Development of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS) Assessment Tool
Abstract
:1. Introduction
- The degree of the forcibly displaced persons’ satisfaction with their occupational participation in the host country;
- Potential factors that may be related to a reported lack of satisfaction;
- Significant occupations in which the people themselves desire to participate;
- Occupations they do not have access to and the reasons for this.
2. Materials and Methods
2.1. Research Design
2.2. Ethical Issues
2.3. Participants
- (a)
- Focus Group I
- (b)
- Focus Group 2
- (c)
- Review 1
- (d)
- Review 2
- (e)
- Focus Group 3
2.4. Instruments
2.5. Procedures and Data Collection
2.6. Data Analysis
3. Results
3.1. Phase 1: Establishment of the Theoretical Background/Creation of First Draft Tool
3.2. Phase 2: Further Development of the Tool
Participant Demographics
3.3. Thematic Analysis
3.3.1. Focus Group 1
- Categorization: Tool items (occupations) were reorganized to clearly differentiate between categories of occupations.
- Formation/structure: Demographics was converted into table format to abbreviate the data collection method. An occupational profile was proposed and added to summarize the respondent’s past occupational experiences. The tool format was modified to include an Introduction, Part 1 (Demographics), Part 2 (Occupational profile), Instructions, and Sections A–C (Occupational items).
- Wording: An annex (Annex 1) was added with more examples of occupations, relative to the situation of refugees. The Instructions and Introduction were rephrased for clarity. More detailed information was provided about the initial annex, renamed to Annex 2 (Factors). Relevant examples to the state of displaced persons were added to Annex 2, one for each of the seven categories of factors. A glossary (Annex 3) was created to help clarify confusing scientific/occupational terms listed.
- Assessment scale: Column D (Comments) changed to “Are there any specific activities for which satisfaction might be different?” to explore this.
3.3.2. Focus Group 2
- Categorization: A new table was added. Ιt presented all occupation items. Respondents could select the three most urgent ones to address (Section D). Discussions concerned play, sleep, social participation, sexual activity, and categorization of items. Section A (Self-care, daily life at home and in the community, health management, and sleep/rest time), Section B (social participation, free time/play, and leisure activities), and Section C (Work and education) were reorganized.
- Formation/structure: The Instructions indicated the use of certain sections to curtail administration when necessary.
- Wording: The “not applicable” option of Column A (Categories of occupations) changed to “not assessed” for sensitive occupations. “Survival activities” were added to Annex 1 (Examples of occupations).
- Administration: Participants noted that administration at the initial reception phase during the asylum process might be challenging. The present tool would serve as a screening tool after the first response procedure.
3.3.3. Review 1
- Wording: The terms “occupation” and “satisfaction” were not clear to participants. Researchers added explanatory definitions in the Introduction.
3.3.4. Review 2
- Categorization: The occupation “educating/informing for legal rights and obligations” was divided to reflect these two diverse notions, adding one more evaluation component (35 in total).
- Wording: “Dialect” was added, along with “language”, in Demographics.
- Administration: The tool was described as useful for adolescents transitioning to adulthood. The tool administration age changed from >18 to >17 years old. Respondents’ fluency in English was stressed, to avoid misinterpretations. The phrase “be able to communicate effectively in the English language” was added in the Introduction. Administration with purposes other than screening, such as self-reflection, was recommended. The purpose of the tool remained the same.
3.3.5. Focus Group 3
- Wording: Column D (“Are there any specific activities for which satisfaction might be different?”) again changed to “Comments” as it confused participants. This time, it was clarified in the Instructions that both the interviewer and the respondent could comment. Further changes were made to the Introduction to refine phrasing of the term “Satisfaction”, which was mistakenly understood as the ability to engage in occupation.
