Student perceptions of the learning environment in Norwegian occupational therapy education programs.

BACKGROUND: To support students' motivation towards constructive and persistent study efforts, their learning environment needs attention. AIM: To develop knowledge about occupational therapy students' perceptions of the learning environment and assess whether identified differences between education programs were stable or changed across the 3 years of study. METHODS: Norwegian occupational therapy students completed the Course Experience Questionnaire (CEQ) while in their first, second, and third years of study. Differences between programs were analysed with multivariate and univariate analysis of variance. RESULTS: Among the first-year students, perceptions of the learning environment differed significantly between the six programs on five out of six scales. Apart from a continued difference on overall study satisfaction, the initial differences were no longer significant 1 year later. Differences on three scales (emphasis on independence, appropriate workload, and generic skills) were present in the third year of study. CONCLUSIONS AND SIGNIFICANCE: Students' perceptions of the learning environment became more similar over time, during the first 2 years of study, possibly reflecting that the students have become more accustomed to the student role and to the culture and requirements of the education programs. However, differences between study sites re-occurring in the third year suggest that group-based comparisons of learning environment perceptions across time may be inconclusive.

Satisfaction with Health Care Interventions among Community Dwelling People with Cognitive Disorders and Their Informal Caregivers-A Systematic Review.

Informal caregivers have a leading role when implementing health care services for people with cognitive disorders living at home. This study aims to examine the current evidence for interventions with dual satisfaction with health care services for people with cognitive disorders and their caregivers. Original papers with quantitative and mixed method designs were extracted from two databases, covering years 2009-2018. Thirty-five original papers reported on satisfaction with health care services. The International Classification of Health Interventions (ICHI) was used to classify the interventions. Most interventions had a home-based approach (80%). Reduction in caregiver depression was the outcome measure with the highest level of satisfaction. Interventions to reduce depression or increase cognitive performance in persons with cognitive disorders gave the least satisfaction. Satisfaction of both caregivers and persons with cognitive disorders increased their use of services. In the ICHI, nearly 50% of the interventions were classified as activities and participation. A limited number of interventions have a positive effect on satisfaction of both the persons with cognitive disorders and the caregiver. It is important to focus on interventions that will benefit both simultaneously. More research is needed with a clear definition of satisfaction and the use of the ICHI guidelines.

Identifying and validating housing adaptation client profiles - a mixed methods study.

Purpose: An increasing number of people will live with disabilities in their homes and consequently, the need for home-based interventions will increase. Housing adaptations (HAs) are modifications to the physical home environment with the purpose to enhance independence for a heterogeneous group of people. Increasing the knowledge of the characteristics of HA clients by exploring their heterogeneity, could facilitate the planning of interventions and allocation of resources. The purpose of this article was to identify and validate HA client profiles.Materials and methods: This cross-sectional study applied a mixed methods design to identify profiles of HA clients through cluster analysis confirmed by qualitative interview data. The sample consists of 241 HA clients in Sweden with a mean age of 75.1 years.Results: A classification into five groups emerged as the one best describing the heterogeneity of characteristics among this sample of clients. Five client profiles were outlined based on their age and level of disability, and the variation between the profiles was confirmed through the qualitative interview data.Conclusions: The identified client profiles are a step towards a better understanding of how home-based interventions could be delivered more effectively to groups of HA clients, based on their different characteristics.Implications for rehabilitationHousing adaptations are structural modifications to the physical home environment with the purpose to enhance independence for people with disabilities.People applying for housing adaptations are a heterogeneous group with different needs.This study outlines five client profiles which can guide professionals on how to differentiate home-based interventions and follow-up processes among housing adaptation clients.

Acceptance and Use of Innovative Assistive Technologies among People with Cognitive Impairment and Their Caregivers: A Systematic Review.

Cognitive impairments (CI), associated with the consequences of Alzheimer's disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI.

Health-Related Quality of Life among People Applying for Housing Adaptations: Associated Factors.

Housing adaptations (HA) clients are a heterogeneous group of people with disabilities experiencing restricted performance and participation in everyday life. While health-related quality of life is a common and relevant outcome in health care research, associated factors among HA clients are largely unknown. Thus, the aim of this study was to investigate which factors are associated with health-related quality of life among HA clients in Sweden. The study has a cross-sectional design, using baseline data collected among 224 participants in three municipalities in Sweden. The main outcome was health-related quality of life measured by the EQ-5D. Factors investigated as potentially associated were age, sex, living conditions, cognitive impairment, usability of the home, activities of daily living (ADL) dependence, participation, and fear of falling. The associations were explored using multiple linear regression analysis. Younger age and higher dependence in ADL were associated with lower scores on the EQ-5D. The social aspect of usability in the home had a positive association with the EQ VAS. Results suggest that certain groups of HA clients might be at risk for low health-related quality of life. Knowledge of their characteristics can potentially improve development and implementation of tailored interventions aiming at increasing their health-related quality of life.

