The implications of implementing evidence-based change in practice settings are complex and far reaching. Research examining ways to implement professional theory-driven approaches and support occupational therapists to advance their practice is limited. This participatory action research (PAR) study set out to investigate the implementation of an evidence-based occupational therapy conceptual model of practice, the Model of Human Occupation (MOHO) (Kielhofner 2002) across a mental health occupational therapy service. Methods used involved preparatory workshops and twelve months of team-based, monthly group reflective supervision sessions. In addition individual meetings with the occupational therapists took place every six months for the initial twelve months and a further year thereafter. The findings present a fusion of theoretical positions which are integrated within a ‘Participatory Change Cycle’. Emphasis is placed upon the development of a communicative space within which critical consciousness-raising occurred. This in turn enabled the therapists to take steps to advance their practice in light of theory. Fundamentally the therapists engaged in a process of re-negotiation of their professional selves in front of colleagues and myself as an external group facilitator and in the context of professional and political structures. The findings examine how learning occurs amongst people, within the contexts in which it holds meaning; I explore how disciplinary learning has occurred via praxis, which served to transform identities and ways of knowing and participating. The study concludes with recognition of the need for an inclusive approach to practice development which embraces each individual therapist’s personal stance and professional craft knowledge alongside the contribution of intellectual constructs. It is argued that those involved in practice development initiatives work to develop a sustainable group collective, a community of practitioners who remain committed to their professional development whilst remaining mindful of contextual issues including subtle individualistic efforts to effect change, which are not always visible at face value. Furthermore, practice development initiatives require collaboration between occupational therapists from education and practice to maintain perspective regarding the contribution of both propositional and practical know-how.

Yes / The quality of care for persons living with dementia in institutional care settings is of global concern. The provision of person-centred care (PCC) for people with dementia is internationally recognised as best practice, which promotes possibilities for people with dementia to experience well-being. However, there remains a lack of evidence of approaches that can help to support delivery of PCC for older people with dementia in long-term care, in South Africa. Dementia Care Mapping (DCM) is a successful practice development tool, originating in the UK, used for supporting the implementation of PCC. However, to date it has not been considered for use by South African occupational therapists working in residential care facilities. This article defines the components of the DCM tool, its process of use and potential outcomes for care practice. In an attempt to scrutinise the value of findings from an occupational therapy perspective, the Kawa Model is drawn upon to explain how the data from DCM can be interpreted. The Kawa Model provides a strong focus on how a sense of being is promoted by a person's context, and is an established vehicle to aid understanding of the potential for application of PCC in South African care facilities.

Hur påverkar kulturen det kliniska arbetsterapeutiska arbetet med människor från en annan kulturell bakgrund? Den/de referens-ram/ar arbetsterapeuter använder sig av kommer, åtminstone oftast, från västvärlden med de värderingar och normer som finns här. I östasiatiska kulturer finns en delvis annan ”tids- och jag-uppfattning” än i västvärlden. Om värderingar och normer inte stämmer med patienternas finns en risk att behandlingen inte blir av tillräckligt god kvalitet. Smärtpatienter är en stor patientgrupp i primärvården. Förändringar av aktivitetsförmågan som påverkar delaktighet i både personligt liv, socialt liv och arbetsliv förekommer ofta. För att knyta samman de båda aspekterna, kultur och aktivitet, gjordes en kvalitativ studie med syfte att belysa uppfattningar om smärta vid aktivitet samt kulturens betydelse för en grupp vietnameser boende i Sverige. Fem informanter med smärta valdes genom lämplighetsurval och intervjuades med semistrukturerade frågor. Genom snöbollssampling valdes två informanter för ett samtal om kulturens betydelse med hjälp av frågeområden från en teoretisk modell. Genom att använda begreppen i två olika teoretiska modeller och fenomengrafisk metod redovisas uppfattningar om smärta vid aktivitet och hur kulturen påverkar dessa uppfattningar. Resultatet visar att smärtan påverkar aktivitetsförmågan negativt och att kulturella faktorer kan göra att arbetsterapeut och patient missuppfattar varandra. / How does culture influence occupational therapy practice with people from another cultural background. The clinical frame/es used by occupational therapists is, most likely, based on values and norms from the western world. In East Asian culture there is partly a different way to relate to self and temporal orientation than in west. If values and norms don’t fit the patient the risk is that the treatment will not be good enough. Patients in pain are a large group in primary care. Change in activities will often have affect on the participation in personal, social and work related areas. In order to connect these two aspects, culture and activity, a qualitative study was made in  purpose of enlightening opinions on pain in activity and the influence of culture in a group of Vietnamese living in Sweden. Five informants with pain were chosen by suitable selection and were interviewed by semi structured questions. With snowball selection two informants were chosen to a conversation about the influence of culture. The questions emerged from a theoretical model. In using the concepts of two different theoretical models and phenomenografical method the experience of pain due to activity and how culture influence these opinions is shown. The result show that pain has a negative impact on the ability to be active and that cultural factors might lead to misunderstanding between occupational therapist and patient.

