Occupational Therapy and Arts Therapies
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/25
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Item Are we getting better at identifying and diagnosing neurodivergent girls and women? Insights into sex ratios and age of diagnosis from clinical population data in Scotland(Sage, 2025) Maciver, Donald; Roy, Anusua Singh; Johnston, Lorna; Boilson, Marie; Curnow, Eleanor; Johnstone-Cooke, Victiora; Rutherford, MarionThis study examined differences in referral and diagnosis based on sex recorded at birth (hereafter, ‘sex’), using case notes from 408 individuals diagnosed by 30 multidisciplinary teams across Scotland. Analyses focused on male-to-female ratios and median ages at referral and diagnosis across attention-deficit/hyperactivity disorder, autism and intellectual disability. The lifespan male-to-female ratio across all diagnoses was 1.31, varying by category and age. In autism, the male-to-female ratio was 2.21 for children under 10 years, but there were more females in adolescence (male-to female ratio=0.79) and adulthood (male-to-female ratio=0.94). Across the lifespan, combining all diagnoses, females were referred later (median ages: 14.4 vs 19.7 years; p<0.001) and diagnosed later (median ages: 15.2 vs 20.2 years; p<0.001), indicating a 5-year delay. Among autistic children and adolescents, females were referred later (median age: 7.5 vs 10.5years; p=0.002) and diagnosed later (median age: 9.3 vs 11.9years; p=0.003). However, no significant differences were found in age of referral or diagnosis for autistic adults. Overall, the results indicate partial equalisation of sex ratios across the lifespan, pronounced asymmetry in younger age groups, andconsistent delays in referral and diagnosis ages for females.Item Reset: Designing Community-Based, Resilience-Affirming Support for Older Adults Through Participatory Action Research - An Environmental Perspective(Emerald, 2025) Górska, Sylwia; Desogus, S.; Moffat, P.; Gunn, L.; Irvine Fitzpatrick, L.Purpose: This paper presents key learning from the Reset programme, an innovative, intersectoral collaboration designed to transform community-based health and social care (HSC) for older adults. The programme aimed to deepen understanding of and enhance post-hospitalisation resilience, improve access to existing resources, and strengthen community connections. Methodology: The programme employed a Participatory Action Research methodology to co-produce and implement resilience-focused, evidence-based HSC across four localities in the city of Edinburgh, Scotland. Data was collected through interviews and focus groups with older adults, referring agencies, community partners, informal carers, and the HSC support team. Narrative data was also gathered by HSC support staff through one-to-one key work, while ongoing reflective practice informed continuous learning and adaptation. Findings: The research confirmed a dynamic, reciprocal relationship between older adults and their environment in shaping resilience outcomes. It expanded understanding of how physical, digital, and social environments can enable or hinder resilience, highlighting the impact of systemic cultural factors within HSC, and broader societal structures. Originality/value: This study offers original insights into participatory, intersectoral approaches to supporting ageing in place. It deepens understanding of environmental determinants of resilience in later life and provides evidence-based recommendations for policy, practice, and research. The co-produced, community-centred approach highlights the value of relational support in improving outcomes for older adults.Item Third Sector Perspectives on Community Link Worker Referrals in Social Prescribing: A Realist Analysis(Frontiers Media, 2025-10-08) Allbutt, Helen; Maciver, Donald; Leitch, Alison; Crandles, Anne; Fitzpatrick, Linda IrvineIntroduction Community Link Workers (CLWs), also known as social prescribing link workers, connect individuals to community support, much of which is provided by third-sector organisations (TSOs). TSOs are common referral destinations for CLWs, yet the relationships between CLWs and TSOs remain under-explored. Method This realist study investigated TSOs’ perceptions of link working, focusing on referral and collaboration dynamics. Conducted across 22 TSOs in Scotland, it involved in-depth interviews with TSO staff and consultations with CLWs and managers, analysing data via realist heuristics to identify contexts, mechanisms, and outcomes. Results Targeted referrals by experienced CLWs, with follow-up, and strong TSO-CLW relationships, improved client health, wellbeing, and independence while reducing reliance on statutory services. These processes fostered professionals’ trust, satisfaction, and innovation, creating a positive feedback loop. Conversely, inconsistent referrals, such as over-referral or scattergun approaches, compounded by resource constraints and perceptions of inequitable partnerships, led to suboptimal client outcomes, dissatisfaction, and weakened collaboration. Important contexts included extreme resource pressures, varying CLW expertise, and perceptions of power imbalances. Discussion Effective social prescribing needs sustained TSO-CLW collaboration, supported by third-sector investment and tools for equitable partnerships. Rather than a referral process, social prescribing should be envisioned as a community of practice, defined by relationships, a common purpose and shared responsibility for challenges and solutions. Future models should prioritise strengthening statutory and third-sector trust and collaboration.Item Developing the Playground Play Value and