Book review: Occupational therapy and physical dysfunction: enabling occupation, 6th ed.

When I did my training, the 4th edition of Occupational therapy and physical dysfunction was the set text with its emphasis on principles, skills and practice, but very much based on the ‘physical conditions’ that occupational therapists were likely to come across in hospitals or in the community. By contrast, the 6th edition of Occupational therapy and physical dysfunction, edited by a completely new team, is similar in name only. With its emphasis on enabling occupation, it examines a much wider world view for occupational therapists and is as relevant to those working in mental health as it is to physical occupational therapists and, in fact, challenges the dichotomy that persists in our profession

Understanding diabetes self-management using the Model of Human Occupation

Introduction: Over 400 million people worldwide are living with diabetes. Research suggests that people struggle to manage their diabetes and an in-depth understanding of the lived experience of diabetes is required to inform and promote occupational therapy practice. This article reports on one part of a PhD study into the role of occupational therapy in diabetes self-management. Method: Semi-structured interviews using an intuitive inquiry methodology were conducted with 22 people with diabetes in three separate studies. Analysis of the lived experience of all participants was drawn together to explore the understanding of diabetes self-management from an occupational perspective using the Model of Human Occupation. Findings: The occupation of diabetes self-management was conceptualised with seven inter-related occupational forms. Challenges were related to occupational identity, volition, habituation, performance capacity and the context in which these took place. Conclusion: This study, embedded in the experiences of those with diabetes, suggests that occupational therapy has a distinct role in diabetes self-management, through seeing this self-management as an occupation. The use of the Model of Human Occupation enables a focus on the characteristics of the occupational forms and how these might be adapted for successful occupational engagement

Craftivism for occupational therapists: finding our political voice

Craftivism is an ongoing movement, combining craft with activism, to bring about positive change in the world. There is a growing emphasis on the need for occupational therapists to engage with the politics of the profession to tackle occupational challenges and injustice. This opinion piece considers whether, with the historical links to and resurgence of craft internationally within the profession, now is the time for occupational therapists to engage in craftivism to effect positive change and transformation for a just and inclusive society. It suggests that craftivism may enable the profession to find its political voice and suggests ideas for action

An occupational therapy perspective on diabetes

The incidence of diabetes in the United Kingdom is increasing and its impact on health and social care costs is significant, with considerable personal consequence for the individual with diabetes. Current approaches to managing or preventing diabetes include education, self management and lifestyle change but the evidence suggests that some people are unwilling or unable to make lifestyle changes recommended for better health and wellbeing. This qualitative study examined the potential role of occupational therapy, with its focus on individual and daily occupations, to enable people with diabetes to manage this condition in the context of their own lives. Using a process of intuitive inquiry, it comprised three separate studies all using semi-structured interviews. The first, designed to explore the lived experience of diabetes, involved seven people with a diagnosis of type 1, type 2 or pre-diabetes. Findings were shared with participants using a felted metaphor of charting a course of health and well-being through a choppy sea. The second study involved ten occupational therapists with type 1, type 2, gestational or pre-diabetes and examined the use of metaphor as a means of understanding the lived experience. In addition the potential role of occupational therapy was explored with participants. Using knowledge gained from studies 1 and 2, the third study involved five people with type 2 diabetes and used metaphor as a means of exploring difficulties and successes in diabetes self management. All three studies were then drawn together to consider the use of metaphor and the potential role of occupational therapy in diabetes self management. From the findings a model of the occupation of diabetes self-management is proposed along with a framework for occupational therapy intervention in diabetes self-management that focuses on the professional belief of the impact of occupation on health and wellbeing and considers the individual in their particular life context

The lived experience of diabetes: conceptualisation using a metaphor

Introduction: It is important for healthcare professionals to understand the reality of living with diabetes in order to better engage and enable people to self-manage. The purpose of this research was thus a preliminary exploration of the lived experience of diabetes. Method: This qualitative study involved seven people with a diagnosis of type 1, type 2 or pre-diabetes. Data was collected via semi-structured interviews and analysed using a phenomenological approach including the use of metaphor. Findings were shared with participants using a felted metaphor of charting a course of health and wellbeing through a choppy sea. Findings: Themes explored within the elements of the metaphor included the boat (self-identity, control, balance, compliance and empowerment, emotions), the sea (physical and social environment, lifestyle, life events), the course (information gathering, change, self-action) and the boatyard (relationships with healthcare providers). Conclusion: For those with type 1, type 2 and pre-diabetes, the elements of charting a course of health and wellbeing through a choppy sea are very much focused on the person in their own context, impacted by their environment, life stage, occupations and attitudes to diabetes self-management, all of which fall within the remit of occupational therapy

Occupational marginalisation in everyday life from fear of gender-based violence

Introduction: Women are known to experience fear of gender-based violence (GBV) and change their behaviour in response, though occupational science has done little to research this. Criticism has been levied against occupational science for failing to critically situate occupation within socio-political systems to illuminate drivers of everyday inequality and exclusion. Purpose: This primary research study aimed to understand the impact of fear of GBV on occupational participation. Methods: Using descriptive phenomenology, data from 8 semi-structured interviews (7 women, 1 non-binary participant) were analysed according to Colaizzi’s method. Findings: Fear of GBV was ubiquitous for participants and came with a range of associated emotions. Participants spoke of the process of socially learning fear of GBV - internalising fear articulated in social discourse, media and in conversations with friends and family. Fear of GBV limits occupational participation as people change when and how they do things, and introduce risk mitigating behaviours. Implications for Occupational Science: This study supports the idea that occupational injustice does not always arise from overt forces. Participants appear to experience occupational marginalisation, their occupational choices narrowed through social norms and attitudes. Participants’ occupations are inseparable from the context they are part of. Equally, the way people participate in everyday occupations may inadvertently perpetuate fear, marginalisation and oppressive social structures or be the site of resistance. This study furthers efforts to move beyond individualism and person-environment dualism in occupational science. This occupational perspective on fear of GBV may be harnessed to raise awareness and advocate for social transformation

