Applying the Ecological Model of Human Performance and the SlutWalk Movement to Support those Affected by Rape Culture in the Context of Occupational Therapy

Improving the occupational lives of others is at the heart of occupational therapy practice. Advocacy for clientele is central to this improvement, both at individual and structural levels. We argue that interventions in the Ecological Model of Human Performance (EHP) and the social movement theSlutWalk can offer increased opportunity for occupational therapists to address the harmful implications for clients affected by sexual assault and rape culture. In addition, through the principles of the EHP and the SlutWalk, we propose that occupational therapists can have a hand in eradicating the culture that facilitates and tolerates sexual violence. This paper highlights the barriers women and sexual assault survivors may face to equitable occupational participation, where occupational therapists may establish/restore, alter, create, prevent, and adapt intervention approaches in the client’s context to elicit optimal engagement in meaningful activity

Gender as Occupation: The Doing of Authentic Expression and Reciprocally Affirming Care for Transgender Individuals

The current predominant view of gender as binary, alongside limited training of affirmative care practices, is severely and negatively impacting transgender and gender diverse (TGD) people. This paper urges the re-conceptualization of gender as an occupation, suggesting that gender is a doing that allows for positive identity development, roles, habits, and routines. Doing gender facilitates meaning-making and the ability to engage in other occupations. However, occupational injustices rooted in discrimination, stigma, and/or implicit biases impede TGD people’s ability to engage in the doing of gender and other occupations. Articulation of conceptual guidelines and interventions to support TGD people’s ability to do gender and other occupations is a critical area of need in occupational therapy literature and practice. In accordance with the profession’s ethical mandate to promote occupational justice, it is critical that occupational therapists become educated and involved in providing affirmative services to support occupational participation for this population

A Grounded Theory of Veterans’ Experiences of Addiction-as-Occupation

This study examined how addiction emerges as an occupation in the lives of veterans. Its purpose was to facilitate better knowledge of how addiction is experienced as an occupation by this population, with the goal of destigmatizing addiction and paving the way for innovative ways to help people with addictions to build new occupational lives. Fifty-eight veterans diagnosed with a substance use disorder were recruited from a VA residential treatment center, of which 35 transcripts of the Indiana Psychiatric Illness Interview—a broad interview inquiring about participants’ life experiences—were randomly selected for grounded theory analysis following a 4-step coding procedure as outlined by Charmaz. Data revealed a five step occupational process: Being Initiated; Increasing Engagement; Establishing an Identity; Experiencing Discord and Defeat; and Finding Other Occupations. Addiction is discussed as a behavioral pattern, and the authors discuss how the use of new occupations may provide individuals with new patterns of organization, social interconnection, and identity development needed to sustain a move away from occupations of addiction

A Mixed-method Analysis of Community-Engaged Theatre Illuminates Black Women’s Experiences of Racism and Addresses Healthcare Inequities by Targeting Provider Bias

Theatre has been a powerful means of eliciting social change. This paper describes methods and outcomes of a theatre project to reduce healthcare inequities experienced by Black women. We conducted narrative interviews with a convenience sample of Black women and conducted thematic analysis of interview transcripts to learn about their experiences of healthcare and to inform development of a professional theatrical production. To assess the impact of the performance on the audience, we used a single post-test concurrent mixed-methods design using a self-created Likert-type survey that included space for open-ended responses. Ten Black women completed narrative interviews. Thematic analysis revealed 5 main themes: being ignored, being accused, being talked-down to, fearing harm, and being hurt. Narratives were used to create a script that centered on these themes, and that was professionally produced and performed. Audience members (n = 113, 25% healthcare providers) produced a mean total post-test score of 19.28 (agree/strongly agree) on a 25-point survey with 2 items scoring in the 2 to 3 range (disagree/not sure). Thematic analysis data revealed the extent to which Black women experienced discrimination in multiple settings. Quantitative survey data suggested audience members conceptually understood and were aware of inequity, but open-ended responses revealed this information was new for some, and prior knowledge for others. The audience reported planning to change personal behaviors that may contribute to inequity. Participants were unsure if they had contributed to inequity in the past. The performance stimulated conversation about implicit bias and discrimination and encouraged audience members to examine their contributions to the problem. Future pre-post studies are needed to better assess the impact of the performance. Theatre has the potential to illuminate the extent and nature of discrimination in healthcare and society, and to foster conversations that allow audience members to consider their own potential contributions to discrimination

