Biomedical subjects

Mona Eklund

Publications and source records attributed to Mona Eklund.

At least 19 recordsLinked to original sources

PubMed2006

Helping alliance and early dropout from psychiatric out-patient care: the influence of patient factors.

BACKGROUND: The study examined client factors of relevance in the establishment of helping alliance and in the prediction of dropout from a routine psychiatric setting admitting a variety of diagnoses and staffed with a multiprofessional team. METHOD: Newly admitted patients (n=122) and staff completed questionnaires regarding helping alliance, and the patients also completed questionnaires regarding motivation, symptoms and interpersonal problems. The patients were also diagnosed according to ICD-10 and were followed up concerning early dropout. RESULTS: Several variables correlated with helping alliance, and multivariate analyses showed that cold/distant factor, motivation and interpersonal sensitivity factor were the most important factors in establishing helping alliance. Moreover, it was the alliance as perceived by the patients (and not by the staff) that proved to be the most essential variable. A logistic regression analysis showed that early dropout was predicted by low helping alliance, low age and cold/distant factor. CONCLUSION: The most important client factors for establishing helping alliance and for predicting early dropout seem to be those relevant to interpersonal processes. Furthermore, the therapists'/staff's responsiveness to these client factors seems to be of decisive importance.

Adolescent↗

PubMed2006

Time use and daily activities in people with persistent mental illness.

The aim of this study was to investigate time use in work/education, self-care/self-maintenance, play/leisure, rest/relaxation, and sleep in people with persistent mental illness. A further aim was to investigate how time use in the daily activities was associated with health-related variables and social interaction. The study comprised 103 participants with a diagnosis of persistent mental illness who completed self-ratings and interviews in order to assess (1) time use of activities during one 24-hour day, (2) social interaction and (3) health-related factors. The major results indicated that the total time in activity (TTA) and the time spent on work/education and sleep seemed to be related to the majority of the target variables. Four groups of daily rhythm were identified and the daily rhythm groups differed concerning perceived mastery and social interaction. Although the results of this study were statistically significant they did not indicate clinical significance. Therefore, the assumption that there is a relationship between occupation and well-being could not be clearly verified. This study had a cross-sectional design based on a one-time measure, which is an important limitation for the validity of the study. Furthermore, no Bonferroni corrections were made for mass significance and some of the findings would have disappeared if such corrections had been made. More studies concerning time use in daily activities, and daily rhythm in relation to health and well-being are needed.

Activities of Daily Living↗

PubMed2006

Engagement in occupations among men and women with schizophrenia.

This study describes engagement in daily occupations of 10 women and 10 men with schizophrenia. A 24-hour diary of time use and interview were used and analysed by content analysis. Three levels of occupational engagement were identified; (1) mainly disengaged throughout the day, (2) disengaged during some part of the day, and (3) largely engaged in occupations during the day. Each level of occupational engagement was related to a daily rhythm and a sense of meaning. The results of the content analysis showed that levels of engagement ranged from performing mostly quiet activities, alone, with little sense of meaning, to engaging in meaningful occupations that involved social interactions. In general female participants preferred activities in their home environment while males preferred activities outside their home environment. Although this study was limited by geographic and cultural boundaries, as well by the sample size, the results showed that being diagnosed as having schizophrenia does not necessarily mean having an impoverished lifestyle. Thus, it is important for occupational therapists to identify these variations in engagement in order to have a realistic point of departure in the evaluation process and in forming a therapeutic alliance with the client. In future research, methods need to be developed that can gather extensive information on how occupational engagement is related to health and well-being in individuals diagnosed with schizophrenia.

Activities of Daily Living↗

PubMed2006

Construct validity of a newly developed instrument: profile of occupational engagement in people with schizophrenia, POES.