Conceptualising diabetes self‐management as an occupation

Diabetes self management requires the ability to cope with the symptoms of diabetes, manage testing and medication, deal with psychosocial consequences and make lifestyle changes. Approaches to self management are typically medical, although occupational therapists have recently started to recognize the opportunities for the profession in understanding self-management in terms of an individual’s life context, roles and routines (Fritz 2014 Pyatak 2011 Thompson 2014). Following ethical approval from the University of Cumbria, a total of 22 participants with type 1, type 2, gestational or pre-diabetes were recruited in three separate stages to the first author’s doctoral study exploring the role of occupational therapy in diabetes self-management. Following initial analysis of digitally recorded semi-structured interviews on the lived experience of diabetes, the findings were taken as a whole to conceptualise the experience of diabetes self-management as an occupation, using the Model of Human Occupation (MOHO) (Kielhofner 2008). The presentation will discuss the occupational forms of the occupation of diabetes self-management, the impact of other occupations on diabetes self-management, and the impact of diabetes on other occupations. Using MOHO and examples from the participants, it will illustrate the interaction between occupational identity, volition, habituation and the environment on diabetes self-management. This research adds to the growing literature on an occupational therapy approach to diabetes. Understanding diabetes self management as an occupation brings a particular non-medical focus that may complement existing services and show how occupational therapy could enable improved diabetes management for those who require it

Diabetes: charting a course of health and wellbeing in the sea of life

In the UK 2.9 million people are diagnosed with diabetes and an estimated further 850,000 people may not be aware that they have this condition (Diabetes UK, 2012). The impact on health and social care costs is significant, with increased risk of further chronic complications, as well as considerable personal difficulties for the individual and their family. The aim of this study is to describe the lived experience of those with type 1, type 2 and pre-diabetes, to ascertain what helps or hinders successful self-management in relation to lifestyle. This qualitative study forms the first part of the first author’s doctoral thesis enquiring into the role of occupational therapy in meeting the demands of this health issue, to promote and drive change in approaches to prevention and self-management. Following ethical approval from the University of Cumbria, seven people with type 1, type 2 or a diagnosis of pre-diabetes were recruited using a self-selecting convenience sample. Digitally recorded unstructured interviews focussed on the lived experience of each participant and were analysed using qualitative mixed methods, including the use of creative metaphor. Findings have revealed the complex interplay between the person and their life circumstances when managing or attempting to prevent diabetes. Examples will be given of participants’ stories and their feelings about living with, or with the threat of, diabetes. The contribution of creative metaphors in analysis will also be discussed and how this shaped the next stage of the research. Diabetes is not an easy condition to control. An in-depth understanding of the pressures of living with (or with the threat of) diabetes will enable occupational therapists to take a specific occupational, rather than medical, approach to enabling people to manage successfully in the context of their particular lifestyle, and to drive change in this area. Diabetes UK (2012) Diabetes in the UK 2012. Key statistics on Diabetes. London: Diabetes UK

An occupational therapy perspective on diabetes

The incidence of diabetes in the United Kingdom is increasing and its impact on health and social care costs is significant, with considerable personal consequence for the individual with diabetes. Current approaches to managing or preventing diabetes include education, self management and lifestyle change but the evidence suggests that some people are unwilling or unable to make lifestyle changes recommended for better health and wellbeing. This qualitative study examined the potential role of occupational therapy, with its focus on individual and daily occupations, to enable people with diabetes to manage this condition in the context of their own lives. Using a process of intuitive inquiry, it comprised three separate studies all using semi-structured interviews. The first, designed to explore the lived experience of diabetes, involved seven people with a diagnosis of type 1, type 2 or pre-diabetes. Findings were shared with participants using a felted metaphor of charting a course of health and well-being through a choppy sea. The second study involved ten occupational therapists with type 1, type 2, gestational or pre-diabetes and examined the use of metaphor as a means of understanding the lived experience. In addition the potential role of occupational therapy was explored with participants. Using knowledge gained from studies 1 and 2, the third study involved five people with type 2 diabetes and used metaphor as a means of exploring difficulties and successes in diabetes self management. All three studies were then drawn together to consider the use of metaphor and the potential role of occupational therapy in diabetes self management. From the findings a model of the occupation of diabetes self-management is proposed along with a framework for occupational therapy intervention in diabetes self-management that focuses on the professional belief of the impact of occupation on health and wellbeing and considers the individual in their particular life context

Slow occupation

Aim: The aim of this workshop is to introduce and explore slow occupation through slow stitching. Background: The slow movement, developed following Honore’s 2004 book ‘In Praise of Slow’, focuses on living ‘at the right speed’. It is about doing things as well as possible rather than as fast as possible. Slow occupation is something that occupational therapists might wish to consider in our increasingly fast-paced world. Slow occupation is about giving ourselves permission to relax, unplug and savour time. This may be beneficial to occupational therapists and clients alike. This workshop will focus on the slow occupation of slow stitching, based on the work of Claire Wellesley-Smith (2015). Slow occupation has value when undertaken on an individual basis and in groups. Group engagement provides opportunity for dual connection with the materials used and with fellow group members. Session plan: Participants will be introduced to slow hand stitching using simple running stitches. Different textiles, needles and threads will be available for participants to experience the feel of materials, to appreciate colours, to take time choosing and to reflect on choice. Participants will be given the opportunity to engage mindfully and connect with a simple sewing project, exploring stitching and where it takes them. No sewing experience is required. Resources: A large room with tables