Using the ICF as a framework to Using the ICF as a framework to explore mental health users' explore mental health users' experiences of activities,  experiences of activities,  participation and environment: An participation and environment: An international studyinternational study

Dr Elizabeth A. McKay, Elizabeth A. McKay, Abigail Henderick, MSc OT & Abigail Henderick, MSc OT & Stephanie Doran, MSc OT: Stephanie Doran, MSc OT: University of Limerick (Ireland )University of Limerick (Ireland )

Dr Thelma Sumsion: Dr Thelma Sumsion: University of Western Ontario, (Canada)University of Western Ontario, (Canada)

Kirsti Haracz, MSc BAppSc Kirsti Haracz, MSc BAppSc University of Newcastle, (AustraliaUniversity of Newcastle, (Australia)

Overview

The ICF (WHO 2001) has been used as a statistical, research, educational and clinical tool.

There has been a call for all health professionals to use and have knowledge of the ICF.

However research into the utility of the ICF in occupational therapy has been limited, particularly in mental health settings.

Social inclusion is…

one of the most cited concepts in mental health literature. It is a concept of equal opportunity, which allows for a person to take part in activities and roles within society (Repper and Perkins 2003).

Any difficulties participating in everyday activities will significantly impact upon an individual’s social inclusiveness.

Research Question

Are the activities, participation and environment components of the ICF effective in identifying the barriers and facilitators to social inclusion?

NEWCASTLE

LIMERICK

LONDON21 participants

38 participants

Questionnaires administered 2009Questionnaires administered 2009

15 participants

Method Two phase study

Phase 1 – Quantitative – structured questionnaire using ICF (1:1)

Phase 2 – Qualitative - follow-up interviews using ICF Categories and recovery (Reported elsewhere).

Ethical Permission approved in all 3 countries.

Activity and Participation Questions

NoDiffic

Milddifficul

Moddifficulty

SevereDifficult

Completedifficulty

Learning and applying knowledge 1 2 3 4 5

Q9. Do you experience difficulties in learning and applying knowledge that is preventing you from participating in your daily life? (e.g. reading, writing, using maths such as budgeting or shopping)

General tasks and demands

Q10. Do you experience difficulty in completing tasks preventing you from participating in your daily life?

Environmental Factors

Short List of Environment Qualifierbarrier or facilitator

Coding Column

Products and technology

Q25 Is public transportation a barrier/facilitator to your participation? Rate.

Data Analysis Cross-tabulated frequency tables

were used to identify the frequency of barriers and facilitators.

Cramer’s V, Pearson’s chi-square (p=0.05) and Fisher’s exact tests (p=0.05) were conducted to analyse the relationship between pairs of variables.

Results: Demographic data (n=74)

Frequency PercentageGender Male 39 53%

Female 35 47%

Age

18-24 2 3%

25-40 15 20%

41-5541-55 3939 53%53%

56-65 18 24%

Occupation

Frequency Percentage Part time work 1 1%Full time workFull time work 1616 22%22%Self-employed 1 1%Non paid work 5 7%Student 1 1%Unemployed 25 34%Housewife 1 1%Retired 2 3%Other 22 30%

Diagnosis

Anxiety7%

Bipolar19%

Borderline Personality Disorder

1%

Schizophrenia28%

Do not know26%

Depression16%

Thought disorder3%

Participants Self ReportedParticipants Self Reported Diagnosis

Breakdown of participant responses

39 40 4149 51

3641

37

24

4435 37

57

41

18 1316

1212

11

16

11

14

13

17 15

5

11

8

6

88 5

10

815

8

79 11

5

8

712

65

10

6 6

15

6 98

4

6

37

3 410

4 482

2223

2

0%

20%

40%

60%

80%

100%

Activities

Rep

ort

ed d

iffic

ulti

es in

par

ticip

atin

g

No difficulty Mild difficulty Moderate difficulty Severe difficulty Complete difficulty

Breakdown of responses to activities and participationBreakdown of responses to activities and participation

Facilitators & Barriers to Participation

ICF Categories Barrier Facilitator

Products & technology % N % N

Public transportation 44% 28 56% 35

Natural & Human Environment

Warm Climate 41% 26 59% 37

Noise 53% 31 47% 28

Support & Relationships

Immediate Family 53% 36 47% 32

Acquaintances & Peers 47% 30 53% 34

Health Professionals 55% 39 45% 32

Facilitators & Barriers to ParticipationICF Categories Barrier Facilitator

Attitudes % N % N

Positive attitude of family 62% 33 38% 20

Negative attitude of family 35% 18 65% 33

Positive attitude of health professionals

62% 42 38% 26

Negative attitude of health professionals

57% 32 43% 24

Positive attitude of society 60% 33 40% 26

Negative attitude of society 39% 23 61% 36

Implications Practice

This work highlights the possibility of using the ICF components as a screening tool.

Education ICF should be an integral part of both undergraduate and

postgraduate occupational therapy professional qualifications, to skill new practitioners in the use of this language and convert it into practice in context.

Research Need for larger study to increase generalisability of the

findings Both clients and therapists’ perspectives of using ICF.

Conclusion

Results of this research are in keeping with social inclusion literature.

Therefore it can be concluded that the ICF components of activity, participation and environment were effective in identifying the barriers and facilitators to social inclusion.

The results of this study will have clinical and social applications for mental health professionals and for broader legislation.