<p>Hur påverkar kulturen det kliniska arbetsterapeutiska arbetet med människor från en annan kulturell bakgrund? Den/de referens-ram/ar arbetsterapeuter använder sig av kommer, åtminstone oftast, från västvärlden med de värderingar och normer som finns här. I östasiatiska kulturer finns en delvis annan ”tids- och jag-uppfattning” än i västvärlden. Om värderingar och normer inte stämmer med patienternas finns en risk att behandlingen inte blir av tillräckligt god kvalitet.</p><p>Smärtpatienter är en stor patientgrupp i primärvården. Förändringar av aktivitetsförmågan som påverkar delaktighet i både personligt liv, socialt liv och arbetsliv förekommer ofta. För att knyta samman de båda aspekterna, kultur och aktivitet, gjordes en kvalitativ studie med syfte att belysa uppfattningar om smärta vid aktivitet samt kulturens betydelse för en grupp vietnameser boende i Sverige. Fem informanter med smärta valdes genom lämplighetsurval och intervjuades med semistrukturerade frågor. Genom snöbollssampling valdes två informanter för ett samtal om kulturens betydelse med hjälp av frågeområden från en teoretisk modell. Genom att använda begreppen i två olika teoretiska modeller och fenomengrafisk metod redovisas uppfattningar om smärta vid aktivitet och hur kulturen påverkar dessa uppfattningar.</p><p>Resultatet visar att smärtan påverkar aktivitetsförmågan negativt och att kulturella faktorer kan göra att arbetsterapeut och patient missuppfattar varandra.</p> / <p>How does culture influence occupational therapy practice with people from another cultural background. The clinical frame/es used by occupational therapists is, most likely, based on values and norms from the western world. In East Asian culture there is partly a different way to relate to self and temporal orientation than in west. If values and norms don’t fit the patient the risk is that the treatment will not be good enough.</p><p>Patients in pain are a large group in primary care. Change in activities will often have affect on the participation in personal, social and work related areas. In order to connect these two aspects, culture and activity, a qualitative study was made in  purpose of enlightening opinions on pain in activity and the influence of culture in a group of Vietnamese living in Sweden. Five informants with pain were chosen by suitable selection and were interviewed by semi structured questions. With snowball selection two informants were chosen to a conversation about the influence of culture. The questions emerged from a theoretical model. In using the concepts of two different theoretical models and phenomenografical method the experience of pain due to activity and how culture influence these opinions is shown.</p><p>The result show that pain has a negative impact on the ability to be active and that cultural factors might lead to misunderstanding between occupational therapist and patient.</p>

On August 31, 2020 the American Occupational Therapy Association (AOTA) published the Occupational Therapy Practice Framework (OTPF), 4th edition. In this edition, interoception has been added under sensory functions (AOTA, 2020, p.3). In a recent survey of occupational therapists (Appendix A), while 79% of respondents were familiar with the term interoception, their definitions of interoception varied widely. Only 21% of respondents used an assessment tool to consider interoceptive function in their practice. Meanwhile 84% believed that knowing more about interoception would change the way they evaluate and intervene in occupational therapy practice. If we, as a profession, believe that interoception is important enough to include in our practice framework, it is imperative that occupational therapy practitioners heed this gap in knowledge to practice translation and utilize educational resources to benefit from practice reinforced by recent research (which suggests that interoception processes underlie many of the client factors occupational therapy addresses). This project seeks to facilitate occupational therapy practitioner’s as they embrace this addition to our practice framework worldwide. This will be accomplished through development of an educational program of online learning modules steeped in evidence-based research to provide practitioners with the most current information about interoception and how it applies to occupational therapy. Utilizing the brand new OTPF-4, occupational therapy practitioners (OTP) can uniquely consider client factors and domain specific areas with an overlay of interoceptive relevancy. / 2023-05-14T00:00:00Z