It is highly relevant to estimate to what extent a person with schizophrenia engages in occupations and participates in different life situations in order to understand the determinants of well-being in this group of people. This study aimed at examining the construct validity of the instrument Profile of Occupational Engagement in persons with Schizophrenia, POES. Global Assessment of Functioning, GAF, and a scale measuring Satisfaction with daily occupations and Activity level were chosen as standards against which POES was validated. As hypothesized, moderate associations were found between POES and GAF (0.73), Activity level (0.70), and Satisfaction with daily occupations (0.50). Regarding the separate items of POES, the items that concerned the range of occupations performed had the strongest association with Activity level, and the items that concerned ongoing occupations, i.e. Routines and Extent of performing meaningful occupations, correlated most strongly with Satisfaction with daily occupations. Thus, the strongest associations were found for the expected items. Altogether, POES seems to possess satisfactory construct validity and be a construct in its own right, as indicated by correlations of expected size and direction with the selected instruments and for expected items.

Adult↗

PubMed2006

Psychometric properties of the Satisfaction with Daily Occupations (SDO) instrument and the Manchester Short Assessment of Quality of Life (MANSA) in women with scleroderma and without known illness.

This study investigated whether two instruments devised for people with mental illness, the Satisfaction with Daily Occupations (SDO) instrument and the Manchester Short Assessment of Quality of Life (MANSA), showed appropriate psychometric properties in terms of internal consistency, convergent/divergent validity, and discriminant validity when used with other samples. The study group comprised two female samples, one with physical disability (scleroderma) and one reference sample without known illness. It was hypothesized that the associations from SDO would be low or moderate to both general life satisfaction and self-rated health. The results confirmed that the associations were equal in size in both samples, but still the relationship to general life satisfaction in the scleroderma sample was somewhat higher than expected. Regarding the MANSA quality of life, the hypotheses were that the quality of life-index would show high correlations with general life satisfaction and moderate with self-rated health, and these hypotheses were confirmed for the reference sample, indicating that quality of life as measured by the MANSA converged with general life satisfaction but mainly diverged from self-rated health. In the scleroderma sample, the association to health was higher than expected. Both instruments appeared to reflect constructs that were stable across the two investigated groups, and both measures could distinguish the disability group from the healthy group. The SDO obtained a good value on internal consistency in the sample with scleroderma but a somewhat low value in the reference group, while the quality of life aspect of the MANSA exhibited good internal consistency in both samples. The instruments showed promising properties, indicating that they could be used for the target groups. However, both measures need further testing of psychometric properties.

Female↗

PubMed2006

The Tree Theme Method in psychosocial occupational therapy: a case study.

This study aimed to describe the Tree Theme Method (TTM) as a method for intervention in psychosocial occupational therapy. The TTM is based on theories concerning creative activities and occupational storytelling and story making. In order to exemplify the method a case study of a treatment process with follow up was undertaken. The participant was a female client suffering from anxiety and depression. During an interview the client painted symbolic trees on five different occasions with specific variations of the tree theme: a tree symbolizing her present life, her childhood, adolescence, adulthood, and, finally, a tree representing her future. The trees were used as starting points for the client to tell her life story. The intention was that she would find new strategies for how to change her daily life. Three years later there was a follow up stage where the client painted new trees and told her story. Some life themes were identified. The TTM appears suitable for intervention in psychosocial occupational therapy. In future studies the TTM should be subjected to evaluation research based on several clients in order to develop a deeper understanding of the process and what kind of results changes in the TTM intervention may provide.

Adult↗

PubMed2006

The role of perceived control for the perception of health by patients with persistent mental illness.

Perceived control has been found to be of significance for patients with psychiatric disorders and may be regarded as an aspect of empowerment. Moreover, a sense of control has been identified as important for occupational performance, both in empirical research and in occupational therapy theory. This study aimed at investigating factors that might be of importance for perceived control: sociodemographic, clinical, and well-being variables. Another aim was to investigate whether perceived control served as a mediator between clinical variables, in terms of psychopathology, and well-being variables, in terms of perceived health. Sociodemographic data were collected from 177 subjects, most of them with psychosis diagnoses. They were also assessed regarding perceived control (locus of control and self-mastery) and different aspects of health and well-being. The findings showed that both clinical and well-being variables were consistently related to both aspects of perceived control. Moreover, the roles of self-mastery and locus of control as mediators of perceived health were identified. The results also identified some important sociodemographic factors that might promote a sense of control and empowerment, mainly educational level and friends. This study provided detailed knowledge of the role of perceived control for well-being among people with mental disorders. Strategies for how occupational therapists may promote a sense of control in this group are discussed.

