İnsan Aktivite Modeli Temelli Ergoterapi Müdahalesinin Aile İçi Şiddet Yaşayan Kadınlarda Etkinliği

Öz

Amaç: Şiddet deneyimi kadınların bağımsız yaşam becerilerini ve günlük aktivitelerini olumsuz etkilemektedir. Bu çalışmanın amacı, "İnsan Aktivite Modeli (Model of Human Occupation-MOHO)" temelli ergoterapi müdahalesinin aile içi şiddete maruz kalan ve sığınma evinde kalan kadınların okupasyonel yeterliliklerine ve okupasyonel katılımlarına etkisinin araştırmaktı. Gereç ve Yöntem: İki sığınma evinde kalan 13 kadına, 10 müdahale alanı içeren MOHO-temelli ergoterapi programı uygulandı. Dört haftalık (16 seans) bireysel ve grup eğitimleri ve çevresel müdahaleler gerçekleştirildi. Bireylerin okupasyonel yeterlikleri “Aktivite Öz Değerlendirmesi” ile, okupasyonel katılımları ise “İnsan Aktivite-Rol Modeli Tarama Aracı” ile değerlendirildi. Değerlendirmeler müdahale öncesi, sonrası ve 3. ay takipte yürütüldü. Bulgular: Müdahale öncesi ve 3 aylık takip değerlendirmeleri arasında okupasyonel yeterlilik (p=0,002) ve okupasyonel katılımda (p=0,004) istatistiksel olarak anlamlı farklılıklar bulundu. OSA-önem ve MOHOST-motor beceriler alanları hariç (p>0,05) tüm alanlarda (OSA-yeterlilik ve MOHOST'un irade, alışkanlık, iletişim-etkileşim, süreç becerileri ve çevre parametreleri) iyileşmeler kaydedilmiştir (p<0,05). Tartışma: Sığınma evlerinde gerçekleştirilen MOHO temeli ergoterapi müdahaleleri, şiddete maruz kalmış kadınların okupasyonel yeterlilikleri ve okupasyonel katılımları üzerinde etkili olabilir.

Anahtar Kelimeler

• Ergoterapi
• Aile içi şiddet
• Kadınlar
• İnsan aktivite modeli

The Effectiveness of Model of Human Occupation-Based Occupational Therapy Intervention for Women who Experienced Domestic Violence

Öz

Purpose: Experiences of violence negatively affect women's independence and daily activities. The aim of this study was to investigate the effectiveness of the "Model of Human Occupation (MOHO)"-based occupational therapy intervention on the occupational competence and occupational participation of women affected by domestic violence and living in a women's shelter. Materials and Methods: The MOHO-based occupational therapy program, which includes 10 intervention areas, was applied to 13 women in two women’s shelters. Four-week (16 sessions) individual and group training and environmental interventions were provided. Participants' occupational competence was assessed with the “Occupational Self-Assessment” and occupational participation with the “Model of Human Occupation Screening Tool”. Assessments were conducted before the intervention, after the intervention, and at the 3-month follow-up. Results: Statistically significant differences were found in occupational competence (p=0.002) and occupational participation (p=0.004) between pre-intervention and 3-month follow-up assessments. Improvements were noted in all domains (OSA-competence, and volution, habituation, communication-interaction, process skills, and environment parameters of MOHOST) (p<0.05), except for the domains of OSA-value and MOHOST-motor skills (p>0.05). Discussion: MOHO-based occupational therapy interventions delivered in women's shelters could have a positive impact on the occupational competence and occupational participation of women experiencing violence.

