Occupational Science & Occupational Therapy - Doctoral Theses
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Item 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' MaltaThis 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.Item 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, ElizabethAim: 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.Item 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 BoardEnvironmental 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.