Occupational Therapy and Arts Therapies
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7189
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Item MU-BEING: MUSIC THERAPY WITH YOUNG PEOPLE FROM MULTICULTURAL BACKGROUNDS IN SOUTH KOREA(Queen Margaret University, Edinburgh, 2025-05) Oh, JoonThis study began with reflective questions regarding the fundamental meaning of music therapy in a multicultural context. The purpose of this study is to explore how music therapy can support the well-being of young people from multicultural backgrounds, how young people and their communities experience music therapy, and what role the therapist’s beliefs, values, and attitudes play in the process. Five young people participated in ‘Mu-Being,’ a music therapy programme developed from the values of Person-Centred Practice and an understanding of the unique contexts of young people and their community. A multimethod based on a multi-paradigmatic approach, consistent with the project’s motivating values and ideas evolved: it included measuring multidimensional well-being, interpretive phenomenological process guided by lifeworld existentials, and arts-based work. The improvement in the social aspects of well-being highlights the role of music therapy practice in challenging and unprecedented contexts. Young people’s music, histories, and the ways in which they participated played a key role in collaboratively developing the conditions for flourishing. Mu-Being facilitated a safe, creative space for young people to experiment and integrate their identities and needs, a transcendent time to cross various existential boundaries, and transformative relationships through shared musical experiences with the local community. Reflective music composition as a way of knowing demonstrated the potential of music to explore aspects of experience that are difficult to identify through numbers and text. The project places music therapy practice at the intersection of well-being theory, personcentred practice framework, and arts-based inquiry, and its transdisciplinary nature fosters multifaceted discussions and resources that can contribute to the development of programmes encompassing the authentic voices of young people and their context; offers an understanding of how person-centredness can be realised in practice; demonstrates how data from various sources can be used together to explore music therapy experiences and their impact.Item INVESTIGATING THE ASSOCIATION BETWEEN FEATURES OF THE ENVIRONMENT AND PARTICIPATION FOR PEOPLE WITH COMPLEX MENTAL HEATLH DIFFICULTIES IN MENTAL HEALTH REHABILITATION SERVICES(Queen Margaret University, Edinburgh, 2025-05) Jose, Akkara LionelBackground: This research investigates the influence of environmental features on the participation of individuals with Complex Mental Health Difficulties (CMHDs) in supported accommodation. The study aims to understand how physical and social environments affect the daily lives and rehabilitation outcomes of residents. Through a comprehensive literature review, the study highlights the importance of participation and participation-related factors such as motivation, habits, roles, responsibilities, and skills. The literature review emphasises the significance of social participation and explores its influence on creating a facilitative and supportive supported accommodation environment. Methods: The research consisted of two studies: a systematic review and a secondary data analysis. The systematic review aimed to identify participation and participation-related factors in the current literature. The review used available data in the studies to calculate an association between the level of support and participation. The secondary data analysis utilized a dataset from one NHS health board to identify an association between social and physical features of the environment and participation and the level of support. The study employed the Residential Environment Impact Scale to measure the features of the environment and utilized a series of univariate and multivariate regression models. Results: The results found a significant association between social features of the environment, specifically ‘Enabling Relationships,’ and both participation and the level of support. The results also identified a significant association between age and both participation and the level of support. The use of various models highlighted the importance of the features of the environment as a significant independent variable when accounting for various confounding variables. Conclusion: The study highlights the importance of the social environment over the physical environment when assessing participation. Results suggested that individuals with better social environments were more independent and had higher levels of social participation. The study challenges the current consensus on variables used to assess the quality of the support environment and highlights the importance of social features of the environment when assessing participation in supported accommodation. It encourages a shift to more holistic approaches and advocates for the use of reliable measures of the environment.Item An Investigation of Adolescent Psychosocial Factors and Disengagement from Education and Employment Among Individuals with Common Mental Health Problems(Queen Margaret University, Edinburgh, 2022) Tayfur, Sumeyra N.Background: Participation in employment and education have been highlighted as key to health and wellbeing. Adolescents with common mental health problems are at risk of being “not in education, employment or training” (NEET) in young adulthood which negatively influences their life chances. Therefore, it is important to address the determinants of education and employment outcomes for this population. Methods: A systematic review and meta-analyses focusing on adolescent psychosocial factors associated with participation in education and employment in young adulthood was completed. This was followed by a quantitative analysis of data from the Next Steps cohort study using waves 2 and 8 which supplied evidence on 2,224 adolescents with common mental health problems in England, United Kingdom. Different statistical techniques were used to examine associations. Results: Fourteen articles