Toward Understanding Person–Place Transactions in Neighborhoods: A Qualitative-Participatory Geospatial Approach

Background and Objectives Emerging research regarding aging in neighborhoods emphasizes the importance of this context for well-being; however, in-depth information about the nature of person–place relationships is lacking. The interwoven and complex nature of person and place points to methods that can examine these relationships in situ and explore meanings attached to places. Participatory geospatial methods can capture situated details about place that are not verbalized during interviews or otherwise discerned, and qualitative methods can explore interpretations, both helping to generate deep understandings of the relationships between person and place. This article describes a combined qualitative-geospatial approach for studying of older adults in neighborhoods and investigates the qualitative-geospatial approach developed, including its utility and feasibility in exploring person–place transactions in neighborhoods. Research Design and Methods We developed and implemented a qualitative-geospatial approach to explore how neighborhood and person transact to shape sense of social connectedness in older adults. Methods included narrative interviews, go-along interviews, and global positioning system tracking with activity/travel diary completion followed by map-based interviews. We used a variety of data analysis methods with attention to fully utilizing diverse forms of data and integrating data during analysis. We reflected on and examined the utility and feasibility of the approach through a variety of methods. Results Findings indicate the unique understandings that each method contributes, the strengths of the overall approach, and the feasibility of implementing the approach. Discussion and Implications The developed approach has strong potential to generate knowledge about person–place transactions that can inform practice, planning, policy, and research to promote older adults’ well-being

Understanding uncertainty in young-onset Parkinson disease

Objectives Individuals living with young-onset Parkinson’s disease compose a rare subtype of a disease typically associated with older age. Situated within a large grounded theory study exploring information behavior, this paper describes the core category of the theory, i.e. uncertainty. Methods Data were collected with 39 individuals living with young-onset Parkinson’s disease who took part in in-depth interviews, focus groups and/or an online discussion board. Fourteen autobiographies written by individuals living with young-onset Parkinson’s disease were also used as data sources. Results Through experiencing young-onset Parkinson’s disease, participants were confronted with uncertainty along two main lines. First, they experienced uncertainty with respect to their identities as young- and middle-aged adults, deviating from the idealized age-graded life path marked out within their socio-cultural context. Second, they experienced uncertainty with respect to their functioning, as the heterogeneous nature of Parkinson’s progression meant that it would not be possible to chart how their disease would change over time. This uncertainty was associated with feelings of lost control over their lives and increased grief. Discussion With a deeper appreciation for how uncertainty is experienced in the lives of those with young-onset Parkinson’s disease, health professionals may be better prepared to discuss these issues with patients and provide support and resources. </jats:sec

Panel Presentation - Critical occupational science: Ethical, philosophical and political frameworks

A recent ‘critical turn’ in occupational science challenges the discipline to expand upon being a basic science focused on the human as an occupational being or the nature of occupation (Angell, 2012; Frank, 2012; Laliberte Rudman, 2013; Sellar, 2012). This critical turn encompasses a vision of occupational science as a socially responsible intellectual and moral enterprise aimed at enhancing awareness of occupational inequities and injustices and acting to bring about social transformation and enable occupation as ‘a human right’. Excitingly, this challenge is being responded to and a growing body of work in occupational science is attempting to enact what, in this panel, will be framed as ‘critical occupational science’. This activity among occupational scientists intersects with recent international developments to develop politically oriented occupational therapy. Given that critical scholars emphasize the need for continuous collective reflexivity regarding the ethical and political underpinnings and drivers of their work (Sayer, 2009; Sellar, 2012), this panel aims to provoke such reflexivity by considering questions pertaining to: (a) how critical occupational science might be framed or defined, (b) how it has been enacted thus far in relation to epistemology and methodology, (c) how it could be enacted in the future, (d) what might be its moral or ethical base, and (e) what it can add to the study of occupation and the capacity of the discipline to be socially and politically responsive and responsible. To promote this dialogue, each panelist will provide critical reflections on her occupational science work which has embraced a critical turn, sharing both the promises and challenges of such work. The panelists draw on various theoretical influences (e.g. Foucault, Black feminist theory, American pragmatist and neo-pragmatist thought, the capabilities approach, critical medical anthropology, globalization theory, Freirian-style pedagogies of the oppressed, and varieties of neo-Marxist and poststructuralist thinking); methodologies (e.g. critical ethnography, critical interpretive synthesis and critical discourse analysis); and substantive topic areas (e.g. aging, poverty, social justice, and international development). Thus, the panel presentation will both address the diversity that can exist within critical occupational science and also point to key anchors and defining features. Following these presentations, the session will be opened to dialogue with the audience to further refine the meaning and possibilities of critical occupational science. Key words:collective reflexivity, critical paradigm, ethic

Enhancing Client-centeredness in Parkinson\u27s Disease Care: Attending to the Psychosocial Implications of Lived Experience

