Department of Occupational Therapy
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Item Editorial: Contextualizing psychological assessment in Africa: COVID-19 and beyond(Frontiers in Psychology, 2023) Oppong, S.; Appiah, R.; Hapunda, G.; Kheswa, J.G.Historically, the science of Psychology and the practice of psychological assessment have in Africa have been influenced by Western ideologies and practices (Nsamenang, 2007; Oppong et al., 2022). However, there are vast cultural differences among people of different social structures and value orientations. Therefore, there is a growing need for locally generated and validated tools to assess the strengths, capacities, and mental health of the African people (Oppong, 2017; Laher, 2019; Appiah et al., 2020; Oppong et al., 2022), who are often under-represented in global psychological research (Nielsen et al., 2017; Rad et al., 2018; Thalmayer et al., 2021). The overarching importance of generating and administering context-appropriate measures is that it strengthens the drive toward ensuring valid, reliable, and context-worthy assessment of mental health and psychological wellbeing among individuals, groups, and communities in the context of research and practice.Item A look back, a path forward: Revisiting the mental health and well-being research and practice models and priorities in sub-Saharan Africa(New Ideas in Psychology, 2022) Appiah, R.Despite the enthusiasm to promote mental health in Ghana and sub-Saharan Africa more generally, the models and frameworks that underpin research and practice in these settings have focused exclusively on understanding and treating mental disorders, to the neglect of the mental health needs of the general, non-clinical population. We discuss the limitations of the bipolar and biomedical models as frameworks for mental health research and practice in the current paradigm. Using Ghana as a case example, we identify gaps in the mental health research priorities in sub-Saharan Africa, and discuss the limitations of the revised Mental Health Policy of Ghana in ensuring a mentally healthy population. Drawing on a consilience of evidence from the literature, we contend that, although important and laudatory, the current research approach and priorities, which remain overwhelmingly fixated on alleviating and treating symptoms of mental disorders, are insufficient to buffer against psychopathology and bolster positive mental health. We argue for the adoption of more global and empirically tested frameworks and population-based approaches to complement clinical approaches to reduce the population burden of mental health problems.Item Measuring Positive Mental Health and Depression in Africa: A Variable-Based and Person-Centred Analysis of the Dual-Continua Model(Frontiers in Psychology, 2022) Khumalo, I.P.; Appiah, R.; Fadiji, A.W.The dual-continua model of mental health provides a contemporary framework for conceptualising and operationalizing mental health. According to this model, mental health is distinct from but related to mental illness, and not the opposite or merely the absence of psychopathology symptoms. To examine the validity of the dual-continua model, previous studies have either applied variable-based analysis or confirmatory factor analysis (CFA), or used predetermined cut-off points for subgroup division. The present study extends this contribution by subjecting data from an African sample to both CFA and latent class analysis (LCA) to test the dual-continua model in Africa. We applied CFA separately for the Mental Health Continuum—Short Form (MHC-SF) and Patient Health Questionnaire—9 (PHQ-9); and LCA on combined item responses. College students (N = 892; average age = 22.74, SD = 4.92; female = 58%) from Ghana (n = 309), Kenya (n = 262), and Mozambique (n = 232), and South Africa (n = 89) completed the MHC-SF and PHQ-9. With minor modifications to the measurement models, the CFA results of this study confirm the three-factor structure of the MHC-SF and a unidimensional solution for the PHQ-9. LCA results show the presence of three distinct latent classes: languishing with moderate endorsement of depressive symptoms (25.9%), flourishing with low endorsement of depressive symptoms (63.7%), and moderate mental health with high endorsement of depressive symptoms (10.4%). These findings further contribute to affirming the evidence for the dual- continuum model of mental health, with implications for the assessment of mental health, to inform policy, practice, and future research in community and clinical settings in Africa.Item The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana(Journal Community Psychology, 2021) Appiah, R.; Fadiji, A.W.; Wissing, M.P.; Schutte, L.Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP). designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting, and problem-solving solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults is feasible and has important policy implications for mental health and social care in sub-Saharan Africa.Item Exploring Students' Experiences In Occupational Therapy Education: A Phenomenological Study Of Professional Identity Development(The Qualitative Report, 2022) Ndaa, P.O.; Bello, A.I.; Wimpenny, K.; et al.The existing literature on professional identity enactment and development subscribes to students’ socializing in a learning environment, where they regularly encounter practicing professionals throughout their education period. However, in most countries with less resourced occupational therapists, like In Ghana, education in occupational therapy is fraught with inadequate number of same professionals. mentor undergraduate occupational therapy students. The students are thus faced with serious dilemma regarding their professional identity, which tends to elicit a bleak perception of their chosen career. The present study was therefore envisaged to interpret and analyse the students’ lived experiences, with the view to capture the process of constructing and developing professional identity. The study focused on purposively sampled group of nine undergraduate occupational therapy students during their practice placement education, and their learning styles on didactic lectures. A hermeneutic phenomenological approach was adopted for the study. The students were followed up throughout their four-year study program for data collection, using one-to-one semi-structured interviews each year. With reference to the threshold concepts, transcribed interview data were analyzed using interpretative phenomenological procedures. The study established a transformational development of professional identity from the novice stage into graduate professionals, amidst complex interaction of co-constructed themes, included: personal knowing, professional knowing and experiential knowing.Item Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research(Journal of Empirical Research on Human Research Ethics, 2024) Appiah, R.; Raviola, G.; Weobong, B.Objective: This review explores the ethical, cultural and implementation challenges associated with the individual-based informed consent (IC) model in the relatively collectivistic African context and examines suggested approaches to managing them. Methods: We searched four databases for peer-reviewed studies published in English between 2000 and 2023 that examined the ethico-cultural and implementation challenges associated with the IC model in Africa. Results: Findings suggest that the individual-based IC model largely misaligns with certain African social values and ethos and subverts the authority and functions of community gatekeepers. Three recommendations were proffered to manage these challenges: that researchers should: adopt a multi-step approach to IC, conduct a rapid ethical assessment, and generate an African-centered IC model. Conclusions: A pluriversal, context-specific, multi-step IC model that critically harmonizes the cultural values of the local population and the general principles of IC can minimize ethical dumping, safeguard the integrity of the research process, and promote respectful engagementItem Facilitating change processes in group-based behaviour change interventions in rural African contexts: practical lessons from Ghana(International Journal of Mental Health Systems, 2023) Appiah, R.Evidence from implementation research suggests that group-based behaviour change interventions (GBCIs) can encourage the development of peer support, promote psychosocial skills, and facilitate collaborative therapeutic relationships. However, although the mechanisms of action that mediate the behavior change process have been extensively described in other settings, less is known about the implementation strategies and contextual factors that actuate the reported behaviour changes among programme participants in Ghana and sub-Saharan Africa, more generally. We draw on insights from the literature and field experiences from designing, implementing, and evaluating GBCIs across several rural and peri-urban communities in Ghana to discuss a range of theoretical, methodological, and contextual factors that facilitate the behaviour change process in programme participants. We offer suggestions to guide researchers to envision and manage potential challenges with the programme development and implementation processes. We propose that intervention programmes designed to facilitate health behaviour change in the defined context should (i) have a context-relevant focus, (ii) be coherent and well-structured, (iii) have explicit techniques to facilitate inter-personal and intra-personal change processes, (iv) include appropriate mechanisms to monitor and assess the progress of the interventional sessions; and (v) be implemented by trained facilitators with a deep knowledge of the sociocultural values and norms of the target group and of the principles and theories underlying the intervention programme. We envisage that these insights could serve to guide the design, implementation, and evaluation of contextually-tailored and potentially effective GBCIs that align with the needs, capacities, and circumstances of the local population.Item Facilitating change processes in group-based behaviour change interventions in rural African contexts: practical lessons from Ghana(International Journal of Mental Health Systems, 2023) Appiah, R.Evidence