were included in the systematic review providing evidence on adolescent psychosocial factors that mapped into seven domains, namely, behavioral problems, peer problems, substance use, prosocial skills, self-evaluations, aspirations, and physical activity. Secondary data analysis suggested that adolescents with common mental health problems who were disengaged as young adults were more likely to be female, have lower socioeconomic status, live in single/no parent households, and have caring responsibilities. Lower self-esteem, external locus of control, no job aspirations, and low/no physical activity increased the likelihood of becoming NEET whereas more positive attitudes to school and avoiding being bullied decreased the likelihood after adjustment for background characteristics. Conclusion: Psychosocial factors play an important role in disengagement from education and employment after compulsory education for adolescents with common mental health problems. School-based interventions during secondary school focusing on psychosocial factors, particularly physical activity could be helpful. The findings encourage provision of targeted mental health support at school, community, and clinical settings to prevent undesired educational and employment outcomes and improve life chances for at-risk youth.Item The relevance of cultural arts practices to the psychosocial well-being of adolescents affected by violence in Trinidad and Tobago(Queen Margaret University, Edinburgh, 2021) Soo Hon, Sarah A.This research focuses on the relevance of cultural arts practices to the psychosocial wellbeing of adolescents affected by violence in Trinidad and Tobago. Previous research identified the need for further inquiry into the use of sustainable interventions with youth in communities affected by poverty and violence (Ryan et al., 1997), since adolescents exposed to violence experience cumulative negative effects, and often display violence and delinquency themselves (Benedini & Fagan, 2018; Foote, 2010; Office of the SRSG on Violence against Children, 2016; Savahl et al., 2013). This research seeks to understand the psychosocial effects of community violence on the wellbeing of adolescents as well as the therapeutic value of cultural arts practices for affected adolescents. It explores the development of approaches to art as therapy, to understand how the psychosocial wellbeing of adolescents might be enhanced. This participatory ethnography utilizes mixed qualitative methods of data collection with students and teachers at a school affected by community and school violence. The relevance of cultural arts practices to the psychosocial wellbeing of adolescents is a complex area of inquiry, given the diversity of the population and the historical and social context of a community affected by violence. Findings that impact the psychosocial wellbeing of adolescents and any implications of these for the fields of art therapy and research on community violence are discussed.Item Exploring the benefits and challenges of volunteering: Participatory action research with people with lived experience of mental illness(Queen Margaret University, Edinburgh, 2020) Hunter, Heather M.Volunteering is associated with a range of health and employability benefits. However, there is limited evidence of the collective experience of volunteering for people recovering from mental illness. This thesis presents a participatory action research project in collaboration with a group of ten working age adults comprising four men and six women of white British ethnicity, predominantly Scottish and all living in the same Scottish city. All had lived experience of mental illness; many had significant experience of volunteering and all were actively engaged at the time of the research in unpaid volunteering in the community through personal choice as part of their recovery journey. The aim of the project was to hear about the benefits and challenges of volunteering including the positives and negatives of sociopolitical and welfare systems that support people with lived experience of mental illness to volunteer, with a view to producing something through action that would be of benefit to the group and/or the wider community. Participants took part in a preliminary interview and attended a series of five participatory action research groups. Thematic data analysis of the interviews was carried out by the researcher. Data generation and analysis of the PAR groups was combined and followed Freire’s (1970, p. 80; p. 104) process of “problem posing” and “conscientization” or critical consciousness raising where participants by asking critical questions about their situation recognised the potential for transformation. Data analysis of the PAR groups was collaborative, iterative, cumulative and coconstructed with themes revisited and revised by participants. Findings revealed factors that supported and hindered a positive volunteering experience including challenges from the socio-political impact of welfare reform. Participants produced a briefing paper to inform newly devolved powers supporting the Social Security (Scotland) Bill to support change at policy level and resolve the problem of mandatory volunteering in Scotland. This project has generated a new understanding of the experience of volunteering for people with lived experience of mental illness proposing an original theory of five conditions for successful volunteering that are necessary to support recovery namely: readiness and support to volunteer; synergy between volunteer and experience to ensure volunteering is meaningful; flexibility to stay well; opportunity to meet needs for identity and connectedness; and opportunity for influence and activism. Findings have also highlighted the negative effects of neoliberal welfare policies on the experience of volunteering for out-of-work disabled welfare recipients; demonstrated how PAR contributes to positive socio-political change with findings supporting Scottish Government policy development; and exposed how at a practice level the hegemony of paid work dominating occupational therapy vocational services limits an understanding of volunteering to one viewed solely through a work lens, with limited critique.Item The resilience of older adults