"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Health Care Sciences, Nova Southeastern University." Abstract Background: In 2005, the Centers for Disease Control and Prevention recognized autism as an urgent public health concern understanding families would need supports services at many levels. Parents are the most prominent caregivers of children with disabilities and inadequacy of support services often influences the placement outside of the home. Federal mandates require that states actively avoid placements based on costs, community connections, and least restrictive environments; however, unsustainable family life potentially leads to undesired placements. Mothers with maternal stress raising children with severe autism with behavioral responses at home are at severe risk for social and economic marginalization (Lucenko, Mancuso, & Janssen-Timmen, 2008; Nankervis et al., 2012; Peacock et al., 2012). Placement and respite options are insufficient to meet the current needs for crisis intervention and long-term care, and community health funding has been inconsistent across the states. Literature review: Interdisciplinary and interprofessional literature on placement considerations, autism, and state, national, and global policy documents such as the World Health Organization was searched. Unique to this study was its inclusion of Sen's (1999) development economics capabilities approach in addition to Law et al.'s (1996) occupational therapy model of practice for its congruence with occupational therapy, its support of freedom and choice, and self-determinacy as a necessity for agency or occupational performance. Methods: A qualitative phenomenological approach to gain untapped insights into the occupations and environments influencing mothers' placement considerations. Phenomenology is useful when a deeper understanding is necessary, or to identify a vulnerable group, to shape services, or to develop or revise policies when a change is needed. Results: Data analysis produced six themes (a) feeling judged in their occupational roles as mothers; (b) restricted freedoms and occupational deprivations as a family; (c) the paradox of support services; (d) fears about their families' well-being; (e) occupational injustices revealed through mothers' feelings about placement considerations; and (f) spiritual aspects of childhood placement considerations. Discussion: The mothers' composite themes were discussed in relation to historical and evolving mental health attitudes, practices and policies, the evolving national health insurance policy, and the economy. The influence of contemporary culture on the mothers placement considerations were discussed in regard to Internet and e-health technologies and new ways of knowing, communicating, and decision-making with public health implications. Conclusion: Professional implications for research, practice, and justice issues are discussed.

"July 2005" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Ferol Ludwig This study explored the relationship between occupational performance, occupational satisfaction, social participation, and quality of life for survivors of brain injury participating in a community based program. This research project used multivariate analysis, specifically path analysis to test a proposed model exploring quality of life for individuals living with brain injury. Few research studies have undertaken the task of looking at relationships between social participation and quality of life; even fewer studies have looked at how meaningful occupations influence quality of life. To explore this relationship the Canadian Occupational Performance Measure, Community Integration Questionnaire, and the Wisconsin HSS Quality of Life Inventory were used. A participant pool of 80 survivors of brain injury completed each of the assessments. The findings of this study determined that social participation is a significant predictor of quality of life. The regression model that explored occupational satisfaction and social participation was also found to be significant. Another finding was that social participation significantly influenced the cohort's feelings of love and belonging. Finally, it was found that safety and security is an area of need for this cohort as they attempt occupations in the broader social environment. The findings indicate that social participation has the greatest effect on quality of life in this model; and occupational satisfaction has a slightly weaker effect. The effects of both occupational satisfaction and occupational performance were stronger as they directly influenced quality of life, however, the path model demonstrated that these two variables are influenced by social participation as they influenced quality of life for the survivor of brain injury participating in community programming. These findings are critical to the development of programming by occupational therapists. Finding indicate that social participation, facilitated by satisfaction with desired occupations, should be an important consideration in influencing the quality of life of survivors of brain injury participating in community programs.