Introduction: Ethical decision-making is an important component of occupational therapy practice in Canada. Research is needed to understand ethical decision-making and how to build occupational therapists’ competency to make ethical decisions. Purpose: The aim of this thesis was to study ethical decision-making in occupational therapy practice in order to contribute to epistemological development regarding ethics in occupational therapy and to support continuing competency in ethical decision-making. Method: Three studies comprise this thesis. A constructivist grounded theory study was conducted involving in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings to explore the process of ethical decision-making. An interpretive description study using secondary analysis of grounded theory data was conducted to explore gaps related to continuing competency in ethical decision-making from the participants’ perspective and to generate recommendations for future directions to support continuing competency. Finally, a non-randomized, single-group, pre- and post-test study (n=33) was conducted to evaluate an on-line education module developed to support competency for clinician-educators. Findings: The grounded theory study led to development of an ethical decision-making prism capturing three processes: Considering the Fundamental Checklist, Consulting Others, and Doing What’s Right. The interpretive description study highlighted two gaps related to continuing competency in ethical decision-making: lack of knowledge and lack of supports. Education, tool development, and ethics mentorship were identified directions for development. The third evaluation study found that an on-line education module led to improvements in ethics knowledge and intent to change practice but not to actual practice change. Implications: This thesis advances a theoretical understanding of ethical decision-making in occupational therapy practice and an applied understanding of occupational therapists’ needs related to competent ethical decision-making. Findings also provide preliminary data regarding on-line ethics education to advance knowledge and skills of clinician-educators who are involved in cultivating ethical decision-making among student occupational therapists. / Thesis / Doctor of Philosophy (PhD) / “Doing what’s right”, or ethical decision-making, is an important part of being an occupational therapist in Canada. To help occupational therapists build knowledge and skills it is important to understand how they make ethical decisions in day-to-day practice. This PhD describes three studies that look at three different aspects of ethical decision-making. The first study presents a theoretical explanation of how occupational therapists decide what’s right to do. The second study uses the same data to look at supports that occupational therapists feel they need to build knowledge and skills about ethical decision-making. The third study measures the value of an on-line education course in helping occupational therapy educators teach students about ethical decision-making. Results of these studies can be used to support occupational therapists in doing what’s right. Results also highlight areas for additional study to further support ethical occupational therapy practice in Canada.