Older Adults and Photo-Elicited Perspectives on Shopping for Groceries in a Changing Community

Background: A community experiencing gentrification created challenges for older adults and their ability to access food. The purpose of this qualitative study was to examine barriers and facilitators perceived by three urban-dwelling older adults during their grocery shopping experiences. Methods: The researchers conducted photo-elicitation supported interviews to gather information on grocery shopping from three older adults attending a local senior center. Photo-elicited interviews were conducted, and the thematic analysis examined the participants’ perspectives on their experiences. Results: Thematic analysis revealed the participants’ experiences in a changing landscape. In the categories of community resources, transportation, and the store, analysis revealed the following themes: encountering obstacles, becoming frustrated, and identifying strategies and facilitators. These themes represent a process for older adults whereby they adapt to obtain their needed or desired items when shopping for groceries. Conclusion: In a community facing urban renewal and gentrification, older adults encountered obstacles and adapted in ways that were productive but not always safe or supportive of good health. This study illustrates the adaptive (or maladaptive) strategies of the participants who are managing change in their community. Advocating for affordable transportation in communities and modifying grocery store layout can support the older adult shoppers

Intersections of occupational participation and borderline personality disorder: A grounded theory approach

Borderline personality disorder (BPD) is characterized by intense emotions, self-harm, unstable self-image, and risky behaviors, which impede wellness and interfere with occupational participation. However, literature on occupational participation of people with BPD is scarce and has mostly focused on women. This study explores and elucidates intersections of occupational participation and BPD in a sample of mostly male veterans in order to identify potential ways occupational therapists and other health professionals can support wellbeing for this population. Grounded theory analysis was conducted on data collected using the Indiana Psychiatric Illness Interview (IPII), a semi-structured interview designed to elicit illness personal narratives. Analysis yielded three main themes—influencing environment, internal experience, and occupation—and several subthemes including being abused, arising problems, feeling neglected, feeling victimized, escape, self-segregating, positive change, participating/engaging, and substance abuse. Occupations both influenced and were influenced by the environment and internal experiences. Environments appeared to influence internal experience, but internal experiences did not influence environments directly. Rather, internal experiences impacted a person’s occupations which, in turn, impacted their environments. Participants’ occupational lives revealed, as expected, several subthemes depicting negative and/or isolating experiences. However, participants’ occupations directly impacted both their environmental contexts and internal experiences, suggesting occupational performance may be a powerful mechanism of change for this population. Findings offer promise that occupational therapists could facilitate health-promoting occupational participation which, in turn, may result in more positive and health-promoting environments and internal experiences

Narrative Theater to Examine and Mitigate Anti-Black Racism Within Occupational Therapy

Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire–Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational therapists to engage in anti-Black racism

Contribution of Genetic Background, Traditional Risk Factors, and HIV-Related Factors to Coronary Artery Disease Events in HIV-Positive Persons

We show in human immunodeficiency virus-positive persons that the coronary artery disease effect of an unfavorable genetic background is comparable to previous studies in the general population, and comparable in size to traditional risk factors and antiretroviral regimens known to increase cardiovascular ris

Comparing Narrative-Informed Occupational Therapy in Adult Outpatient Mental Health to Treatment as Usual: A Quasi-Experimental Feasibility Study with Preliminary Treatment Outcomes

This paper describes implementation of narrative-informed occupation-based service delivery in outpatient community mental health that addresses (1) the need for outcome data on occupational therapy in this setting, (2) an ongoing mental health provider shortage, and (3) a need for innovative approaches to supporting mental health. We found a significant improvement from baseline to post-intervention in occupational participation. Dose of occupational therapy was significantly related to improvements in roles, habits, values, long-term goals, social environment, and readiness for change. This study supports future, larger effectiveness studies of narrative-informed occupation-based intervention delivered by occupational therapists in outpatient community mental health