Date Presented 04/19/21
People with schizophrenia have daily living challenges related to impaired cognitive skills and low self-efficacy. This study used the Model of Human Occupation Screening Tool (MOHOST) in a single-case design with multiple baselines (N = 5) to investigate a strengths-based intervention for people with schizophrenia. Visual and statistical analyses yielded a small intervention effect (d = 0.26) and relationships among cognitive variables and MOHOST domains. Participants reported increased self-confidence and occupational engagement.
Primary Author and Speaker: Christine A. Linkie
Additional Authors and Speakers: Karen Ratcliff, Ickpyo Hong
PURPOSE: This dissertation study investigated a strengths-based cognitive prompting intervention to improve occupational performance and self-efficacy in people with schizophrenia spectrum disorders. Other research questions explored participants’ lived experience of the intervention and relationships between occupational performance, executive function, social cognition, self-efficacy, and life satisfaction.
DESIGN: The study used a mixed methodology. Quasi-experimental single-case design with multiple baselines investigated the intervention. Quantitative methods explored relationships among variables and compared preintervention (T1) and postintervention (T2) test scores. Qualitative methods included participant interviews and focus group.
METHODOLOGY: Participants were five members of community-based psychiatric rehabilitation services (PRS).The Model of Human Occupation Screening Tool (MOHOST), the repeated measure of occupational performance, was completed by research assistants (RAs) who observed participants during baseline (A) and intervention (B) phases. Prior to Phase A, the PI conducted an assessment protocol guided by the cognitive functional evaluation (CFE) process: Executive Function Performance Test (EFPT, bill-paying), Behavioral Rating Inventory of Executive Function (BRIEF), Comprehensive Trail-Making Test (CTMT), Montreal Cognitive Assessment (MoCA), General Self-Efficacy (GSE), Satisfaction with Life (SWL), Brief Psychiatric Rating Scale (BPRS), and tests of social cognition (Hinting Task, Bell-Lysaker Emotion Recognition Task). Participants’ strengths were gleaned from test results and baseline MOHOST scores. In Phase A, RAs observed participants during PRS session activities. After Phase A, PI met with participants to review their strengths and discuss ways to apply strengths to self-identified goals. In Phase B, RAs prompted participants to use strengths during activities. After Phase B, PI conducted T2 assessments, individual interviews, and focus group. Data analyses included visual analysis of graphed MOHOST scores. Statistical analyses (d-statistics, Spearman’s rho correlations, Wilcoxon matched-pairs signed-ranks tests) compared T1 and T2 data and explored relationships among variables. Qualitative methods analyzed focus group and interview data.
RESULTS: Interrater reliability was established (ICC = .868, p = .002). Visual analysis showed positive intervention effects with varying results among participants and MOHOST domains. Statistical analysis of MOHOST scores yielded small effect size (d = .26). T2 correlations suggested occupational performance (MOHOST) was related to cognitive skills and life satisfaction: CTMT (r = .90, p = . 038), EFPT (r = -.97, p = .006), SWL (r = .98, p = .005). Improved scores in 3 tests trended toward significance: MoCA (Z = -1.826, p = .068), BRIEF-MI (Z = -1.826, p = .068), and HT (Z = -1.890, p = .059). Participants reported positive experiences of the intervention and assessment protocol, improved self-confidence, and increased occupational engagement, especially socially.
CONCLUSION: This was the first known study to use the MOHOST for single-case design and to explore relationships between MOHOST domains and cognition.The strengths-based cognitive prompting intervention showed initial positive results for people with schizophrenia, including increased self-confidence and improved occupational performance and participation, warranting further development.
IMPACT STATEMENT: A strengths-based approach to rehabilitation may positively affect occupational performance and participation. Single-case design allows OT researchers to investigate factors and interventions that affect occupational performance and to engage in clinical research with community partners.
References
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