Factors associated with participation frequency and satisfaction among people applying for a housing adaptation grant.

BACKGROUND: People applying for a housing adaptation (HA) grant are at great risk of participation restrictions due to declining capacity and environmental barriers. AIM: To investigate the association of person-, environment-, and activity-related factors with participation frequency and satisfaction among people applying for a housing adaptation grant. MATERIAL AND METHODS: Baseline cross-sectional data were collected during home visits (n = 128). The association between person-, environment-, and activity-related factors and participation frequency and satisfaction was analysed using logistic regressions. RESULTS: The main result is that frequency of participation outside the home is strongly associated with dependence in activities of daily living (ADL) and cognitive impairments, while satisfaction with participation outside the home is strongly associated with self-reported health. Moreover, aspects of usability in the home were associated with frequency of participation outside the home and satisfaction with participation in the home and outside the home alone. CONCLUSION: Dependence in ADL, cognitive impairments, self-rated health, and aspects of usability are important factors contributing to participation frequency and satisfaction among people applying for a housing adaptation grant, particularly outside the home. SIGNIFICANCE: Our findings indicate that more attention should be directed towards activity-related factors to facilitate participation among HA applicants, inside and outside the home.

Barriers and Facilitators for Participation in People with Parkinson's Disease.

BACKGROUND: Activity performance is marked by the degenerative nature of Parkinson's disease (PD), but few qualitative studies have focused on how people with PD perceive participation in life situations. OBJECTIVE: To identify and describe barriers and facilitators for participation from the perspective of people with PD. METHODS: Qualitative data was obtained by the focus group method using a semi-structured interview guide. Participants were recruited by purposeful sampling until saturation was reached. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate, severe). Nine focus groups (three per PD severity level) included a total of 29 participants. RESULTS: Complex dynamics between the individual and the physical and social environment create barriers and facilitators for participation as described in the four categories which emerged out of the focus group discussions. The category Ambiguity of attitudes and the support of others describes how attitudes and support of other people act both as facilitators and barriers for participation. PD specific complexity of the body and physical environment interaction describes barriers for participation. Facilitators emerged in the two categories PD expertise in health care and social services and Information and education foster PD specific understanding. CONCLUSIONS: Our findings imply several potential means to facilitate participation for people with PD, taking the person as well as the environment into account in person-centred interventions. This involves aspects such as having access to PD specific expertise, increasing the knowledge and thereby the understanding of PD as well as providing support for maintained work-life.

Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden--Relationship to Participation and Self-Rated Health.

The aim of the paper was to explore the heterogeneity among housing adaptation clients. Cluster analysis was performed using baseline data from applicants in three Swedish municipalities. The analysis identified six main groups: "adults at risk of disability", "young old with disabilities", "well-functioning older adults", "frail older adults", "frail older with moderate cognitive impairments" and "resilient oldest old". The clusters differed significantly in terms of participation frequency and satisfaction in and outside the home as well as in terms of self-rated health. The identification of clusters in a heterogeneous sample served the purpose of finding groups with different characteristics, including participation and self-rated health which could be used to facilitate targeted home-based interventions. The findings indicate that housing adaptions should take person/environment/activity specific characteristics into consideration so that they may fully serve the purpose of facilitating independent living, as well as enhancing participation and health.

"You plan, but you never know"--participation among people with different levels of severity of Parkinson's disease.

PURPOSE: The aim of this study was to improve our understanding of important aspects of participation in everyday life for people with different levels of severity of Parkinson's disease (PD). METHODS: A qualitative design was used, with empirical data obtained from focus groups. The participants had all been diagnosed with PD at least one year prior to the start of the study. Purposeful sampling was used to ensure that both sexes, with variations in age, marital status, living arrangements, education and employment, were represented. Recruitment continued until saturation was reached and resulted in 29 participants. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate or severe). FINDINGS: The aspects that influence participation at different stages of PD are that those with PD stand out in public, as a result of disease-specific features, and that the disease is unpredictable. Planning was highlighted as a strategy that is required to support participation and cope with stress and to compensate for the fact that everyday activities demanded a great deal of time and energy. CONCLUSION: These findings are of importance to the development of rehabilitation interventions that support people with PD in maintaining their participation in everyday life, throughout the course of the disease.