Adult↗

PubMed2005

A model of subjective quality of life for outpatients with schizophrenia and other psychoses.

This study investigated predictors of quality of life among persons with schizophrenia and other psychoses. On the basis of previous research, it was hypothesised that objective life circumstances, self-variables, psychopathology, activity level, satisfaction with daily activities, and satisfaction with medical care would be determinants of quality of life. 134 persons were investigated, and the analysis was based on Structural Equation Modelling (SEM). A model with two quality of life variables, General quality of life and Security, fitted the data best. A self-variable, Sense of self, and Satisfaction with daily activities, Psychopathology, and Satisfaction with medical care served as mediators and explained the variation in the quality of life variables. External to the mediators, and related to these, were Activity level, Educational level, and Independent living. In conclusion, a self-variable showed the strongest association with quality of life, but two aspects that should be feasible to influence in mental health care, daily activity and medical care, contributed to the subjects' self-rated quality of life. These results render a somewhat optimistic view on how to accomplish a better self-perceived quality of life among people with severe mental illness.

Activities of Daily Living↗

PubMed2005

Well-being and occupational roles among middle-aged women.

One purpose of the present study is to explore the stability of the pattern of health/work and sickness absence among middle-aged women over a period of three years. This study tested two hypotheses: (a) that enduringly healthy working women would perceive more valued occupational roles and higher well-being than long-term sick-listed women; (b) that high levels of well-being at baseline would predict enduring health and occupational role value at a 3-year follow-up. Middle-aged women (n = 208) answered a postal survey with the Role checklist, a well-being scale and questions about work and sickness situation. The results showed that there was a considerable variability in the pattern of health/work and sickness absence. The variability was greatest among the women who were long-term sick-listed at baseline, and the internal drop out was great among them. The results showed that the enduringly healthy women experienced a more valued worker role and higher well-being than the long-term sick-listed women. Furthermore, high levels of well-being concerning health and work predicted enduring health in the studied sample, and high well-being concerning work was predictive of a valued worker role. Interventions that enable women to develop valuable worker and leisure roles, as well as harmony between different roles, may be important constituents of health promotion/rehabilitation programmes.

Absenteeism↗

PubMed2004

Evaluation of paraffin bath treatment in patients with systemic sclerosis.

OBJECTIVE: To investigate the effects of treatment with paraffin bath in patients with systemic sclerosis (scleroderma). METHODS: In 17 patients with scleroderma one hand was treated daily with paraffin bath in combination with hand exercise. The other hand was treated with exercise only and was considered a control. Hand function was estimated before treatment and after 1 month of treatment, concerning hand mobility and grip force, and perceived pain, stiffness and skin elasticity. RESULTS: At the follow-up, finger flexion and extension, thumb abduction, volar flexion in the wrist, and perceived stiffness and skin elasticity had improved significantly in the paraffin-treated hand compared with the baseline values. The improved hand function was independent of skin score and disease duration. Improvements in function were significantly greater in the hand which was treated with paraffin bath and exercise than in the hand treated with exercise only concerning extension deficit, perceived stiffness and skin elasticity. CONCLUSIONS: In this pilot study hand exercise in combination with paraffin bath seemed to improve mobility, perceived stiffness and skin elasticity. However, further studies with larger sample size are needed to attain more reliable results of the effect of paraffin bath treatment in patients with scleroderma.

Adult↗

PubMed2004

The influence of temperament and character on functioning and aspects of psychological health among people with schizophrenia.

