A framework of strategies for client-centred practice

Reflecting on challenges and opportunities for the practice of person-centred rehabilitation

OBJECTIVES

To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation.

CHALLENGES

Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation.

OPPORTUNITIES

Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation.

CONCLUSION

Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.

Influencing discussions and use of Neuroadvancements: Perspectives of Canadian occupational therapists

BACKGROUND: The early involvement of many actors including health professionals is identified in neuroethics and neurogovernance discussions as crucial in constructing conversations around awareness, reaction, and knowledge development pertaining to the ethical, legal, and societal consequences of neuroscientific or neurotechnological advancements (NA). Occupational Therapists (OTs) have a stake in NA; however, OTs are rarely mentioned within this context. Lifelong learning (LL) could be used to increase OTs knowledge on NA and its consequences. However, LL is rarely mentioned within neuroethics and neurogovernance discussions. OBJECTIVE: The study’s purpose is to understand the role of OTs as professionals and citizens in neuroethics and neurogovernance discussions and to examine the utility of LL processes put in place for OTs to empower OTs to contribute in a meaningful way to NA discussions. METHODS: 8 semi-structured interviews with OTs were conducted and analyzed using a directed content analysis. RESULTS: Although participants believed OTs can provide a holistic perspective to neurogovernance discussions, their knowledge on NA and its consequences is limited, and LL is not used as a tool to remain informed about such consequences. CONCLUSION: More education on NA and its consequences throughout their OT degree and through LL opportunities is warranted to facilitate their involvement.

Collaborative Relationship-Focused Occupational Therapy: Evolving Lexicon and Practice

BACKGROUND.

Client-centred practice has been part of occupational therapists' identity for several decades. However, therapists have begun to question whether the term obstructs critical relational aspects of therapy.

PURPOSE.

The purpose of this article is to summarize critiques of the use of the term client-centred and propose an expanded descriptor and a fundamental shift in how occupational therapists engage with individuals, families, groups, communities, and populations.

KEY ISSUES.

Three themes summarize critiques of how client-centred practice has been envisioned: (a) the language of client-centred, (b) insufficient appreciation of how the therapist affects the relationship, and (c) inadequate consideration of the relational context of occupation. We propose collaborative relationship-focused practice that has key relational elements of being contextually relevant, nuanced, and safe, and promotes rights-based self-determination.

CONCLUSION.

We argue that these essential relational elements, along with a focus on occupations, are required to promote occupational participation, equity, and justice.

Client-centred practice in Scandinavian contexts: A critical discourse analysis

Background: The concept of client-centred practice is an essential element of occupational therapy (OT), but there is a lack of a clear and shared definition of the concept in Scandinavia (Norway, Sweden and Denmark). This may complicate the articulation, discussion, development and implementation of client-centredness in OT practices.Aim: The purpose of this study was to investigate and discuss current understandings of client-centred practice in Scandinavian contexts.Material and method: The study was based on a social constructivist research approach in which Fairclough's critical discourse analysis was applied. The analysis was based on six documents published in Scandinavian OT journals and four documents published in Scandinavian Journal of OT.Results: In Scandinavian contexts, the concept of client-centred practice was articulated in three overall discourses: a client, collaborative and practice discourse. The practice discourse was the most prominent and the source of the other discourses.Conclusions and significance: Occupational therapists (OTs) in the Scandinavian countries have conceptual understandings of client-centred practice that potentially provide the basis for knowledge sharing and collaboration between OT communities. However, the study also found that client-centred practice may not yet be firmly established in all OT practices in Scandinavia.

Rehabilitation for participation in life after spinal cord injury - clinician responses to a preliminary conceptual framework

PURPOSE

To explore face validity of a preliminary conceptual framework for rehabilitation (the HEAR Framework), which is grounded in the narratives of people with spinal cord injury.

METHODS

Using a quantitative online survey, experienced spinal cord injury rehabilitation practitioners were asked to compare the overall Framework, and its three components and nine elements, against usual practice. Participants rated the helpfulness and ease of implementation of each component. Perceived training needs, to support the implementation of the Framework were also explored. Respondents were given the opportunity to provide qualitative feedback about the Framework.

