Arts on Referral (AoR) is a complementary intervention used to support people who are on sick leave due to common mental disorders (CMD) and/or musculoskeletal pain, challenging public health.

Aim: To deepen the understanding of how AoR works from a health-promoting perspective and how people with CMD and/or musculoskeletal pain experience AoR.

Design: The study adopted a qualitative approach. Thirty women (21–65 years old) participated in a total of five focus groups after the AoR intervention, which consisted of two sessions a week for ten weeks.

Findings: A qualitative content analysis of the focus group identified four categories: 1. Place of belonging including descriptions of social connectedness and understanding; 2. Experiences of AoR as a respite from demands; 3. Arts activities offering challenge and reward; and 4. Contributing to health-promoting changes. The findings were discussed in the light of Wenger’s concept of community of practice and Csikszentmihalyi’s concept of flow.

Value: This study describes how AoR contributed to health-promoting changes by offering a place of belonging, free from demands but still with opportunities to challenge oneself and explore new skills. Findings suggest that AoR can be helpful in improving mental wellbeing and feelings of belonging.

Purpose: To evaluate the long-term effects of an Arts on Prescription (AoP) programme on sense of coherence (SOC) in Sweden.

Design: A controlled intervention study with a quasi-experimental prospective design, including questionnaires at baseline, with follow-ups at 6 and 12 months. Participants were on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain, recruited from primary care in six regions. The intervention group also included participants from open psychiatric care. The study sample comprised 586 participants (335 in the intervention group and 251 in the control group).

Results: Both groups showed a significantly stronger SOC at follow-up, with a medium effect size for the intervention group and a small effect size for the control group. No statistically significant difference in SOC change over time was observed between the groups. Participants from open psychiatric care in the intervention group showed a significant improvement in SOC compared to those from primary care. Concerns about finances had a significant main effect on SOC for the entire study population.

Originality: Unlike most AoP studies, this controlled study with a relatively large sample provides insights into the long-term effects of AoP on SOC, with results reported using p-values and effect sizes.

Aims: Involvement in arts has shown potential to promote mental health. Thus, arts may be able to complement conventional healthcare to address common mental disorders (CMD). The aim of this study was to evaluate the long-term effect of a 10-week Arts on Prescription program regarding CMD (stress, anxiety, depression), compared to conventional healthcare. The study also aimed to examine whether CMD differed between groups.

Methods: A quasi-experimental prospective design with intervention and control group and 6- and 12-month follow-up was used to evaluate an Arts on Prescription program in Sweden, focusing on the effects on stress, anxiety, and depression. Participants were on sick leave due to CMD and/or musculoskeletal pain. Data was collected using questionnaires.

Results: The study population consisted of 479 participants (n=247 intervention group, n=232 control group). The result indicates a greater effect size (ŋ) in the intervention group compared to the control group for reduction in stress, anxiety, and depression at follow-up after 12 months. The difference in depression was significant.

Conclusions: The results indicate AoP could be an adjunct to conventional healthcare interventions to address CMD, especially depression.

The jobs strategy emphasizes paid work as necessary for welfare. However, both the jobs strategy and continual economic grow th have been questioned. Here, philosopher Hannah Arendt’s three modalities of human activity, labour, work and action, can be of interest. Labour implies activities that are constantly carried out to maintain biological existence. Work means  activities that create a man-made world. Action is activity taking place between people. Arendt means that the organization of paid work is in accordance with the labour modality. According to Arendt, it is in the action modality that humans achieve real freedom. Basic income may liberate groups of people from paid work. Growth would thereby have the potential to take place in the action modality rather than in the labour modality.

