An occupational perspective on user involvement in mental health day services

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This participatory action research project enabled service users to influence the modernisation of local mental health day services. The modernisation programme was based on principles of social inclusion, and there were limited understandings of how it could be applied locally. Interpretations of policy gave priority to the relocation of services and facilitating individual recovery. An occupational perspective informed the design, implementation and analysis, emphasising what people chose to do. Critical ethnography informed the role of the researcher. Service user involvement was understood as a democratic process, drawing on direct experience for service development. A forum, established for four years, worked on and supported three research strands, focused on social networking. Service users captured their use of a social lounge using photography in Strand A. In Strand B a checklist was used to investigate social activities. Userled social groups were explored in Strand C through individual interviews. All the findings were systematically analysed and service users were involved in this for Strands A and B. The findings of this research emphasised the importance of social networking within the day services. Strand A indicated the benefits of a safe space, before getting involved and moving on. The final report from this strand led to ongoing funding being allocated for a safe space. For Strand B many social and recreational activities were identified by service users. Stigma was recognised as an ongoing barrier to sustained inclusion. A poster was designed and displayed locally to share the findings. Themes from Strand C demonstrated that user-led groups required active collaboration with mental health services to survive and thrive. A final stage of analysis aimed to uncover the details of taking an occupational perspective. The findings indicated that varied occupational forms involved different service users in different ways, enabling more people to participate. Making the functions of the different events explicit was important for negotiating participation. Meanings were expressed in shared and individual reflection as the research unfolded. Understanding and attending to these aspects facilitated meaningful service user involvement in this research, enabling many people to influence the development of the services they received

Sharing Stories: Insights on the Holistic Experiences of Latino ELLs

Through interviewing local students, this thesis seeks to understand the experiences of Latino English Language Learners (ELLs) in high school. National research and test results suggest that Latino ELLs are both failing and being underserved in a number of categories, including school completion with “the highest rates of drop out among all students” (Edl, Jones, & Estell, 2008, p. 39). These findings are also substantiated by the testing statistics reported at state and local levels. By interviewing six students who are directly affected by changing policies and testing approaches, this study will discuss and give voice to the academic, interpersonal, and intrapersonal experiences of these students. Furthermore, their accounts will be compared to national research and findings to begin telling part of the story of language learners in the state where I reside: Oregon. These stories are a powerful resource for educators seeking to better understand the needs and experiences of their students

Connecting Women: Wikipedia Editing in the Sciences, Ada Lovelace Day Edit-a-thon 2019

Cornell University hosted its inaugural Ada Lovelace Day Wikipedia Edit-a-thon in 2019. Led by two librarians, this event is a chance to highlight the contributions of women past in present in the Sciences. Ada Lovelace is considered the first computer programmer and is a good example of the invisible contributions women have made in the field of the sciences. Participants learned how to edit in Wikipedia and both Cornell affiliates and people in the Ithaca community were welcome. We highlighted female-identified Cornell professors in the Sciences, https://guides.library.cornell.edu/adalovelace, with underdeveloped or no Wikipedia pages for real world examples as well

Developing cessation interventions for the social and community service setting: A qualitative study of barriers to quitting among disadvantaged Australian smokers

Background: Smoking rates remain unacceptably high among individuals who are socially disadvantaged. Social and community service organisations (SCSO) are increasingly interested in providing smoking cessation support to clients, however little is known about the best way to assist disadvantaged smokers to quit in this setting. This study aimed to explore barriers and facilitators to quitting within the conceptual framework of the PRECEDE model to identify possible interventions appropriate to the social and community service setting. Methods: Semi-structured focus groups were conducted with clients attending five community welfare organisations located in New South Wales, Australia. Thirty-two clients participated in six focus groups. A discussion guide was used to explore the barriers and facilitators to smoking and smoking cessation including: current smoking behaviour, motivation to quit, past quit attempts, barriers to quitting and preferences for cessation support. Focus groups were audio-taped, transcribed and analysed using thematic analysis techniques. Results: Participants were current smokers and most expressed a desire to quit. Factors predisposing continued smoking included perceived benefits of smoking for stress relief, doubting of ability to quit, fear of gaining weight, and poor knowledge and scepticism about available quit support. The high cost of nicotine replacement therapy was a barrier to its use. Continual exposure to smoking in personal relationships and in the community reinforced smoking. Participants expressed a strong preference for personalised quit support. Conclusions: Disadvantaged smokers in Australia express a desire to quit smoking, but find quitting difficult for a number of reasons. SCSOs may have a role in providing information about the availability of quit support, engaging disadvantaged smokers with available quit support, and providing personalised, ongoing support

Childhood obesity prevention trials: A systematic review and meta‐analysis on trial design and the impact of type 1 error