"August 2006" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Ferol Ludwig Background and need : Prior research studies on adaptation to low vision have excluded the importance of engagement in occupation to the adaptation process. The purpose of this study was to develop a theory on how visually impaired women achieve adaptation through engagement in occupation. The theoretical framework for this study is occupational adaptation. A premise of occupational adaptation is that the occupational environment, the person, and their interaction are equally important in the adaptation process. Methodology : This qualitative study explored the reflections of seven visually impaired older women, aged 65 to 91, on their adaptation to low vision. I used grounded theory methodology to construct a theoretical model of Adaptation to Low Vision by Seven Older Women. Results : Engagement in meaningful occupations facilitates internal adaptation by increasing participants' self-esteem and motivating them to continue to find methods of doing and in getting help to participate in valued occupations or their abilities. Threats to performance initiate the process of adaptation and abilities serve to motivate participants to continue getting help and finding methods of doing their meaningful occupations. It is through the integration of losses and abilities that adaptation is achieved. Conclusions : The study adds to the knowledge base of occupational therapy by illustrating how integral engagement in occupation is to the process of adaptation. Engagement in meaningful and purposeful occupations supports adaptation to low vision and is an important component of the adaptation process. Results of the study should be considered in the treatment or program planning for the visually impaired. Rehabilitation for the visually impaired could be improved with: (a) education for clients and support persons on available services, (b) provision of opportunities for peer association, (c) use of client-centered practice, (d) training for necessary adaptive equipment, (e) home evaluations, (f) intervention at any point in the adaptation process, (g) therapist familiarity of visual impairment manifestations and effects of concurrent issues, and (h) therapeutic use of occupation to address personal occupational performance challenges.

"February 2008" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max Ito Older adults may undergo changes in occupational participation patterns due to the process of aging, to institutionalization, or to illness. Measuring occupational participation of older adults using a client-centered approach has become a professional mandate for occupational therapists. The Activity Card Sort was developed to measure the level of client activity participation in instrumental, socio-cultural, and leisure activities. With the authors' permission, a valid method of translation and cultural adaptation of the ACS was developed based on a sample of older Puerto Rican adults and occupations relevant to this population derived from a previous study. The final version used in this analysis included 82 picture cards of older adults participating in typical Puerto Rican occupations which clients were to sort into five categories. The purpose of this study was to determine the validity and reliability of the translated and culturally-adapted Puerto Rican Spanish version of the Activity Card Sort (PR-ACS) for older Spanish-speaking adults living in Puerto Rico. This study included 146 participants, two groups of 106 community-living, healthy older adults aged 60 or older and 40 adults with multiple sclerosis (MS) aged 50 or older. The study explored evidence of validity by examining the relationship of the PR-ACS current activity scores with other variables. Reliability evidence included test-retest and internal consistency. Results showed that the PR-ACS was able to discriminate between clients with different levels of functioning (t = 6.86; p = .00), and was positively associated with the Puerto Rican Version of the RAND 36-Short Form Health Survey (r = 0.66; p = .00). Good test-retest reliability (r = 0.82) and high internal consistency of the total scores of the combined sample (r = 0.91) and the sample of healthy older adults (.91) were demonstrated, as well as good internal consistency of these scores for the sample of individuals with MS (.77). The findings suggest the PR-ACS is a reliable and valid instrument to use with the Puerto Rican elderly population.

"September 2008" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Sandra Dunbar Objective. The purpose of this study was to gain insight regarding mothers' perceptions of their occupations when mothering a child with feeding and eating difficulties. This research study examined the following research questions. What is the perception of life satisfaction in mothers of young children who demonstrate difficulties in the occupations of feeding and eating as compared to that of mothers whose children are typically developing? What is the perception of stress in mothers of young children who demonstrate difficulties in the occupations of feeding and eating compared to that of mothers whose children are typically developing? What are mothers' perceptions of their occupations when mothering a young child with feeding and eating difficulties? Method. The design for this study was mixed methodology, specifically a triangulation design: convergence model (Creswell & Plano-Clark, 2007). In this method, both quantitative and qualitative data are collected simultaneously. In the quantitative portion of the study, two groups of women (34 mothers of typically developing children and 29 mothers of children with feeding difficulties) were surveyed utilizing the Parental Stress Scale (PSS) and the Life Satisfaction Index for Parents (LSI-P). In the qualitative portion of this study, five women from the group of mothers of children with feeding difficulties were interviewed using phenomenological inquiry. Results. Overall, there was no statistically significant difference between groups in terms of life satisfaction. However, in one of the five LSI-P categories, that of leisure and recreation, there was a statistically significant difference between groups (p value = .019). Data analysis revealed no statistically significant difference between the groups on the PSS. The qualitative data analysis revealed the following themes: feeling supported, seeking support, the range of emotions/feelings, the complexity of feeding, and dealing with the system. Mixed methods comparison of the quantitative and qualitative data offered further exploration and illumination of both data sets. Conclusion. With regard to the first research question concerning the issue of life satisfaction, the qualitative data provided further insight into the results of the quantitative data analysis. The qualitative data analysis revealed significant statements related to all five of the domains of the LSI-P. In terms of the second research question concerning the issue of stress, the qualitative data analysis provided further insight into the results of the quantitative data analysis. The qualitative data analysis shed light on the issue of stress, revealing that mothers of children with feeding difficulties do experience concerns that result in feelings of stress, anxiety, difficulty, and worry. The final mixed methods data analysis revealed the complex nature of the interaction between mothering occupations and mothering a child with feeding concerns. The additional occupations and challenges that mothers of children with feeding difficulties face often result in feelings of decreased life satisfaction and stress.