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Focus Groups | Reviews | ||||
---|---|---|---|---|---|
1 | 2 | 3 | 1 | 2 | |
Setting/ location | In person (EUC 1 premises) | Video Conference | Video Conference | In person (EUC premises) | Video Conference |
Purpose | Discuss content and design | Review draft version, critically discuss outlook, content, and procedure | Discuss usability, understandability, and relativity | Discuss clarity and understandability of components and structure | Discuss ease of use by professionals other than occupational therapists |
Population | Greek and Cypriot professional Occupational Therapists and Occupational Therapy students | International OTs | Refugees and asylum seekers residing in Cyprus | Laypeople residing in Cyprus | Health or humanitarian professionals residing in Cyprus |
Protocol | Interview guide with semi-structured questions | One-on-one interviews using a sample of questions | Individual reviews of draft instrument based on a sample of questions | ||
Questions | Opinions/attitudes/feelings regarding dimensions of occupations, occupational meaning, and tool content and format | Opinions/attitudes/feelings regarding dimensions of occupations, occupational meaning, and tool content and format | Occupational profile and history (what occupations they participate in/used to participate in)/Opinions/attitudes/feelings regarding dimensions of occupations and occupational meaning/ Opinions about tool usability, understandability, and relativity | Opinions about tool usability and understandability | Opinions about tool usability, understandability, and relativity |
Focus Group 1 | n = 8 | Focus Group 2 | n = 8 | Review 1 | n = 4 | Review 2 | n = 4 | Focus Group 3 | n = 5 | |
---|---|---|---|---|---|---|---|---|---|---|
Role/Status | OT professional | 6 | OΤ professional | 2 | Layperson | 4 | Social Worker | 1 | Refugee | 2 |
OT student | 2 | Researcher | 2 | Psychologist | 1 | Refugee with subsidiary protection | 1 | |||
Clinician | 4 | Safety officer | 1 | Asylum seeker | 2 | |||||
Social Advisor | 1 | |||||||||
Age | 20–50 years old | 25–50 years old | 20–50 years old | 20–55 years old | 19–35 years old | |||||
Gender | Male | 2 | Male | 2 | Male | 2 | Male | 2 | Male | 3 |
Female | 6 | Female | 6 | Female | 2 | Female | 2 | Female | 2 | |
Experience In this field | <6 months | 2 | <6 months | 0 | <6 months | 0 | ||||
7–12 months | 3 | 7–12 months | 2 | 7–12 months | 0 | |||||
13–24 months | 2 | 13–24 months | 0 | 13–24 months | 2 | |||||
>25 months | 1 | >25 months | 6 | >25 months | 2 | |||||
Setting | Reception Center | 2 | ||||||||
Shelter | 1 | |||||||||
Semi-independent houses | 1 | |||||||||
Community Center | 1 | |||||||||
Country of origin | Cyprus | 4 | Cyprus | 2 | Cyprus | 3 | Cyprus | 4 | Cameroon | 1 |
Greece | 4 | Greece | 1 | Greece | 1 | Somalia | 2 | |||
Belgium | 1 | Central African Republic | 1 | |||||||
Germany | 1 | Guinea | 1 | |||||||
Canada | 1 | |||||||||
Australia | 1 | |||||||||
USA | 1 |
Feedback | Modifications | ||
---|---|---|---|
Focus Group 1 | Formation/structure | Some participants mentioned that it is difficult to clearly differentiate between categories of occupations. | Tool items (occupations) were reorganized. |
Data collection in Demographics should be abbreviated. | Demographics was converted into table format. | ||
The tool needs to give the opportunity to summarize the respondent’s past occupational experiences and history, as, this way, we can gather information about their skills and motives. | An occupational profile, which drew mostly from the Occupational Profile (AOTA, 2020) and was adapted to gather information that describes occupational history and experiences before arrival in the host country, was created and added. | ||
Some participants mentioned that the organization and structure of tool elements are not clear. | The tool format was modified to include an Introduction, Part 1 (Demographics), Part 2 (Occupational profile), Instructions, and Sections A–C (Occupational items). | ||
Wording | All the participants agree to add more examples, relative to the situation of the displaced population. | An annex (Annex 1) was created containing examples of occupations that are relative to the experience of resettlement in the host country for displaced persons concerning personal hygiene and care, life at home or within the community, religion or spirituality, managing communications with public services, self-advocating, management of personal documents and accounts, following work norms and procedures, family planning, identifying interests, skills, opportunities, and recognizing systems for psychosocial support. | |
Information in the Introduction and Instructions is not clear. | The Introduction and Instructions were rephrased for clarity. | ||
The purpose of Column C is difficult to verbalize. | A proposed phrase was added in the Instructions. | ||
More information is needed about the use of the initial annex in Instructions. | More detailed information about the initial annex was provided in the Instructions. It was also renamed to Annex 2. | ||
For understandability, relevant examples to the state of refugees need to be added to Annex 2. | One relevant example for each of the seven categories of factors was added to Annex 2. | ||
Some found the scientific/occupational terms confusing. | A glossary (Annex 3) was created to help clarify these terms. | ||
Assessment scale | One participant argued that it is difficult to identify the degree of satisfaction as each occupational category can involve many sub-categories of occupations with differences in satisfaction. | Column D changed from “Comments” to “Are there any specific activities for which satisfaction might be different?” to explore this. | |