receiving hospital care: Validation of the Making it CLEAR questionnaire, and an exploration of protective and vulnerability factors(Queen Margaret University, Edinburgh, 2020) Whitehall, LucyBackground ‘Resilience’ is the process by which individuals adapt to and manage adversity. Through the identification of older adults who may struggle to ‘adapt well’ following health difficulties, resilience research may support health improvement. As resilience is influenced by an individual’s personal characteristics, resources, and physical and social environment, resilience measures that comprehensively capture resilience are important. Furthermore, due to the contextual nature of resilience, research findings should not be generalised across populations who experience unique adversities. Despite this, most resilience measures used with older adults assess resilience at the individual level, and current resilience research has largely recruited community-dwelling older adults, preventing the findings from being generalised to those receiving hospital care. The Making it CLEAR (Community Living, Enablement and Resilience) (MiC) questionnaire was designed to measure the individual and environmental determinants of an older adult’s resilience. This work focuses on assessing its validity with a population of older adults receiving inpatient care and uses the data to investigate the protective and vulnerability factors of this population. Methods The study analyses data collected from older adults recruited during acute hospital admission across three Medicine of the Elderly wards. Exploratory factor analysis and item analysis was used to assess the validity of the MiC questionnaire, while item response analysis identified the key ‘resilience needs’ of the population. Regression analyses identified the protective and vulnerability factors of the sample and investigated the mediatory effect of self-efficacy on the relationship between frailty and resilience. Results Exploratory factor analyses and item analysis demonstrated acceptable construct validity, internal consistency, discriminant validity, and item difficulty for each subscale of the MiC questionnaire. Multiple regression analysis found that gender, marital state, perceived physical and mental health, and receipt of a daily care package predicted individual determinants of resilience. Religion, frailty status, perceived physical and mental health, and visual impairment predicted environmental determinants of resilience. Self-efficacy was found to mediate the relationship between frailty and resilience; and low self-efficacy, poor person-environment fit, and a lack of social support from friends were identified as the most common resilience needs. Conclusion The results demonstrate that the MiC questionnaire is a valid measure of both the individual and environmental determinants of resilience of older adults during hospital admission, thus supporting the use of the MiC questionnaire with this population. In addition, the regression analyses suggest potential characteristics of older adults with low resilience, while the identified resilience needs are suggested as potential priorities for targeted intervention.Item Improving outcomes in autism spectrum disorder through effective service provision: diagnostic assessment pathways and parent focussed interventions [PhD by publication](Queen Margaret University, Edinburgh, 2020) Rutherford, MarionIntroduction: This thesis on the topic of autism spectrum disorder presents six publications focussed on research about improving outcomes through effective service provision, together with a critical appraisal, which adds depth and breadth to the reasoning and decision making involved in this work. The work follows an iterative process and is positioned from a pragmatist philosophical standpoint, using mixed methods to clarify shared language, concepts and meanings and to ensure translation of research findings into real world practice. The thesis provides evidence of the urgent need for research to inform services as to how they might address the issue of delays in ASD assessment and diagnosis, alongside better understanding of which interventions improve wellbeing outcomes. Aims: This portfolio of published research has arisen from three related research programmes, with the unifying objectives of: 1. Adding to clinical and research knowledge of current ASD service provision across the lifespan and how that might be improved through adherence to ASD clinical guidelines; 2. Reducing family stress associated with ASD by reducing delays in diagnosis through identification of factors which influence efficiency and quality in a diagnostic pathway, and; 3. Developing understanding of the effectiveness of parent focused interventions to inform future research and practice. The critical appraisal aims to: (a) Explore key areas for debate that have arisen in the work, which transcend the individual publications; (b) Position this debate within the context of international literature, research evidence and theory in relation to autism, implementation science and pragmatist epistemology underpinning the work; (c) Highlight the contribution of this research to the advancement of clinical practice and research knowledge, and the potential for further clinical reach and informing evidence based practice through diffusion of innovation. Methods: Research aims, methods and outcomes are presented within a series of publications, using mixed methods to seek to address these. Findings: Through this research, it was identified that the wait for diagnosis in child and adult services, from referral to diagnosis shared, exceeds the recommended 119 day time standard in 74% of child and 59% of adult services. There was a significant difference in mean age of referral and diagnosis for girls compared to boys and this delay occurred prior to referral through delayed recognition rather than through delays in the assessment process. Findings provide strong evidence of the need to address the way we collectively deliver ASD services. This research identified factors which influence waiting times in child and adult services. These included the availability of relevant pre-referral information at first appointment, consideration of the number of