Introduction: Play is foundational to learning and well-being, and prepares children for functional participation later in life. Playfulness forms a critical aspect to play, and describes a general disposition to play. There is currently no reported research study on playfulness levels for children with HIV/AIDS. The play needs of this population are therefore not adequately understood. The play-informed caregiver implemented home-based intervention (PICIHBI) was developed by pediatric occupational therapists as part of occupation-centred occupational therapy practice. PICIHBI appears to have potential for promoting play and development in children with HIV/AIDS who have been on Highly Active Anti-Retroviral Treatment (HAART) since early childhood. The current study forms part of a larger project investigating the effects of a play-informed caregiver implemented home-based intervention on participation outcomes for HIV positive children on HAART and living in families with low socio-economic status (SES). Objectives: This study aimed to establish a playfulness profile for HIV positive children on HAART as well as compare differences in playfulness between children with HIV on HAART since early childhood attending traditional one-on-one occupational therapy, and those attending PICIHBI.

No description available.

Background Children attending South African low quintile schools are faced with various barriers to learning which impacts academic performance, with handwriting being an aspect with which they experience difficulty. Provision of on-site occupational therapy services to address handwriting at such schools is limited by human resource constraints. To address this, final year occupational therapy students attending University of Cape Town placed in a low quintile school were tasked to collaborate with Grade R educators to train them to implement a classroom-based fine motor programme. Aim This study describes the educators' experiences of the factors impacting on the implementation of a fine motor programme in a low quintile school. Methodology A qualitative, descriptive study was conducted to explore their experiences relating to the programme, which is an emerging area of research in the South African context. Using sampling, three Grade R educators were purposively trained in implementing a fine motor skills programme. They participated in two focus groups to describe their experiences of the training and the implementation of the programme. Data was audio-recorded and transcribed verbatim. Inductive approach to analysis led to the generation of themes and categories focussing on their experiences, of the hindrances and factors supporting the implementation. Ethical principles were upheld throughout the research process. Findings and Discussion The theme “Them and us” was highlighted throughout the discussion as there was a divide between the educators and the students. The lack of communication and role clarification resulted in both the educators and students missing out on opportunities for collaboration and teamwork, and in turn the learners lost out on intervention albeit on a population basis that could impact learning and development. The process, fraught with challenges, resulted in a difficult partnership and a programme which was not implemented and subsequently not sustained. Conclusion The South African Educational Policy encourages therapists working in schools to integrate their services into the classrooms as well as the homes of learners by means of contextual interventions implemented in partnership with educators and parents. Lack of understanding of how to invest in the initiation of partnerships and consistent attention to grasping roles and responsibilities is a vital component of the collaborative partnership. Power dynamics within the relationship, commitment and spontaneous communication are aspects that stakeholders need to be conscious of to bring about change for positive occupational engagement of learners.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, May 2019 / Background: Literature shows that access to rehabilitation services for persons with disabilities in South Africa is limited. Recent policy documents by the National Department of Health related to disability and rehabilitation propose integration of occupational therapy services in primary healthcare (PHC) reengineering. However, the implementation strategies are not entirely clear as there is inadequate evidence locally on the occupational therapy service provision in PHC even though there is growing evidence internationally. Purpose: This study sought to determine the services provided by occupational therapists in PHC. Their perceptions of the integration of occupational therapy services within the PHC reengineering streams was also explored. Methods: A two-phase explanatory sequential mixed method strategy was utilized in this study with data from the first quantitative phase guiding the second qualitative phase both of equal weights. The first phase was a nationwide cross-sectional quantitative survey strategy using an electronic questionnaire developed on REDCap to establish the extent to which occupational therapy services are delivered in PHC in South Africa. The second phase was an in-depth study using semi structured interviews to comprehensively explore with the occupational therapists practicing in PHC on their perceptions of integrating occupational therapy services in the PHC reengineering streams of the National Health Insurance (NHI). Ethics approval (M180819) was sought and obtained from the University of the Witwatersrand Human Research Ethics Committee (Medical). Analysis: Descriptive analysis was done for the close-ended questions of the quantitative survey, frequencies and content analysis was done for the open-ended questions in the survey, and thematic content analysis was done for the qualitative data. Trustworthiness procedure such as confirmability, member-checking, dependability and triangulation of data sources (In-depth semi-structured interviews, field notes and survey) was used to ensure credibility of the research findings. Results: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the community-based rehabilitation (CBR), the Social Model, the International Classification of Functioning (ICF), and Medical Model using self-management and case-management intervention approaches. The majority of occupational therapists in PHC work on the hospital-based MDT comprising other rehabilitation professionals and nurses. Occupational therapists in PHC have a strong perception of their relevance in the PHC reengineering streams despite the numerous barriers and few facilitators available for the integration of occupational therapy services in PHC reengineering streams of the NHI currently. Their perception is that occupational therapy service integration in the PHC reengineering streams will lead to improved healthcare and the integration will not happen without occupational therapy being adequately supported in PHC. Conclusion: This study serves to provide evidence to help position occupational therapy and by extension other rehabilitation professions in the PHC reengineering streams of the NHI. The integration of occupational therapy services in the PHC reengineering streams of the NHI is essential to improve the health outcomes of the population and reduce the overall healthcare cost and growing burden of non-communicable diseases in the country / E.K. 2019

