Sharing the agenda: pondering the politics and practices of occupational therapy research

Patient and public involvement in health research from researchers' perspective

BACKGROUND

Patient and public involvement (PPI) is increasingly considered an integral part of health research, and the focus has shifted from why we need PPI to how users can be involved in a meaningful way. The rationale for investigating experiences with PPI from the perspective of occupational therapy (OT)-trained researchers' originates in the interrelationship between the inclusive approach to knowledge production, and participation and inclusion as core tenets of OT. The aim of this study was to explore PPI in health research from the perspective of OT-trained researchers.

METHOD

Semi-structured individual interviews were conducted online with nine Norwegian researchers. The interviews were analysed using reflexive thematic analysis.

RESULTS

Professional background and clinical experience from person-centred OT formed the foundation for how these researchers approached and facilitated PPI in their research. Valuing experiential knowledge and facilitating PPI to be meaningful for public collaborators were highlighted as essential for PPI to have an impact. The need to balance mutual expectations, requirements for research, and what might be possible to achieve within a research study were found to be vital.

CONCLUSION

Collaborative clinical experience constituted a sound foundation for implementing PPI in research. The occupational perspective underlines the importance of acknowledging experiential knowledge as essential to facilitating meaningful PPI. Challenges related to requirements for research and culture for implementing PPI were addressed by clarifying roles and expectations.

PATIENT OR PUBLIC CONTRIBUTION

Three public collaborators were involved in developing the aims, the interview guide, and the data analysis. They all had previous experience being involved in research.

Patient and Public Involvement in Occupational Therapy Health Research: A Scoping Review

Patient and public involvement (PPI) in research has the potential to improve research validity and relevance.

OBJECTIVES

To explore how PPI has been carried out and how its impacts have been reported in occupational therapy (OT) health research.

METHODOLOGY

Scoping review based on a search in four databases for OT research with descriptions of PPI, published between 2010 and 2020.

RESULTS

Across the 17 included studies PPI was reported in all stages of research. Descriptions of how PPI was carried out varied across the studies, and details with respect to the kind of approach used were lacking. Positive impacts on research design, research ethics, public collaborators and researchers were reported, but only anecdotally. Reflections and challenges related to PPI were also addressed.

IMPLICATIONS

In future studies, comprehensiveness and consistency is needed to document the diversity of how PPI is carried out in OT health research.

A call to resist occupational therapy's promotion of ableism

BACKGROUND

Critical occupational therapists have exhorted their profession to engage with disability studies' scholarship, curtail occupational therapy's promotion of ableism and amend its disabling practices. These appeals have largely been ignored despite their importance for a profession that researches, theorizes, assesses, and intervenes in the lives of disabled people.

AIMS AND OBJECTIVES

To interrogate occupational therapy's collusion with an ableist neoliberal agenda; and call for occupational therapists to resist their profession's disabling practices.

MATERIAL AND METHODS

This paper draws from critical disability scholarship to expose, critique and contest the ableist ideology underpinning occupational therapy.

RESULTS

Interlinked with racism, heteronormativity and gender binarism, ableism upholds certain bodies as normal and appropriate. Ableist values shape occupational therapy, with clients classified according to their proximity to 'normality', and exhorted to minimize their occupational performance deviations from dominant norms.

CONCLUSIONS

Collusion with colonialism's binary classificatory systems and neoliberal ableist norms, and avowed aspirations to improve bodies, 'normalize' performances, promote individualism, self-reliance, independence, self-care, and productivity contribute to the perception that ours is a disabling profession.

SIGNIFICANCE

This paper calls for occupational therapists to resist their profession's promotion of ableism, and refuse to collude with colonial practices that contribute to the oppression of disabled people.

Different in so many ways: Exploring consumer, health service staff, and academic partnerships in a research advisory group through rapid ethnography

INTRODUCTION

Consumer and community involvement (CCI) encompasses the range of consumer engagement activities across the research cycle. Research advisory groups (RAGs) are a common method of CCI that may empower the consumer voice in research. However, there is limited evaluation of RAGs to guide occupational therapists considering this as a CCI strategy in research. The aim of this study was to explore the processes and outcomes of a RAG partnership for an eDelphi study.

