Enhancing engagement in meaningful occupation in a dementia town: A qualitative evaluation of MOED – The meaningful occupational engagement intervention for people with dementia

Introduction Engagement in meaningful everyday life occupations is linked to well-being. However, people with dementia are often deprived of engagement. As a response, a Danish Dementia Town was established with the intention of transforming care services to improve opportunities for meaningful engagement. The evidence-based The meaningful occupational engagement intervention for people with dementia (MOED) intervention was developed and implemented in dementia town to enhance meaningful occupational engagement. The purpose of this paper is to evaluate the content, impact and implementation process of MOED. Method To evaluate MOED, we applied a program theory-based qualitative approach, building on participant observations and informal conversations with people with dementia ( n = 7) and staff ( n = 9). Data were analysed from a hermeneutic approach to gain an in-depth understanding of how MOED influenced meaningful occupational engagement and to evaluate the implementation process. Findings The main theme ‘Engagement in meaningful occupations – a conditional and fragile process’ emerged along with three subthemes: ‘Creating an everyday space of meaning: Conditions of the intervention’, ‘Occupational engagement as an opportunity to blossom: Impact of the intervention’ and ‘Professional identity, culture and reflections: Contextual barriers to changes to working practice’. Together, the subthemes illustrate how engagement in meaningful occupations arose. However, opportunities to engage in meaningful occupations were fragile, as they depended on various factors within the context. Conclusion Engagement in meaningful occupations emerged when MOED was applied in accordance with the program theory, as it seemed to create spaces where people with dementia could engage in meaningful occupations and they could blossom over time. However, MOED was only partially implemented in accordance with the developed program theory, as several contextual barriers influenced the sustainability of the intervention. MOED showed potential to support improvement in dementia care activity programmes to enhance opportunities to engage in meaningful occupations in everyday life for people living with dementia.

Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study

Background Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. Objective This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. Methods The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. Results During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. Conclusions A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment.

Doing gender and being gendered through occupation: Transgender and non-binary experiences

Background Transgender people can face discrimination which can be reflected in and encoded by their occupational experiences. There is emerging research regarding those who are transgender but experiences of non-binary people remain under-explored. Purpose This study considered the occupational experiences of transgender and non-binary people and how gender expression related to engagement in occupations and space. Method Five transgender and non-binary people participated in repeat interviews, including a ‘walking interview’. Analysis was informed by new materialism. Findings Occupational engagement can re-enforce binary understandings of gender or facilitate creative expressions of gender identity. Within normative environments, occupational participation can offer assimilation, particularly for non-binary people. Some occupations provided emancipation from binary gender norms through expression such as clothing and creative activities which provided recognition and belonging. Symbolic and personal meanings of occupations shifted when participants were able to express themselves in a way that felt authentic. Conclusion ‘Occupational assimilation’ can bring safety from scrutiny for those who are transgender and non-binary but curtails authentic expression. Occupational therapists have a role in supporting transgender and non-binary people in accessing occupations which facilitate their authentic gender expression and need to improve critical awareness of the culturally encoded binary nature of many occupations and environments.

Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study (Preprint)

BACKGROUND Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. OBJECTIVE This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. METHODS The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. RESULTS During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. CONCLUSIONS A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment. CLINICALTRIAL

Occupational Lives in Sustained Recovery From Alcohol Dependency: An Interpretive Phenomenological Analysis

Alcohol use is a significant risk factor for ill health. Although many people complete treatment, only one third maintain their sobriety. Research has suggested that occupational engagement supports early recovery, but its role in sustained recovery is not known. This study aimed to explore the occupational lives of individuals in sustained recovery from alcohol dependency. An interpretive phenomenological analysis methodology was used, utilizing an occupational perspective. Participants were recruited from a substance use recovery center. Data were collected through interviews and analyzed thematically. This study had three participants. Four themes emerged: (a) shaping occupational lives, (b) shifting coping strategies, (c) finding a gateway to new social connections and a sense of belonging, and (d) establishing a new role in the context of recovery. Findings suggest that in sustained recovery, occupations develop new meanings and purposes that have the potential to support recovery.

Occupation in Natural Environments; Health Equity and Environmental Justice

Background. Occupations undertaken in natural environments can positively impact physical and mental health, improve cognitive functioning, contribute spiritual and cultural benefits, and increase belonging, self-worth, and the meaningfulness of occupations. However, occupational opportunities in healthy natural spaces are inequitably distributed; and the deleterious effects of climate change and environmental degradation are borne disproportionately by socioeconomically disadvantaged people. Purposes. To highlight evidence that occupational engagement in nature is a determinant of health, foreground environmental injustices and identify some implications for occupational therapy. Key issues. Cross-disciplinary, cross-cultural research and critical environmental justice scholarship indicate that healthy nature is an inequitably distributed determinant of occupation, wellbeing, and human health. This merits critical attention from occupational therapy. Implications. By researching, identifying, and addressing occupational and health inequities arising from environmental degradation, climate change and inequitable access to health-promoting natural environments occupational therapists could contribute valuable, occupational perspectives to initiatives addressing human rights and environmental justice.

Perceptions of Stress, Mindfulness, and Occupational Engagement Among Graduate-Level OT Students

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The exploratory mixed-methods study of 490 OT graduate students revealed that high levels of reported stress along with limited coping strategies impacted students’ perceived occupational engagement and quality of life. Students identified mindfulness as an effective coping mechanism; however, its reported use did not appear to alter quality of life. The study supported a link between mindfulness and occupational engagement and has broad implications for the field of OT. Primary Author and Speaker: Patricia A. Henton Additional Authors and Speakers: Acacia Gambrel, Jerome Klah, Catherine Rink, Caroline Targonski, and Sarah Wirtz

Assessing Functional Disability Among Persons Experiencing Homelessness

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This cross-sectional study provides a deeper understanding of how the experience of homelessness affects occupational engagement and quality of life. Health-related disparities among persons experiencing homelessness and their implications for functioning in daily life were analyzed through the World Health Organization Disability Assessment Schedule 2.0. Results indicate that the emotional burden of health conditions had the greatest impact on daily functioning. Highly affected domains included participation, mobility, and life activities. Primary Author and Speaker: John V. Rider Additional Authors and Speakers: Justina Selim, Alexys Garcia