contacts or appointments used to reach a conclusion and complexity of the case. Mixed methods were used to further identify a broader range of factors affecting wait times in each service and to develop child and adult action plans as proposed solutions that could be applied by local service providers. Plans developed were then successfully applied in a 12 month service improvement intervention with 11 adult services, resulting in a statistically significant reduction in duration of assessment (b=-0.25, t(136) = -2.88, p=0.005), taking the duration to within the recommended timescale. In child services, this model also led to a statistically significant reduction in waiting times for diagnostic assessment and increased identification of girls with ASD. Systematic review and meta analysis of parent focused intervention for older children and adults found that a) parent training and education and b) mindfulness interventions provide measureable improvements in family wellbeing, which in turn are known to have a reciprocal effect on the individuals with ASD. A number of recommendations for future research arise from this work. These include the aspiration for an ASD specific wellbeing measure which can be applied with greater consistency across ASD intervention studies; and the need for consensus on theoretical models to underpin evaluation of complex interventions in ASD, which in turn may lead to deeper understanding of which elements of interventions are most effective in which circumstances. Conclusion: In a field where research evidence has been lacking, this body of work applies a range of research methods, in order to add to the evidence base and provide practical steps, which clinical service providers could apply, to reduce the delays in diagnosis. Earlier access to ASD specific interventions, as a result of earlier diagnosis, has the potential to improve wellbeing for individuals with ASD and their families. Despite limitations of the research on ASD parent focused interventions for older children and adults, findings reported here add further support to the ASD clinical guideline recommendations to use such interventions.Item AN EXPLORATORY SECONDARY DATA ANALYSIS OF THE IMPACT OF HETEROGENEITY ON ASSISTIVE TECHNOLOGY TO REDUCE SAFETY AND WANDERING RISKS FOR PEOPLE WITH DEMENTIA LIVING AT HOME(Queen Margaret University, Edinburgh, 2020) Curnow, EleanorIntroduction: There is an acknowledged gap between the potential and achieved benefit of assistive technology in the care of people with dementia. In order to make better use of this resource, this research aimed to investigate the heterogeneity of population characteristics of people with dementia living at home who have safety and wandering risks and how this is related to assistive technology recommended and installed to meet their needs. Methods: This research consisted of two studies; a systematic review and secondary data analysis. Initially, published quantitative data describing the needs of people with dementia living at home was subjected to meta-analysis in order to explore the prevalence of needs reported by people with dementia and their caregivers and associated heterogeneity. Following univariate analyses, ordinal models were developed using secondary data which described the needs of people with dementia, and their level of wandering and safety risk, to explore the relationship between needs and risks in this population. The possibility of grouping participants according to data describing multiple needs, predisposing characteristics and enabling resources was investigated using cluster analysis. Associations between these groups and recommended and installed Assistive Technology were investigated. Results: Prevalence estimates for twenty-four needs reported by people with dementia and their caregivers were provided for the first time. Heterogeneity was associated with the person reporting the needs and age of onset. Level of need was often not recorded in the dataset indicating limited assessment. Wandering risks were shown to be associated with posture and mobility, routine and cognition needs, whilst safety risks were associated with posture and mobility, and problem-solving needs. Partitioning Around Medoids cluster analysis demonstrated that robust clustering solutions could be created from data describing participants. Clustering solutions were then validated through exploring their association with recommended and installed Assistive Technology data and the published literature. Caregiver support and living situation impact Assistive Technology installed for people with dementia. Discussion: This research advances understanding of the impact that needs, safety and wandering risks, caregiver support and the living situation of the person with dementia have on variation in the assistive technology interventions recommended and installed for people with dementia. Results have implications for needs assessment and for the tailoring of Assistive Technology for this population. Keywords: dementia, assistive technology, community dwelling, meta-analysis, cluster analysis, ordinal regression, wandering, safety, risk, needs.Item THE CHARACTERISTICS AND COMMUNITY-BASED PARTICIPATION OF CHILDREN WITH DISABILITIES AGED 10-12 YEARS IN THE UNITED KINGDOM(Queen Margaret University, Edinburgh, 2020) Arakelyan, StellaIntroduction: Participation is a key therapy and health promotion outcome for children with disabilities. This thesis contributes to childhood disability participation literature by (a) synthesizing evidence on family factors consistently associated with the participation of children with disabilities, (b) providing evidence on characteristics, family circumstances and community-based participation of a nationally representative sample of children with and without disabilities, and (c) identifying factors associated with participation frequency of children with disabilities in community-based social and physical activities. Methods: A systematic review focusing on family factors consistently associated with participation was completed. This was followed by a quantitative analysis of data from the fifth sweep of the Millennium Cohort Study (MCS5) (2012-2013) which supplied evidence on 1,073 children with disabilities and 11,122 children