METHODS

Rapid ethnography enabled a rich, thick description of the RAG through triangulation of field notes, a monthly research team log, focus groups, and an individual interview. Data were analysed using reflexive thematic analysis. Recruitment targeted consumers, health service staff, and academics with experience in CCI to enhance the diversity of perspectives guiding the eDelphi study. The RAG met four times over 4 months.

FINDINGS

Seven diverse RAG members were recruited resulting in a RAG of 12 members, including the research team that included two consumers. Reflexive thematic analysis resulted in an overarching theme: Different in so many ways, which reinforced that authentic CCI in research continues to be rare even for stakeholders with experience in CCI. There were four subthemes: Set up for success, Authentic and capable facilitation, Structures and strategies for genuine partnerships, and A ripple effect of benefits. Findings added to the limited research regarding RAGs and highlighted that a short-term RAG with 12 diverse stakeholders was an effective strategy to foster mutually beneficial and meaningful collaboration. Partnering with two consumer co-researchers in RAG planning, implementation, and evaluation was central to success.

CONCLUSION

Findings demonstrated that with careful co-planning and recruitment, capable facilitation with support of a committed research team (inclusive of consumers), and empowering meeting processes and structures, a short-term RAG resulted in many benefits to participants and enhanced research outcomes.

Recreation and collaboration within the Expanded Chronic Care Model: working towards social transformation

Assisting people to live well with a chronic physical or mental health condition requires the creation of intersectoral community-based supports for chronic condition self-management. One important but underutilized resource for supporting chronic condition self-management in the community is recreation, which refers to relatively self-determined and enjoyable physical, social or expressive everyday activities. The Expanded Chronic Care Model (ECCM) provides a framework for identifying systems-level strategies to support self-management through increased access to community recreation opportunities. In this article, an occupation-based social transformation approach, which involves examining assumptions, considering contexts of daily activities and partnering to create meaningful social change, is used to examine the ECCM. Recommendations related to strengthening social change with a specific focus on collaborations and networks through recreation are provided. Through such collaborations, self-management of chronic conditions in community recreation contexts is advanced. Health providers and community-based recreation services providers are invited to be part of these intersectoral changes that will promote health amongst those living with chronic conditions.

Occupational therapy students' views on addressing sexual health

BACKGROUND

Sexual health is an important issue in daily life, but little is known about occupational therapy (OT) students' views on these matters.

AIM

To explore occupational therapy students' views on addressing sexual health in their future professional role.

MATERIAL AND METHODS

A descriptive qualitative study involving 37 OT students in 5 focus groups was performed and analyzed using content analysis.

RESULTS

Three categories: 'Sexual health is part of occupational therapy and but not of the OT educational program'; 'Need for knowledge to identify and intervene related to sexual health problems'; and finally, 'Communication about sexual health-unknown, untried, but necessary', formed the theme, 'Willing to try, wanting to know more, and recognizing not only the difficulties and challenges but also the importance of sexual health in OT practice'.

CONCLUSIONS

OT-students consider sexual health as part of OT-practice, but experience lack of knowledge of sexual health related to disease/disability, cultural diversity, and age and sexual orientation. Educational programs need to cover these matters, including how to address sexual health in OT-practice, to enhance OT's future competence related to promotion of sexual health for clients.

SIGNIFICANCE

Knowledge on students' views are vital to guide education on this important, rather neglected, area.

Le partenariat en recherche

Description.

Les partenariats en ergothérapie entre les praticiens et les chercheurs sont importants pour produire des connaissances pertinentes pour la pratique clinique et pour favoriser la pratique fondée sur les données probantes au sein de la profession.

But.

Dans ce discours Muriel Driver, l’auteure discute des raisons pour lesquelles nous devons favoriser la participation des praticiens à la recherche et elle examine les conditions essentielles à la réussite des partenariats de recherche en collaboration.

Questions clés.