RESULTS

Thirty-four participants completed the survey. Median rating of congruence of the Framework with usual practice was 6 (out of 10). The Help component of the Framework was rated as more like usual practice than the Encourage and Accept components. Median rating of the potential helpfulness to practice, of all the elements of the Framework was 5 (out of 5). Participants rated the elements within the Help component of the Framework as easiest to implement. Teaching assertiveness, promoting flexible thinking and fostering responsive communication were the highest rated training topics related to implementation of the Framework.

CONCLUSIONS

Face validity testing suggests the preliminary HEAR Framework is promising as a basis for spinal cord injury rehabilitation theory. Broad-based testing is required to progress the promise of the Framework.IMPLICATIONS FOR REHABILITATIONSpinal cord injury rehabilitation lacks conceptual frameworks to guide practice.This validity study suggests moderate alignment between the preliminary HEAR Framework and usual practice (based on the perceptions of professionals in a spinal cord injury service).The Framework may be useful to individual rehabilitation practitioners as a basis for clinical reflection.The Framework may be useful as a practice development tool for teams of rehabilitation practitioners.

An occupational therapy community development practice process

BACKGROUND.

Little research has focused on the application of the Canadian Practice Process Framework (CPPF) to occupational therapists' work in community development (CD).

PURPOSE.

This study sought to describe Canadian occupational therapists' CD practice processes.

METHOD.

Using interpretive description, Canadian occupational therapists engaged in CD practice participated in an initial interview and follow-up interview or focus group. Content analysis was used to analyze the data.

FINDINGS.

Eight occupational therapists participated in describing a process that focused on five key elements: (1) getting to know the community, (2) getting the ball rolling/planning together, (3) building (upon) occupational opportunities, (4) revisiting the approach, and (5) striving for sustainability. These elements occurred within a practice context and frames of reference related to CD practice.

IMPLICATIONS.

Participants outlined a process that was less discrete than the CPPF and highlighted the knowledge and skills needed along with the less tangible attitudes/approaches required to engage with communities.

Social change agent training program tailored to occupational therapists' needs: a design-based study protocol

BACKGROUND

As social change agents (SCAs), occupational therapists (OTs) are expected to defend the rights of their clients, advocate for and with them, and try to influence organizational and political decision-makers. However, OTs do not generally feel equipped to take effective action. The overall goal of this research partnership is to support practising OTs in acquiring the knowledge and skills required to act as SCAs through a specific SCA training program and a toolkit that summarizes the key training points.

METHODS

The study will include three iterative phases (conceptualization, implementation and evaluation) and use a participatory process. The design of the training program and toolkit will draw on the expertise of the researchers (theoretical knowledge), a professional provincial partner and study participants (experiential knowledge). To evaluate the training program and toolkit, a self-administered evaluation questionnaire, facilitator observation grid and semi-structured guide designed to facilitate focus group discussions will be used. The quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The results of the initial implementation and evaluation phases will inform improvement of the training program and toolkit before starting the cycle with the following groups.

DISCUSSION

In addition to training about 100 OTs, this study will produce three main benefits: 1) development of two products, namely the SCA training program and toolkit, that are easy to reuse and potentially transferable to other professionals; 2) ownership of these products by the partner through its close involvement in all stages of the study; and 3) development of a sustainable partnership between a team of researchers and a recognized organization with networks across Canada and internationally. These three spin-offs will provide a solid basis for an increasing number of permanent implementation initiatives, in Québec and elsewhere in Canada, not just in occupational therapy but also in other professions.

The Equity Lens for Occupational Therapy: A program development and evaluation tool: L'Equity Lens for Occupational Therapy : un outil pour le développement et l'évaluation de programme

BACKGROUND

Occupational therapists value the principles of health and health care equity and often face challenges addressing inequities within the systems in which they work.

PURPOSE

We present the Equity Lens for Occupational Therapy (ELOT), a framework to provide a practical starting point for reflecting on equity issues and the ways inequities are enacted in daily practice.

KEY ISSUES

Building on an existing occupational therapy practice model and well-established program development and evaluation processes, we overlay an equity lens. The lens provides a structured way to critically reflect on occupational therapy programs within their contexts and develop action strategies to prevent or redress inequities.