There is a debate about the meaning and importance of paid work for individuals as well as for society. On the one hand, paid work is considered the only way to secure general welfare. On the other hand, the Jobs Strategy urged by the OECD as the only possible model for achieving welfare is questioned and challenged through the idea of basic income. While basic income is frequently discussed within other disciplines, it is scarcely raised within occupational science, despite its obvious relevance. In this article, the significance of paid work and the possible consequences of introducing basic income are raised. Paid work may have healthy effects, but for many people worldwide dependence on paid work for basic security implies unhealthy, hazardous, and unsecure circumstances. Basic income may have a substantial impact on people’s occupational patterns as well as their experiences of occupational meaning. Three underlying rationales for introducing basic income can be traced: i) abolish a bureaucratic payment transfer system and maintain consumption, ii) diminish poverty and enhance a self-determined life, and iii) deepen democratization. These three rationales are discussed through the lens of Arendt’s vita activa: labor, work and action. Rationales underlying claims for basic income have substantially different underlying ideologies and are therefore important to scrutinize. Rationales mainly building on maintaining consumption imply a risk that people are reduced to homo consumens and denizens. Developing all modalities creates opportunities for occupational justice as well as inclusion and citizenship.

‘Work ability’ is a multidimensional concept with importance for both society and the individual. The overall aim of this thesis was to illuminate work ability from the perspective of individuals (Studies I, III), rehabilitation (Study II) and employers (Study IV). In Study I five focus-group interviews were conducted with a total of 16 former unemployed sickness absentee participants. The interviews focused on their experiences of the environmental impact on return to work. The participants expressed a changed self-image and life rhythm. A need for reorientation and support from professionals was stressed. Experiences of being stuck in a ‘time quarantine’, i.e. a long and destructive wait for support, were also revealed. Study II was a randomised controlled study evaluating the interventional capacity of problem-based method (PBM) groups regarding anxiety, depression and stress and work ability compared to cognitive behavioural therapy (CBT) as a method within the Rehabilitation Guarantee. Effects were measured with psychometric instruments. The participants, 22 in the PBM group and 28 in the CBT group, were persons on sick leave because of common mental disorders. Within-group analysis showed significant lower degree of symptoms regarding anxiety and depression for both interventions. Between-group analysis showed significant lower degree of symptoms for CBT regarding anxiety, depression and stress. Within-group analysis of work ability showed significant improvement in one (out of five) subscales for the PBM group and in four for the CBT group. No significant between-group differences were found regarding work ability. In Study III, 16 participants were interviewed after completed interventions in Study II, eight from each intervention group. The interviews focused on their experiences from the interventions and the impact on their ability to work and perform other everyday activities. The interventions were experienced as having a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. The findings support the use of active coping-developing interventions rather than passive treatments. Study IV included interviews with 12 employers and investigated their conceptions of ‘work ability’. In the results three domains were identified: ‘employees’ contributions to work ability’, ‘employers’ contributions to work ability’ and ‘circumstances with limited work ability’. Work ability was regarded as a tool in production and its output, production, was the main issue. The employees’ commitment could bridge other shortcomings. In summary, in the work rehabilitation process, different perspectives on work ability need to be considered in order to improve not only individual performance but also rehabilitation interventions, work-places and everyday circumstances. Clearly pronounced perspectives can contribute to better illustrating the dynamic within the relational and multifaceted concept of ‘work ability’. The ability to work can thus be enhanced through improving individual abilities, discovered through reorientation and created through support and adaptation.

The purpose of this qualitative study was to explore from an environmental perspective the experiences of returning to work of former unemployed sickness absentees. Five separate focus-group interviews were carried out with themes concerning different environmental areas. The findings showed that the participants in their process of being off work and then attempting returning to work experienced a personal transition manifesting itself as a negative self-image, change of life-rhythm and restrictions in their roles and activities. In their progression, the participants experienced a need for reorientation and expressed feelings of alienation, and for that reason felt need of support from a network, especially a professional one. Regarding attitudes in society, the participants reported experiences of social stigmatization, both in mass media and in their immediate social environment, and an increasing egocentricity among their fellow-workers. They perceived their progression back to work as a ‘time quarantine’ and as a long and destructive wait for support. The findings indicate that the phenomenon of ‘returning to work’ after unemployment and sick leave could not be reduced to a single issue. It should rather be seen as a dynamic problem with individual and structural, environmental aspects.

