Exploring factors shaping family involvement in promoting the participation of adults with substance use disorders in meaningful occupations

Chikwanha, Theodora Mildred (2019-04)

Thesis (PhD)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background and rationale: Approximately 60% of re-admissions at the main acute mental health units at two of the referral hospitals in Zimbabwe comprise of adults with substance use disorders. Occupational therapy management of individuals recovering from substance use disorders at these institutions begins in the acute phase when clients are hospitalised. There are no rehabilitation programmes with defined minimum care standards in which occupational therapy is available to people with substance use disorders. Follow up of clients in their homes is also not possible due to limited financial and human resources. There is therefore no further psychosocial support or follow up rehabilitative care for clients with substance use disorders post discharge, their families take over the caring role. Aim: In this study, I explored the influence of the family on rehabilitation outcomes by examining the extent to which family involvement promoted participation in meaningful occupations by adults recovering from substance use disorders. Specific objectives: The specific objectives of this study were to: - Explore how a family member’s substance use affected his/her occupational patterns as well as those of other family members - Investigate what made it difficult or easier for families to support a family member who was undergoing occupational therapy to help modify substance use behaviour - Investigate how involvement of family members in occupational therapy interventions influenced participation in meaningful occupations by adults with substance use disorders - Develop a treatment framework for family based occupational therapy interventions for substance use disorders in the Zimbabwean context Methodology: This study was positioned within a decoloniality perspective. A qualitative design using a narrative inquiry approach was used to conduct this study. Fourteen family units with an adult family member recovering from substance use disorders participated in the study. Purposive maximum variation sampling was used during recruitment. Narrative interviews on the family`s experiences of living with an adult family member with a substance use disorder were conducted. Data were transcribed and analysed using interpretive narrative analysis strategies. Results: The theme “Reconstructing occupational participation through transactions enacted within the family context” emerged as the overarching theme during data analysis. The overarching theme comprised of two subthemes namely i) Occupational disruption from an intrapersonal and interpersonal perspective and ii) The centrality of the family in creating opportunities for participating in occupations. Exploring the connections between these subthemes and the overarching theme afforded the exploration of factors shaping family involvement in promoting the participation of adults with substance use disorders in meaningful occupations. Conclusion: The findings indicated that the family is extremely important in the management of substance use disorders. Through support from family members, the relatives who were recovering from substance use disorders were able to identify new occupational opportunities and reconstruct occupational participation. The new opportunities for occupational participation facilitated future participation in occupations that were health enhancing. These findings provided useful insights into the occupational therapy services that would be contextually relevant for individuals recovering from substance use disorders in Zimbabwe. A treatment framework which is occupation based and initiated by the families was proposed as a sustainable approach to providing post discharge occupational therapy services.

AFRIKAANSE OPSOMMING : Agtergrond en rasionaal: Ongeveer 60% van hertoelatings tot die belangrikste akute geestesgesondheidsorgeenhede by twee van die verwysingshospitale in Zimbabwe bestaan uit volwassenes met substansgebruiksteurings. Arbeidsterapie insette in die behandeling van individue met substansgebruiksteurings by hierdie instellings begin in die akute fase, wanneer kliënte in die hospitaal opgeneem word. Daar is geen rehabilitasieprogramme met bepaalde minimum sorgstandaarde waarin arbeidsterapiedienste beskikbaar is vir mense met substansgebruiksteurings nie. Die gebrek aan finansiële en menslike hulpbronne beteken ook dat daar geen dienste is vir opvolg van kliënte na ontslag nie, daarom neem families die versorgingrol oor. Doel: Die studie het die invloed van familiegesinsbetrokkenheid op die rehabilitasie-uitkomste van volwassenes wat herstel van substansgebruiksteurings ondersoek ten einde hul rol te bepaal in die bevordering van deelname in betekenisvolle aktiwiteitsverrigting. Spesifieke doelstellings: Die spesifieke doelstellings van hierdie studie was om te ondersoek: - Hoe 'n familielid se substansgebruik sy/haar aktiwiteitsverrigting sowel as dié van ander familielede beïnvloed het. - Wat dit moeiliker of makliker gemaak het vir families om ʼn familielid te ondersteun wat arbeidsterapie ontvang het om die gebruik van substanse te help verander. - deelname in betekenisvolle aktiwiteitsverrigting beïnvloed het vir volwassenes met substansgebruiksteurings. - Ontwikkeling van ʼn behandelingsraamwerk vir familie-gebaseerde intervensie vir die hantering van persone met substansgebruiksteuring in Zimbabwe. Metodologie: Die navorsing is binne ‘n dekolonialiteitsperspektief gedoen. 'n Kwalitatiewe navorsingsontwerp, met 'n narratiewe ondersoek benadering, is gebruik. Veertien familie-eenhede waarvan een volwasse familielid herstel van ʼn substansgebruiksteuring het aan die studie deelgeneem. ʼn Doelgerigte steekproef met maksimum variasie is gebruik vir werwing van familie-eenhede. Narratiewe onderhoude om ʼn familie se ervaring om te leef met ʼn volwasse familielid met substansgebruiksteuring is uitgevoer. Data is getranskribeer en geanaliseer met behulp van interpretatiewe narratiewe analise strategieë. Resultate: Die tema "Rekonstruksie van aktiwiteitsverrigting deur middel van onderhandeling binne die familie konteks", is tydens data-analise ge-identifiseer. Die oorkoepelende tema het bestaan uit twee subtemas naamlik i) Ontwrigting van aktiwiteitsverrigting vanuit 'n intrapersoonlike en interpersoonlike perspektief en ii) Die kernrol van die familie om geleenthede te skep vir deelname aan aktiwiteite. ʼn Ondersoek na die verband tussen die subtemas en die oorkoepelende tema het die verkenning van faktore wat ʼn rol gespeel het in familiebetrokkenheid by die bevordering van deelname van volwassenes met substansgebruiksteurings in betekenisvolle aktiwiteite, tot gevolg gehad. Gevolgtrekkings: Bevindinge van die studie het aangedui dat families uiters belangrik is in die hantering van substansgebruiksteurings. Vanweë die familie se ondersteuning kon familielede wat herstel van substansgebruiksteurings nuwe aktiwiteite identifiseer en aktiwiteitsverrigting herbou. Die bevindinge het gelei tot nuttige insigte aangaande kontekstueel-relevante arbeidsterapiedienste vir individue wat herstel van substansgebruiksteurings in Zimbabwe. ‘n Aktiwiteitsgerigte, familie-geïnisieerde behandelingsraamwerk word voorgestel as 'n volhoubare benadering tot die verskaffing van arbeidsterapiedienste na ontslag.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105954
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