IMPLICATIONS

Taking action on the multiple ways that inequities can be embedded in occupational therapy programs within health and social systems can be a daunting task. The ELOT provides a systematic way to stimulate critical reflection and dialogue, examine practice, focus social advocacy, and take action.

Exploring Canadian Occupational Therapists' Understanding of and Experiences in Community Development

Background. Occupational therapists are increasingly recognizing the importance of working with communities as a way to enhance health and well-being. Such work can occur through community development, a community-driven process in which communities are supported in identifying and addressing their health priorities. Purpose. This paper presents the qualitative findings of a study that explored the experiences of occupational therapists in Canada working in community development including how they understand community development and how they designed their role in this field. Methods. Occupational therapists working in community development shared their experiences and understanding of community development during 12 interviews. Results. The results of this study describe the iterative, reflexive process occupational therapists have undergone in coming to establish their role in this field. Implications. Recommendations are made regarding the preparation of future occupational therapists and for supporting those currently working in this field.

Enhancing student occupational therapists' client-centred counselling skills

BACKGROUND

Client-centred practice is the cornerstone of the occupational therapy profession. However, there has been little focus on how to teach students to be client-centred practitioners while engaged in counselling.

PURPOSE

The purpose of this study was to examine the impact of the use of a client-completed rating scale on student occupational therapists' client-centred counselling skills.

METHOD

A time-series design was used to measure the changes in students' counselling skills over time. Demographic information was collected prior to time one. An online questionnaire was administered after study completion to explore students' experiences of using the Session Rating Scale.

FINDINGS

The impact of using the Session Rating Scale as a measure of students' client-centred counselling skills performance significantly improved over time. Most students valued using the rating scale and would recommend its use for future students.

IMPLICATIONS

The process of supporting students to learn how to engage clients in providing timely feedback and using this feedback to design treatment sets the stage for integration and application of client-centred practice.

Are health promotion and prevention interventions integrated into occupational therapy practice with older adults having disabilities? Insights from six community health settings in Québec, Canada

BACKGROUND/AIM

Increasingly, health-care systems should promote seniors' health and prevent disability. As they enable engagement in meaningful activities within the individuals' living environment, community occupational therapists have great potential to contribute to health promotion and prevention. Despite this potential, little is known about current health promotion and prevention activities in occupational therapy community practice. This study thus aimed to: (1) identify health promotion and prevention interventions used with seniors having disabilities, and (2) explore barriers to integrating such interventions into practice.

METHODS

Secondary data analysis of a qualitative study was carried out using thematic saliency analysis. Eleven community occupational therapists working with seniors having disabilities were recruited in six community health settings in Québec, Canada. Observations of 12 home visits, followed by 12 semi-structured interviews, were conducted with occupational therapists.

RESULTS

Most interventions involved optimising independence in personal care and mobility. Explicit health promotion interventions were limited and included enabling healthy lifestyles by increasing health literacy and empowerment. Meaningful activities (leisure, community participation) were not targeted. Barriers to integrating health promotion into practice were clients' complex health conditions and limited openness to change combined with organisational and professional obstacles, such as a misunderstanding of occupational therapists' role in health promotion.

CONCLUSIONS

Health promotion and prevention interventions are not intentionally integrated into community occupational therapy practice with seniors having disabilities. As a result, seniors' needs to engage in meaningful activities might remain unmet. Overcoming barriers to integrating health promotion and prevention in practice could help improve population health and wellbeing.

A macro perspective for client-centred practice in curricula: Critique and teaching methods

BACKGROUND

Client-centred practice is often eclipsed by social, economic, and political inequities. Ignoring these realities obstructs clients' goal attainment.

OBJECTIVES

The author advocates for the integration of a macro perspective inclusive of participation barriers and supports in occupational therapy curricula and seeks to motivate educators to adopt teaching approaches that develop students' abilities to address the complexities of client-centred practice.

METHOD

This article integrates a critical analysis of the literature on client-centred practice with reflexivity on disability studies and autoethnography.

FINDINGS

Educational standards require students to learn about the social, economic, and political contexts that impact on client-centred practice and the need for advocacy to enable participation. Theoretical support of a macro perspective for client-centred practice is strongly evident in the literature. Information on methods for teaching students how to actualize these concepts in practice is scant. Thus, strategies to inform the integration of a macro perspective into curricula and concrete activities to develop students' competencies for empowered client-centred practice are required.