Research findings that link personality factors to functioning and symptoms in schizophrenia are inconsistent, and further studies are needed within the area. The purpose of this study was to investigate how personality, as measured by the Temperament and Character Inventory (TCI), was related to demographic factors, subtypes of diagnoses, level of functioning, and aspects of psychological health, including sense of coherence, perceived control, and self-esteem, among people with schizophrenia. Subjects were 104 individuals, aged 20-55 years, in psychiatric outpatient care. The results indicated that personality was not related to subtypes of diagnoses or demographic characteristics of the respondents, but to level of functioning and all aspects of psychological health. Especially self-directedness distinguished three groups of functioning and was highly correlated with the different aspects of psychological health. The article discusses how knowledge of schizophrenic patients' personality structure might be used for tailoring psychiatric treatments.

Adult↗

PubMed2004

The importance of work as compared to other forms of daily occupations for wellbeing and functioning among persons with long-term mental illness.

This study investigated the importance of competitive work as compared to participating in community-based activities and having no regular daily activity for people with long-term mental illness. One hundred and three persons visiting an outpatient unit and representing the three targeted occupational conditions were randomized to the study and assessed on satisfaction with daily occupations, health, and wellbeing. Persons with work were more satisfied with their daily occupations and were interviewer-rated as better functioning than the other groups, but the groups did not differ on self-ratings of health and wellbeing. Unexpectedly, people participating in community-based activities did not show better satisfaction or functioning than those without regular daily activity. It was concluded that competitive work should be an urgent end goal for services designed for occupational or vocational support.

Activities of Daily Living↗

PubMed2004

Evaluation of changes in occupational performance among patients in a pain management program.

OBJECTIVES: The aims of this study were to evaluate changes in occupational performance among chronic pain patients after a pain management program and to explore relationships between these changes and demographic and clinical factors, psychosocial functioning and psychological well-being. SUBJECTS: 188 consecutive patients were included. METHODS: Changes were registered by using Canadian Occupational Performance Measure, Multidimensional Pain Inventory and Psychological General Well-Being Index. RESULTS: There were statistically significant positive changes in occupational performance. Patients with sickness compensation had significantly higher changes in occupational performance than those without sickness compensation. The patients with a profile group as interpersonally distressed had statistically significant higher change scores on occupational performance than the adaptive coper group. Furthermore, increases in changes on general activity level, general health, and vitality and decreases in pain severity were associated with positive changes on perceived occupational performance and performance satisfaction. CONCLUSION: Changes in occupational performance, psychological well-being and psychosocial functioning seem all to be of relevance in the evaluation of pain management programs. Psychosocial profiles and sickness compensation has relevance for directions on changes in occupational performance, whereas other demographic and clinical factors do not.

Adaptation, Psychological↗

PubMed2004

Helping alliance and ward atmosphere in psychiatric in-patient care.

OBJECTIVE: The study investigated how patients in a psychiatric in-patient ward perceived the therapeutic relationship and the ward atmosphere, the interrelationships between these phenomena, and whether demographic and clinical factors had an influence on the helping alliance. DESIGN: This was an explorative study in a natural setting. A correlational and multiple regression design were adopted. METHOD: All discharged patients (N = 61) during a limited period completed questionnaires regarding the ward atmosphere and the helping alliance, were rated on psychosocial functioning, and diagnosed according to the ICD-10. RESULTS: Several ward-atmosphere factors correlated with the helping alliance. A multivariate analysis suggested that support, programme clarity, and spontaneity were important ingredients and that support was the most important contributor. Patients with a high level of psychosocial functioning established a better helping alliance and patients with personality disorders tended to develop a weaker helping alliance. CONCLUSION: The findings emphasize that a holding environment is important in establishing a good helping alliance, which is consistent with results from the psychotherapy area. Since helping alliance is known to have a most important influence on therapy outcome, one conclusion must be that the staff, in their endeavour to strengthen the supportive element of the ward atmosphere, may improve the therapeutic outcome as well.

Adult↗

PubMed2003

Women's experiences of hassles and uplifts in their everyday patterns of occupations.

