Occupational Science & Occupational Therapy - Doctoral Theses

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Conceptualizing school based occupational therapy for Malta: enabling children’s participation in school occupations through collaboration in early years settings
(University College Cork, 2021-10-10) Buhagiar, Nathalie; Lynch, Helen; Jackson, Jeanne; Università ta' Malta
This thesis explores occupation, participation and occupational therapy schoolbased practice in an early years school setting. It adopts a rights-based approach that acknowledges the human and moral rights of all children to be educated; a strengths-based philosophy that moves away from an impairment focus, recognising the centrality of children, their occupations and the transactions between the stakeholders within the school environment. The main research questions were: What are the occupations that children in Maltese early-years classrooms are participating in? What are the enablers and barriers to children’s participation in school occupations in Maltese early-years classrooms? How can occupational therapy involvement in early-years classrooms contribute to children’s participation in school occupations? The arena was investigated through a qualitative paradigm, a longitudinal instrumental case study with elements of action theory. It was carried out in one selected primary mainstream state school and involved the participation of children and parents, with the educators being the main focus of this study This was a two-phased study with participation at the core of the conceptual framework underpinned by Occupational Science and had 3 pillars: The first exploratory part of the study was underpinned by concepts from Bio-ecological Systems Theory (Bronfenbrenner, 2007). The second intervention part of the study was framed within the Social Model of Disability (Oliver, 1998), and the Canadian Model of Occupational Performance – Engagement (Townsend & Polatajko, 2013). The data was analysed for its content and through thematic analysis (Braun & Clarke, 2013). The data were collected over a period of one school year through the researcher’s weekly presence in the school. Methods used to obtain data included observation, interviews, focus groups. Such data was supplemented with other documentary evidence: intervention logs, a reflective journal and research diary, and discussions with critical friends, children’s photos, school development plans, e mail correspondence and other recorded feedback. vii The findings of this study identified the social environment as key to supporting young children’s occupations through connectedness, regular, consistent presence and involvement of occupational therapy in the school, the building of relationships and trust, attitudinal factors and knowledge translation between adults: therapist and educators. The importance of play especially physical play, choice, fun and movement in daily routines and children’s engagement with peers and educators were also outcomes of the study. The centrality of educator and parental involvement through active engagement, were additional significant findings. The importance of Tier 1 intervention to build educators resilience in delivering their curriculum was identified whilst Tier 2 intervention provided a way forward in supporting children with ”hidden” needs. The uniqueness of Tier 3 was namely the collaboration between the occupational therapist and class teacher in the education of students with a statement of needs. The primary importance of working with school leadership was a novel and important finding in this study. Inter-professional working and education, as well as student education and training, were also identified as essential for collaborative consultation to be effective in early years settings. This research contributes to the international body of evidence on collaborative consultation and also provides recommendations as to how a model of school-based occupational therapy tiered intervention for Malta, can be implemented in Maltese schools, specifically in the early years. In this respect it is also unique as no other projects or studies have ever addressed this topic in Malta. Finally, this study suggests the way forward in developing school - centred practice to support the participation and inclusion for all children in school and society.