BACKGROUND: Since work ability is manifested in working life and "bought" by employers, employers perceptions of the concept are important to understand. Studies have shown that people with health problems want to take part in the labour market, but experience difficulties in gaining access. Additionally, studies have demonstrated the doubt felt by employers when they consider hiring a person with a disability.

OBJECTIVE: The aim was to identify and characterise employers' conceptions of work ability.

METHODS: The study design was qualitative with a phenomenographic approach. Six male and six female employers from various workplaces and geographical areas in Sweden were interviewed.

RESULTS: Three domains were identified: employees' contributions to work ability, employers' contributions to work ability and circumstances with limited work ability. Work ability was regarded as a tool in production and its output, production, was the main issue. The employees' commitment and interest could bridge other shortcomings.

CONCLUSIONS: The employers highlighted their own contributions in shaping work ability in order to fit with work circumstances. Health problems were not the only limiting issues; other circumstances, such as individual characteristics and contextual factors, could limit work ability too. Knowing the importance of commitment and interest is valuable in work rehabilitation.

BACKGROUND: Mental health problems (MHP) are common in working life and can be hard to respond to for employers. Therefore, knowledge of employers' perceptions of employees with MHP is important to support coping efforts of persons and their work environments.

OBJECTIVE: Identify and characterise employers' perceptions of the impact of MHP on work ability.

METHODS: Twelve employers with experience of employees with MHP were interviewed. Data were analysed with a phenomenographic method.

RESULTS: The first main category, 'Experiences of employees with MHP', included experiences of diffuse and unexpressed signs of the onset of MHP and frustration among employers and work-mates which was difficult to verbalise. MHP could also be turned off, thus having no impact on work ability. The second main category, 'Strategies to handle effects of MHP in the workplace', included the importance of continual responsiveness and communication, and of fluctuating adaptations. The informants expressed diversity in the workplace as a strategy.

CONCLUSIONS: Employers have experiences of, as well as strategies for, how to handle MHP at times when they impact with the ability to work. However, neither experiences nor strategies were explicitly pronounced and verbalised which makes it a challenge to develop strategies and guidelines in workplaces.

Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

Objective: Lengthy sick leave makes demands on work ability enhancing interventions in primary health care. Problem-based method (PBM) and cognitive behavioural therapy (CBT) are interventions aimed at people with common mental disorders. This study aimed to describe how individuals experienced interventions and the impact the interventions had on the individuals' ability to work and perform other everyday activities. Method: Fourteen women and two men, eight each from two interventions, were interviewed. The interviews were analysed using qualitative content analysis. Results: The analysis revealed one overarching theme: "Reaching safe ground or continuing to seek help". Four categories were identified: "From being passive to making one's own efforts in the rehabilitation process", "Being stuck on a treadmill or daring to change", "Evolving from routine to more aware behaviour", and "Fitting in or not fitting in with workplace situations". Conclusions: According to the participants, experiences from both PBM and CBT had a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. In general, the results support the use of active coping-developing interventions rather than passive treatments.

Background: Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

Aims: To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

Materials and methods: Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

Results: The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

Conclusion: Existential conversations in group may contribute to a more reflected doing in accordance with one’s own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual’s own preferences.

Significance: This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

In his response to our article “Hannah Arendt’s vita activa: A valuable contribution to occupational science,” Turnbull (2017) outlined some tensions he perceived with our discussion of “her approach to philosophy, politics and science”. In our reply, we express appreciation of his interest in Arendt related to occupational science and the contribution his article makes, as well as clarifying some points in his critique. We argue that Turnbull’s main arguments do not address our primary purpose of presenting Arendt’s vita activa and provide examples of its relevance for occupational science. We thus focused on activity-related aspects of Arendt’s thoughts, to raise awareness of this work amongst occupational scientists. However, we are thankful for Turnbull’s reflections, which broaden the insights of Arendt’s thinking and contribute to a better understanding of human occupation. 

