Conceptualizations of occupation in relation to health: A conversation between theory and experience-near data

Current occupational science theory describes a positive link between occupation and human health. This theory asserts that an essential unit of analysis for understanding health is in every-day human actions (Wilcock, 2006). Indeed, extant literature has identified occupation as a powerful facilitator of health and wellbeing. Consequently, basic theory in occupational science has favored positive implications for health based on engagement in occupations. However, experience-near accounts reveal that engaging in occupation has both positive and negative implications. Recent scholarship in occupational science has recognized this conflict and asserts that further understanding of the occupation-health link is necessary (Durocher, Rappolt, & Gibson, 2014). This panel will advance the discussion between experience-near accounts and basic theory by employing case examples from interdisciplinary research. Presentation #1 will frame the discourse by providing a conceptual map (Feyerabend, 2011) of how occupational science has described the relationship between occupation and health, and identify opportunities for theoretical expansion. We will argue for adopting a dialectic perspective on the occupation-health link. To illustrate the need for expanded theory, a case example will be given employing data from a large mixed-methods ethnographic study (‘Autism in urban context: linking heterogeneity with health and service disparities’, NIMH, R01MH089474, 09/30/2009 - 08/31/2012, Solomon, O., P.I.). These data capture the experiences of a child with ASD and his family related to ways in which his medical and developmental conditions make participation in physical play both transformative and detrimental. Presentation #2 extends this dialogue to the clinical care setting by challenging notions of the health-promoting effects of healthcare providers’ recommendations within chronic disease management. This presenter will provide one exemplar case from a study on diabetes as a lens into the experiences of making agentic choices between maintaining the intensive requirements of diabetes management and engaging in developmentally normative, though potentially risky activities. These choices are further examined using theoretical tools from medical sociology and anthropology combined with concepts introduced within occupational science literature. Presentation #3 will describe the activities of a Latino gang. Drawing from a transactionalism framework and understanding the interrelatedness of contextual conditions to occupation (Dickie, Cutchin & Humphry, 2006). The presenter will discuss the affordances and constraints typical of a gang-inhabited neighborhood, and evaluate both the positive and negative health-related aspects of gangs. Additional excerpts from memoirs and first-hand accounts of former gang members (Rodriguez, 2005) will be analyzed to describe the occupational activities of gangs from a participant perspective. This presentation will critically appraise the limitations of a health-promoting view of occupation by framing culturally grounded information as necessary when describing possible impacts on health. As these presentations will illustrate, occupations lead to flourishing for some aspects of health, but may also lead to some negative impact. The panel will demonstrate the importance of including both the positive and the negative impact into conceptualizations of occupation to better understand how it is linked to human health, wellness and participation. Key Words: Health Promotion, Critical Occupational Science, Experience-Near Research Presenter information Mark E. Hardison, MS, OTR/L¹ Kristine M. Carandang, MS, OTR/L¹ Lucía I. Floríndez, MA¹ Elizabeth A. Pyatak, PhD, OTR/L, CDE² Olga Solomon, PhD² Ruth Zemke, PhD, OTR(Retired), FAOTA³ 1 = Presenter and author, 2 = Author only, 3 = Moderator Affiliation University of Southern California, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy Acknowledgements Autism in Urban Context: Linking Heterogeneity with Health and Service Disparities (NIMH, R01 MH089474, 2009-2012, O. Solomon, P.I.) Objectives for the Discussion Period 1. Participants will ask questions of the panel to clarify or expand the presentation. 2. Participants will share other experiential examples critically appraising the health-promoting view of occupation. 3. Participants and panel members will explore reconciliation of these observations with basic theory of occupation

Reliability and Validity of Noncognitive Ecological Momentary Assessment Survey Response Times as an Indicator of Cognitive Processing Speed in People’s Natural Environment: Intensive Longitudinal Study

