Background: Mental ill-health is a significant problem among young people, negatively affecting their quality of life with long-term consequences. A need exists for a broader range of interventions to address the determinants that affect mental health, early, when problems are emerging. Research suggests that the balance and nature of daily occupational choices can influence mental health in adults, but its influence on adolescent mental health has yet to be fully explored. Adolescence is a key period in developing occupational choice and learning how to balance daily occupations. To date there is a limited understanding of how adolescents choose and balance occupations, the relationship of occupational choices to mental health, and whether an intervention developed with young people can support individuals in their occupational choices to affect their mental health. Aim: This study aims to understand how young people use their time, their perception of this process in relation to their situational context and mental health, and to inform the co-development of an occupational therapy theory-based intervention for young people aged 16 to 17 years experiencing emerging mental health difficulties. Methodology: Informed by the Intervention Mapping framework, a pragmatic five-study, sequential, mixed method project was completed. Study one used a systematic scoping review method, to describe the academic literature reporting occupation-based interventions designed to improve the mental health of adolescents. Study two surveyed a cohort sample of typical 16- to 17-year-olds from two mainstream UK co-educational secondary schools, using time-use diaries and the SDQ questionnaires. Providing a sampling frame for a third study using a constructivist grounded theory method. The findings from the first three studies informed a structured consultation with occupational therapists and researchers using a consensus Delphi study, designed to prioritise emerging occupational determinants. Study five used the prioritised determinants to inform the content development of a manualised intervention, which underwent initial acceptability testing with young people. Results: The scoping review found three occupational therapy-based interventions targeting adolescent mental health, and a diverse range of thirty-six other occupation-based studies, using a wide breadth of approaches and outcome measures across a variety of settings. A school cohort sample of 134 students completed two surveys, providing an insight into the feasibility issues, recruitment rate, measure completion and potential for patterns and relationships. Drawing on the sample, six focus groups were conducted with twenty-seven young people, informing a theoretical model of occupational choice. The Delphi identified and prioritised eighty-nine determinants leading to the prioritisation of eighteen, informing the aims, objectives, and content of the intervention. The studies informed the construction of the eight-week ‘Activity-Time Use’ intervention manual including exploration and development of the occupational repertoire, balancing occupation, volitional aspects, the situational context, occupational choice, and the occupational self. The intervention review against six acceptability criteria suggested that the intervention required minor amendments but appeared acceptable to the target population. Conclusion: New knowledge of occupational determinants and their influence on occupational choices, in conjunction with occupational therapy and behaviour change theories, informed a manualised intervention, co-developed with young people and experts, which, following initial acceptability testing with young people, shows potential for further development and feasibility testing.
Permanent link to this resource: https://doi.org/10.24384/zkmj-mh15
Parsonage, Jackie
Supervisors: Dawes, Helen; Eklund, Mona
Faculty of Health and Life Sciences
Year: 2021
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