Previous time-use research suggests that it is highly relevant for an occupational therapist to estimate time use and occupational engagement in order to understand some of the determinants of wellbeing for people with schizophrenia. This article describes the development and the testing of the psychometric properties of an instrument, Profiles of Occupational Engagement in people with Schizophrenia (POES), with the aim of helping to interpret and evaluate time-use diaries and thus providing a systematic description of status regarding occupational engagement. The first part of POES involves completion of time-use diaries and the second part, the assessment, is based on nine items that are rated on a four-point ordinal scale. The time-use diaries of 41 people with schizophrenia and the judgements from 12 occupational therapists were used in the study. A test of content validation involved experts from Sweden and the United Kingdom and resulted in two stages of revisions. The strength of agreement between two raters resulted in a mean weighted kappa of 0.70. Internal consistency was calculated for both raters separately and the alpha coefficients were 0.97 and 0.95. This study provides initial support for the content validity, interrater agreement and internal consistency of POES. Based on the judgements of the occupational therapists in this study, POES seems to have good clinical utility. However, further research on the clinical utility as well as the criterion validity of the construct is warranted.
Background People with psychiatric disability have been found to have a poorer quality of life ( QOL ) compared to the general population, and QOL is an important outcome from psychosocial rehabilitation. Aims This study aimed at comparing users of two approaches to psychosocial rehabilitation in Sweden, community‐based mental health day centres ( DC s) and clubhouses, regarding QOL . A further aim was to investigate predictors of QOL . Methods People regularly attending DC s (n = 128) or clubhouses (n = 57) completed questionnaires at baseline and a 9‐month follow‐up about socio‐demographics, QOL , self‐esteem, social network, satisfaction with daily occupations, satisfaction with services and the unit's organisation. Results Quality of life remained stable over time in both groups. QOL at follow‐up was associated with baseline self‐esteem, social network, satisfaction with daily occupations and QOL at baseline. The strongest indicator of a higher QOL at follow‐up was attending a clubhouse programme followed by having scored high on QOL at baseline. Conclusion Both approaches were suited for supporting their users in maintaining QOL . Visiting clubhouses seems, however, advantageous for QOL in a longer‐term perspective. Although this study contributed some new knowledge, research should further address which circumstances are associated with maintaining stability in QOL .
Background/Aim Previous research has shown that the R edesigning D aily O ccupations programme reduced the degree of sick leave and increased return to work rates among women on sick leave for stress‐related disorders when compared with “care as usual”. To further investigate the Redesigning Daily Occupations intervention, this study explored changes in the work situation from baseline to a 12‐month follow‐up in the Redesigning Daily Occupations group compared with the “care as usual” group and analysed any predictors of change. Methods A matched‐control design was used and 84 women were recruited. Objective (return to work and sick leave) and subjective work outcomes (perceptions of the worker role and the work environment) were explored. Potential predictors were clinical and demographic variables and an anxiety–depression factor. Results In both groups, large positive effect sizes from baseline to follow‐up were found regarding the objective outcomes, a moderate positive effect size was found for perceived work environment, whereas perceived worker role remained unaffected. Previous work rehabilitation predicted objective work outcomes in both groups. Higher education and older age were predictors of subjective outcomes in the Redesigning Daily Occupations group, whereas a more severe anxiety–depression rating was negative for work environment ratings in the “care as usual” group. Conclusions Return to work seemed possible without a change in the women's perceptions of the worker role; rather they renegotiated their view of the work environment. The Redesigning Daily Occupations programme was found to be promising, with a positive effect on return to work and sick leave reduction. It seemed more suitable for the higher educated and older women.
Knowing whether interventions addressing everyday life as a whole can affect work readiness for people with severe mental health issues would be important for how to develop support.To compare two groups of people with mental health problems, receiving either of two types of 16-week activity-based interventions, Balancing Everyday Life (BEL) or Care as Usual (CAU), regarding work readiness in terms of perceived worker role and satisfaction with recent work experience. Changes from baseline (T1) to completed intervention (T2) and a six-month follow-up (T3) and variables of potential importance to changes were also explored.This cluster RCT recruited participants for BEL (n = 133) and CAU (n = 93) from specialized and community-based psychiatry. Questionnaires addressing work readiness and potentially influencing variables (sociodemographic, clinical, type of intervention, work experience, non-work activity factors, social interaction and self-esteem) were used. Mixed model regression analyses were employed.Positive changes occurred for both groups in one worker role aspect (resources for a future worker role) and in satisfaction with recent work participation. Satisfaction with non-work everyday activities, having valued activities, and self-esteem were important for change in the work readiness variables, whereas intervention type, age, sex or general activity level were not.Both interventions yielded equally positive work readiness outcomes. Support that emphasizes engagement in satisfying and valued everyday activities and boosts self-esteem would be a potential way to help people with mental health issues develop work readiness in terms of the worker role and satisfaction with work participation.