Usability Audit (PVUA) Tool: An Evaluation of Content Validity via an Expert Panel(Project MUSE, 2025-08) Morgenthaler, Thomas; Loebach, Janet; Lynch, Helen; Pentland, Duncan; Kottorp, Anders; Schulze, ChristinaThis study describes procedures for developing and exploring the content validity of a tool to audit playgrounds for play value and usability for diverse populations. Development of the tool included reviewing existing tools, creating an initial draft from evidence literature, followed by iterative rounds with an international, interdisciplinary expert panel (N=22). Panelists' comments and ratings of relevance and clarity supported refinements of items, content areas, scoring, instructions, and interpretations of the PVUA content. The preliminary tool consists of 203 items divided across 28 content areas and two domains. Future research should examine PVUA's reliability and construct validity using a diverse sample of playgrounds.Item Contextual factors influencing neuro-affirming practice – identifying what helps or hinders implementation in health and social care(SAGE Publications, 2025-09-09) Gray, Anna; Johnston, Lorna; Rutherford, Marion; Curnow, Eleanor; Maciver, DonaldThere has been limited research to date into contextual factors hindering or supporting the successful implementation of neuro-affirming practice in support for Autistic and otherwise neurodivergent adults. We used a Realist Evaluation approach to explore key contexts affecting neuro-affirming practice. A preliminary programme theory of key aspects of support was developed. Views on current practice were sought through structured interviews with 32 senior professionals in leadership roles within Health and Social Care services in Scotland. This study identified important contexts shaping the implementation of neuro-affirming practice for adults. Results indicate widespread professional support for modifying practice to better accommodate neuro-affirming ideas, and scope to achieve this. However, some contexts, including limited resources, restrictive eligibility criteria and rigid service structures, hinder progress. Growing demand for services was often viewed as a restrictive context, but it also offered a chance to rethink conventional, one-size-fits-all models and adopt neuro-affirming approaches. The study is important in addressing a current gap in research into professional perspectives of the contexts required to develop transdiagnostic, neuro-affirming approaches and pathways for Autistic and neurodivergent adults. The insights from this study may offer transferable practice approaches, applicable across different countries with similar healthcare contexts.Item Unveiling mirror-writing: Exploring the phenomenon in typically developing children within the Greek school context(SIG Writing of EARLI, 2025-06-03) Kanitaki, EleniMirror-writing has consistently intrigued researchers throughout the years. This study is the first to explore Greek-letter and Arabic-digit reversals from typically developing children within the Greek School Environment. The hypotheses were: (1) Visual discrimination, visual memory, and visual-spatial relationships skills will negatively correlate with the occurrence of character reversals, (2) Left-oriented symbols will be reversed most frequently, (3) Children from year 1 will exhibit fewer reversals than children in nurseries. To test those predictions, 117 children (4.5 to 7.5 years) were recruited from Greek nurseries and primary schools. Character-recognition tasks were conducted, and children’s visual-perceptual ability was measured. Moreover, participants produced capital Greek letters and Arabic digits under dictation. Results yielded a significant negative correlation only between visual-perceptual skills and digit reversals in the total sample, suggesting that children with higher visual-perceptual skills tend to produce fewer digit mirrorings, unlike letters. Furthermore, left-oriented characters were significantly mirrored the most. Finally, only digit reversals were significantly reduced by year 1, probably due to the limited knowledge of letters by children in nurseries. Implications, and suggestions for future research are discussed.Item Using visual research methods to study occupations: A scoping review(Informa UK Limited, 2025-06-18) Bratun, Urša; Morgenthaler, Thomas; Lee, Ben D.Background Visual research methods (VRMs), including photovoice, photo-elicitation, drawing, collaging, and videography, are increasingly employed in qualitative research exploring occupation. However, an in-depth analysis of these methods within occupational science (OS) and occupational therapy (OT) is scarce. Objectives To summarize the literature on VRMs and critically analyze the use within OS and OT, with a particular focus on the methodological aspects of VRMs’ application. Materials and methods The six steps of the scoping review framework were followed. The extracted data were analyzed using summative content analysis. Findings Seventy-three articles were included in the analysis. VRMs were used with people of all age groups across all continents, with and without disabilities or health conditions. VRMs were used both independently and in combination with other research methods, most often within ethnographic or phenomenological methodological frameworks. Thematic analysis was the most frequent method of data analysis. Conclusions and significance The review provides insights into occupation-related topics and populations studied using VRMs and the methods of collecting and analyzing data from visual materials. VRMs can enhance occupation-focused participatory research. It is essential that researchers in OS and OT adhere to