Designing public playgrounds for inclusion: Universal Design for Play (UDP), a tailored perspective
(University College Cork, 2022-08-31) Moore, Alice; Lynch, Helen; Boyle, Bryan; Irish Research Council
To extend knowledge on how to enable outdoor play, social participation, and inclusion in public playgrounds, the overall aim of this thesis is to establish an evidence base for using Universal Design (UD) for public playground design. The scope of this doctoral research encompassed a multi-layered approach to understanding this complex concept of UD from a higher conceptual level as well as an applied level. It includes five studies that employed multiple methods to review published and grey literature as well as explore the perspectives of “professional experts” and “user experts”. Study I included a review of evidence for using UD in public playground design. Specifically, a scoping review of peer reviewed literature was undertaken to identify and synthesise what is known from published, peer reviewed studies about inclusive public playgrounds, underpinned by a commitment to understanding the concept of UD as it applies specifically to public playground design. Findings show that although UD is recognised to have the potential to support the design of public playgrounds, the evidence is currently very sparse and identified the gap in knowledge internationally of how UD is understood as a concept. Study II included a review of the conceptual understanding of UD in public playground design. Indeed, this consisted of a scoping review to determine how UD and related non-discriminatory planning and design concepts are represented in the context of published research exploring public playground design for inclusion. Findings revealed that that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design processes arbitrarily and without regard for higher or lower order concepts, which has potentially led to inconsistency and confusion. Altogether, diverse interpretations of UD were evident; for some UD was understood as a basic concept resulting in accessibility, for others, UD was more holistic in terms of designing for inclusion. In Study III, scoping review search methods were developed and applied to synthesise findings from a review of international grey literature guidelines for the design of public playgrounds for inclusion and sought to determine the evidence for using UD and play value in public playground design. Findings highlighted that although UD is recognised to have the potential to support the design of public playgrounds, inconsistent design approaches, principles, and recommendations, were communicated among the included guideline documents. However, the core concept of inclusion underpinned all guideline documents, and a tailored application of UD dominated. Study IV involved survey methods to determine the ways in which UD is understood and implemented, when planning, designing, and/or providing public playgrounds, from the perspectives of a national sample of playground professionals in the Republic of Ireland. The findings show that playground professionals recognise the importance of UD and implement UD in various ways. However, significant barriers to implementing UD included a lack of knowledge and good practice guides for embedding UD. To counteract these barriers, a variety of opportunities, initiatives and training prospects were identified. In Study V, a qualitative descriptive study sought to explore the experiences of using playgrounds, as well as the reasons for non-use, from child and adult perspectives, through the lens of play and play value to inform UD. Findings emphasised that although children and adults value playgrounds as spaces for outdoor play, social participation, and inclusion, playgrounds are not always useable, and do not always meet the needs of families. Participants in this study confirmed that there are variable standards when it comes to playground provision, and some facilities lack essential elements for outdoor play, social participation, and inclusion. Nevertheless, participants offered many creative ideas to improve the usability of playgrounds, and therefore, identified potentially practical ways of implementing UD in playground design for inclusion (Chapter Seven). In conclusion, this doctoral research contributes with an evidence base for using UD for public playground design both at a conceptual and an applied level. It challenges the current UD concept and argues for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion. Moving forward the challenge is to promote the universal establishment of inclusive public playgrounds that offer high play value and include all persons in everyday occupations without injustice.
Healthcare professionals’ experience of interprofessional collaborative encounters in primary care: a descriptive phenomenological analysis
(University College Cork, 2020-04-27) Trace, Anna; Jackson, Jeanne; Savage, Eileen
Interprofessional collaboration amongst healthcare professionals in Primary Care is becoming an important focus as a worldwide shift from secondary (specialist hospital care) to primary (first level of contact in general practice) healthcare delivery is being made. The establishment and development of Interprofessional collaboration has been supported by the World Health Organisation and many worldwide government strategies and policies to enhance quality, safety, and effectiveness within an increasingly burdened healthcare system. A lot of focus in the mainly qualitative research literature has been on healthcare professionals general experience, and/or identifying what key structure and process factors support interprofessional collaboration, or team working. However, more in-depth understanding of the nature of interprofessional collaboration is needed. This study is a qualitative enquiry into the lived experiences of interprofessional collaborative encounters in Primary Care in Ireland. Six healthcare professionals’ descriptions of collaborative encounters with others involved in Primary Care were acquired. The data was analysed using Giorgi’s descriptive phenomenological method, which is based on Husserl’s and Merleau-Ponty’s philosophical phenomenology. The results indicate that a collaborative encounter involves the following essential psychological constituents: change in momentum or drive; communication adaptation; development of closer relationship that provided nurturing, but in some cases enmeshment; exertion of influence in order to protect and provide benefit; and learning from experience, reflection and education. The lived experience of an interprofessional collaborative encounter/s as shown in this study gives a deeper understanding of the complexities and nuances involved. Thus, this study aids the appreciation of the actual, whole interprofessional collaborative experience rather than a focus on the idealized, or only positive aspects of this experience. This has relevance for healthcare professionals, managers, educators, and researchers who can use this understanding of the phenomenon to develop and expand their knowledge, or management, or educational support, and/or research focus.