Les partenariats de collaboration peuvent réduire les obstacles empêchant les praticiens de participer à la recherche et permettre de veiller à ce que les initiatives de recherche soient plus pertinentes pour la pratique clinique. Les facteurs clés pour établir et maintenir des partenariats significatifs sont la présence de conditions préalables et favorables au partenariat en lien avec le contexte, de même que l’utilisation de principes directeurs axés sur la vision, les valeurs, la confiance, la communication, le partage du pouvoir et les interactions.

Conséquences.

Plusieurs des facteurs identifiés comme étant favorables à la réussite d’un partenariat de collaboration correspondent aux rôles fondamentaux des ergothérapeutes et témoignent de nos valeurs professionnelles. La prise en compte de ces facteurs lors de l’établissement de collaborations de recherche permettrait d’accroître les probabilités de réussite.

Partnership in research: A vehicle for reaching higher summits

BACKGROUND

Partnerships in occupational therapy between practitioners and researchers are important to advance knowledge relevant to clinical practice and support evidence-based practice in the profession.

PURPOSE

This Muriel Driver lecture discusses why we should support practitioners' engagement in research and examines essential conditions required for successful collaborative partnerships in research.

KEY ISSUES

Collaborative partnerships can alleviate the challenges preventing practitioners from participating in research and ensure that research initiatives are more relevant to clinical practice. Key factors for building and sustaining meaningful partnerships include the presence of favourable pre-partnership conditions related to the context and the use of guiding principles focusing on vision, values, trust, communication, power sharing, and interactions.

IMPLICATIONS

Several of the factors found to foster a good collaborative partnership are consistent with our core competency roles and reflect our professional values. Being mindful of these factors when initiating research collaborations would increase the likelihood of success.

Community participation and environment of children with and without autism spectrum disorder: parent perspectives

AIM

This study explored parent perspectives of participation patterns and environmental supports and barriers for high-functioning children with autism spectrum disorder (ASD) within their communities compared with a group of children without ASD.

METHOD

The Participation and Environment Measure for Children and Youth was used to gather online data from parents of 99 children with ASD and 241 children without ASD. Mann-Whitney U test and chi-square tests were used to explore differences between groups and Cohen's d was calculated to examine effect sizes.

RESULTS

Significant differences between children with and without ASD were observed for all participation and environment summary scores. Children with ASD participated less frequently, were less involved, and their parents were less satisfied with their child's participation in community-based activities. Parents of children with ASD also identified fewer supports for their child's participation and more environmental barriers than other parents.

CONCLUSION

Children with ASD participated less in community-related activities than children without ASD as perceived by their parents. Barriers limiting community participation included features of the social and physical environment and limited resources.

SIGNIFICANCE

Occupational therapists should focus on decreasing environmental challenges in their efforts to facilitate participation of children with ASD in the community.

Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention

BACKGROUND

Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials.

AIM

To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT.

MATERIAL AND METHODS

A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories.

RESULTS

Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design.

CONCLUSION

The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.

A scoping review of end user involvement in disability research

BACKGROUND

Involving clients and consumers of health care in research, policy and health service development has been widely advocated for across a number of different fields and disciplines. Despite some promising evidence, 'end users' have not been meaningfully involved in all stages of the research process in the area of disability research.

OBJECTIVE

To conduct a scoping review on end user involvement in disability research, service and policy development.

METHODS

Literature was searched using electronic databases, hand searching reference lists of papers and grey literature. Electronic databases searched included the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO and Google Scholar. The search was restricted to articles published in English between January 2000 and April 2013.

RESULTS

Two clear themes emerged from a review of twenty-seven articles. Firstly, end users can benefit research as 'experts of experience' through their role as a co-researcher. Secondly, evidence suggests end users add value at different stages of the research process in this role. However, less is understood about end user involvement in the latter stages of the research process.

CONCLUSIONS

This review suggests that end users can meaningfully contribute to the quality of disability research. End users are likely to engage in research with differing perspectives, desires to be involved at distinct stages of the process, differing roles and different abilities to participate in the research. Academic rigor, however, must be maintained by the researcher.

Client-centred practice in occupational therapy: critical reflections

AIMS

The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices.

MAJOR FINDINGS

Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power.

PRACTICE CONCLUSION

Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.