Occupational Science & Occupational Therapy - Doctoral Theses

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    Inclusive playgrounds: insights into play and inclusion from the perspectives of users and providers
    (University College Cork, 2023) Wenger, Ines; Lynch, Helen; Prellwitz, Maria; Schulze, Christina; Lundström, Ulrica; Horizon 2020 Framework Programme
    Play for play's sake is an important part of a child's life. In this sense, play is also enshrined as a child's right and understood from an occupational therapy and occupational science perspective as a central occupation in children's lives. Children report that outdoor environments, such as playgrounds, are some of their favourite places to play. However, studies also show that children’s experiences of play occupation in playgrounds can be limited by barriers related to the physical, social and political environment, especially for children with disabilities. To address these barriers, so-called inclusive playgrounds have been developed and implemented. The aim of such playgrounds is to provide play and social experiences for all children to foster a sense of belonging and inclusion. Inclusive playgrounds could therefore be considered places created by playground providers for children where situational elements of the physical, social and political environment converge with children's play occupation. The Transactional Model of Occupation (TMO) was chosen as the theoretical underpinning of the thesis, providing a framework for interpreting playground users’ and playground providers’ perspectives in relation to the intertwined nature of the situational elements from an occupational and child-centred perspective. Furthermore, the TMO was found to be useful in integrating other concepts related to inclusive playgrounds and their transactions with situational elements, such as play value, affordances, place-making, inclusion and Universal Design (UD). The overall aim of the thesis was to gain a deeper understanding of play and inclusion on inclusive playgrounds from the perspectives of playground users (children with and without disabilities and advocates of children with disabilities) and playground providers (including experts in UD). The thesis was informed by four studies. Study I and Study III looked at the children’s perspectives; Study II at the perspectives of playground providers and advocates of children with disabilities; and Study IV at the perspectives of experts in UD. Study I explored the experiences of children with (n=18) and children without (n=14) disabilities of playing on inclusive playgrounds through the use of interviews and observations. Data were analysed using qualitative content analysis. Study III aimed to expand current knowledge from a child-centred perspective of how environmental characteristics influence play value and inclusion for all children in outdoor playgrounds. The study was conducted as a meta-ethnography and included 17 studies. Study II explored the design and use of inclusive playgrounds with a particular focus on how design supports or hinders inclusion from the perspective of people involved in designing (n=14) or advocating for children with disabilities (n=12). Data consisted of focus group interviews and were analysed with thematic analysis. Study IV aimed to advance the understanding and use of UD in inclusive playground provision by identifying expert’s (n=6) strategies and experiences of applying UD in playgrounds. Data consisted of expert interviews conducted using a go-along method of walk and talk interviews and analysed using qualitative content analysis. The synthesis of the findings provided insights into three areas; firstly, children’s experience of participation in play occupation and play value on inclusive playgrounds; secondly, how play value emerges from transactions of the situational elements; and, thirdly, what UD adds to playground design to create a welcoming atmosphere and make playgrounds inclusive. Children’s experiences of play value were found to emerge from transactions of the play occupation and the physical and social environmental elements, and sociocultural, and geopolitical elements. These experiences created a sense of belonging. A sense of belonging was found to be associated with inclusion from the perspective of children and advocates of children with disabilities, and from the perspective of experts in UD. Thus, children’s perspectives on play value and participation in play occupation were found to contribute to an understanding of what makes a playground inclusive from a child's perspective. Furthermore, findings suggest that UD may be a useful design approach to ensure inclusion in playgrounds. Thus, for the UD experts, the social environmental elements and the sociocultural and geopolitical elements were pivotal at the beginning of the design process and guided the design of the physical environmental elements accordingly. This focus is also reflected in four strategies identified from the synthesis of the findings for designing playgrounds to promote a sense of belonging. To further explore play occupation and inclusion in playgrounds, it may be useful to focus on the social aspect by perspectives that encompass communities rather than individuals, such as communal or collective occupations.
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    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.
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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.
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    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.
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    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 ; 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.