Introduction: During the COVID-19 pandemic, college students experienced occupational disruptions to their daily routines and alarming mental health outcomes. This paper seeks to examine associations between college students’ occupational engagement and psychological well-being; identify potential protective and risk factors for gender, race, and ethnic identities; and explore the impacts of occupational disruptions during COVID-19. Method: Undergraduate students (n = 152) were recruited through social media and ResearchMatch and completed an online survey. Associations and differential impacts on identity were analyzed for occupational balance, satisfaction with participation in discretionary activities, depression, fatigue, general anxiety, stress, loneliness, and COVID-19 behaviors, beliefs, and experiences (CBBE). Results: Occupational engagement had significant negative correlations with the five mental health measures. Females reported more fatigue, anxiety, and stress than males. Hispanic/Latinx participants reported greater occupational engagement. Black/African American participants reported greater occupational balance than their multiracial peers. Occupational Impairment subscale was positively associated with depression, anxiety, and stress. Participants who lost their job were more depressed. Males reported a greater increase in alcohol, cigarette, and recreational drug consumption than females. The COVID-19 Preventative Action subscale was positively correlated with COVID-19 Worry. Females both engaged in more preventive actions and worried more than males. Conclusion: Overall, this study reveals that increasing occupational engagement during the COVID-19 pandemic could be beneficial for mental health and well-being, that COVID-19 had differential impacts on occupational engagement and mental health outcomes based on identity, and that behaviors, beliefs, and experiences shifted with the global occupational disruption.

Background.: Lifestyle Redesign ^® occupational therapy (LR-OT) originated in the Well Elderly studies as a preventive intervention for older adults, demonstrating positive health and cost outcomes. Although LR-OT later expanded to chronic condition management and inspired numerous programme adaptations for different contexts and populations, systematic reporting of intervention modifications remains scarce. This gap extends beyond OT, reflecting a broader movement in implementation science. Purpose.: This study applies the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to systematically document adaptations across four LR-OT programmes. Additionally, we examine fidelity-consistency by mapping programme components to the Well Elderly programme and core LR-OT elements. Methods. Four teams implementing adapted programmes—diabetic foot ulcer self-management, primary care chronic condition management, Remodeler sa Vie for French-Canadian older adults, and LR weight management—participated in a structured mapping exercise to align programmes with FRAME and LR-OT principle components. Results. Adaptation approaches varied from highly structured to loosely standardized methods. Despite numerous modifications, all programmes strongly aligned with LR-OT's core characteristics and domains. Conclusion. This study highlights LR-OT's adaptability across diverse contexts while maintaining fidelity to its foundational framework. Findings contribute to implementation research, providing a model for systematically documenting and characterizing adaptations made to client-centred, evidence-based OT programmes.

Background: In primary care (PC) clinical, healthcare utilization, and financial outcomes associated with Lifestyle Redesign ^® Occupational Therapy (LR-OT), a framework that incorporates healthy habits into daily routines, are not well documented in the United States. Purpose: (a) Compare clinical outcomes, healthcare utilization, and associated cost differences between patients who received LR-OT and a control group. (b) Assess the investment required integrate LR-OT into PC. Method: LR-OT was integrated into a safety-net PC clinic. In a hybrid effectiveness-implementation clinical trial (#NCT03293914), clinical (glycated hemoglobin A1c [HbA1c], blood pressure, cholesterol, and body mass index) and utilization (outpatient, emergency department [ED], hospital visits) data were extracted from medical records of provider-referred adults with diabetes (HbA1c ≥ 9.0%) who were willing to make lifestyle changes. Results: Of 155 referred patients, 142 were randomized to LR-OT ( n = 73) or a control group ( n = 69), and 42 completed eight LR-OT sessions within 6 months. Underpowered clinical outcomes indicated no significant change, with aggregated trends suggesting LR-OT supports sustained cardiometabolic improvement. Savings of $250,518.96 is attributed to LR-OT, driven by significant decreases in ED visits ( p = .03) and hospital days ( p = .03), despite nonsignificant increases in outpatient utilization. The projected cost-benefit of integrating a full-time LR-OT in PC is $352,326.72 with a 236% return on investment. Conclusion: Clinical trends and significant reductions in acute care services drove healthcare-wide cost savings, demonstrating clinical and financial value of integrating LR-OT into PC.

Illness intrusiveness is a psychological process reflecting the perceived impact of illness-related disruptions on daily life in chronic conditions. Type 1 diabetes (T1D) disrupts daily activities through symptoms, self-care demands, and device use, yet little is known about how these disruptions shape psychosocial well-being. This study examined activity disruptions in adults with T1D using ecological momentary assessment (EMA) and tested whether illness intrusiveness mediates the relationship between activity disruptions and life satisfaction. A total of 196 adults with T1D completed 14 days of momentary activity disruption assessments and follow-up surveys assessing illness intrusiveness and life satisfaction. On average, participants reported disruptions in 11% of momentary daily activities, with notable variation across activity types, racial/ethnic groups, and treatment regimens. Activity disruption significantly predicted greater illness intrusiveness (β = 0.33, p < 0.001), which in turn predicted lower life satisfaction (β = -0.51, p < 0.001). Mediation analysis revealed that illness intrusiveness fully mediated the relationship when adjusted for income. Subtype analyses showed that device-related (indirect effect: β = -0.12, p < 0.001) and symptom-related disruptions (indirect effect: β = -0.12, p = 0.01) were fully mediated, whereas self-care disruptions were not associated with life satisfaction. Findings highlight the value of capturing real-time activity disruptions and suggest that illness intrusiveness may be a key explanatory mechanism linking activity disruption and psychosocial outcomes. Device burden and socioeconomic context emerged as factors shaping these relationships.

Purpose: The purpose of this study was to examine 12-month outcomes of the Resilient, Empowered, Active Living-Telehealth (REAL-T) intervention for young adults with diabetes. Methods: Young adults ages 18 to 30 years with type 1 diabetes ≥1 year and A1C ≥7.5% (≥58 mmol/mol) were randomized 1:1 to REAL-T (6 months of telehealth occupational therapy) or usual care. Continuous glucose monitor metrics, diabetes distress, and diabetes-related quality of life (DQoL) were assessed at baseline, 6, and 12 months, while A1C and hypothesized mediators were assessed quarterly. Linear mixed-effects models estimated longitudinal treatment effects. Results: Of 209 randomized participants, 171 (82%) contributed 12-month data. No significant between-group differences were observed for glycemia. REAL-T participants showed greater improvements in emotional distress and diabetes self-efficacy than control group participants. Per protocol analyses excluding untreated participants yielded stronger effects, with significantly improved DQoL and regimen distress. Conclusions: A telehealth occupational therapy intervention produced durable improvements in emotional distress and self-efficacy over 12 months, supporting psychosocial outcomes as central treatment targets in young adults with type 1 diabetes.