Occupational science is undergoing dynamic development and claims have been articulated that human occupation must be understood from multiple ontological standpoints. Hannah Arendt (1906–1975) is known for her work The Human Condition in which she explored human occupation from a philosophical and political standpoint. She distinguished the modalities labor, work and action, and labelled them vita activa. The aim of this paper is to present Arendt and her vita activa, in order to provide examples of its relevance for occupational science, showing how vita activa can assist occupational scientists to take a deeper perspective on human occupation. According to Arendt, human occupation is always conditioned. The condition for labor is necessity, which reflects human biological needs and represents the basics of life. The condition for work is utility, as something persistent and durable is produced. Action is the activity that takes place between people without the intermediary of things. Similar to occupational science, vita activa is concerned with human doing but their origins differ. Arendt also emphasized the public sphere as an arena for human occupation, a viewpoint that is shared with recent occupational science literature. The need to expand the scope of occupational science to encompass all aspects of human occupations, including the deleterious, has been expressed and vita activa can contribute to broadening this perspective. Examples of the need for sustainability in working life are also presented in this paper.

Aim

The aim of the literature review was to describe how adulthood transition is used in health and welfare.

Design

A qualitative design with a deductive approach were used.

Methods

As material, 283 articles published in scientific journals, between 2011–August 2013, were selected. The search was conducted August 2013. The data were analysed and sorted in a categorization matrix.

Results

Transition was identified as a process mainly related to the four types previously identified; developmental, situational, health-illness and organizational transitions. Another one transition was also identified, lifestyle transition.

This article describes thoughts and reflections based on two ongoing studies. Both concern existential group conversations, but with different target groups: clients and healthcare professionals respectively. The two studies differ in aims and theoretical frameworks.

In the client study the concepts doing, being, belonging, and becoming, all commonly used in occupational science, were applied; whereas the study of the healthcare professionals applied the theoretical framework of practice architectures together with the concept resonance to understand what happens in ongoing practices.

Five common areas from the results have been identified, and these are illuminated from the respective studies’ aims and theoretical frameworks. These areas are: Existential framing and leadership, Freedom framed by time and space, The significance of the group, Reflective judgement and Becoming and transformative learning.

Finally, the authors share their experiences when two studies’ research processes become intertwined in the work with this article.   

Long-term unemployment impacts a person’s life and opportunities for participating in occupations. Despite the frequent occurrence of short-term unemployment, the proportion of long-term unemployment in Western contexts remains high and is growing, which particularly affects vulnerable groups and thus is an issue of relevance for occupational science. Research into the lived experiences of being long-term unemployed and how it affects daily life is limited, although the need to look more closely into unemployment has been recognized. The aim of this study was to describe people’s experiences of long-term unemployment from an occupational perspective. Due to the dearth of studies in this area, a scoping review methodological framework was used, resulting in nine relevant studies reported in English to be included in a thematic analysis. Results revealed three analytical themes: Experiences of occupations during and due to long-term unemployment; Experiences of occupational obstacles; and Experiences of occupational enablers. The daily lives of long-term unemployed people consist largely of occupations they perform for obligatory reasons, that is, to be eligible for economic subsidies for their survival, and less of anything related to what they want or need. People also experience obstacles that limit and restrict their opportunities of engaging in meaningful occupations. These obstacles could be seen as occupational injustices. Enabling factors also exist, but they are not available or possible for all. Being long-term unemployed changes people’s participation and engagement in occupations. By understanding the experience of long-term unemployment, it is possible to plan and implement better services.

Occupational therapy has a lot to contribute to sustainable development considering the discipline's occupational focus and knowledge. This has been recognised by researchers and professional associations, but there is still a scarcity of research explicitly mentioning sustainability. Relevant contributions may be identified by relating education and research to the Agenda 2030 sustainable development goals. The aim of this article was to describe explicit and implicit inclusion of sustainable development and Agenda 2030 goals in occupational therapy education and research at one Swedish university. Current course syllabi and study guides, as well as research over the past five-year period, were examined and related to sustainability. The results showed that although only a few courses and articles were explicitly related to sustainable development, more course and research content became relevant when this content was compared with the sustainable development goals. It can be concluded that sustainability was more extensively addressed than first visible, but further studies including more universities are warranted.