Background: Understanding the factors that contribute to drinking alcohol during pregnancy is critical to supporting women's and children's health and wellness in rural Tanzania. The drinking of alcohol during pregnancy is a cause for concern in Tanzania. Due to high rates of foetal alcohol spectrum disorder (FASD) in the country, reducing alcohol use during pregnancy is a pressing public health priority. Purpose: Alcohol consumption is a major problem in Tanzania that needs immediate attention (Franscis, Weiss, Mshana, Baisley, Grosskurth & Kapiga, 2015). The purpose of this research was to investigate the factors that contribute to the drinking of alcohol among pregnant women in rural Kilimanjaro to inform the health promotion actions which the government, the health systems, and Tanzania Occupational Therapy Association (TOTA) need to take regarding drinking during pregnancy. Method: A qualitative research approach was used for the study, utilising a qualitative descriptive design. The study was located within the social constructivist theoretical framework (Creswell, 2013). Eight participants were selected for this study, who were eighteen years old and above, some of whom were pregnant and drinking alcohol, and some who were not currently pregnant but had engaged in drinking alcohol in previous pregnancies. In-depth interviews explored the participants' personal experiences with drinking during pregnancy, and community norms and attitudes towards maternal drinking and knowledge about FASD were observed using participant observation. Transcripts were analysed using an inductive, thematic data analysis approach. Findings: From the data analysis, three themes emerged: “Tangu enzi na enzi”(from generation to generation), “kua na muda mzuri” (to have a quality moment) and “mimi ni binadamu kama wengine”(I am a human like others). The first theme affirmed the contextual factors such as historical, cultural, physical, and social-political factors that contribute to women from rural Kilimanjaro drinking alcohol during pregnancy. This theme confirms the historical and pervasive presence of alcohol use during pregnancy. The second theme revealed social engagement and interactions, particularly due to deeply rooted values of ujamaa (familyhood/unity) in the community, as the factors influencing drinking alcohol among women during pregnancy. The third theme gave insight into how economic situations, conflicting knowledge, religion, and spirituality factors enhanced women's decision to drink alcohol during pregnancy. Implications: By examining the factors contributing to drinking alcohol during pregnancy, this study is contributing to the body of knowledge in assisting the Tanzania Occupational Therapy Association (TOTA) and the Tanzania Ministry of Health towards their goal of reducing the prevalence of FASD in rural Kilimanjaro. This research will also contribute to the capacitation of women about healthy choices regarding their drinking during pregnancy and substitution.