Philosophiae Doctor - PhD / The purpose of this qualitative study was to identify ways in which the University of the Western Cape (UWC) occupational therapy (OT) curriculum could be developed to prepare its graduates to advance occupational justice in community service practice. The background to the study is the development of occupational therapy practice and education within a policy context of health reform that gave momentum to the shift in emphasis from a bio-medical to a more socio-political approach to health in South Africa. Underpinning this study was the assumption that OT education informs professional practice and that uncovering new graduates’ practice experiences can inform the development of the UWC OT curriculum. The aim of the studyn was to examine how UWC OT graduates conceptualised occupational justice and how it manifested in their daily practice of community service in three provinces in South Africa. The study is framed within the theories of occupational justice and critical curriculum theory, in particular, critical pedagogy. A literature review pertaining to the application of occupational justice in OT practice and education is presented. This includes the background values that inform the practice of occupational justice, the application of occupational justice as it relates to OT practice and the relationship between OT education and occupational justice. The research design that was adopted is that of a single, interpretive case study. Through purposive sampling seven occupational therapy graduates from UWC who graduated in 2009, and who practiced in under-resourced, rural community service settings in 2010, were selected to participate in the study. The methods of data collection that were utilised were participant observation, a reflective journal, semi-structured paired or dyadic interviews and document review. The findings revealed that occupational justice held considerable value for the participants. They conceptualised occupational justice as enhanced health and well-being, and broader social change as an outcome of the facilitation of occupational enablement. The nature of their community service practice settings, however, posed several challenges for the participants. From the perspective of the participants, the dominance of the medical model, lack of resources and system of bureaucracy appeared to be the biggest challenges they encountered. While the participants’ education was geared towards equipping them to provide appropriate services as indicated by local needs, the health system was not ready tob accommodate their practice. Consequently, the participants appeared to encounter hegemony in practice. In encountering hegemony, however, they displayed an attitude of defeatism, leaving them with feelings of guilt, despondency and powerlessness. They lacked the skills to respond to power dynamics and to interact with people in positions of power. The main conclusion drawn from the study findings is that for OT graduates to impact the contexts in which they practice in South Africa, OT education must ensure that students develop competence to deal with the complexities of community service practice. This implies that transformational learning as pedagogical practice is of the essence, as it frames student preparation not just as learning but as a process of critical reflexivity that equips them to respond to power dynamics and intervene in matters related to occupational justice as active agents of change. The role and practice of occupational justice are subjects of debate in the context of OT education as they are for the profession broadly. This study contributed to this conversation through its examination of UWC OT graduates’ actual practice and the transmission of occupational justice-promoting practice through UWC OT education. The study highlighted that it is imperative that OT curricula in South Africa provide opportunities for students to engage in critical reflection on ways in which indigenous knowledge and a local understanding of occupational justice, as it relates to collective agency and critical consciousness, can be made more explicit in everyday practices. To this end, recommendations for the development of the UWC OT curriculum are made in respect of curriculum structure, content and approach; interdisciplinary education and practice, support for community service graduates and occupational therapy continued professional development.

This mixed-methods research study was conducted for the purpose of examining school-based occupational therapists' child psychosocial knowledge and attitudes, along with how therapists developed this knowledge and attitudes. Using a phenomenological qualitative approach, the study addressed the following broad research question: What meaning do school-based occupational therapists give to their experience in developing child psychosocial knowledge? Using a quantitative approach, a survey instrument was used to answer the following questions: (a) What level of child psychosocial knowledge and attitudes do school-based occupational therapists possess? (b) How do the following variables impact child psychosocial knowledge and attitudes: (1) level of education, (2) academic course content, (3) participation in mental health fieldwork, (4) application of psychosocial knowledge in non-mental health fieldwork, (5) professional practice experiences, and ( 6) continuing education experiences. Snowball sampling was used to select 11 school-based occupational therapists for the phenomenological portion of the design. Data were analyzed using Giorgi and Giorgi's (2008) method of phenomenological analysis. Random sampling was used to select 1,000 school-based therapists who were mailed the Occupational Therapy Child Mental Health Questionnaire based upon The Teacher Mental Health Opinion Inventory (Morris, 2002). The response was N = 630. Data were analyzed using descriptive statistics and analysis of association. Using the mixed-methods triangulation convergence model, where both quantitative and qualitative data were collected at the same time and the results converged during interpretation by comparing and contrasting them, the following conclusions were made: (a) school-based occupational therapists possess and use child psychosocial knowledge: however. they do not believe it is sufficient; (b) school-based occupational therapists have a difficult time articulating psychosocial knowledge; however. through case descriptions they are able to give many examples of psychosocial knowledge they use in practice; (c) school-based occupational therapists believe that holistic, occupation-based, and client-centered practice, along with additional psychosocial intervention strategics, help them maintain a positive attitude toward children with emotional disturbance; (d) school-based occupational therapists experience tension when attempting to apply their holistic, occupation-based, and client-centered practice in an environment that is typically focused on students changing to meet the environmental demands; (e) due to the constraints of the educational system and the IEP, school-based occupational therapists practice holistically by incorporating psychosocial knowledge in a hidden fashion; (f) school-based occupational therapists believe that mental health fieldwork and rich experiences with individuals who have mental illness is important to developing a comfort level with people who have mental illness; (g) school-based occupational therapists do not readily connect the learning from adult mental health fieldwork that they apply in their school-based practices.