BackgroundVarious populations with chronic conditions are at risk for decreased cognitive performance, making assessment of their cognition important. Formal mobile cognitive assessments measure cognitive performance with greater ecological validity than traditional laboratory-based testing but add to participant task demands. Given that responding to a survey is considered a cognitively demanding task itself, information that is passively collected as a by-product of ecological momentary assessment (EMA) may be a means through which people’s cognitive performance in their natural environment can be estimated when formal ambulatory cognitive assessment is not feasible. We specifically examined whether the item response times (RTs) to EMA questions (eg, mood) can serve as approximations of cognitive processing speed. ObjectiveThis study aims to investigate whether the RTs from noncognitive EMA surveys can serve as approximate indicators of between-person (BP) differences and momentary within-person (WP) variability in cognitive processing speed. MethodsData from a 2-week EMA study investigating the relationships among glucose, emotion, and functioning in adults with type 1 diabetes were analyzed. Validated mobile cognitive tests assessing processing speed (Symbol Search task) and sustained attention (Go-No Go task) were administered together with noncognitive EMA surveys 5 to 6 times per day via smartphones. Multilevel modeling was used to examine the reliability of EMA RTs, their convergent validity with the Symbol Search task, and their divergent validity with the Go-No Go task. Other tests of the validity of EMA RTs included the examination of their associations with age, depression, fatigue, and the time of day. ResultsOverall, in BP analyses, evidence was found supporting the reliability and convergent validity of EMA question RTs from even a single repeatedly administered EMA item as a measure of average processing speed. BP correlations between the Symbol Search task and EMA RTs ranged from 0.43 to 0.58 (P0.70) WP reliability. After correcting for unreliability in multilevel models, EMA RTs from most combinations of items showed moderate WP correlations with the Symbol Search task (ranged from 0.29 to 0.58; P<.001) and demonstrated theoretically expected relationships with momentary fatigue and the time of day. The associations between EMA RTs and the Symbol Search task were greater than those between EMA RTs and the Go-No Go task at both the BP and WP levels, providing evidence of divergent validity. ConclusionsAssessing the RTs to EMA items (eg, mood) may be a method of approximating people’s average levels of and momentary fluctuations in processing speed without adding tasks beyond the survey questions

Exploring Eating Challenges and Food Selectivity for Latinx Children with and without Autism Spectrum Disorder Using Qualitative Visual Methodology: Implications for Oral Health

Diet and food choices significantly impact teeth, including enamel quality and development of dental caries. However, studies focusing on diet and its relation to oral care in Latinx children with and without Autism Spectrum Disorders (ASD) have been minimally addressed in research. This qualitative study used an inclusive visual methodology to explore what Latinx caregivers learned about their child’s diet preferences and food routines in relation to their oral health. As a secondary aim, the study sought to explore whether notable differences in diet emerged between Latinx children with and without ASD. Participants were 32 Latinx caregivers from 18 families with children with and without Autism (n = 8 with a typically developing child and n = 10 with a child with ASD) who completed a food journal activity and photo elicitation interview. Interviews were thematically coded for themes pertaining to parents’ perceptions of their child’s diet and oral health. Findings of this study indicate that the process of taking photos helped Latinx caregivers to better situate the barriers and behaviors influencing everyday food routines in their children within the context of relating to their overall oral health. Via their active participation in the research process, parents were empowered to note strategies they could employ that would directly impact their child’s oral health outcomes, such as reducing juice intake and monitoring sugar consumption. Therefore, visual research methodologies are an important strategy for researchers to consider in order to empower participants to be part of the research process and part of the outcomes, and to offer better understanding of the lived experience of populations underrepresented in the literature, such as Latinx children with and without ASD and their families

Implementing trials of complex interventions in community settings: The USC–Rancho Los Amigos Pressure Ulcer Prevention Study (PUPS)

BACKGROUND: Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)–Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to: (a) participant recruitment and retention, (b) intervention delivery and fidelity, (c) randomization and assessment, and (d) potential inadvertent treatment effects. PURPOSE: We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury. METHOD: Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes. RESULTS: PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accord with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to: (a) determining pressure ulcer incidence/severity, (b) randomization imbalance, and (c) inadvertent potential control group contamination. LIMITATIONS: We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings. CONCLUSIONS: Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence as well as the ability to implement needed mid-course corrections

Lifestyle intervention for adults with spinal cord injury: Results of the USC–RLANRC Pressure Ulcer Prevention Study

© 2019, © The Academy of Spinal Cord Injury Professionals, Inc. 2019. Context/Objective: Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI. Design: A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group. Setting: Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County. Participants: Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group. Interventions: The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts. Outcome Measures: Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures. Results: Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were.56 for intervention recipients,.48 for randomized controls, and.65 for nonrandomized controls. At follow-up, rates were.44 and.39 respectively for randomized intervention and control participants. Conclusions: Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect. Trial Registration: ClinicalTrials.gov NCT01999816