Administration | Some of the participants claimed that the tool should be administered only by occupational therapists. | The issue would be further discussed in Focus group 2, before proceeding to the final pilot tool. | |
On the other hand, the tool would be useful in settings without an established occupational therapist, which is usually the case. | |||
Feedback | Modification | ||
Focus Group 2 | Categorization | Setting some “priority” occupations would be useful. On the other hand, all occupational needs should be addressed. | A new table was added (Section D) that presented all occupational items. Respondents would select the three most urgent ones to address. |
Categorization of occupational items, including play, sleep, social participation, and sexual activity occupations, is debatable. | Section A (Self-care, daily life at home and in the community, health management, and sleep/rest time), Section B (social participation, free time/play, and leisure activities), and Section C (Work and education) were reorganized. | ||
Formation | All of the participants agree that the tool is time-consuming. A short version of it needs to be created. | It was added in the Instructions to administer certain sections of the tool to curtail administration when necessary. | |
Wording | There should be the option to omit assessment of sensitive occupations due to reasons such as culture or trauma. | The “not applicable” option of Column A changed to “not assessed”. | |
Few participants stated that the tool needs to be translated into different languages for a better understanding by non-English speakers. | Researchers decided to initially create the pilot tool in English, even though language is an important part of culture, as it was designed to be administered by specialists in the field that could support respondents’ participation despite difficulties in language use, given that respondents are English speakers. Later, it could be translated into other languages. | ||
One participant suggested to add “survival activities” in Annex 1 as they are often indicative of occupations in which displaced persons engage in the host country to support themselves. | “Survival activities” were added in Annex 1 for relativity. | ||
Administration | It is important that the tool be administered by non-occupational therapists, as well, because often an occupational therapist is not available in refugee settings. | The Instructions changed to encompass this. | |
The tool should be administered by trained experts in the field who would be able to manage ethical and practical challenges during administration pertinent to culture, language, resources, or trauma. | This was included in the Introduction. | ||
Administration at the initial reception phase during asylum process might be challenging as, at that point, more urgent needs have to be addressed and displaced persons need to receive emergency response aid. | In the Instructions, it was added that the tool was created as a screening tool after first response procedure. | ||
Feedback | Modification | ||
Review 1 | Wording | A few participants found the terms “occupation” and “satisfaction” unclear. | Explanatory definitions in the Introduction were added. |
Feedback | Modification | ||
Review 2 | Categorization | The occupation “educating/informing for legal rights and obligations” needs to be divided into two distinct occupations to reflect these two diverse notions. | The occupation was divided, adding one more evaluation component (35 in total). |
Wording | “Dialect” needs to be added in Demographics along with “language”, as it is important when identifying specific groups and minorities. | “Dialect” was added in the Demographics part. | |
Administration | One participant stated that the tool would be useful for adolescents in need of psychosocial support as they transition to adulthood in a strange country that is often unwelcoming. | The tool administration age changed from >18 years old to >17 years old. | |
Respondents need to be fluent in the English language to avoid misinterpretations. | The phrase “be able to communicate effectively in the English language” was added in the Introduction. | ||
Feedback | Modification | ||
Focus Group 3 | Wording | The purpose of Column D, which addressed occupations for which satisfaction might be different even though they fall under the same occupational category, was confusing for participants. On the other hand, other issues regarding relativity, culture, or challenges during administration needed to be addressed. | Column D again changed to “Comments”, for comments or concerns by either the interviewer or the respondent that could be considered regarding issues during administration relating to language use, cross-cultural differences, or others. |
Most of the participants mistakenly understood the term “satisfaction” as the ability to engage in occupations. | Changes were made to the Introduction to refine phrasing of the term “Satisfaction”. |
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Psychouli, P.; Louta, I.; Christodoulou, C. Development of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS) Assessment Tool. Int. J. Environ. Res. Public Health 2023, 20, 6826. https://doi.org/10.3390/ijerph20196826
Psychouli P, Louta I, Christodoulou C. Development of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS) Assessment Tool. International Journal of Environmental Research and Public Health. 2023; 20(19):6826. https://doi.org/10.3390/ijerph20196826
Chicago/Turabian StylePsychouli, Pavlina, Ioulia Louta, and Constantina Christodoulou. 2023. "Development of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS) Assessment Tool" International Journal of Environmental Research and Public Health 20, no. 19: 6826. https://doi.org/10.3390/ijerph20196826