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No / To develop a culturally sensitive occupation-based health promotion intervention for older Hispanic adults who live alone. Methods: We used a mixed method design for the content validation of the intervention and the Ecological Validity Model (EVM) to culturally center the intervention. In the quantitative phase, aging experts as well as community members from two activity centers for the elderly in Puerto Rico completed a content validity ratio exercise. In the qualitative phase, we conducted three focus groups with these participants. Data analysis included content validity ratio and a directed content analysis. Results: This resulted in a working version of the intervention protocol addressing the eight dimensions of the EVM. Conclusions: The EVM can be used to culturally center preventive interventions to other ethnic minority groups to augment the external validity and cultural competence of interventions. Future research must test the feasibility of this new intervention. / This publication was supported by National Institute of Health (NIH), National Institute of Minority Health and Health Disparities (NIMHD), Clinical Research Education and Career Development (CRECD) [R25RR017589] in collaboration with Puerto Rico Clinical and Translational Research Consortium (PRCTRC) [8U54 MD 007587-03] and the National Center for Research Resources (NCRR) [8U54RR026139-01A1]. The second author was supported by the National Institute of Drug Abuse (NIDA) (1K02DA035122-01A1). Its content is solely the responsibility of the authors and do not necessarily represent the official views of the NIH, NIMHD, or NCRR.

The profession of occupational therapy is widely misunderstood. Other healthcare professionals and clients do not understand the values, scope of practice, or skillset occupational therapy practitioners (OTPs) embody. This leads to OTP burnout and suboptimal patient care. Further, OTPs have assimilated to the practices of other health disciplines which perpetuates the problem. This project proposes a solution to be utilized within a home health setting that addresses the issue from three angles: instruction for other healthcare professionals that is provided at a level commensurate with previous experience and education, education for clients accessible for all levels of general and health literacy, and support for OTPs in the form of updated documentation methods to facilitate a return to occupation-based practice. EKB Model of Consumer Behavior drives the approach, and instruction methods are based on Adult Learning Theory. AOTA’s Occupational Therapy Practice Framework: Domain and Process 4th Edition (OTPF-4) supports the development of documentation to facilitate occupation-based practice. This proposal is the first to provide a comprehensive, theory-driven solution to the issue and this model can easily be adapted to settings outside home health.

Background: Occupational therapy (OT) plays an important role in providing early childhood interventions for children with developmental delay. While paediatric OT has long been guided by developmental principles, occupation-centred interventions have been promoted during the last decades, but no unifying definition exists about the core features. Aims/Objectives: The aim of this paper is to (a) identify and describe how occupation-based and occupation-focused interventions are demonstrated in paediatric occupational therapy for infants and young children with developmental delay, (b) identify which outcomes these interventions address and (c) analyse which outcome measures are used. Material and Methods: Eight databases and 15 OT journals were searched. Included studies were peer-reviewed primary sources published in English since 1999, selected based on the terminology proposed by Fisher (2013). Nineteen papers met inclusion criteria. Results: Eight occupation-based, two occupation-focused and nine occupation-based and occupation-focused interventions were identified. Outcomes related mainly to occupational and play skill acquisition as well as mastery of co-occupations. A limited number of occupation-focused outcome measures was implemented. Conclusions: Several occupation-centred interventions have been researched. Gaps in knowledge exist regarding measures taking into account (co-)occupational performance and young children’s perspective. Significance: OTs might want to expand their scope of practice to include all occupational domains and increase parent-delivered interventions in natural environments. Measures used should be relevant to occupational performance and take into account the parent’s and children’s view. Use of uniform terminology can aid identification of evidence and clear placement of OT among other professionals.

Changes in health care delivery practices are impacting the provision of care in all venues. Occupational therapists working in hospital settings strive to meet professional mandates for occupation-based practice within a medical-model system. Ethical practice is another aspect of service provision vulnerable to contextual influences. The aims of the two studies reported here were to explore occupational therapists’ experiences with occupation-based practice, and with ethical issues, in hospital settings. Grounded theory methods were employed for both studies. Data were collected via individual, semi-structured interviews with 22 participants for the first study. For the second study, nine participants participated in individual, semi-structured interviews, journaling, and follow up interviews. Data analysis resulted in four emergent themes for each study. The main themes of the first study were Occupation-based practice expresses professional identity; Occupation-based practice is more effective; Occupation-based practice can be challenging in the clinic; and, Occupation-based practice takes creativity to adapt. The four themes of the second study were Anything less would be unethical: Key issues; I trust my gut: Affective dimension of ethical practice; Ethical practice is expected but challenging; and, It takes a village. Occupational therapists negotiate challenges inherent in contemporary hospital-based practice to provide occupation-based services and to practice ethically. Occupation-based practice is perceived to be more effective than biomedical approaches to intervention. Therapists must employ creative strategies to overcome challenges presented by medical-model service delivery contexts in order to provide occupation-based interventions. In comparison to other health care professionals working in adult rehabilitation practice, occupational therapists experience both common and unique ethical issues. A discovery of this study was that occupational therapists also experience ethical tensions related to team members’ and families’ sometimes subtle, and less frequently explicit, requests to falsify recommendations in documentation. Experiences with ethical issues include an inherent affective component in the form of moral distress and a strong sense of caring. The impact of systemic/organizational and relational forces is a reality that contemporary occupational therapists must negotiate in order to provide occupation-based and ethical practice.

