maintenance than men and individuals living without children. Individuals with a diagnosis of psychosis spent less total time in daily activities than individuals with non-psychosis. In conclusion, general psychiatric symptoms, such as self-blame, anxiety, and difficulties in cooperating with others, explained most of the risk of spending little time in work/education as well as the risk of spending long periods asleep and having an adverse daily rhythm. A diagnosis of psychosis and high levels of general symptoms together explained most of the risk of having low total time use in activity. Factors such as age and living with children or not seemed to be important factors in relation to time use and daily rhythm.

Relationships between occupational factors and health and well-being in individuals with persistent mental illness living in the community.

PURPOSE: This study identified relationships between occupational factors and health and well-being among individuals with persistent mental illness. METHODS: There were 103 subjects assessed in regards to time spent in different occupations, activity level, satisfaction with daily occupations, and experienced occupational value. The health-related variables were self-rated health, quality of life, self-esteem, sense of coherence, self-mastery, psychosocial functioning, and psychiatric symptoms. RESULTS: Subjective perceptions of occupational performance were consistently related to both self-rated and interviewer-rated aspects of health and functioning. While variables pertaining to actual doing showed weak or no associations with self-rated health-related variables, they exhibited moderate relationships to interviewer-rated health and functioning. IMPLICATIONS: The health-promoting ingredients in occupations were determined by the way occupations were perceived, rather than the doing per se. The findings indicate that perceived meaning and satisfaction ought to be prioritized when setting goals in occupational therapy practice, and, besides, that existing occupational therapy theory needs to be updated.

Time use and daily activities in people with persistent mental illness.

The aim of this study was to investigate time use in work/education, self-care/self-maintenance, play/leisure, rest/relaxation, and sleep in people with persistent mental illness. A further aim was to investigate how time use in the daily activities was associated with health-related variables and social interaction. The study comprised 103 participants with a diagnosis of persistent mental illness who completed self-ratings and interviews in order to assess (1) time use of activities during one 24-hour day, (2) social interaction and (3) health-related factors. The major results indicated that the total time in activity (TTA) and the time spent on work/education and sleep seemed to be related to the majority of the target variables. Four groups of daily rhythm were identified and the daily rhythm groups differed concerning perceived mastery and social interaction. Although the results of this study were statistically significant they did not indicate clinical significance. Therefore, the assumption that there is a relationship between occupation and well-being could not be clearly verified. This study had a cross-sectional design based on a one-time measure, which is an important limitation for the validity of the study. Furthermore, no Bonferroni corrections were made for mass significance and some of the findings would have disappeared if such corrections had been made. More studies concerning time use in daily activities, and daily rhythm in relation to health and well-being are needed.