A mixed method investigation to develop a specialised occupational therapy theory based intervention manual for use with young people with emerging mental health issues

Background: Mental ill-health is a significant problem among young people, negatively affecting their quality of life with long-term consequences. A need exists for a broader range of interventions to address the determinants that affect mental health, early, when problems are emerging. Research suggests that the balance and nature of daily occupational choices can influence mental health in adults, but its influence on adolescent mental health has yet to be fully explored. Adolescence is a key period in developing occupational choice and learning how to balance daily occupations. To date there is a limited understanding of how adolescents choose and balance occupations, the relationship of occupational choices to mental health, and whether an intervention developed with young people can support individuals in their occupational choices to affect their mental health. Aim: This study aims to understand how young people use their time, their perception of this process in relation to their situational context and mental health, and to inform the co-development of an occupational therapy theory-based intervention for young people aged 16 to 17 years experiencing emerging mental health difficulties. Methodology: Informed by the Intervention Mapping framework, a pragmatic five-study, sequential, mixed method project was completed. Study one used a systematic scoping review method, to describe the academic literature reporting occupation-based interventions designed to improve the mental health of adolescents. Study two surveyed a cohort sample of typical 16- to 17-year-olds from two mainstream UK co-educational secondary schools, using time-use diaries and the SDQ questionnaires. Providing a sampling frame for a third study using a constructivist grounded theory method. The findings from the first three studies informed a structured consultation with occupational therapists and researchers using a consensus Delphi study, designed to prioritise emerging occupational determinants. Study five used the prioritised determinants to inform the content development of a manualised intervention, which underwent initial acceptability testing with young people. Results: The scoping review found three occupational therapy-based interventions targeting adolescent mental health, and a diverse range of thirty-six other occupation-based studies, using a wide breadth of approaches and outcome measures across a variety of settings. A school cohort sample of 134 students completed two surveys, providing an insight into the feasibility issues, recruitment rate, measure completion and potential for patterns and relationships. Drawing on the sample, six focus groups were conducted with twenty-seven young people, informing a theoretical model of occupational choice. The Delphi identified and prioritised eighty-nine determinants leading to the prioritisation of eighteen, informing the aims, objectives, and content of the intervention. The studies informed the construction of the eight-week ‘Activity-Time Use’ intervention manual including exploration and development of the occupational repertoire, balancing occupation, volitional aspects, the situational context, occupational choice, and the occupational self. The intervention review against six acceptability criteria suggested that the intervention required minor amendments but appeared acceptable to the target population. Conclusion: New knowledge of occupational determinants and their influence on occupational choices, in conjunction with occupational therapy and behaviour change theories, informed a manualised intervention, co-developed with young people and experts, which, following initial acceptability testing with young people, shows potential for further development and feasibility testing

Patients’ and parents’ views about lower limb orthopaedic surgery for ambulant children and young people with cerebral palsy: A qualitative evidence synthesis

Purpose. The article identifies the aspects of health and outcomes that are considered important from the perspective of ambulatory children with cerebral palsy (CP) and their parents regarding lower limb orthopaedic surgery and explores how they experience surgical interventions. Methods. Four databases (Embase, MEDLINE (Ovid), CINAHL and PsycINFO) were searched from inception to 11 April 2020. Studies were included if they: 1) they involved children or young adults diagnosed with ambulant CP or their family, 2) participants had experience with lower limb orthopaedic surgery and 3) studies employed qualitative research methods. The Critical Appraisal Skills Programme was used to appraise identified studies. The ‘Best-fit framework’ synthesis approach was used by applying the International Classification of Functioning-Children and Youth (ICF–CY) linking rules and thematic synthesis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results. Six studies were included. Four themes were generated which were linked to the ICF–CY framework: Body function and structure, Activity and participation, Environmental factors, Personal factors, as well as non-ICF–CY themes including Emotional well-being and Goal setting. Important surgical outcomes identified were pain, fatigue, movement-related function, mobility, walking ability, community life, emotional well-being, and adequate provision of public and health services. Conclusion. These findings are important for understanding patient-centred outcomes in lower limb ortho-paedics surgery and providing focus for future interventional studies aimed at improving outcomes of importance to children with CP. These findings highlight the importance of long-term support to help people negotiate the challenge of surgical regimes and to achieve good outcomes after orthopaedic surgery. The outcomes identified will contribute to the development of a core outcome set in this field

A scoping review of interventions using occupation to improve mental health or mental wellbeing in adolescent populations

Introduction. Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds. Aim. The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents’ and young people’s mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research. Method. An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool. Results. Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified. Conclusions. Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area

An exploration of occupational choices in adolescence: A constructivist grounded theory study.

Background. Adolescence is a critical period within the life course, for developing adult occupational competencies and health behaviours. Few studies have considered how 16–17 year olds choose activities and behaviours from an occupational perspective. Aim and objectives. To explore how adolescents aged 16–17 years old make choices about their daily occupations to inform a theoretical model of occupational choice. Materials and methods. About 27 secondary school students aged 16–17 years attended one of six focus groups. Transcripts were analyzed using constructivist grounded theory, informing the iterative development of a theoretical model of occupational choice. Results. Adolescent occupational choice occurred in response to experiencing needs, and was characterized by ‘weighing up’ and ‘juggling’ the following four key domains: ‘Appraising values and priorities’, ‘Interacting with the situational context’, ‘Exploring skills and occupational repertoire’ and ‘Considering time factors’. A developing sense of responsibility and autonomy for occupational choices was described, leading to the development of the future occupational self. Conclusions and significance. A theory illuminating how adolescents make choices was developed. The theory aligns with existing developmental literature and provides unique insights, from an occupational science perspective, on the conscious process by which adolescents make, develop and adapt choices about the occupations they do considering contextual and individual opportunities and constraints

A scoping review of interventions using occupation to improve mental health or mental wellbeing in adolescent populations

Introduction: Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds. Aim: The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents’ and young people’s mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research. Method: An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool. Results: Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified. Conclusions: Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area

An exploration of occupational choices in adolescence : A constructivist grounded theory study

Background: Adolescence is a critical period within the life course, for developing adult occupational competencies and health behaviours. Few studies have considered how 16–17 year olds choose activities and behaviours from an occupational perspective. Aim and objectives: To explore how adolescents aged 16–17 years old make choices about their daily occupations to inform a theoretical model of occupational choice. Materials and methods: About 27 secondary school students aged 16–17 years attended one of six focus groups. Transcripts were analyzed using constructivist grounded theory, informing the iterative development of a theoretical model of occupational choice. Results: Adolescent occupational choice occurred in response to experiencing needs, and was characterized by ‘weighing up’ and ‘juggling’ the following four key domains: ‘Appraising values and priorities’, ‘Interacting with the situational context’, ‘Exploring skills and occupational repertoire’ and ‘Considering time factors’. A developing sense of responsibility and autonomy for occupational choices was described, leading to the development of the future occupational self. Conclusions and significance: A theory illuminating how adolescents make choices was developed. The theory aligns with existing developmental literature and provides unique insights, from an occupational science perspective, on the conscious process by which adolescents make, develop and adapt choices about the occupations they do considering contextual and individual opportunities and constraints