from implementation research suggests that group-based behaviour change interventions (GBCIs) can encourage the development of peer support, promote psychosocial skills, and facilitate collaborative therapeutic relationships. However, although the mechanisms of action that mediate the behaviour change process have been extensively described in other settings, less is known about the implementation strategies and contextual factors that actuate the reported behaviour changes among programme participants in Ghana and sub-Saharan Africa, more generally. We draw on insights from the literature and field experiences from designing, implementing, and evaluating GBCIs across several rural and peri-urban communities in Ghana to discuss a range of theoretical, methodological, and contextual factors that facilitate the behaviour change process in programme participants. We offer suggestions to guide researchers to envision and manage potential challenges with the programme development and implementation processes. We propose that intervention programmes designed to facilitate health behaviour change in the defined context should (i) have a context-relevant focus, (ii) be coherent and well-structured, (iii) have explicit techniques to facilitate inter-personal and intra-personal change processes, (iv) include appropriate mechanisms to monitor and assess the progress of the interventional sessions; and (v) be implemented by trained facilitators with a deep knowledge of the sociocultural values and norms of the target group and of the principles and theories underlying the intervention programme. We envisage that these insights could serve to guide the design, implementation, and evaluation of contextually-tailored and potentially effective GBCIs that align with the needs, capacities, and circumstances of the local population.Item Context matters: Sociocultural considerations in the design and implementation of community-based positive psychology interventions in sub-Saharan Africa(Culture & Psychology, 2022) Appiah, R.Abstract Scholars conducting cross-cultural research in mental health often import intervention programs found to be efficacious in one social context (e.g., Western) and directly implement them in other contexts (e.g., African and Asian) without recourse to the sociocultural disparities between the target populations and the theoretical foundations of the constructs and principles underpinning the intervention programs. Such efforts mistakenly assume that positive psychology interventions (PPIs), most of which were developed from Western perspectives and assumed individualistic cultural orientation and value systems, operate equally across all contexts. Drawing on the extant literature and on insights from designing, implementing, and evaluating group-based (mental) health behavior change intervention programs across several communities in Ghana, we discuss some sociocultural, theoretical, and methodological issues that can significantly constrain the design, uptake, and effectiveness of PPIs in the rural, low literate, socioeconomically disadvantaged, highly collectivistic context of Ghana, and sub-Saharan Africa more generally. In all illustrations, we offer suggestions to guide the design and implementation processes to ensure culturally appropriate, highly acceptable, and potentially effective intervention programs. We argue that PPIs can be potentially fructuous in the sub-region when adapted to, or embedded in, the cultural values of the target population and tailored to the needs, capacities, and circumstances of participants.Item Participants’ experiences and impressions of a group-based positive psychology intervention programme for rural adults in Ghana(Taylor & Francis Group, 2021) Appiah, R.; Fadiji, A.W.; Wissing, M.P.; Schutte, L.Introduction: There is growing evidence that group-based mental health intervention programmes can encourage the development of peer support, psychosocial skills, and collaborative therapeutic relationships with longer lasting effects. This study explored participants’ experiences of, perceived benefits of, and recommendations to improve a 10-session group based multicomponent positive psychology intervention (mPPI)—the Inspired Life Programme (ILP)—designed to promote positive mental health and reduce symptoms of depression and negative affect in a sample of rural Ghanaian adults. Method: Face-to-face semi-structured individual interviews were conducted with 18 randomly selected programme participants three months after their participation in the ILP. Data were analysed thematically with an inductive approach. Results: Participants described their experience of the ILP as a forum for growth that granted them the opportunity to introspect, practicalise and situate everyday life challenges, connect with others, and to develop a sense of mutual accountability. Results indicate that the ILP led participants to develop a stronger sense of positivity and well-being, fructify their ideas, and to cultivate stronger social networks and relationships that led to increased vocational productiveness. Participants recommended that researchers include facets of physical health promotion in