CONCLUSION

Educators have an ethical responsibility to critique their pedagogy to determine whether they are adequately preparing students for client-centred practice. The focus must move from teaching a micro perspective of client-centred practice to a macro perspective that enables occupational justice and empowerment.

A Pilot Randomized Controlled Trial of Community-Based Occupational Therapy in Late Stroke Rehabilitation

Chronic participation deficits are common following stroke. We hypothesized that a brief period of occupation-focused, client-centered occupational therapy would lead to improved participation in valued activities for individuals who had experienced strokes 6 or more months previously. Sixteen individuals were randomized to the intervention or no-treatment control group. All participants identified up to five activities in which they wished to improve. Following intervention, both groups rated their performance of these activities similarly. However, those who received the intervention rated their satisfaction with these activities significantly higher than did the participants who did not receive the occupational therapy intervention. There were no differences between postintervention measures of well-being or overall participation. Further evaluation of such a program of late stroke rehabilitation is recommended.

Coping strategies associated with participation and quality of life in older adults

Background.

It is important to understand the coping strategies that optimize or restrict participation or quality of life, especially for older adults.

Purpose.

The purpose of this study was to examine the associations between, on the one hand, problem- and emotion-focused coping strategies used to deal with aging limitations or health problems and, on the other hand, participation and quality of life.

Method.

A cross-sectional design was used with 82 community-dwelling participants aged 65 and older.

Findings.

Participants used both problem-focused (distancing, self-control) and emotion-focused (seeking social support, planful problem solving, positive appraisal) coping strategies to deal with aging limitations or health problems. Only a few moderately significant associations were found except for escape–avoidance coping strategies, which were significantly associated with lower participation and quality of life.

Implications.

Before developing interventions to improve or maintain older adults’ participation and quality of life, more studies are needed to better understand coping strategies used by older adults to deal with aging limitations or health problems and especially escape–avoidance strategies.

Family-centered care for children with cerebral palsy: conceptual and practical considerations to advance care and practice

This article focuses on conceptual and practical considerations in family-centered care for children with cerebral palsy and their families. In the last 5 years, there have been important advances in our understanding of the components of family-centered care, and initial attempts to understand the client change processes at play. Recent research elaborates on family-centered care by delving into aspects of family-provider partnership, and applying family-centered principles to organizational service delivery to bring about organizational cultures of family-centered care. Recent research has also begun to consider mediators of client change, and new practice models have been proposed that embrace family-centered principles and illustrate the "art" of practice. Future research directions are discussed, including explorations of causal relationships between family-centered care principles, elements of caregiving practice, client change processes, and child and family outcomes. The meaning of the recent literature for pediatric neurology practice is considered.

How Occupational Therapists Engage Adults with Cognitive Impairments in Assessments

Introduction:

There is little discussion in the multidisciplinary literature about how to engage adults with cognitive impairments in health-related assessments. This qualitative descriptive study used semi-structured interviews to explore how nine occupational therapists working across a range of practice settings addressed this issue.

Method:

Interviews were digitally recorded and transcribed verbatim. Inductive analysis revealed themes, which were refined through an iterative process.

Findings:

The findings showed that the participants used individually developed strategies to engage clients in assessments. The first theme, ‘Managing a complex process’, described the steps used with clients and families to obtain informed consent, prepare for the assessment, and consider the impact of having a third party present. The second theme, ‘Recruiting cooperation’, addressed how the participants used their relationship with clients to recruit them to engage in the assessment.

Conclusion:

The findings provided a snapshot of processes employed in practice to determine the needs and capabilities of clients with cognitive impairments, and the compromises therapists make in relation to eliciting informed consent and the integrity of formal assessment tools. The findings have implications for the profession and further research.

The Community Development Progress and Evaluation Tool: Assessing community development fieldwork / Un outil pour évaluer les stages en développement communautaire: Le Community Development Progress and Evaluation Tool

Background.

Both the Canadian Association of Occupational Therapists (CAOT) and World Federation of Occupational Therapists (WFOT) fieldwork guidelines promote fieldwork experiences that build community capacity. Yet, no existing tool that assesses the unique skills of community development fieldwork could be identified within or outside of occupational therapy.

