MOHO's Impact on Life Skills & QoL in Mentally Ill Offenders: A Tamil Nadu Study (MOHO)

Effectiveness of the Model of Human Occupation (MOHO) in Enhancing Life Skills and Its Impact on Quality of Life (QoL) Among Mentally Ill Offenders in Tamil Nadu: A Quasi-Experimental Study

What is the goal of this study?

The goal of this study is to learn if a 12-week occupational therapy programme based on the Model of Human Occupation (MOHO) can improve life skills and quality of life in mentally ill offenders in Chennai, India.

Who will take part?

12 mentally ill offenders from the Prisoners' Ward, Central Prison, Puzhal, Chennai will take part in this study.

What will participants do?

Participants will:

Attend 24 structured occupational therapy sessions, twice a week for 12 weeks Be assessed for life skills using the Vellore Occupational Therapy Evaluation Scale (VOTES) Be assessed for quality of life using the WHOQOL-BREF questionnaire

What are the main questions this study aims to answer?

Does a MOHO-based occupational therapy programme improve life skills among mentally ill offenders? Does a MOHO-based occupational therapy programme improve quality of life among mentally ill offenders?

Study Overview

• Status: Completed
• Conditions: Occupational Therapy; Psychiatric Diagnosis; Mentally Ill Persons
• Intervention / Treatment: Behavioral: Model of Human Occupation (MOHO)

Detailed Description

Mentally ill offenders represent a particularly vulnerable forensic population, frequently exhibiting impaired life skills and reduced quality of life (QoL) as a consequence of prolonged institutionalisation and limited occupational engagement. This quasi-experimental study examined the effectiveness of a 12-week Model of Human Occupation (MOHO)-based occupational therapy programme delivered to 12 purposively sampled mentally ill offenders in the Prisoners' Ward, Central Prison, Puzhal, Chennai, India. Participants received 24 structured occupational therapy sessions delivered twice weekly. Life skills were assessed using the Vellore Occupational Therapy Evaluation Scale (VOTES), and quality of life was measured using the World Health Organization Quality of Life - Brief Version (WHOQOL-BREF). Paired-sample analysis (IBM SPSS Statistics, Version 29) revealed statistically significant improvement in life skills (p = .006), whereas no significant changes were observed across the four WHOQOL-BREF domains (p > .05). Findings indicate that MOHO-based interventions effectively enhance life skills in this forensic mental health population, supporting the integration of occupational therapy into forensic psychiatric rehabilitation programmes. The limited impact on perceived quality of life warrants further investigation through extended and individually tailored intervention designs.

• Study Type: Interventional
• Enrollment (Actual): 12
• Phase: Not Applicable

Contacts and Locations

Study Locations

• India
  • Tamil Nadu
    • Chennai, Tamil Nadu, India, 636016
      • Sri Ramachandra Institute of Higher Education and Research (Deemed University)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Offenders committed crimes under the section IPC & CrPc of Indian Constitution April,1 1974 Offenders from age 18 to 64 (14.1 % to 13.9 % Male prevalence) Male offenders with or without differential diagnosis of psychotic symptoms HCR-20 V3 Risk assessment tool score ranging from low to moderate level Short Orientation Memory Concentration Test (OMCT) scores ranging from 0-19

Exclusion Criteria:

• Offenders with Physical disabilities Offenders with Activity Limitations

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Mentally ill Offenders in State Prison, Tamil Nadu, India; Mentally ill offenders are individuals diagnosed with a psychiatric disorder who are concurrently involved in the criminal justice system. This arm comprises 12 purposively sampled mentally ill offenders residing in the Prisoners' Ward, Central Prison, Puzhal, Chennai, Tamil Nadu, India. Participants will receive a structured 12-week MOHO-based occupational therapy intervention consisting of 24 sessions delivered twice weekly by a trained occupational therapist. Sessions will incorporate MOHO constructs - volition, habituation, and performance capacity - to address occupational dysfunction. Activities will focus on self-care, daily living, communication, interpersonal skills, and community reintegration. Life skills will be assessed using the Vellore Occupational Therapy Evaluation Scale (VOTES) and quality of life will be measured using the WHOQOL-BREF at baseline and post-intervention.

Behavioral: Model of Human Occupation (MOHO); Description of MOHO (Model of Human Occupation): The Model of Human Occupation (MOHO) is a client-centred occupational therapy theoretical framework developed by Gary Kielhofner in 1980. MOHO explains how humans are motivated to engage in occupation, how occupational patterns are organised, and how occupation is performed within the environment. It is built upon three core subsystems: Volition- refers to the motivation for occupation, encompassing personal causation, values, and interests *Habituation- refers to the organisation of occupation into patterns and routines through roles and habits Performance Capacity- refers to the physical and mental abilities that enable occupational performance MOHO emphasises that meaningful occupational engagement is essential for health, well-being, and quality of life. It considers the dynamic interaction between the person, their occupation, and the environment. MOHO-based interventions are widely used in psychiatric and; Other Names: MOHO