the programme and invite close relations of participants to participate in the programme. Conclusion: This study provides the first insight into participants’ experiences of a group based mPPI in Ghana. These findings may provide useful information to inform the design of context-appropriate community-based mental health interventions to fit participants’ specific needs, capacities, and circumstances.Item Exploring the factors that affect the transition from student to health professional(BMC Medical Education, 2021) Opoku, E.N.; Khuabi, L. J.; Niekerk, L.V.Background: The nature of a new health professional’s transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice. Methods: Whittemore and Knafl’s methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach. Results: Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates. Conclusion: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged. Keywords: Role transition, Clinical practice, New clinicians, Professional competence, Novice professionals, Professional practice, Systematic literature reviewItem Exploring the factors that affect the transition from student to health professional: an Integrative review(BMC Med Educ, 2021) Opoku, E.N.; Jacobs‑Nzuzi Khuabi, L-E.; Niekerk, L.V.Background: The nature of a new health professional’s transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice. Methods: Whittemore and Knafl’s methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach. Results: Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates. Conclusion: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.Item Gurus and Griots: Revisiting the research informed consent process in rural African contexts(BMC Medical Ethics, 2021) Appiah, R.Background: Researchers conducting community-based participatory action research (CBPAR) in highly collectivistic and socioeconomically disadvantaged community settings in sub-Saharan Africa are confronted with the distinctive challenge of balancing universal ethical standards with local standards, where traditional customs or beliefs may con fict with regulatory requirements and ethical guidelines underlying the informed consent (IC) process. The unique ethnic, socioeconomic, and cultural diversities in these settings have important implications for the IC process, such as individual decisional autonomy, beneficence, confidentiality, and signing the IC document. Main text: Drawing on insights and field observations from conducting CBPARs across several rural, highly communal, low literate, and low-income communities in Ghana, we discuss some theoretical, ethico-cultural, and methodological challenges associated with applying the universal, Western individualistic cultural value-laden IC process in sub-Saharan Africa. By citing fled situations, we discuss how local cultural customs and the socioeconomic adversities prevalent in these settings can influence (and disrupt) the information disclosure process, individual decisional authority for consent, and voluntariness. We review the theoretical assumptions of the Declaration of Helsinki’s statement on IC and discuss its limitations as an ultimate guide for the conduct of social science research in the highly communal African context. We argue that the IC process in these settings should include strategies directed at preventing deception and coercion, in addition to ensuring respect for individual autonomy. We urge Universities, research institutions, and institutional review boards in Africa to design and promote the use of context-appropriate ethical IC guidelines that take into consideration both the local customs and traditional practices of the people as well as the scientific principles underpinning the universal IC standards. Conclusion: We recommend that, rather than adopt a universal one-size-fts-all IC approach, researchers working in the rural, highly collectivistic, low literate, socioeconomically disadvantaged settings of sub-Saharan Africa should deeply consider the roles and influence of cultural values and traditional practices on the IC and the research process. We encourage researchers to collaborate with target communities and stakeholders in the design and implementation of context-appropriate IC to prevent ethics dumping and safeguard the integrity of the research process.Item Inter-rater reliability and test-retest reliability of the Performance and Fitness (PERF-FIT) test battery for children: a test for motor skill related fitness(BMC Pediatrics, 2021) Smits-Engelsman, B.C.M; Smit, E.; Doe-Asinyo, R.X.; Lawerteh, S.E.; Aertssen, W.; Ferguson, G.; Jelsma, D.L.Background: The Performance and Fitness (PERF-FIT) test battery for children is a recently developed, valid assessment tool for measuring motor skill-related physical fitness in 5 to 12-year-old children living in low-income settings. The aim of this study was to determine: (1) inter-rater reliability and (2) test-retest reliability of the PERF-FIT in children from 3 different countries (Ghana, South Africa and the Netherlands). Method: For inter-rater reliability 29 children, (16 boys and 13 girls, 6–10 years) were scored by 2 raters simultaneously. For test–retest reliability 72 children, (33 