Purpose.

This article describes the development of the Community Development Progress and Evaluation Tool (CD-PET), an assessment of community development fieldwork in occupational therapy.

Tool Development.

The CD-PET was developed in five distinct phases: (a) literature review, (b) identification of a theoretical framework, (c) tool construction, (d) pilot testing, and (e) ongoing refinement. Focus groups yielded input from preceptors and students. Once developed, the assessment was pilot tested with feedback received through an online survey completed by preceptors and students. Key enablement skills identified in Enabling Occupation II provided the foundation for the tool.

Implication.

The CD-PET is a student assessment and learning tool for occupational therapy students and preceptors that supports learning in the key enablement skills that are used in community development fieldwork.

The Development of Client-Centredness in Student Occupational Therapists

Introduction:

While the occupational therapy profession emphasizes the importance of a client-centred approach, the student perspective on development of client-centredness has been absent in the research literature. The purpose of this grounded theory study was to gain an understanding of occupational therapy students' perceptions of the curricular and practice experiences that contributed to their client-centred development.

Method:

Study participants were recruited from three cohorts (n = 29) of an entry-level Canadian occupational therapy programme: students from two separate years of an occupational therapy programme, and graduates from the programme who were 1 year into practice. Researchers conducted six focus groups using a semi-structured interview guide; focus group transcripts were reviewed to develop a coding scheme. Emergent categories were collapsed to develop overarching themes.

Findings:

Six developmental themes were constructed: Internalizing client-centredness; Relationship building; Who is the client?; Systems influences; Academic/practice discrepancy; and Power and control. Each theme was of greater or lesser emphasis at different points, and participants revisited and expanded upon themes throughout their academic programme.

Conclusion:

Academic and placement educators can use the findings of the study to understand how student occupational therapists develop client-centredness. Educators can use this understanding to implement strategies to intentionally foster client-centred development in students at opportune times.

Striving for Shared Understandings: Therapists' Perspectives of the Benefits and Dilemmas of Using a Child Self-Assessment

Pediatric client-centered intervention planning is particularly complex because children, parents, and professionals must form a “tridactic” partnership and reach a shared understanding for therapy. Therapists may use child self-reports to facilitate children's involvement in this process. The purpose of this study was to understand how therapists used and interpreted a child self-report to achieve a shared understanding in the context of a tridactic relationship, using the Children's Occupational Self-Assessment (COSA) as an exemplar. Thirty-three pediatric therapists participated in five focus groups and qualitative analysis was conducted in four iterative phases. Therapists' decision to use the COSA led to either “good” responses or unexpected tensions between the therapist's, child's, and parent's perspectives. Therapists used demonstration, negotiation, or reflection to shift beliefs to achieve a shared understanding for therapy. Findings suggest that although therapists valued children's voices, professional knowledge usually took precedence over child and parent self-knowledge during intervention planning.

Teaching Transfer Skills to Older Adults: Identification of Strategies Used by Occupational Therapists

Introduction:

Community occupational therapists frequently teach transfer skills to older adults. The teaching strategies used should be documented because they can affect the outcomes of interventions.

Objective:

The objective of the study was to identify the strategies used by community occupational therapists when teaching transfer skills to older adults.

Method:

Eleven community occupational therapists were recruited from six health and social services centres in Québec, Canada. Data were collected through observations of transfer interventions (n = 31), followed by in-depth interviews (n = 12). Data were analysed using descriptive statistics and grounded theory methods.

Findings:

Strategies consisted of nine methods, eight tools and nine intensity adjustments. The methods were explaining, demonstrating, having the client try, giving feedback on performance, involving the client, seeking and obtaining client's feedback, questioning, and involving a teaching assistant. Tools varied according to the teaching method. These tools were gestures, equipment, visual aids, written, verbal and somatosensory instructions, assistant as client and occupational therapist as client. Finally, intensity adjustments were related to the scope, directedness, duration, frequency and pace of teaching.

Conclusion:

A range of teaching strategies used by community occupational therapists were identified. Three methods, five tools and nine intensity adjustments were identified for the first time.