Summary: Effect sizes from previously reported trials are often used to determine the meaningful change in weight in childhood obesity prevention interventions because information on clinically meaningful differences is lacking. Estimates from previous trials may be influenced by statistical significance; therefore, it is important that they have a low risk of type 1 error. A systematic review and meta‐analysis were conducted to report on the design of child obesity prevention randomized controlled trials and effectiveness according to risk of type 1 error. Eighty‐four randomized controlled trials were identified. A large range of assumptions were applied in the sample size calculations. The most common primary outcome was BMI, with detectable effect size differences used in sample size calculations ranging from 0.25 kg/m2 (followed up at 2 years) to 1.1 kg/m2 (at 9 months) and BMI z‐score ranging from 0.1 (at 4 years) to 0.67 (at 3 years). There was no consistent relationship between low risk of type 1 error and reports of higher or lower effectiveness. Further clarity of the size of a meaningful difference in weight in childhood obesity prevention trials is required to support evaluation design and decision‐making for intervention and policy. Type 1 error risk does not appear to impact effect sizes in a consistent direction

Interventions to Strengthen Environmental Sustainability of School Food Systems : Narrative Scoping Review

School food systems play a role in the wider food system, but there is a scarcity of literature exploring interventions that aim to improve the environmental sustainability of school food systems. The present review aimed to understand and describe the types of interventions that have previously been explored to strengthen the sustainability of school food systems along with their impact. We applied a scoping review methodology guided by Arksey and O'Malley, which included a review of the online database Scopus and the grey literature. Information relating to intervention design, study population, evaluation method and impact were extracted. In total, 6016 records were screened for eligibility, 24 of which were eligible for inclusion. The most common types of interventions were school lunch menus designed to be more sustainable; school food waste reduction; sustainable food system education using school gardens; and dietary interventions with added environmental components. This review highlights a range of interventions which could positively influence the environmental sustainability of school food systems. Further research is needed to explore the effectiveness of such interventions

Making activism a participatory, inclusive and developmental process: a research programme involving mental health service users

Understanding real-world experiences and issues is a priority for research funders, yet there are challenges in directly engaging with people for evaluation and investigation of the professional services they receive. Much professional work takes place within institutional restrictions, arising from legislation, policy and local practices. Collaborative research is therefore complex but relevant for improving services. This research programme started in 2002 with focus group research, led by occupational therapists based in a local National Health Service trust and a university, followed by eight further projects including a Photovoice project. This programme and our perspectives from reflections suggest we do not always know who we are, what we want or who cares about research outcomes, but it is important to embrace the potential of activism, to energise and focus people for positive action, wherever they are based

Identification and Characterization of Nitrogen Fixing Bacteria Associated with Kudzu Root Nodules

Pueraria montana, better known as kudzu, is an invasive species rapidly spreading throughout the southeastern United States. This plant can form root nodules which house nitrogen-fixing bacteria, allowing atmospheric nitrogen to be converted into biologically available forms of nitrogen for use by the plant host. Given the centrality of these bacteria to the spread of kudzu, isolates from nodules were characterized after collection from seven different locations across the metropolitan Atlanta area. Twenty-five isolates were grown on two different variants of nitrogen free media. Four different carbon sources were evaluated as well. Finally, growth under both aerobic and anaerobic conditions was investigated. Almost all isolates grew better under anaerobic conditions. Additionally, the carbon source and other components of the composition of the media affected growth. These data suggest significant metabolic diversity inside a relatively small geographic area posing questions about the relative contribution of nitrogen fixing bacteria to kudzu’s invasive expansion in this region. In addition, four possible “promiscuous ineffective” isolates were identified using data evaluating relative growth, possibly reflecting reduced nitrogen fixation and corresponding benefit to the host. The kudzu can be described as “promiscuous ineffective” because it allows nodulation of bacteria that have very poor nitrogen fixing capabilities. Two sequences, 16S rRNA and the gene nifD, were amplified from these four isolates. The 16S rRNA sequence reveals minor evolutionary diversity amongst isolates. Analysis of nifD reveals variations between isolates and some correspondence with an ability to fix nitrogen. With these data, further characterization of the “promiscuous ineffective” isolates may reveal the mechanism of reduced fixation rates and provide insight into possible bioremediation of kudzu

Levelling the playing field: Exploring inequalities and exclusions with a community‐based football league for people with experience of mental distress

Introduction Sport workforce strategy in the United Kingdom (UK) has identified the occupational therapy profession as being ideally positioned to contribute to public health agendas relating to tackling physical inactivity amongst marginalised populations, such as disabled people and people with experience of mental distress. However, a robust understanding of the enablers, restrictions, and exclusions such groups encounter when seeking to participate in sport and physical activity is currently lacking. Methods This study aimed to gain an in-depth understanding of the different ways people with experience of mental distress talked about their participation in a community-based football league in England, in the UK. Nine people took part in this strand of a larger participatory action research (PAR) study, which used go-along interviews as the method of data collection. In alignment with PAR seeking to address power imbalances, the data from the go-along interviews were analysed through a Foucauldian lens using a collaboratively produced analytic framework. Findings Participants constructed the community-based football league as fostering feelings of purpose and belonging, against a backdrop of them describing experiencing stigma and exclusion when seeking to be active in their wider communities. They used the concept of occupational marginalisation to further interpret their situation. Conclusion Understanding why and how people participate in football extends beyond seeing it as an individual exercise to shared social lives and occupations. With this perspective, occupational therapists could address occupational marginalisation in partnership with community sports organisations, collaborating for wider social change beyond specialist services