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Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint.Design Cost effectiveness study alongside a single blind randomised controlled trial.Setting Memory clinic, day clinic of a geriatrics department, and participants’ homes.Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers.Intervention 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures.Results The intervention cost €1183 (£848, $1738) (95% confidence interval €1128 (£808, $1657) to €1239 (£888, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were €1748 (£1279, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9).Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.

Objective: Evaluate the effectiveness of a training package to implement a community occupational therapy program for people with dementia and their caregiver (COTiD). Design: Cluster randomized controlled trial. Subjects: A total of 45 service units including 94 occupational therapists, 48 managers, 80 physicians, treating 71 client-caregiver couples. Interventions: Control intervention: A postgraduate course for occupational therapists only. Experimental intervention: A training package including the usual postgraduate course, additional training days, outreach visits, regional meetings, and access to a reporting system for occupational therapists. Physicians and managers received newsletters, had access to a website, and were approached by telephone. Main measures: Primary outcome: The intended adherence of therapists to the COTiD program. This was assessed using vignettes. Secondary outcomes: clients’ daily functioning, caregivers’ sense of competence, quality of life, and self-perceived performance of daily activities of both clients and caregivers. Between-group differences were assessed using multilevel analyses with therapist and intervention factors as covariates. Results: No significant between-group differences between baseline and 12 months were found for adherence (1.58, 95% CI −0.10 to 3.25), nor for any client or caregiver outcome. A higher number of coaching sessions and higher self-perceived knowledge of dementia at baseline positively correlated with adherence scores. In contrast, experiencing more support from occupational therapy colleagues or having conducted more COTiD treatments at baseline negatively affected adherence scores. Conclusion: The training package was not effective in increasing therapist adherence and client–caregiver outcomes. This study suggests that coaching sessions and increasing therapist knowledge on dementia positively affect adherence. Clinical trial number: NCT01117285

Background: This review aims to evaluate the level of scientific evidence for the effectiveness of Community Occupational Therapy interventions. Methods: A systematic review was used to analyze and synthesize the studies collected. The databases of Cochrane, OTseeker, OTCATS, Web of Science, Scielo and Scopus were used in order to collect articles published between 2007 and 2020. PRISMA recommendations were followed. Results: A total of 12 articles comprised part of the study (7 randomized controlled studies, 4 systematic reviews and 1 meta-analysis). The main areas of practice were geriatric gerontology (22.1%) and mental health (19.7%), which were statistically significant (χ2; p < 0.005) compared to the rest. Regarding the studies analyzed, all of them had scores of >7 on the PEDro and AMSTAR scales. Conclusions: Research on Community Occupational Therapy constitutes a consolidated line of research but the objectives and areas of research were limited. Descriptive qualitative methodology predominated and studies on the effectiveness of Community Occupational Therapy interventions showed a medium–low level of evidence.

We examine how different occupational communities that are embedded in organizations exercise control processes to achieve emergent coordination as they create complex products together. We compare two types of organizations, equipment manufacturing and film production, and find that although occupational control was important for emergent coordination in both settings, this relationship varied according to two aspects of occupational embeddedness: organizational acknowledgment of occupational control and occupational interdependence. In the equipment manufacturing setting, occupational control was latent: the communities visibly conformed to organizational control processes while exercising occupational control behind the scenes to coordinate emergently. In the film setting, the organization granted the occupational community significant latitude over its tasks, which enabled members to coordinate emergently to solve problems the majority of the time. We propose that these two aspects of occupational embeddedness must be analyzed together with occupational control processes to explain how integration unfolds in knowledge-based settings in ways that organizational control processes are illequipped to manage.

This article explores the relationship between occupational community and restructuring at a UK steelworks. Through historic and contemporary experiences, restructuring has become an internalized feature of the steelworker identity. Zittoun and Gillespie’s framework of proximal and distal experiences is adapted to analyse the internalization process. The article argues that experiential resources associated with restructuring are transmitted via the occupational community, forming a part of a collective memory of workplace change. These experiences relate to the historical precedence of restructuring, the role of trade unions in accepting the inevitability of downsizing and prior personal and vicarious experiences of redundancy. The findings build on debates around the determinants of an occupational community, highlighting the role of ‘marginality’ and how experiences of restructuring bind steelworkers to a broader community of fate.