boys and 39 girls, 5–12 years) performed the test twice, minimally 1 week and maximally 2 weeks apart. Relative and absolute reliability indices were calculated. ANOVA was used to examine differences between the three assessor teams in the three countries. Results: The PERF-FIT demonstrated excellent inter-rater reliability (ICC, 0.99) and good test-retest reliability (ICC, ≥ 0.80) for 11 of the 12 tasks, with a poor ICC for the Jumping item, due to low spread in values. A significant difference between first and second test occasion was present on half of the items, but the differences were small (Cohen’s d 0.01–0.17), except for Stepping, Side jump and Bouncing and Catching (Cohen’s d 0.34, 0.41 and 0.33, respectively). Overall, measurement error, Limits of Agreement and Coefficient of Variation had acceptable levels to support clinical use. No systematic dissimilarities in error were found between first and second measurement between the three countries but for one item (Overhead throw). Conclusions: The PERF-FIT can reliably measure motor skill related fitness in 5 to 12-year-old children in different settings and help clinicians monitor levels of fundamental motor skills (throwing, bouncing, catching, jumping, hopping and balance), power and agility.Item Ghanaian undergraduate biomedical engineering students' perceptions of their discipline and career opportunities(Global Journal of Engineering Education, 2015-01) Mohedas, I.; Kaufmann, E.E.; Daly, S.R.; Sienko, K.H.Biomedical and clinical engineers are critical to low- and middle-income countries (LMICs) in order to facilitate the local design, development and production of health technologies. Undergraduate biomedical engineering programmes are growing in LMICs, but few studies have sought to understand student perceptions of their discipline. Two open-ended survey instruments were used to measure perceptions of biomedical engineering students at a large Ghanaian university. Upper and lower classmen revealed similar conceptions of what it means to be a biomedical engineer, however, they perceived limited job opportunities (almost exclusively in the sales, maintenance or procurement of hospital equipment). Furthermore, upper classmen noted the desire to pursue further education to obtain better employment, whereas lower classmen did not consider it a likely path after graduation. © WIETE 2015.Item Learning better by repetition or variation? Is transfer at odds with task specific training?(Public Library of Science, 2017) Bonney, E.; Jelsma, L.D.; Ferguson, G.D.; Smits-Engelsman, B.C.M.Objective Transfer of motor skills is the ultimate goal of motor training in rehabilitation practice. In children with Developmental Coordination Disorder (DCD), very little is known about how skills are transferred from training situations to real life contexts. In this study we examined the influence of two types of practice on transfer of motor skills acquired in a virtual reality (VR) environment. Method One hundred and eleven children with DCD and their typically developing (TD) peers, aged 6±10 years (M = 8.0 SD = 1.0) were randomly assigned to either variable (n = 56) or repetitive practice (n = 55). Participants in the repetitive practice played the same exergame (ski slalom) twice weekly for 20 minutes, over a period of 5 weeks, while those in the variable group played 10 different games. Motor skills such as balance tasks (hopping), running and agility tasks, ball skills and functional activities were evaluated before and after 5 weeks of training. Results ANOVA repeated measures indicated that both DCD and TD children demonstrated transfer effects to real life skills with identical and non-identical elements at exactly the same rate, irrespective of the type of practice they were assigned to. Conclusion Based on these findings, we conclude that motor skills acquired in the VR environment, transfers to real world contexts in similar proportions for both TD and DCD children. The type of practice adopted does not seem to influence children's ability to transfer skills acquired in an exergame to life situations but the number of identical elements does.Item The risks and benefits of antidepressant treatment for youth depression.(2005-01) Bridge, J.A.; Salary, C.B.; Birmaher, B.; Asare, A.G.; Brent, D.A.he U.S. Food and Drug Administration (FDA) has mandated that all antidepressants carry a 'black box' warning label indicating that antidepressants increase the risk of suicidality in youth taking these medications. In the U.K., the Medicine and Healthcare Products Regulatory Agency (MHRA) has determined that the balance of risks and benefits favors only the use of fluoxetine in the treatment of depressive illness in children and adolescents. This article reviews the PDA's analysis linking antidepressant medication use and pediatric suicidality in major depressive disorder, discusses the efficacy of antidepressants in treating depression in children and adolescents, and offers suggestions to aid clinicians, patients, and families in making clinical decisions based on an accurate assessment of the benefits and risks of medication and psychosocial treatments for pediatric depression.