rigorous protocols and to clearly articulate the purpose of using VRMs.Item Music therapy in adult hospices: a national multicentre survey(BMJ Publishing Group, 2025-05-07) Baroni, Mariagrazia; Tsiris, Giorgos; Marzi, Annamaria; Barbero, Nicola; Guido, Anna; Murachelli, Claudia; Marvulli, Tommaso; Nosenzo, Maria Cristina; Scamuzzi, Elena; Giordano, FilippoBackground: In recent years, there has been an increased demand for non-pharmacological, complementary therapies and psychosocial provisions in hospices, aimed at creating spaces for communication and personalised expression in response to the bio-psycho-socio-existential needs of patients and their caregivers. As a contemporary evidence-based professional practice, music therapy is an integral part of multidisciplinary teams in many palliative care settings internationally. In Italy, however, music therapy is a developing area of practice facing certain challenges around professionalisation, funding and service development. This study seeks to explore the current state of music therapy in Italian hospices. Methods: From January 2024 to March 2024, an online survey was disseminated to 213 hospices across Italy. The survey consisted of 10 closed-ended questions. Data was analysed using descriptive statistics. Results: A 73.7% completion rate was achieved. Music-based interventions are provided in 49.6% of hospices (n=62), and 43.5% of these offer a music therapy service led by a qualified music therapist. Most hospices (n=17) offer music therapy sessions for 3 hours per week. Across all hospices, sessions are primarily individual and take place in patients' rooms. The presence of caregivers varies, and patients are referred to music therapy by different professionals in the team. Information was gathered regarding the use of music therapy during sedation and for bereavement support of caregivers, along with details on assessment tools used. Conclusion: This study offers an initial overview of music therapy in hospices across Italy and highlights critical questions regarding team integration, training standards, evaluation and funding.Item The Arts Therapies in Palliative and End-of-Life Care: Insights from a Cross-Cultural Knowledge Exchange Forum(MDPI, 2025-05-01) Mondanaro, John F.; Armstrong, Bruce; McRae, Sally; Meyerson, Edith; O'Connor, Todd; Tsiris, GiorgosIn October 2023, a Knowledge Exchange Forum was established, bringing together arts therapies staff and students from three different palliative and end-of-life care (PEoLC) settings: St Columba’s Hospice Care in Edinburgh, the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital and the Mount Sinai Kravis Children’s Hospital in New York. Adopting a practice-led approach, the Forum offers a space to unpack questions and challenges that arts therapists face in PEoLC. In this dialogical paper, we outline the development of the Forum and share emerging insights from our cross-cultural discussions. When working in PEoLC settings, arts therapists are commonly required to work across a continuum of care. This continuum extends from individual sessions with patients, families and bereaved carers, to groups and community-oriented initiatives. It often requires a capacity to work flexibly and fluidly with regard to, for example, therapeutic boundaries, consistency of location, and time. Discussion of emerging insights leads to a consideration of their implications for education and practice, and for future directions in professional networking and knowledge exchange.Item Nature-based interventions for older adults: a systematic review of intervention types and methods, health effects and pathways(Oxford University Press, 2025-04-10) Tong, Ki; Thompson, Catharine Ward; Carin-Levy, Gail; Liddle, Jennifer; Morton, Sarah; Mead, Gillian EBackground Nature-based interventions (NBIs) may support older adults’ health and well-being, but it remains unclear which interventions are most effective, for whom and in which contexts. The existing Wilkie and Davinson framework explains the pathways between NBIs and health outcomes but underemphasises the effects of environmental qualities. Therefore, the study aims to critically examine existing NBIs and their associated health outcomes, with a focus on identifying the environmental qualities and pathways that are either facilitating or impeding. Methods The review sought 16 databases for any nature-based interventions aimed at enhancing health outcomes where participants are older adults aged ≥65. The Mixed Methods Appraisal Tool assessed risk of bias. Narrative synthesis was used for result presentation. Results Of 6143 articles retrieved, 84 studies were included. Participants were primarily community dwelling without specific conditions. Most studies were quantitative experiments. Interventions were predominantly multicomponent, with restoring psychological capacities as the most common pathway. Spiritual, behavioural and socioecological changes were identified. Some health mechanisms were specific to outdoor interventions, but indoor interventions showed comparable outcomes. Conclusions The study predominantly included community-dwelling participants without specific health conditions, potentially limiting the generalisability of findings to older adults with multimorbidity or those in alternative living environments. Multicomponent interventions challenged direct associations between pathways and outcomes. Results extend existing frameworks by identifying spiritual, behavioural and socioecological benefits. Limited detailing of environmental qualities warrants further research to associate them with specific health outcomes. Registration The protocol was registered on PROSPERO (CRD42024496114).