In Morocco, the social and environmental context influences the volition and development of meaningful activities, creating physical, personal and social barriers to the occupational performance of people with disabilities. This study develops a community Occupational Therapy program in order to verify its effectiveness in the volition, quality of life and perceived self-stigma of people with disabilities in the Moroccan city of Azrou, and to reduce the stigma of the community towards people with disabilities in the city. Data were collected from people with disabilities who participated in the program (N = 52), using the Volitional Questionnaire (VQ), The World Health Organization Quality of Life scale (WHOQOL-BREF), the Stigma Awareness Questionnaire (SCQ) and an ad hoc interview. In addition, community stigma was assessed by the Attribution Questionnaire (AQ-27) in citizens without disabilities (N = 42). Results confirmed that this intervention favors the inclusion of people with disabilities in their closest environment, improving volition and quality of life and reducing self-stigma. Furthermore, the community’s stigma towards people with disabilities was also significantly reduced after the intervention.

This paper suggests that knowledge is shared in organizations through the transformation of occupational communities' situated understandings of their work. In this paper, I link the misunderstandings between engineers, technicians, and assemblers on a production floor to their work contexts, and demonstrate how members of these communities overcome such problems by cocreating common ground that transforms their understanding of the product and the production process. In particular, I find that the communities' knowledge-sharing difficulties are rooted in differences in their language, the locus of their practice, and their conceptualization of the product. When communication problems arise, if members of these communities provide solutions which invoke the differences in the work contexts and create common ground between the communities, they can transform the understandings of others and generate a richer understanding of the product and the problems they face.

The article examines the relationship between restructuring and work-based identity among older workers, exploring occupational identity, occupational community and their roles in navigating transitions in the life course. Based on working-life biographical interviews with late career and retired telecoms engineers, the article explores the role of occupational identity in dealing with change prior to and following the end of careers at BT, the UK’s national telecommunications provider. Restructuring and perpetual organizational change undermined key aspects of the engineering occupational identity, inspiring many to seek alternative employment outside BT. For older workers, some seeking bridge employment in the transition to retirement, the occupational community not only served as a mechanism for finding work but also provided a sustained collective identity resource. Distinctively, the research points to a dialectical relationship between occupational identity and the navigation of change as opposed to the former simply facilitating the latter.

Introduction. Depression in adulthood decreases social participation in the workplace, family, and community, which further results in decreased work performance and cessation and social isolation. There is a high statistic of outpatient consultation and readmission of Thais with depression, yet the mental health support for remission in community life and social participation remains limited and unclear. Further, due to the lack of mental health professional resources, particularly occupational therapists, there is much to be known regarding how such therapists work to support the development of social participation in Thai adults with depression. Objective. This research was aimed at understanding the process of how occupational therapists work to redevelop the social participation of community-dwelling Thai adults with depression. Method. The grounded theory methodology was used in this study. Data were collected through interviews and nonparticipatory observations of 14 participants who had experience providing mental health care in community services. The constant comparative analysis method was employed. Result. Three concepts illustrated a proactive community occupational therapy service for depression (PCOTS-D), namely, integrating depression care in community occupational therapy service (COTS), supporting meaningful participation, and forming collaborative networks. The PCOTS-D supported the reconnection of social participation by leading from proactive depression care service to COTS and then working to support meaningful participation toward the patient’s self-management and building collaborative networks with inter- and intraprofessional teams simultaneously. Conclusion. The PCOTS-D presented a holistic view of working with community-dwelling Thai adults with depression by considering the importance of the community and researchers’ network to redevelop social participation, promote health and recovery, build teams in depression care, and encourage research evidence to enhance the supportive advocacy policy for Thai people with depression.

Senior executives in major corporations have drawn attention in recent years for a range of unethical activities. Despite a rise in measures to protect against such lapses, executives still make decisions whether or not to comply with reporting standards, best practices, industry norms and legislation. The prior literature in this area addresses individual characteristics of decision makers and social networks between executives and boards of directors, but to this point has largely overlooked group dynamics of the executive team. Our study addresses this gap and examines the relationship between an occupational community of top executives and the quality of internal control. We construct a unique measure for the executive occupational community based on CEO and CFO's joint tenure. Our findings show that the number of years of CEO/CFO's joint tenure is significantly and negatively associated with internal control weakness, suggesting that the longer the executive relationship, the lower the likelihood of internal control weakness. Our study indicates that the presence of an occupational community contributes to better internal control.