Living long-term with acquired brain injury in Ireland: towards a counter discourse
(University College Cork, 2008-07) McGowan, Phil; Ryan, Susan E.; Chard, Gill; Glavanis-Grantham, Kathy
Irish literature on Acquired Brain Injury (ABI) is very scant and is mainly deficits and/or needs based. The focus is generally on how to manage the short term needs of the younger population with ABI. The starting position of my thesis is that people living long-term with ABI are important participants in developing knowledge about this social phenomenon, living with ABI while accepting that their brain injury does not determine them. Six mature adults with ABI and their six significant others participated in this longitudinal study. Using a narrative approach in interviews, over twenty months, five repeat individual interviews with each of the twelve participants was held. From this I gained an understanding of their lived experiences, their life-world and their experiences of our local public ABI/disability services, systems and discourse. Along with this new empirical data, theoretical developments from occupational therapy, occupational science, sociology, and disability studies were also used within a meta-narrative informed by critical theory and critical realism to develop a synthesis of this study. Social analysis of their narratives co-constructed with me, allowed me generate nuanced insights into tendencies and social processes that impacted and continues to impact on their everyday-everynight living. I discuss in some depth here, the relational attitudinal, structural, occupational and environmental supports, barriers or discrimination that they face(d) in their search for social participation and community inclusion. Personal recognition of the disabled participants by their family, friends and/or local community, was generally enhanced after much suffering, social supports, slow recovery, and with some form of meaningful occupational engagement. This engagement was generally linked with pre-injury interests or habits, while Time itself became both a major aid and a need. The present local ABI discourse seldom includes advocacy and inclusion in everyday/every night local events, yet most participants sought both peer-support or collective recognition, and social/community inclusion to help develop their own counter-discourse to the dominant ABI discourse. This thesis aims to give a broad social explanation on aspects of their social becoming, 'self-sameness' and social participation, and the status of the disabled participants wanting to live 'the slow life'. Tensions and dialectical issues involved in moving from the category of a person in coma, to person with a disability, to being a citizen should not demote the need for special services. While individualized short-term neuro-rehabilitation is necessary, it is not sufficient. Along with the participants, this researcher asks that community health and/or social care planners and service-providers rethink how ABI is understood and represented, and how people with ABI are included in their local communities
The meaning of environmental control systems (ECS) for people with spinal cord injury: An occupational therapist explores an intervention
(University College Cork, 2012-05) Verdonck, Michèle Claire; Chard, Gill; Nolan, Maeve; Gibbon, Fiona E.; Health Research Board
Environmental Control Systems (ECS), enable people with high cervical Spinal Cord Injury (high SCI) to control and access everyday electronic devices. In Ireland, however, access for those who might benefit from ECS is limited. This study used a qualitative approach to explore the insider experience of an ECS starter-pack developed by the author, an occupational therapist. The primary research questions: what is it really like to live with ECS, and what does it mean to live with ECS, were explored using a phenomenological methodology conducted in three phases. In Phase 1 fifteen people with high SCI met twice in four focus groups to discuss experiences and expectations of ECS. Thematic analysis (Krueger & Casey, 2000), influenced by the psychological phenomenological approach (Creswell, 1998), yielded three categories of rich, practical, phenomenological findings: ECS Usage and utility; ECS Expectations and The meaning of living with ECS. Phase 1 findings informed Phase 2 which consisted of the development of a generic electronic assistive technology pack (GrEAT) that included commercially available constituents as well as short instructional videos and an information booklet. This second phase culminated in a one-person, three-week pilot trial. Phase 3 involved a six person, 8-week trial of the GrEAT, followed by individual in-depth interviews. Interpretative Phenomenological Analysis IPA (Smith, Larkin & Flowers, 2009), aided by computer software ATLAS.ti and iMindmap, guided data analysis and identification of themes. Getting used to ECS, experienced as both a hassle and engaging, resulted in participants being able to Take back a little of what you have lost, which involved both feeling enabled and reclaiming a little doing. The findings of this study provide substantial insights into what it is like to live with ECS and the meanings attributed to that experience. Several practical, real world implications are discussed.