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Life skills	Mentally ill offenders frequently experience significant deterioration of essential life skills due to prolonged institutionalization, psychiatric symptoms, and limited occupational engagement. Life skills rehabilitation is therefore critical in this forensic population for the following reasons: Addresses occupational dysfunction by targeting volition, habituation, and performance capacity through MOHO-based intervention Reduces recidivism by equipping offenders with practical competencies necessary for community reintegration Enhances quality of life across physical, psychological, social, and environmental domains Supports forensic psychiatric rehabilitation** through structured, evidence-based occupational therapy Promotes social inclusion by fostering self-efficacy, role competence, and community participation Empowers a vulnerable population by addressing occupational needs and supporting recovery-oriented outcomes	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life (QoL)	Quality of life (QoL) is a fundamental outcome measure in the rehabilitation of mentally ill offenders. It reflects an individual's perceived well-being across physical, psychological, social, and environmental domains. Among mentally ill offenders, QoL is severely compromised due to psychiatric illness, incarceration, stigma, and occupational deprivation. Improving QoL is essential in forensic rehabilitation because: Reflects holistic recovery beyond symptom reduction, encompassing functional independence and well-being Measures rehabilitation outcomes across physical, psychological, social, and environmental domains using WHOQOL-BREF Supports reintegration by improving social participation, interpersonal functioning, and community living Reduces institutionalization effects by restoring meaningful occupational roles and routines through MOHO Promotes mental health recovery by addressing individual occupational needs and priorities	3 months

Collaborators and Investigators

• Sponsor: Sri Ramachandra Institute of Higher Education and Research
• Investigators: Principal Investigator: SriBalaji R Mr, Master in Occupational Therapy, Sri Ramachandra Institute of Higher Education and research,Porur,Chennai-600116

Publications and helpful links

General Publications

• World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27;310(20):2191-4. doi: 10.1001/jama.2013.281053. No abstract available.
• Ozkan, E., Belhan, S., Yaran, M., & Zarif, M. (2018). Occupational therapy in forensic settings. In [Eds.], Occupational therapy - therapeutic and creative use of activity. IntechOpen. https://doi.org/10.5772/intechopen.80726
• Moore, M. (2014). Occupational therapy and forensic psychiatry. In [Ed.], Psychiatry and mental health occupational therapy (pp. 106-114).
• Lloyd, C., & Williams, P. L. (2010). Occupational therapy in the modern adult acute mental health setting: A review of current practice. International Journal of Therapy and Rehabilitation, 17(9), 483-493. https://doi.org/10.12968/ijtr.2010.17.9.78414
• Knott, G., & Bannigan, K. (2013). A critical review of the approved mental health professional role and occupational therapy. British Journal of Occupational Therapy, 76(3), 118-126. https://doi.org/10.4276/030802213X13627524435119
• Kirsh, B., Martin, L., Hultqvist, J., & Eklund, M. (2019). Occupational therapy interventions in mental health: A literature review in search of evidence. Occupational Therapy in Mental Health, 35(2), 109-156. https://doi.org/10.1080/0164212X.2018.1508603
• Soeker MS, Hare S, Mall S, van der Berg J. The value of occupational therapy intervention for the worker roles of forensic mental healthcare users in Cape Town, South Africa. Work. 2021;68(2):399-414. doi: 10.3233/WOR-203381.
• Galson SK. Mental health matters. Public Health Rep. 2009 Mar-Apr;124(2):189-91. doi: 10.1177/003335490912400202. No abstract available.
• Fieldhouse, J., Bryant, W., & Plastow, N. (Eds.). (2022). Creek's occupational therapy and mental health (6th ed.). Elsevier Health Sciences
• Daffern, M., & Chu, C. M. (2024). Approaches to offender rehabilitation in Asian jurisdictions. In J. Creek, L. Lougher, & A. Plastow (Eds.), Creek's occupational therapy and mental health
• Craik, C. (1998). An overview of the literature on occupational therapy in mental health. British Journal of Occupational Therapy, 61(5), 186-192. https://doi.org/10.1177/030802269806100502
• Swarbrick M, Noyes S. Effectiveness of Occupational Therapy Services in Mental Health Practice. Am J Occup Ther. 2018 Sep/Oct;72(5):7205170010p1-7205170010p4. doi: 10.5014/ajot.2018.725001.
• Rocamora-Montenegro M, Compan-Gabucio LM, Garcia de la Hera M. Occupational therapy interventions for adults with severe mental illness: a scoping review. BMJ Open. 2021 Oct 29;11(10):e047467. doi: 10.1136/bmjopen-2020-047467.

Study record dates

Study Major Dates

• Study Start (Actual): April 5, 2024
• Primary Completion (Actual): July 18, 2024
• Study Completion (Actual): July 23, 2024

Study Registration Dates

• First Submitted: June 17, 2026
• First Submitted That Met QC Criteria: June 24, 2026
• First Posted (Actual): July 1, 2026

Study Record Updates

• Last Update Posted (Actual): July 1, 2026
• Last Update Submitted That Met QC Criteria: June 24, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders
• Other Study ID Numbers: CSP/23/OCT/138/882; SRIHER(DU) (Other Identifier: Sri Ramachandra Institute OF Higher Education and Research (Deemed University))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: all 12 participants data will be shared
• IPD Sharing Time Frame: April 5,2024 to July 18,2024
• IPD Sharing Access Criteria: The principal investigator will be able to access the IPD, they will be accessing the data's of the patients by means of recoded data
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No