This PhD-by-publication thesis describes a journey of developing research and different approaches used for measuring therapeutic change. The focus of this thesis is to investigate what psychological and economic measures can be used to measure clinical outcomes and cost measurement. At every stage consideration has been given to capturing costs and cost effectiveness where possible. The research, considered as a group of papers, focuses on quality of life, outcome measurement, utility measurement, health economics, randomised controlled trials and spans a number of different clinical domains including mental health, nursing, social work and occupational therapy.

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There has been an understanding that occupational therapists suffer from a weak professional identity. This qualitative study examined the ways in which the professional identity of occupational therapists was perceived from the stance of practitioners, educators, and those working for the College of Occupational Therapists (COT) and the Council for Professions Supplementary to Medicine (CPSM). There are many ways of defining 'profession'. In this case the perspective of symbolic interaction was taken and Becker's (1977), explanation of it as a symbolised concept was used. This framework was used to generate an interview schedule for 50 in-depth interviews, which facilitated an exploration of the actions that were undertaken to expand professional status, how individuals and collectives had interpreted those actions and the ways in which meaning was attributed to professionalism. The research findings showed notable differences in interpretation between practitioners and organising bodies. Practitioners were confident that occupational therapy could claim a discrete body of knowledge but collective actions to align the skill to science had undermined its value. Changes in education, whilst beneficial to status, have weakened the capacity of the profession to control how it is managed. Government measures to monitor the competence of all health professionals have placed a greater imperative on occupational therapists' self-regulatory mechanisms to be visibly effective. A code of ethics is important for professional cohesion and has more potency than previously thought but events have made it difficult for occupational therapists to live a service ideal. In essence the profession was not acting as a cohesive unit. There needs to be a stronger identification with a unique skill with more professional control over what form the work should take. There should be effective gate-keeping guarding against inappropriate admissions to the profession, effective monitoring of competence and discipline and a strong code of ethics. Socialisation has the potential to enhance individual professionalism and strengthen collective professional identity. Exploring these issues requires co-ordination, a purpose for which professional bodies, in this case COT, were established.

Background. Despite the prevalence of Physical Activity Referral Schemes (PARS) in Britain, to date, there has been no attempt to elucidate their public health role. The nature of this role will depend upon who schemes are accessible to, and appropriate for. Objective. The aim of the present research was to provide a rigorous account of sociodemographic bias in referral to, and attendance of a county-wide PARS by tracking participant progress, from point of referral to the end of their involvement with the scheme. Methods. Epidemiological methods were applied to analyse data from people referred to the Somerset-wide ProActive PARS over a three-year period. For all Somerset residents referred, age, gender, and the deprivation level (measured by the Townsend score) and urban-rural character of their area of residence were used to make socio-demographic comparisons with the county population as a whole. Mann-Whitney and Kruskal-Wallis difference tests were used to compare socio-economic characteristics. Binary logistic regression analysis was used to identify sociodemographic characteristics associated with referral uptake (attending ≥1 session) and completion of physical activity programmes (≥80% attendance). Results. The proportion of referred participants (n=3569) who were female was above the county average (61.1 vs. 51.4%). Referrals increased markedly with age from 6.6% (≤30 yrs) to 22.7% (50-59 yrs), dropping off sharply thereafter (≥60 yrs). The mean Townsend deprivation score for participant area of residence was greater than the county average (0.33 vs. 0.00, p<0.001). These patterns indicated that, with the exception of older adults, those groups most likely to consult primary care were referred most frequently. Regression analysis (n=2864) revealed that increasing age (Exp(B)=1.014, p<0.001) and urban residency (Exp(B)=1.317, p<0.001) increased the likelihood of referral uptake. Uptake was less likely for those living in more deprived areas (Exp(B)=0.933, p<0.001). In participants who took up referral, the likelihood of completion was lower in women than men (Exp(B)=0.818, p=0.041) but increased with age (Exp(B)=1.018, P<0.001). Conclusion. Younger people, residents of deprived and rural areas, and women appear less likely to progress through schemes or complete PARS programmes, regardless of relative scheme exposure. PARS appear more appropriate for adults of middle-to-old age who are more likely to require supervision and should be targeted accordingly. To promote physical activity in a preventive capacity and to increase activity across the socio-economic strata is likely to require broader and multi-faceted environmental and policy-led interventions to promote habitual activity, rather than attempting to increase recreational activity through individual-orientated such as PARS.

Bibliography: leaves 406-473. / x, 473 leaves : ill., map ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Following an exploration of health and illness from an occupational perspective, the position of occupational therapists as agents for promoting health according to their view of occupation is considered. / Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1996

