Operationalizing family quality of life: occupational therapy outcome measurement for South African forensic psychiatric rehabilitation.

Abstract

Background: Families of forensic mental health care users (MHCUs) experience a great burden of disease. Families of forensic MHCUs in KwaZulu-Natal, South Africa, are identified as the primary community based support system. Relevant psycho-social rehabilitation and support services are required to empower the family as the primary community based support structures, for successful community reintegration and role re-acquisition of young adult forensic MHCUs to be achieved. Occupational therapists (OTs) have had a limited role in forensic “family work” in achieving family-centred health outcomes. Health outcomes have not been developed for occupational therapy practice to direct strategic family-centred rehabilitation. Family Quality of Life (FQOL) has been identified as a strengths-based family outcome which could be used in forensic mental health care. Operationalization of a unique occupation-based FQOL construct was required to inform outcome measurement tool development ensuring family-centred effective and efficient service delivery in the future. Research aim: This study aimed to identify and operationally define FQOL in the development of a FQOL outcome measurement tool that could direct family centred OT services for MHCUs and their families within a forensic psychiatric facility setting in KwaZulu-Natal, South Africa. Method: A qualitative research strategy was used to establish the meaning of FQOL, particularly, an interpretivist qualitative research design. Focus groups of experts (mental health care professionals, forensic MHCUs, and family members) attributed meaning to the existing FQOL construct. A hybrid of inductive and deductive data analysis was necessary to operationalize this construct for application to forensic mental health outcome measurement tool development. Results: An operational definition of the occupation-based FQOL construct using an occupational lens for evidence-based forensic mental health OT practice, was developed. FQOL operational definition(s) of the construct, themes, sub-themes, domains, and sub-domains were formulated and presented in a meaning map of meaning attributed by expert participants. This novel construct consists of two (2) themes (family unit factors, and individual member factors), their related sub-themes (e.g. family unit factors’ sub-themes: family characteristics, family dynamics, and external family unit support) and domains addressing pertinent areas of family life contributing to a collective FQOL experience of forensic MHCUs and their family members. Findings merged FQOL and OT frameworks for application to forensic mental health as compared to previous disability fields of inquiry. A diagrammatic presentation of the novel FQOL construct using an ecological perspective iv displays pertinent areas of family life requiring support by OTs rendering psycho-social rehabilitation. Conclusion: OTs practicing within the specialist forensic mental health facility in KwaZuluNatal, South Africa, are hereby presented with an operationalized FQOL health outcome which could direct evidence-based, family-centred, strengths-based, and support-orientated service delivery, strategically positioning the profession in community-based rehabilitation.