Supporting therapist engagement in evidence based practice: Developing a continuing education programme through participatory action research
(University College Cork, 2013) Crausaz, Janice; Savage, Eileen; Chard, Gill
Therapists find it challenging to integrate research evidence into their clinical decision-making because it may involve modifying their existing practices. Although continuing education (CE) programmes for evidence-based practice (EBP) have employed various approaches to increase individual practitioner’s knowledge and skills, these have been shown to have little impact in changing customary behaviours. To date, there has been little attempt to actively engage therapists as collaborators in developing educational processes concerning EBP. The researcher collaborated with seven clinical therapists (one occupational therapist, four physiotherapists and two speech and language therapists) enrolled in a new post-qualification Implementing Evidence in Therapy Practice (IETP) MSc module to monitor and adapt the learning programme over ten weeks. The participating therapists actively engaged in participatory action research (PAR) iterative cycles of reflecting→ planning→ acting→ observing→ reflecting with the researcher. Mixed methods were used to evaluate the IETP module and its influence on therapists’ subsequent engagement in EBP activities. Data were gathered immediately on completion of the module and five months later. Immediate post-module findings revealed four components as being important to the therapists: 1) characteristics of the learning environment; 2) acquisition of relevant EBP skills; 3) nature of the learning process; and 4) acquiring confidence. The two themes and sub-themes which emerged from individual interviews conducted five months post-module expanded on the four components already identified. Theme 1: Experiencing the learning (sub-themes: module organisation; learning is relational; improving the module); and theme 2: Enacting the learning through a new way of being (sub-themes: criticality and reflection; self agency; modelling EBP behaviours; positioning self in an EB work culture). The therapists’ perspectives had by then shifted from that of a learner to that of a clinician constructing a new sense of self as an evidence-based practitioner. Findings from this study underline the importance of the process of socially constructed knowledge and of empowering learners through collaboratively designed continuing education programmes. In the student-driven learning environment, therapists chose repetitive skill-building and authentic problem-solving activities which reflected the complexity of the environments to which they were expected to transfer their learning. These findings have implications for educators designing EBP continuing education programmes, during which students develop professional ways of being.
Time use, daily activities, and health-related quality of life of school-going late adolescents in Cork city and county: A cross-sectional study
(University College Cork, 2014) Hunt, Eithne B.; Gibbon, Fiona E.; Perry, Ivan J.; Fitzgerald, Anthony P.; McKay, Elizabeth
Aim: This thesis examines a question posed by founding occupational scientist Dr. Elizabeth Yerxa (1993) – “what is the relationship between human engagement in a daily round of activity (such as work, play, rest and sleep) and the quality of life people experience including their healthfulness” (p. 3). Specifically, I consider Yerxa’s question in relation to the quotidian activities and health-related quality of life (HRQoL) of late adolescents (aged 15 - 19 years) in Ireland. This research enquiry was informed by an occupational perspective of health and by population health, ecological, and positive youth development perspectives. Methods: This thesis is comprised of five studies. Two scoping literature reviews informed the direction of three empirical studies. In the latter, cross-sectional time use and HRQoL data were collected from a representative sample of 731 school-going late adolescents (response rate 52%) across 28 schools across Cork city and county (response rate 76%). In addition to socio-demographic data, time use data were collected using a standard time diary instrument while a nationally and internationally validated instrument, the KIDSCREEN-52, was used to measure HRQoL. Variable-centred and person-centred analyses were used. Results: The scoping reviews identified the lack of research on well populations or an adolescent age range within occupational therapy and occupational science; limited research testing the popular assumption that time use is related to overall well-being and quality of life; and the absence of studies that examined adolescent 24-hour time use and quality of life. Established international trends were mirrored in the findings of the examination of weekday and weekend time use. Aggregate-level, variable-centred analyses yielded some significant associations between HRQoL and individual activities, independent of school year, school location, family context, social class, nationality or diary day. The person-centred analysis of overall time use identified three male profiles (productive, high leisure and all-rounder) and two female profiles (higher study/lower leisure and moderate study/higher leisure). There was tentative support for the association between higher HRQoL and more balanced time use profiles. Conclusion: The findings of this thesis highlight the gendered nature of adolescent time use and HRQoL. Participation in daily activities, singly and in combination, appears to be associated with HRQoL. However, the nature of this relationship is complex. Individually and collectively, adolescents need to be educated and supported to create health through their everyday patterns of doing.

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