Many fields of interest, of which Pediatrics is one, exist in Occupational Therapy. In the field of Pediatrics there are also diversity fields of interest. Many diagnostic groups are treated in the field of Pediatric Occupational Therapy. The traditional Pediatric Occupational Therapy process aims at treating the child holistically with regards to his cognitive, perceptual, motor and emotional areas of development. It seems that there is a tendency to focus on the more tangible aspects of development rather than the less visible elements such as emotional needs and problems. The question that might be asked is whether Pediatric Occupational Therapists are in fact equipped to deal with emotional needs and problems. Due to the nature of their work, there is a strong possibility that Pediatric Occupational Therapists can encounter children who suffer from emotional problems. These children are more often than not seen by Occupational Therapists although the therapists might prefer to rather work on the more tangibly aspects of development. This research study was aimed at assessing the need amongst Pediatric Occupational Therapists to deal with emotional problems. After completing the study it was possible to make valuable conclusions and recommendations. Gestalt Play Therapy was also proposed as a possible approach in dealing with children's emotional needs and problems in the course of their Occupational Therapy intervention. OPSOMMING Arbeidsterapie omsluit `n breë spektrum van spesialiteitsrigtings, waarvan Pediatrie een is. Binne die veld van Pediatrie blyk daar egter verdere diversiteit te wees met betrekking tot die diagnostiese groepe wat binne hierdie veld hanteer word. Die tradisionele Pediatriese Arbeidsterapie proses het ten doel om die kind holisties te benader met verwysing na die kognitief -perseptuele, motoriese en emosionele ontwikkelingsareas van die kind. Dit blyk egter dat daar `n geneigdheid is, en moontlik ook groter gemak bestaan om eerder aan die meer sigbare aspekte soos byvoorbeeld perseptuele en motoriese ontwikkeling te werk. Die vraag kan dus gevra word of Arbeidsterapeute genoegaam toegerus is om ook aan die emosionele behoeftes en probeleme van die kind aandag te kan gee. Die moontlikheid dat Arbeidsterapeute vanwee die diversiteit met betrekking tot die diagnostiese groepe wat ter sprake is in kontak kan kom met kinders wat ook emosionele behoeftes en probleme het bestaan. Alhoewel hierdie kinders opgeneem word in die Arbeidsterapie proses, is behandeling dikwels net op die tasbare ontwikkelings areas gerig. Die navorsing was spesifiek daarop gerig om te bepaal of daar wel `n behoefte bestaan onder Arbeidsterapeute om kinders se emosionele behoeftes aan te spreek. Na afloop van die studie, en nadat alle toepaslike inligting geïntegreer is, is daar waardevolle afleidings gemaak en is hierdie behoefte onder Arbeidsterapeute bevestig. Gestalt Spelterapie is ook voorgestel as `n moontlike benadering wat geïntegreer kan word ten einde die Arbeidsterapeut instaat te stel om meer effektief te werk te gaan met die kind se emosionele behoeftes en probleme. / Social work / D.Phil.

Many fields of interest, of which Pediatrics is one, exist in Occupational Therapy. In the field of Pediatrics there are also diversity fields of interest. Many diagnostic groups are treated in the field of Pediatric Occupational Therapy. The traditional Pediatric Occupational Therapy process aims at treating the child holistically with regards to his cognitive, perceptual, motor and emotional areas of development. It seems that there is a tendency to focus on the more tangible aspects of development rather than the less visible elements such as emotional needs and problems. The question that might be asked is whether Pediatric Occupational Therapists are in fact equipped to deal with emotional needs and problems. Due to the nature of their work, there is a strong possibility that Pediatric Occupational Therapists can encounter children who suffer from emotional problems. These children are more often than not seen by Occupational Therapists although the therapists might prefer to rather work on the more tangibly aspects of development. This research study was aimed at assessing the need amongst Pediatric Occupational Therapists to deal with emotional problems. After completing the study it was possible to make valuable conclusions and recommendations. Gestalt Play Therapy was also proposed as a possible approach in dealing with children's emotional needs and problems in the course of their Occupational Therapy intervention. OPSOMMING Arbeidsterapie omsluit `n breë spektrum van spesialiteitsrigtings, waarvan Pediatrie een is. Binne die veld van Pediatrie blyk daar egter verdere diversiteit te wees met betrekking tot die diagnostiese groepe wat binne hierdie veld hanteer word. Die tradisionele Pediatriese Arbeidsterapie proses het ten doel om die kind holisties te benader met verwysing na die kognitief -perseptuele, motoriese en emosionele ontwikkelingsareas van die kind. Dit blyk egter dat daar `n geneigdheid is, en moontlik ook groter gemak bestaan om eerder aan die meer sigbare aspekte soos byvoorbeeld perseptuele en motoriese ontwikkeling te werk. Die vraag kan dus gevra word of Arbeidsterapeute genoegaam toegerus is om ook aan die emosionele behoeftes en probeleme van die kind aandag te kan gee. Die moontlikheid dat Arbeidsterapeute vanwee die diversiteit met betrekking tot die diagnostiese groepe wat ter sprake is in kontak kan kom met kinders wat ook emosionele behoeftes en probleme het bestaan. Alhoewel hierdie kinders opgeneem word in die Arbeidsterapie proses, is behandeling dikwels net op die tasbare ontwikkelings areas gerig. Die navorsing was spesifiek daarop gerig om te bepaal of daar wel `n behoefte bestaan onder Arbeidsterapeute om kinders se emosionele behoeftes aan te spreek. Na afloop van die studie, en nadat alle toepaslike inligting geïntegreer is, is daar waardevolle afleidings gemaak en is hierdie behoefte onder Arbeidsterapeute bevestig. Gestalt Spelterapie is ook voorgestel as `n moontlike benadering wat geïntegreer kan word ten einde die Arbeidsterapeut instaat te stel om meer effektief te werk te gaan met die kind se emosionele behoeftes en probleme. / Social work / D.Phil.