Insert Table 2 here
Table 2 shows the level of agreement between round one and round two,
has increased from that observed in the first round. The observed levels
of agreement for round one of the Delphi can be rated as poor,
increasing to a moderate level of agreement in round two (Landis and
Koch, 1977).
Discussion
Eighty-nine different occupational related determinants thought to
affect adolescents’ mental health were ranked and prioritised. This
Delphi study achieved a level of agreement on the prioritisation of
determinants with each question but the results highlight a range of
different responses when ranking the determinants. The results suggest a
range of modifiable and non-modifiable determinants and that the
importance of each of them may vary. Our findings highlight the
complexity of rating activity related determinants against each other,
and the need for consideration of the nuanced areas affecting
occupational choices in adolescent populations. These findings are
supported by earlier research that highlighted the complexity
adolescents experience when making choices about what to do with their
time, highlighting a process of weighing up four domains against each,
which are ‘considering time factors’, ‘exploring skills and occupational
repertoire’, ‘Interacting with the situational context’ and ‘appraising
values and priorities (Parsonage 2020). Occupational therapy literature
suggests a complex interrelated relationship exists between the
subjective concept of ‘occupational balance’ and the objective concept
of ‘patterns of daily activities’ that have implications for health
(Eklund et al. , 2017).
In our study occupational therapists and researchers ranked the
determinants ‘types of activity’, ‘balance of activity’, ‘pressure to
conform’ and ‘freedom of choice’ as highest for their effect on mental
health. The expert panel ranked determinants linked to behaviours
affecting occupational performance and health. The highest ranked
included ‘under and over consumption of activities’, ‘underdeveloped
coping skills’, and ‘inadequate balance of activity types’. The
prioritisation of these determinants is important in adolescent
populations and provides a valuable life course perspective for
occupational therapy research targeting adolescent mental health.
Prioritised determinants can be used to focus adolescent mental health
research, and may be particularly relevant to occupational therapists.
For example, an occupational therapy theory informed intervention for
adolescents with emerging mental health difficulties is currently being
developed by the first author based on the top three prioritised
determinants from the first three questions.
In this study a moderate level of agreement was reached, the levels of
agreement increased between rounds and the rankings remained mostly
consistent for items at the upper and low ends of the scale. The panel
of this study was small, vulnerable to selection bias, and may not
represent all views given the loss of some participants during the
study. This should be balanced against the fact that the occupational
therapy profession is small and specialised. The panel had a high number
of years of relevant experience and responses may reflect an
evidenced-based approach embedded in clinicians’ thinking. A brief
sensitivity checking exercise conducted at a conference in 2022 as part
of disseminating the findings, using question one, suggests those with
experience of mental health issues as adolescents organised items in a
similar way to our study results. This study highlights the need for
more research into the impact of occupational determinants on adolescent
mental health and research is needed to ensure adolescents’ perspectives
are properly captured.
In summary, the use of the Delphi methodology enabled access to the
valuable, experiential knowledge of researchers and those providing
interventions to adolescents with mental health difficulties, and the
selection and prioritisation of occupational determinants that affect
mental health. To the best of the authors’ knowledge, this is the first
Delphi study identifying and prioritising occupational determinants that
affect mental health in adolescents and could help to inform
activity-based interventions targeting adolescent’s mental health
difficulties.