Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research.

BACKGROUND: Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult. PURPOSE: This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease. METHODS: Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes. FINDINGS: For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments. IMPLICATIONS: Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.

An agenda for occupational therapy's contribution to collaborative chronic disease research.

BACKGROUND: To meet the needs of adults with chronic diseases, Canadian health care is moving toward more interdisciplinary, collaborative practice. There is limited high-quality evidence to support practice in this area. Occupational therapists can play a significant role in this area of practice and research. PURPOSE: To develop an agenda of priority areas within collaborative chronic disease research to which occupational therapy can make a contribution. METHODS: The project involved literature and Internet review, a consensus meeting with a range of stakeholders, a survey of occupational therapists, and synthesis of findings to create a research agenda. FINDINGS: An interdisciplinary and intersectoral group of stakeholders identified seven main priority areas. One priority is specific to occupational therapy while the remaining six cross disciplines. IMPLICATIONS: The research agenda can support funding applications and encourage interdisciplinary research collaboration to ultimately produce research evidence that can benefit people with chronic diseases.

Young drivers' determinants of driving under the influence of cannabis: Findings from the Youth Cannabis and Driving Survey (YouCanDS).

INTRODUCTION: Driving under the influence of cannabis (DUIC) is proven to increase the risk of collisions and is most common among young drivers (ages 16 to 24). However, little is known about the specific determinants of DUIC behavior among youth, which limits the capacity to develop evidence-based prevention and intervention efforts. This study developed and evaluated a youth DUIC questionnaire, which was used to establish the DUIC determinants of young drivers. METHOD: The questionnaire was based on the theoretical framework of general deterrence and general prevention. Data obtained included: demographics, past cannabis use and DUIC experiences, DUIC intention, experiences riding as a passenger with someone DUIC, knowledge and credibility of the law, attitudes towards DUIC, and social controls. The resulting questionnaire was validated for a sample of 426 young drivers in the province of Ontario, Canada. An ordinal regression was conducted to examine the relationships between questionnaire items and DUIC intention. RESULTS: The questionnaire displayed good construct validity and internal consistency across four out of five domains (KMO and Cronbach α values ≥ 0.70). Of the 426 respondents (52.6% female), 356 (83.6%) reported previous cannabis use, with 296 (69.5%) doing so in the past year, and 142 (33.3%) reporting DUIC. Furthermore, 179 (42%) study participants indicated at least a slight chance of DUIC in the next year. The regression analysis identified six variables predictive of DUIC intention: past DUIC incidence, perceived percent of those convicted that receive the penalty, moral awareness, perceived dangerousness, minor accident risk, and vicarious punishment avoidance. CONCLUSIONS: Preventive efforts should emphasize these determinants when designing targeted strategies and interventions. Practical Applications: These efforts should focus on educating the dangers and risk of a vehicle collision, that law enforcement has the capacity to apprehend and appropriately punish individuals DUIC, and that DUIC is wrong and socially unacceptable.

Measuring Social Participation in the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: Large data sets have the potential to reveal useful information regarding social participation; however, most data sets measure social participation via individual items without a global assessment of social participation. RESEARCH DESIGN AND METHODS: We used data from the Health and Retirement Study (HRS) to assess whether 8 items from questionnaire pertaining to social participation (religious attendance, caring for an adult, activities with grandchildren, volunteering, charity work, education, social clubs, nonreligious organizations) formed a reliable, cohesive scale and to explore the predictive validity of this scale. We included respondents 65 years and older in the HRS who returned the psychosocial questionnaire in 2010 and 2012 with responses to the social participation items (n = 4,317 and n = 3,978). Three scales were explored: SoPart-30 using the original scoring; SoPart-10 using modified scoring; and SoPart-5 using dichotomous scoring. RESULTS: Five items were retained as a single factor for each scale, and graded response models and Mokken scale analysis confirmed the scale items with the SoPart-10 scale having the highest reliability (alpha = 0.74). DISCUSSION AND IMPLICATIONS: Results suggest that a scale derived from the social participation items in the HRS may be useful in characterizing general social participation levels and identifying modifiable factors that can promote it in older populations.

Associations Among Neighborhood Characteristics, Mobility Limitation, and Social Participation in Late Life.

OBJECTIVES: Although emerging research suggests neighborhood characteristics can support and restrict social participation in older adults, further research regarding a wider range of neighborhood characteristics and interactions between individual and neighborhood characteristics is needed. This study explored associations between neighborhood characteristics and frequency of participation in three social activities among older adults and interactions between neighborhood characteristics and mobility limitation as they relate to participation. METHOD: Data from the 2008 wave of the Health and Retirement Study linked with American Community Survey data were used. Participants included community-dwelling adults aged 65 years or older. Analysis involved multivariate logistic regression. RESULTS: High proportion of neighborhood residents aged 65 and older was associated with increased odds of more frequent participation in all three activities. High population density was associated with increased odds of club attendance. High neighborhood social cohesion was associated with increased odds of attending nonreligious meetings. Interactions between walking limitation and population density or social cohesion related to increased odds of participation. DISCUSSION: Findings suggest that improving older adults' ability to participate in community life and age in place requires strategies that consider how neighborhood and individual characteristics interact and how these characteristics may differentially affect types of participation.

Toward Understanding Person-Place Transactions in Neighborhoods: A Qualitative-Participatory Geospatial Approach.

Background and Objectives: Emerging research regarding aging in neighborhoods emphasizes the importance of this context for well-being; however, in-depth information about the nature of person-place relationships is lacking. The interwoven and complex nature of person and place points to methods that can examine these relationships in situ and explore meanings attached to places. Participatory geospatial methods can capture situated details about place that are not verbalized during interviews or otherwise discerned, and qualitative methods can explore interpretations, both helping to generate deep understandings of the relationships between person and place. This article describes a combined qualitative-geospatial approach for studying of older adults in neighborhoods and investigates the qualitative-geospatial approach developed, including its utility and feasibility in exploring person-place transactions in neighborhoods. Research Design and Methods: We developed and implemented a qualitative-geospatial approach to explore how neighborhood and person transact to shape sense of social connectedness in older adults. Methods included narrative interviews, go-along interviews, and global positioning system tracking with activity/travel diary completion followed by map-based interviews. We used a variety of data analysis methods with attention to fully utilizing diverse forms of data and integrating data during analysis. We reflected on and examined the utility and feasibility of the approach through a variety of methods. Results: Findings indicate the unique understandings that each method contributes, the strengths of the overall approach, and the feasibility of implementing the approach. Discussion and Implications: The developed approach has strong potential to generate knowledge about person-place transactions that can inform practice, planning, policy, and research to promote older adults' well-being.

Occupational therapy in primary care: Results from a national survey: L'ergothérapie dans les soins primaires : Résultats d'un sondage national.

BACKGROUND.: To support integration of occupational therapy in primary care and research in this area, it is critical to document examples of occupational therapy in primary care. PURPOSE.: This study describes occupational therapy roles and models of practice used in primary care. METHOD.: An electronic survey was sent to occupational therapists across Canada. Participants were identified using purposive and snowball sampling strategies. Descriptive statistics were used to analyze the data. FINDINGS.: Respondents ( n = 52) were almost exclusively working on interprofessional teams. Intervention was provided most frequently to individual clients, and services were provided both within the home/community and in the clinic. Occupational therapists offered a range of health promotion and prevention services, predominantly to adults and older adults. A number of supports and barriers to the integration of occupational therapy were identified. IMPLICATIONS.: A growing number of occupational therapists are working in primary care providing a broad range of services across the life span.