Abstract Associations between occupational factors and characteristics of the social network in people with persistent mental illness were investigated. Participant groups (N = 103) representing three types of daily occupations— working or studying, visiting community-based activity centers, and having no regular daily occupation—were selected for the study. Participants were assessed regarding social interaction and on the occupational factors of time spent in productive occupations, activity level, satisfaction with daily occupations, and perceived occupational value. The groups based on daily occupation did not differ in social interaction. Associations were found mainly between the subjective estimations of occupation—satisfaction and perceived value—and characteristics of the social network. In conclusion, experiential aspects of occupation were more closely related to social interaction than actual circumstances, such as type of daily occupation or time spent in productive occupations. The results suggest that occupational therapists should focus their attention on the patient’s participation in a supportive social network because it may be related to valued and satisfying occupations.
Day centres can prepare for open-market employment, and attendees' work motivation is key in this.Adopting a gender perspective, this study investigated (1) motivation for day centre attendance, satisfaction with the day centre services, number of hours spent there, and number and type of occupations performed; and (2) whether those factors were related with motivation for open-market employment.Women (n = 164) and men (n = 160) with psychiatric disabilities completed self-report questionnaires.There were no gender differences regarding satisfaction with the day centre services or number of hours spent there, but women engaged in more occupations. More women than men performed externally-oriented services and textile work, while men were in the majority in workshops. Externally oriented services, working in workshops, and low satisfaction with the day centre services were associated with higher motivation for employment. Women and men were equally motivated for employment. Women scored higher on motivation for attending the day centre, something that may deter transition into open-market employment. For men, less motivation for attending day centres may reduce their possibilities of gaining skills that can facilitate transitioning to open-market employment.Thus, the possibility for transitioning from day centre activities to open-market employment may be gendered.
Community-based day centres (CBDCs) for people with mental illness are a common service for both people with an immigrant background and native Swedes.The aim was to compare CBDC attendees with an immigrant background with attendees who were native Swedes in terms of well-being and perceptions of everyday activities and investigate whether ethnic background could predict these factors.Attendees at nine CBDCs were invited to participate. In all, 56 with an immigrant background and 69 native Swedes completed self-report questionnaires that addressed various aspects of well-being and everyday activities.Attendees with an immigrant background had a worse situation regarding perceived self-esteem, empowerment and satisfaction with everyday activities. In multivariate logistic regression analyses, ethnic background only became a significant predictor in regard to empowerment. Quality of life and activity level were of importance for satisfaction with everyday activities. Empowerment and self-esteem mutually influenced each other.Having a mental illness and an immigrant background may infer a particular risk for low empowerment. The mental health services and society at large should consider measures for adjusting the support to this group, including an analysis of how environments and contexts may act as barriers to activity enrichment and culturally congruent support.
Purpose: The study aimed to investigate (a) if women's perceptions of their work environment changed during a 16-week rehabilitation period and at a 12-month follow-up; (b) whether such changes were related to outcomes in terms of return to work, well-being and valued occupations. Methods: Eighty-four gainfully employed women on sick-leave due to stress-related disorders responded to instruments assessing perceptions of the work environment, well-being (self-esteem, self-mastery, quality of life, perceived stress, self-rated health) and perceived occupational value. Data about return to work were collected from registers. Non-parametric statistics were used. Results: The increase in the women's ratings of their work environment was non-significant between baseline and completed rehabilitation but was statistically significant between baseline and the 12-month follow-up. No relationships were found between changes in perceptions of the work environment and outcomes after the rehabilitation. At the follow-up, however, there were associations between perceived work environment changes in a positive direction and return to work; improved self-esteem, self-mastery, quality of life, perceived occupational value and self-rated health; and reduced stress. Conclusion: It seems important to consider the work environment in rehabilitation for stress-related problems, and a follow-up appears warranted to detect changes and associations not visible immediately after rehabilitation.Implications for RehabilitationWork environmentPerceptions of the work environment seem important for return to work, although other factors are likely to contribute as well.Perceptions of the work environment are associated with several aspects of well-being.When developing rehabilitation interventions a focus on the clients' perceptions of their work environment seems vital.
Abstract The connection between health and the activation of the body that occurs through occupational engagement in rehabilitation is unquestionable, but what impact on health and well‐being does the experience of occupational performance have in itself? This pilot study was conducted to develop a methodology that captured qualities of experience in the daily occupational repertoire of six heterogeneous cases. The following instruments were used: 1) Experience Sampling Method, 2) Occupational Storytelling, and 3) the Sense of Coherence Scale, encompassing both quantitative and qualitative dimensions of experiences. The first two instruments were found to supplement each other in capturing specific and global experiences of occupations respectively, while the third focused on the individual's sense of coherence in life, connected to a salutogenic understanding of health. The results of the study were the development of 1) individual Experience Quality Profiles (EQPs), based on an eight‐channel flow model, and 2) a tentative ranking strategy for the EQP and SoC, enabling comparisons between the concepts. Preparations have started for a larger study, based on the methodology developed here. It aims to reveal in greater depth the relationship between quality of experience and sense of coherence in chronic pain subjects and a healthy comparison group. Key words: Experience sampling methodFlow theoryHealthOccupational therapyOccupational storytellingSalutogenesisWell‐being
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