Anahtar Kelimeler

• Occupational therapy
• Domestic violence
• Women
• Model of human occupation

Kaynakça

1. Baron, K., Kielhofner, G., Iyenger, A., Goldhammer, V., & Wolenski, J. (2006). A User's Manual for the Occupational Self Assessment (OSA). (Version 2.2) Chicago, IL: University of Illinois.
2. Cage, A. (2007). Occupational therapy with women and children survivors of domestic violence: are we fulfilling our activist heritage? A review of the literature. Br J Occup Ther, 70(5), 192-198. https://doi.org/10.1177/03080226070700050
3. Carlson, B. E. (1997). A stress and coping approach to intervention with abused women. Fam Relat, 46(3), 291-298. https://doi.org/10.2307/585127 Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack.
4. d'Ardenne, P., & Balakrishna, J. (2001). Domestic violence and intimacy: what the relationship therapist needs to know. Sex Relat Therapy, 16(3), 229-246. https://doi.org/10.1080/14681990123489
5. Gorde, M. W., Helfrich, C. A., & Finlayson, M. L. (2004). Trauma symptoms and life skill needs of domestic violence victims. J Interpers Violence, 19(6), 691-708. https://doi.org/10.1177/0886260504263871
6. Gutman, S. A., Diamond, H., Holness-Parchment, S. E., Brandofino, D. N., Pacheco, D. G., Jolly-Edouard, M., et al. (2004). Enhancing independence in women experiencing domestic violence and possible brain injury: an assessment of an occupational therapy intervention. Occup Ther Ment Health, 20(1), 49-79. https://doi.org/10.1300/J004v20n01_03
7. Hammell, K. R. W. (2016). Empowerment and occupation: a new perspective: autonomisation et occupation: une nouvelle perspective. Can J Occup Ther, 83(5), 281-287. https://doi.org/10.1177/0008417416652910
8. Helfrich, C. A., & Aviles, A. (2001). Occupational therapy's role with victims of domestic violence: assessment and intervention. Occup Ther Ment Health, 16(3-4), 53-70. https://doi.org/10.1300/J004v16n03_04

9. Helfrich, C. A., Aviles, A. M., Badiani, C., Walens, D., & Sabol, P. (2006). Life skill interventions with homeless youth, domestic violence victims and adults with mental illness. Occup Ther Health Care, 20(3-4), 189-207. https://doi.org/10.1080/J003v20n03_12
10. Helfrich, C. A., & Rivera, Y. (2006). Employment skills and domestic violence survivors: a shelter-based intervention. Occup Ther Ment Health, 22(1), 33-48. https://doi.org/10.1300/J004v22n01_03
11. Helfrich, C. A., & Fogg, L. F. (2007). Outcomes of a life skills intervention for homeless adults with mental illness. J Prim Prev, 28(3-4), 313-326. https://doi.org/10.1007/s10935-007-0103-y
12. Javaherian, H., Krabacher, V., Andriacco, K., & German, D. (2007). Surviving domestic violence: rebuilding one's life. Occup Ther Health Care, 21(3), 35-59. https://doi.org/10.1080/J003v21n03_03
13. Javaherian-Dysinger, H., Krpalek, D., Huecker, E., Hewitt, L., Cabrera, M., Brown, C., et al. (2016). Occupational needs and goals of survivors of domestic violence. Occup Ther Health Care, 30(2), 175-186. https://doi.org/10.3109/07380577.2015.1109741
14. Levendosky, A. A., & Graham-Bermann, S. A. (2001). Parenting in battered women: the effects of domestic violence on women and their children. J Fam Violence, 16(2), 171-192. https://doi.org/10.1023/A:1011111003373
15. Marshall, C. A., Boland, L., Westover, L. A., Isard, R., & Gutman, S. A. (2021). A systematic review of occupational therapy interventions in the transition from homelessness. Scand J Occup Ther, 28(3), 171-187. https://doi.org/10.1080/11038128.2020.1764094
16. Monahan, K., & O'Leary, K. D. (1999). Head injury and battered women: an initial inquiry. Health Soc Work, 24(4), 269-278. https://doi.org/10.1093/hsw/24.4.269
17. Muñoz, J. P., Reichenbach, D., & Hansen, A. M. W. (2005). Project employ: engineering hope and breaking down barriers to homelessness. Work, 25(3), 241-252.
18. Muñoz, J. P., Dix, S., & Reichenbach, D. (2006). Building productive roles: occupational therapy in a homeless shelter. Occup Ther Health Care, 20(3-4), 167-187. https://doi.org/10.1080/J003v20n03_11
19. Parkinson, S., Forsyth, K., & Kielhofner, G. (2006). Model of Human Occupation Screening Tool (MOHOST). (Version 2.0). Chicago, IL: University of Illinois.
20. Pekçetin, S., Salar, S., İnal, Ö., & Kayıhan, H. (2018). Validity of the Turkish Occupational Self Assessment for elderly individuals. OTJR, 38(2), 105-112. https://doi.org/10.1177/1539449217743457
21. Thomas, Y., Gray, M., & McGinty, S. (2011). A systematic review of occupational therapy interventions with homeless people. Occup Ther Health Care, 25(1), 38-53. https://doi.org/10.3109/07380577.2010.528554
22. Zakarneh, M. (2015). Ankara Umut Evlerinde Kalan Bireylerin Aktivite-Rol Katılımı Açısından Ergoterapi Modeline Göre İncelenmesi. (Yüksek lisans tezi). Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, Ankara.