without disabilities aged 10-12 in the United Kingdom. Chi-squared and logistic regression analyses were used. Results: Thirty studies included in the review provided evidence on non-modifiable family “status” factors and modifiable family “process” factors. “Status” factors consistently associated with participation were parental ethnicity, parental education, family type and family socio-economic status. Family “process” factors with consistent associations were parental mental and physical health functioning, parental self-efficacy beliefs, parental support, parental time, family preferences, and activity orientation. Quantitative data suggested that children with disabilities were more likely to be boys, have psychosocial and behavioural problems, live in single-parent households and have a parent with a longstanding illness compared to peers without disabilities. They also had greater restriction in community-based participation, especially in social and physical activities. Child psychosocial and behavioural problems, ethnicity, parental education, family income, parental physical activity, parental play of physically active games with a child and parental social support had independent effects on participation frequency of children with disabilities in social and physical activities. Conclusion: Support services for children with disabilities and their families should be strengthened. Interventions targeting child psychosocial and behavioural functioning and immediate social environment are required to promote children’s participation in community-based social and physical activities. Revisions to the “immediate family” component of the WHO’s conceptual framework for functioning, disability and health of children and youth are proposed. Keywords: children, disability, characteristics, participation, family factors, environment, community activitiesItem REALISING AUTHENTIC OCCUPATIONAL THERAPY THROUGH PROFESSIONAL ARTISTRY: UNCOVERING THE NATURE AND CONTEXT OF PRACTICE FOR PERSONS LIVING WITH DEMENTIA(Queen Margaret University, Edinburgh, 2018) Kinsella, NiamhBackground: All occupational therapists in the UK are expected to engage in and develop evidence-based, person-centred practice in order to provide therapy that facilitates well-being through occupation. There has been recognition in occupational therapy literature that differences often exist between the values the underpin research evidence and occupational therapists’ professional values, and that practice culture and context influence the way research evidence is used in practice. However, current research into practice with persons living with dementia suggests that the contextual influences on practice have not been adequately considered. This has resulted in research and practice examples that reflect a compliance-orientated model of evidence-based practice. In such examples research guidelines and protocols are applied directly to practice, despite recognition that consideration of contextual factors and other forms of evidence enable creative practice that is meaningful for both persons living with dementia and occupational therapists. This study set out to explore the components of context that facilitate evidence-based practice congruent with professional values, and the values of the person living with dementia, as well as the nature of such practice. Approach and methods: This research is underpinned by a theory of critical creativity, which facilitates understanding, and guides deconstruction, of context through use of creative expression, imagination, and ancient wisdom and traditions. Creativity acts as a vehicle to transform embodied knowledge about the nature of practice to language, through reflection. It also enables blending of worldviews for the purpose of developing research praxis. A critical creativity methodology facilitated exploration of context and foregrounding of the issues that were influencing occupational therapists’ practice. Observation, critical creative reflection, and critical creative dialogue were layered to develop an understanding of the interplay between context and practitioners’ values and action, and the nature of their actions in practice. ii Findings: The findings of the exploration of practice context revealed that occupational therapists appeared to feel fear and anxiety about exploring and sharing their practice as a consequence of conflicting understandings about the way research evidence should be used in practice. Occupational therapists’ engagement in evidence-based practice and intervention ‘roll-out’, which are underpinned by learning that is often removed from practice context, resulted in practice that was often compliance-orientated and devoid of critical reflection. These contextual influences limited occupational therapists’ ability and opportunity to embody person-centred values that they hold, namely to make autonomous decisions about their practice with person(s) living with dementia and their families. Additionally, their engagement in developing professional artistry and creative practice was hindered, and their energy for practice development depleted. Conclusions and implications: Occupational therapists require contexts that are conducive to human flourishing to facilitate exploration, dialogue and development of creative, reflective practice. Such contexts consist of psychologically safe spaces, facilitative leadership, and researchers and practice developers that support all ways of knowing, being and doing in practice, to encourage contextually appropriate learning and practice enquiry. Facilitation of practice development in such contexts should be done in collaboration with practitioners. In such contexts, the contextual relevance of practice policies and guidelines that are heavily informed by technical-rational research evidence should be closely and critically considered. Development of such contexts and developmental approaches could result in authentic practice, in which occupational therapists can embody their values and blend research evidence with other ways of knowing, being and doing, and realise their professional identity. Keywords: occupational therapy, dementia, professional artistry, critical creativity, authentic, context, person-centred, compliance.