The aim of this study was to investigate experiences of hassles and uplifts among women. One hundred working mothers were interviewed using the Target Complaints instrument. Content analysis, resulting in both qualitative categories and quantitative variables, was used. Working mothers' hassles were mainly generated by their social, temporal and doing contexts and illustrate the importance of considering women's total patterns of everyday occupations and not focusing one-sidedly on the work situation when treating occupation-related ill-health. Women's uplifts were experienced through the social context and by doing such different occupations as going to the movies, cleaning the house, or attending a class. This indicates the appropriateness of using a client-centred approach in interventions with openness to the client's unique situation. Unexpected occupations were identified almost exclusively among the hassles. This is important knowledge for occupational therapists since women will continue to be dual workers and at potential risk of developing unbalanced and detrimental patterns of occupations, in turn causing ill health.

Adult↗

PubMed2003

Content validity and clinical applicability of the Irena Daily Activity assessment measuring occupational performance in adults with developmental disability.

The purpose of this study was to investigate the validity of the Irena Daily Activity (IDA) assessment which measures occupational performance in adults with developmental disabilities. The instrument's content validity was investigated by elucidating its general appropriateness, its clinical applicability and the feasibility of the measurement procedure. Data were collected from a multidisciplinary panel of clinical experts working in day activity centres. Each expert independently judged and reviewed the IDA instrument's content validity. The results show that the content validity index (CVI) values ranged from 0.8 to 1.0 for the instrument's general appropriateness and clinical applicability, and from 0.7 to 1.0 with respect to the significance of the IDA domains' clinical applicability. The applicability of the IDA items were judged as satisfactory (CVI > 80) with respect to their importance for planning treatment and intervention. The feasibility of the measurement procedure was estimated as satisfactory in relation to the items (CVI > 0.70) and satisfactory with respect to the time needed and material used, with CVI values ranging from 0.8 to 1.0. The results of this study support the use of the IDA as a feasible and time-efficient assessment that provides insights regarding the occupational performance of adults with developmental disabilities. A limitation of this study was that it could not illuminate all-important aspects of validity. In conclusion, the IDA has the potential to become a reliable and valid clinical assessment, but additional research on psychometric properties is still needed.

Activities of Daily Living↗

PubMed2003

The meaning of psychosocial occupational therapy in a life-story perspective. A long-term follow-up of three cases.

This study is a long-term follow-up in narrative form of three former psychiatric patients who had been discharged eight to nine years earlier from an outpatient occupational therapy programme. The purpose of the study was to gain an understanding about the participants' views about the period of therapy from a long-term perspective and of how the outcome of therapy could be understood within the context of the patients' life plots. In-depth retrospective interviews and two former interviews with each participant, conducted at the time of therapy, comprised the data. The interview transcripts were subjected to narrative analysis. The fit between the characteristics of the therapy programme and important life themes of the informants seemed crucial for the long-term outcome of therapy, suggesting that taking life histories is important for occupational therapists in clinical practice in order to design appropriate interventions. Four components of the therapy, the activities, the social interaction, the milieu, and the therapeutic relationship, appeared as vital in re-shaping the informants' life plots.

Adult↗

PubMed2003

Patients' opinion on what constitutes good psychiatric care.

The present study investigates patients' opinion on what constitutes good psychiatric care. It was a qualitative study using an open-ended in-depth interview centering on the patient's experiences of receiving psychiatric care. The subjects were selected to ensure maximum variation and heterogeneity. A model of deliberate sampling for heterogeneity and a modified, stratified sampling method were used. One outpatient and one inpatient sample were selected. The description and analysis of data were based on a variable-oriented, cross-case technique. The analysis was made separately for the two sub-samples. The main result for both samples was the emergence of one main category: the quality of the helping encounter. The quality of the relationship between patient and therapist/staff, and being understood by the therapist/staff, formed the most central aspects of good care. For the inpatient group the analyses also pointed to stability and structure and relief of pressure as main categories. Though the focus of the study was on satisfaction with general psychiatric care, the results revealed a construct initially identified within the field of psychotherapy, namely the 'helping alliance', as the most crucial factor. The results also gave some further indications of what bring about a good therapeutic relationship; and prominent in this study, and not very often reported in the context of helping alliance, was that ambivalence, time and meaning were important constituents of the relationship. The findings emphasize the importance and quality of the therapeutic relationship and point to the incorporation of psychotherapeutic principles in all provider-patient relationships in general psychiatric care.

Adult↗