Integrating health literacy into occupational therapy: findings from a scoping review

This paper aims to report ways of integrating health literacy into occupational therapy practice. Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in various settings over the life-course. A scoping study of the scientific and grey literature on health and, specifically, occupational therapy and health promotion was done from 1980 to May 2010. Five databases were searched by combining key words (i) "health literacy" with (ii) "rehabilitation", "occupational therapy", or "health promotion". Data were extracted from 44 documents: five textbooks, nine reports, and 29 articles. The literature on health literacy needs enhancing in both quantity and quality. Nevertheless, six ways of integrating health literacy into occupational therapy practice were identified (frequency; %): occupational therapists should (i) be informed about and recognize health literacy (27; 61.4), (ii) standardize their practice (10; 22.7), (iii) make information accessible (37; 84.1), (iv) interact optimally with clients (26; 59.1), (v) intervene (29; 65.9) and (vi) collaborate to increase health literacy (21; 47.7). Since health literacy can directly impact on intervention efficacy, further studies are needed on how to integrate health literacy into occupational therapy practice.

Community occupational therapists' clinical reasoning: identifying tacit knowledge

BACKGROUND

  Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community-dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions.

AIM

  To synthesise current knowledge about community occupational therapists' clinical reasoning.

METHOD

  A scoping study of the literature on community occupational therapists' clinical reasoning was undertaken.

RESULTS

  Fifteen textbooks and 25 articles, including six focussing on community occupational therapists' clinical reasoning, were reviewed. Community occupational therapists' clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists' clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear.

CONCLUSION

  Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.

Accessibility of occupational therapy community services: a legal, ethical, and clinical analysis

ABSTRACT Accessibility of health care services is a major concern in many countries. This paper examines the impact of limited access to occupational therapy community services on the right to services, distributive justice (resource distribution based on social solidarity), and service quality. Legal documents and relevant scientific papers were analyzed from three standpoints: legal, ethical, and clinical. Random use of criteria to prioritize requests, partial response to complex needs, task delegation, and long waiting times, all affect distributive justice and compromise the right to and quality of services. Various alternatives are suggested to ensure a balance between the distribution and quality of occupational therapy services.

Do rehabilitation professionals need to consider their clients' health literacy for effective practice?

OBJECTIVE

To discuss the importance of integrating health literacy into rehabilitation practice.

BACKGROUND

The effectiveness of rehabilitation interventions and clients' long-term health might depend on various factors, including health literacy. Health literacy is defined as the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings over the life-course. Rehabilitation professionals are often uniformed about and neglect health literacy in their interventions.

METHOD

The scientific and grey literature on health and, more specifically, rehabilitation and health promotion was reviewed. The MEDLINE, OTDBASE, CINAHL, AMED and MANTIS databases were searched by combining the keyword (1) 'health literacy' with the keywords (2) 'rehabilitation', 'physical therapy', 'occupational therapy' or 'health promotion'.

RESULTS

Health literacy is one of the foundations of individual health and might have an impact on interventions, the individual and society. All papers addressing both health literacy and rehabilitation (n = 10) specifically mentioned that rehabilitation professionals need to consider their clients' health literacy. Rehabilitation is particularly linked to health literacy because both stress the importance of (1) capacities, functioning, participation and empowerment of clients; (2) holistic approach; (3) client-centred practice; (4) teaching of information and methods; and (5) access to services and equity issues.

CONCLUSIONS

Based on these results, we think it is important that rehabilitation professionals be aware of the importance of health literacy and intervene to improve it. The challenge is now to better understand how health literacy influences the effectiveness of rehabilitation and health outcomes.

Practitioners' Use of Interpersonal Modes within the Therapeutic Relationship: Results from a Nationwide Study

Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists' use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixty-four percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population. Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.

Re-Examining Concepts of Occupation and Occupation-Based Models: Occupational Therapy and Community Development

Background. A growing body of literature supports the role of occupational therapists in community development. Using a community development approach, occupational therapists respond to community-identified occupational needs. They work to build local resources and capacities and self-sustaining programs that foster change within the community and potentially beyond. Purpose. The purpose of this paper is to highlight some key issues related to occupational therapy practice in community development. Key Issues. The definitions and classifications of occupation focus primarily on the individual and fail to elaborate on the shared occupations of a community. As well, occupation-based models of practice are not easily applied to occupational therapy practice in community development. Implications. In order for occupational therapy to articulate its role in community development, greater heed needs to be given to the definition and categorization of occupation, occupation-based models of practice, and their application to communities.

