Psychiatric rehabilitation in community-based day centres: Motivation and satisfaction.

Abstract Objective: This study investigated attendees' motivation and motives for participation in day centres and their satisfaction with the rehabilitation, while also addressing the influence of day centre orientation (work- or meeting-place orientation), gender and age. Methods: Ninety-three Swedish day centre attendees participated in a cross-sectional study and completed questionnaires about motivation, motives, and satisfaction with the rehabilitation. Data were analysed with non-parametric statistics. Results: The participants were highly motivated for going to the day centre and set clear goals for their rehabilitation. Female gender, but not age, was associated with stronger motivation. The strongest motives for going to the day centre were getting structure to the day and socializing. Attendees at work-oriented day centres more often expressed that they went there to get structure to the day and gain social status. Satisfaction with the rehabilitation was high, and the most common wishes for further opportunities concerned earning money and learning new things. Conclusions and implications for practice: The rehabilitation largely seemed to meet the attendees' needs, but the findings indicated that further developments were desired, such as participation in work on the open market and more work-like occupations in the day centre, accompanied by some kind of remuneration

Participation in day centres for people with psychiatric disabilities: Characteristics of occupations.

Abstract People with psychiatric disabilities (PD) are a vulnerable group, and should be offered support and rehabilitation when needed. Day centres that provide individually matched daily occupations are an important link to provide that. The present study aimed at gaining knowledge regarding the occupations performed in day centres, in terms of the participants' descriptions of what they were doing. Eighty-eight persons with PD completed a time-use diary that focused on the most recent day. The participants were selected from six different day centres, meeting-place-oriented as well as more work-oriented ones. By qualitative content analysis six categories were identified, representing the occupations performed; social occupations, maintenance occupations, creative occupations, manufacturing occupations, service occupations, and information-focused occupations. A main theme termed "being at the day centre means participating in occupations with different levels of demand" was also discerned. The day centres served as a social meeting point and an opportunity to be involved in occupations with different levels of demand. This study highlights the role day centres could play in the rehabilitation of people with PD, and the potential that lies in the knowledge of the levels of occupational demands when meeting individual occupational needs and when analysing and planning interventions

Psychometric testing of a self-report measure of engagement in productive occupations.

Occupational therapists working with clients in productive occupations explicitly or implicitly assess their clients' occupational engagement

Factors Influencing Occupational Engagement in Day Centers for People with Psychiatric Disabilities.

Occupational engagement is a vital factor in people's lives since it has been shown to be important for health and well-being. Community-based day centers (DCs), both meeting place-oriented and work-oriented ones, are common service alternatives in many western countries for enabling engagement in productive and leisure occupations among people with psychiatric disabilities. Little is, however, known about factors influencing occupational engagement in such settings. We aimed to investigate how factors pertaining to day center attendance, socio-demographics, motivation, clinical and self-related characteristics were related to how day center attendees rated their occupational engagement in productive occupations. These variables were assessed among day center attendees in meeting place-oriented (n = 39) and work-oriented (n = 54) DCs in Sweden through questionnaires and interviews. Logistic regression models showed that (1) less general psychopathology and more time spent on day center occupations were indicators of belonging to the group with a high level of occupational engagement according to a median cut; (2) higher perceived self-mastery was the only important factor with respect to ratings of occupational engagement above the third quartile. The models may be seen as creating a stepwise indication on which factors are important for reaching a medium level of occupational engagement (less severe general psychopathology and time spent at the day center) and for reaching a still higher level (a high level self-mastery), respectively, of occupational engagement. The findings may also be discussed in relation to different levels of engagement in a recovery process

Perceived social status among people with psychiatric disabilities attending work-oriented and meeting place-oriented day centers

BACKGROUND: Day centers have been criticized for giving attendees a lower social status because they only offer activities that are often work-like although not financially of benefit to attendees. OBJECTIVES: To explore day center attendees' perceived social status and to identify associations among the attendees with the center's orientation with activity, well-being, and psychiatric symptoms. METHOD: Day center attendees in meeting place-oriented (n = 39) and work-oriented (n = 54) day centers in Sweden were interviewed addressing the targeted factors using both self-rated and interview-based instruments. RESULT: Attendees rated themselves close to the middle on the social status measure. No difference between groups based on day center orientation was found. Their self-perceived positioning on social status was positively related to the worker role, occupational engagement, self-rated health, self-esteem, self-mastery, and depressive symptoms. Logistic regression models showed better self-rated health was the only predictor of belonging to the group with a higher level of social status when dichotomized according to the median. Self-rated health was the strongest indicator for scoring above the 75th percentile on perceived status, followed by self-esteem, which was also a significant indicator. CONCLUSION: These findings yielded new knowledge concerning perceived social status in the target group and the importance of health and self-esteem

Engagement in community-based day centres for people with psychiatric disabilities

This thesis provides knowledge of occupational engagement in day centres for people with psychiatric disabilities and contributes to measurement development in the area of occupational engagement. The first study focused on the characteristics of the occupations carried out at the day centre by exploring occupational engagement using time-use diaries with a person-environment-occupation perspective. The occupations performed were categorized as social occupations, maintenance occupations, creative occupations, manufacturing occupations, service occupations and information-focused occupations. The study also showed that being at the day centre meant participating in occupations with varying levels of demands on the individual. The second study highlighted that attendance in day centres brought a feeling of being socially included through participation in occupations. Attendance in day centres created structure and routines, and the perceptions of contributing and being entrusted with responsibilities were considered motivational. The attendees were challenged to learn new things, to be more active and to master new goals in their daily life, and were in a process of seizing control over their everyday lives. The third study was a psychometric study of the Profile of Occupational Engagement in people with Severe mental illness - Productive occupations (POES-P). The findings indicated good internal consistency, and a logical pattern of relationships between the POES-P and other instruments was found. POES-P was considered to be mainly a construct in its own right. The distribution of responses indicated a ceiling effect, which calls for further development of the instrument. Study IV revealed a stepwise indication of which factors are most likely to be important for occupational engagement. The participants’ psychopathology, especially general symptoms, and time spent at the day centre were important factors for reaching occupational engagement above a medium level, and self-mastery was the only variable associated with belonging to the group with the highest level (> the 75th percentile) of occupational engagement

Associations between occupational and social interaction factors and well-being among people with psychiatric disabilities living in supported housing in Sweden

Research indicates that occupation is important for well-being in people with mental illness, but this has not been extensively studied among those with severe psychiatric disabilities. Social contacts may possibly play a more vital role for them. This study aimed to explore how aspects of occupation and social interaction were related with well-being factors in that group, while controlling for the influence of clinical factors. People with psychiatric disabilities living in congregate supported housing (CSH; N = 155) responded to questionnaires addressing occupation, social contacts and well-being aspects, such as subjective health, quality of life, self-mastery, and personal recovery. A comparison group with psychiatric disabilities who lived in an ordinary flat or house and received outreach housing support (N = 111) completed the same instruments. The two groups were compared regarding their pattern of associations between occupation, social contacts, and well-being. Associations between occupation and well-being in the CSH group showed that general satisfaction with everyday occupations in particular was related to all aspects of well-being, whereas activity level and occupational balance were not related to well-being. The relationships were fewer and weaker, in comparison to the group in ordinary housing with outreach support. Indicators of social contacts were basically unrelated to well-being. The study contributes to occupational science by showing that the role of a high activity level for well-being, although important, should not be overemphasized. Future research should focus on narratives to get the voices of people residing in CSH and on exploration of how individually/socially performed occupations are associated with well-being