Evidence-based practice requires that clinicians interpret the best research evidence in the context of their clinical experience, while at the same time considering client knowledge and experiences. Although clinicians are becoming increasingly skilled at the evaluation of research evidence, the evidence-based practice process often neglects client values and self-identified health issues. Ignoring these key aspects of client-centered practice may lead to interventions that fail to target the implications of a client’s disease that are important to occupational participation and quality of life (QOL). A focus on client-centeredness is particularly important in progressive neurodegenerative disorders, such as Parkinson’s disease, where there are no known curative treatments, and interventions must instead focus on symptom management. In this paper, we explore the published literature on the psychosocial aspects of the lived experience among individuals with Parkinson’s disease, arguing that such literature provides insight into the implications of the disease and into potential treatment priorities. As such, this literature provides an additional form of evidence that raises awareness of the lived implications of this disease for clients’ occupations and QOL that, in turn, may lead clinicians to be more cognizant of client values and self-identified issues

Beyond traditional notions of validity: Selecting appropriate measures for occupational therapy practice.

Increasingly, tied to factors such as increased emphasis on accountability and health care spending restraints, occupational therapists are required to implement evidence-based practice. When implementing evidence-based assessment, it is critical that occupational therapists examine and challenge some of the assumptions underlying the current use of measures, as well as the conclusions being drawn from their use. In order to most effectively judge the appropriateness of measures informing their assessments, interventions and recommendations, occupational therapists must draw upon measurement theory and concepts. To date, occupational therapy literature has predominantly emphasized a narrow conceptualization of validity that focuses on empirical evidence. The work of Samuel Messick provides a more comprehensive framework of construct validity that considers both empirical and ethical issues. This framework binds the social consequences of assessment to the evidential basis of test interpretation and use, and challenges occupational therapists to broaden their consideration of validity by addressing both ethical and empirical issues when choosing measures

Mapping occupational engagement during long-term unemployment: Interconnections and cross-national comparisons of people, places and performances

Statement of Purpose: This presentation will report one set of findings from a two-sited, multi-year study of long-term unemployment. Rates of long-term unemployment remain higher than pre-recession estimates despite North American economies’ return to nearly full employment. To understand possibilities and boundaries for occupational engagement within the situation of long-term unemployment, we generated data at three levels in the United States and Canada: we interviewed 15 organizational stakeholders and reviewed organizational documents; we interviewed and observed 18 front-line employment support service providers; and we interviewed, observed, and completed time diaries and/or occupational maps with 23 people who self-identified as being long-term unemployed. In this presentation, we report findings from the occupational mapping process used with 18 participants. Methods: Occupational mapping is an elicitation method that is as much about process as it is about product. In our study, we asked participants to hand draw a map to explain the places they regularly traveled within their communities. We prompted participants to describe what was being drawn, the places depicted, activities engaged in within particular places, and modes of travel used. Once the map was completed, we asked participants to reflect on if and how their experience of long-term unemployment had implications for where they went, how they got to places, and the types of activities they needed and wanted to do. We audio-recorded all conversations during the mapping process. Our ongoing analyses of maps and accompanying transcriptions address the types of places and occupations represented; the ways in which maps and transcriptions illuminate social, political, and economic influences on occupation in each study context; common threads between maps; and omissions in maps. Results: We will present emerging findings from our occupational mapping process in relation to national context, gender, financial and transportation resources, and family situation. We will also integrate these findings with understandings gained through other analytic approaches used in the study, such as situational analysis and critical narrative inquiry. Implications: Occupational mapping can elicit details about everyday doing that are difficult to articulate using narrative methods given the tacit and experiential nature of daily occupations. It can be a useful strategy for understanding interconnections between people, places, and performances of everyday occupations in line with calls to transcend individual perspectives in occupational science. Our findings suggest that this method is a valuable means of illuminating the transactional person-environment relationships that shape occupational engagement during contemporary long-term unemployment. Discussion questions: In what ways can occupational mapping augment other data generation and analysis approaches? How does occupational mapping fit within larger efforts to transcend individual perspectives in occupational science? Within a multi-level, cross-national study of long-term unemployment, what kinds of understandings does occupational mapping yield? Key words: Occupational mapping, long-term unemployment, critical qualitative researc

Enhancing Client-centeredness in Parkinson's Disease Care: Attending to the Psychosocial Implications of Lived Experience

Evidence-based practice requires that clinicians interpret the best research evidence in the context of their clinical experience, while at the same time considering client knowledge and experiences. Although clinicians are becoming increasingly skilled at the evaluation of research evidence, the evidence-based practice process often neglects client values and self-identified health issues. Ignoring these key aspects of client-centered practice may lead to interventions that fail to target the implications of a client’s disease that are important to occupational participation and quality of life (QOL). A focus on client-centeredness is particularly important in progressive neurodegenerative disorders, such as Parkinson’s disease, where there are no known curative treatments, and interventions must instead focus on symptom management. In this paper, we explore the published literature on the psychosocial aspects of the lived experience among individuals with Parkinson’s disease, arguing that such literature provides insight into the implications of the disease and into potential treatment priorities. As such, this literature provides an additional form of evidence that raises awareness of the lived implications of this disease for clients’ occupations and QOL that, in turn, may lead clinicians to be more cognizant of client values and self-identified issues