The Winter Walkability Project: Occupational Therapists' Role in Promoting Citizen Engagement

Background. Walkability is one feature of a person-friendly community that citizen engagement can influence. Purpose. Describe a winter walkability project and how an occupational therapist supported citizen engagement and participation in local policy decision making. Methods. Seven stakeholder representatives undertook a participatory research project to address winter walkability. Through focus groups and walking logs, 10 citizens provided feedback on barriers to winter walking and a new sidewalk snow-clearing method. Analysis ascertained factors contributing to winter sidewalk walkability and factors promoting citizen engagement. Findings. Results identified reasons for and barriers to walking, perceived reasons for sidewalk conditions, and perceived effectiveness of the snow-clearing intervention. Citizens recommended against using the new snow-clearing method. Factors promoting citizen engagement included individual actions producing nominal results, individual and community-level interest, and development as citizen-experts. Implications. This project provides one example of how occupational therapists can take a sociopolitical role and facilitate citizen and occupational engagement.

Perspectives of therapist's role in care coordination between medical and early intervention services

This study explored perspectives of therapist's role in care coordination between early intervention (EI) and medical services, and identified strategies for improving service delivery. Fifty adults participated in one of six focus groups. Participants included parents, pediatricians, and therapists working in hospital and EI programs. Structured guiding questions were used to obtain participants' perceptions. Transcript analysis included open code identification, axial code grouping, and constant comparative methods. The researchers established inter-rater reliability (kappa = 0.85) in the coding scheme before data analysis. The themes identified included information exchange, communication among parents and therapists, approaches toward child and family care, supporting social and emotional needs, perceptions of therapists' roles, and understanding service delivery systems to improve care coordination. Participants recommended training for therapy service providers and pediatricians in the areas of child development, team building, and service systems. Family-centered strategies emphasizing systems of care are recommended to improve therapists' role in care coordination.

Identifying Occupational Performance Issues with Older Adults: Therapists’ Perspectives

Background

Identifying occupational performance issues is an essential component of the occupational therapy process. Little attention has been paid to therapists’ management of this aspect of geriatric practice.

Purpose

This study explored therapists’ approach to identifying occupational performance issues (OPI) with older adults.

Methods

Information gathered from semi-structured interviews was analyzed using Polkinghorne's (1995) analysis of narrative method.

Findings

The study demonstrated how therapists prepare clients to engage in the OPI identification process; use interviewing strategies to build trust; and tap into client narratives to foster hope in occupational possibilities.

Implications

Findings suggest that therapists require a complex set of highly skilled strategies to engage clients in OPI identification through tapping into aspects of the client's motivational influences, occupational histories, therapy expectations, and generational attitudes about aging. Further study is required to identify ways to overcome structural barriers to more occupational and narrative-based approaches to identifying occupational performance issues.

Development of the client-centred care questionnaire

AIM

This paper reports the development and testing of the Client-Centred Care Questionnaire, aimed at evaluating the client-centredness of professional home nursing care from a client perspective.

BACKGROUND

Client-centred care has become an important theme in health care. To evaluate the client-centredness of care and services from a client's perspective, there is a need for measurement instruments.

METHOD

The questionnaire was developed on the basis of a qualitative study into client perspectives on home nursing care. Items were formulated that closely followed the aspects clients mentioned as central to client-centred home care. A pilot study was conducted with a sample of 107 clients in three home care organizations in 2003 and 2004. These clients had chronic diseases and were expected to receive care for at least another 6 months. The questionnaire comprises 15 items.

FINDINGS

Principal components analysis and internal consistency analysis show strong internal consistency of the items. All items had strong factor loadings on one dimension, and Cronbach's alpha was 0.94. Clients tended to be most critical about their say in the practical arrangements and organization of care: which person came, how often and when? Clients of the three organizations differed in their perceptions of client-centredness, which may indicate that the questionnaire is capable of differentiating between respondents.

CONCLUSION

The results of this pilot study are promising. The validity of the questionnaire needs further testing.