Magister Scientiae (Occupational Therapy) - MSc(OT) / Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference while remaining rooted in an occupational therapy perspective. Hand function is important for participation in daily occupations. The current focus in assessment and treatment of clients in occupational therapy remains on body structure and function which is also true in South Africa. The gap in the literature about the effects of OBHT indicates that there is a need for a study in a South African context. This research was conducted to examine the influences of an OBHT among clients with hand injuries within occupational therapy practice in a South African context.

Aim: The purpose of this study is to describe the intervention process at a psychiatric clinic in Vietnam, from evaluation to goal setting, and how the staff choose occupation-based intervention for their patients. Method: This study is a qualitative study with inductive approach where the data collection is based on a semi-structured interview with the health care staff at a psychiatric clinic in Vietnam. The respondents consisted of a total of ten participants and were required by a purposive sample. Content analysis according to Kristensson (2014) was used to examine the data. Result: The findings from the result revealed that the clinic work without a standard procedure where the staff evaluates and assess their patient from their own experience. They also interview and observe the patients without an aim. The result also showed that the clinic offers different occupation-based interventions where the doctor decides occupation-training but not in consultation with the patient. It was revealed that the purpose of the occupation is to make the patients independent. The last finding was that the staff has a lack of individual goal setting and the general goal is for patients to get healthy. To see if the patients achieve improvement, observations are made without aim. Conclusion: The study concludes that the health care staff at the clinic has found their strategies using their own experience, for evaluating and assessing their patients.

Introduction: Stroke puts a burden on the society as half of the stroke survivors have long term care needs. After six months many stroke survivors cannot independently perform basic daily life activities, which makes living independently at home challenging. Stroke survivors who received occupational therapy are more independent for those activities. As more and more stroke survivors are discharged home faster, having an insight into the continued rehabilitation in the home environment is of great importance for the future. Aim: The aim of this review was to map which occupation-based interventions occupational therapists use in home-based stroke rehabilitation with the goal to improve basic activities of daily life. Methods: A scoping review was chosen to map and to summarize the research content and to identify possible research gaps. Data for this study was systematically collected by following Arksey and O’Malley’s framework. In total, six studies were obtained that met the inclusion criteria. Results: The results show that a combination of intervention strategies is used and besides Control Induced Movement Therapy the usage of activities as treatment came to the fore. Conclusion: The results lead to the conclusion that occupation-based activities are used to improve basic activities of daily life. The lack of detailed explanation of the interventions makes it difficult to implement those in daily life practice and therefore more descriptive interventions should be published to encourage evidence-based practice.

When people are healthy, they are able to accomplish with relative ease what they set out to do, such as going to work, traveling, meeting with friends, and taking care of their personal necessities. However, once chronic illness becomes a factor in a person’s life, he or she is faced with limitations in the ability to perform daily activities, take care of health needs and participate in life activities. More effort is required for everyday activities, leading to abandonment of previously enjoyed routines and further declines in health and quality of life (Erlandsson, 2013a). In response to the complex, dynamic, and often unpredictable care requirements of individuals with one or more chronic conditions, newer primary care delivery models were developed to improve health management and reduce costs (Sevick et al., 2007). The expectation is that these interprofessional team–based models are the best way to address the needs of persons with multiple chronic conditions (Piette et al., 2011). However those charged with providing primary care based on these models have been unable to expand beyond disease-based episodic approaches and healthcare delivery is thus perceived as inadequate in fully serving this growing population (Fortin et al., 2013). The author developed and implemented occupation-based occupational therapy (OT) services and the VA Everyday Matters workshop to demonstrate that OT should be included as a vital component of a primary care effort aimed at meeting the complex needs of Veterans with chronic conditions. Health behavior theory and occupational therapy models informed the role of OT in primary care and the development of the workshop. The use of an occupation-based approach represents an innovative change in how health promotion is conceptualized and delivered in the traditional primary care setting. The immediate and long-term outcomes of this project will have important implications for occupational therapy practice and will contribute to a growing body of knowledge about the health promoting effects of occupation. Findings from the program evaluation will be disseminated throughout the VA and will inform the continued development of innovative ways occupational therapy and primary care can partner to optimize function and quality of life for at-risk Veteran populations.

Background: Kawa is a client-centered and culturally sensitive occupational therapy model. Discussion has aroused if Kawa would be a suitable model for the clientele, which is culturally more diverse than before. Aim: To investigate how occupational therapists have applied Kawa for the occupational therapy process. Material and Methods: This qualitative study involved 15 occupational therapists, who had applied Kawa to their clients. They got selected on social media by ‘snowball sampling’. Data was collected using an electronic questionnaire. Directed content analysis was conducted, guided by The Occupational Therapy Intervention Process Model. Results: Kawa was considered a client-centered model enhancing therapeutic relationships. By using Kawa, therapists gained relevant information through the client’s subjective self-report. However, observation of the client’s occupational performance omitted. Kawa did not provide sufficient tools, and therapists had to apply knowledge from other models. Conclusions: Kawa provided a strong starting point for the occupational therapy process by enhancing the therapeutic relationships and the client’s subjective self-report, but it did not guide the therapist to complete the whole occupational therapy process. Significance: This study proved that Kawa is a useful model for developing therapeutic rapport and gaining information through self-report. The study suggests that Kawa should be developed further or combined with occupation-based models.