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

Physical activity on prescription at the time of stroke or transient ischemic attack diagnosis - from a patient perspective

INTRODUCTION

Physical activity is known to reduce the risk of recurrent stroke. Despite this many individuals diagnosed with stroke have an insufficient level of physical activity. Physical activity on prescription is provided within healthcare to encourage increased physical activity.

PURPOSE

To examine individuals' experiences of physical activity on prescription at the time of stroke or transient ischemic attack diagnosis and explore various factors affecting the ability to follow the prescription.

MATERIAL AND METHOD

A qualitative approach was undertaken; using interviews, analyzed with content analysis to elicit information from individuals who had been admitted to a stroke unit due to stroke or transient ischemic attack.

RESULTS

Five women and five men (median age 60.5 years), eight with stroke and two with TIA (median NIHSS at onset 2.5), participated and the analysis resulted in an overall theme Change of life-style through physical activity on prescription - a multifaceted process containing the categories Experience of support, Barriers and opportunities and Personal motivators.

CONCLUSION

Individuals need to participate in the prescription process when prescription on physical activity is initiated in acute stroke care and clinicians need to reflect on how the prescription is implemented and followed-up; creating good conditions for long-term effects.IMPLICATIONS FOR REHABILITATIONWhen prescribing physical activity on prescription healthcare providers in acute stroke care need to consider:• The right timing: when and how physical activity on prescription should be given.• How to create opportunities for individuals to participate in the prescription process.• How to create individual adaptation of the prescription.• How to ensure that follow-up is conducted by registered healthcare professionals with knowledge of physical activity as disease prevention.

Experiences using the poststroke checklist in Sweden with a focus on feasibility and relevance: a mixed-method design

OBJECTIVE

The wide range of outcomes after stroke emphasises the need for comprehensive long-term follow-up. The aim was to evaluate how people with stroke and health professionals (HPs) perceive the use of the poststroke checklist (PSC), with a focus on feasibility and relevance.

DESIGN

An exploratory design with a mix of qualitative and quantitative methods.

SETTING

Outpatient care at a university hospital and primary care centres in western Sweden.

PARTICIPANTS

Forty-six consecutive patients (median age, 70; range, 41-85; 13 women) and 10 health professionals (median age 46; range, 35-63; 7 women).

RESULTS

Most patients (87%) had one or more problems identified by the PSC. The most common problem areas were life after stroke (61%), cognition (56%), mood (41%) and activities of daily living (39%). Three organisational themes emerged from the focus group discussions. The perception of the content and relevance of the PSC was that common poststroke problems were covered but that unmet needs still could be missed. Identifying needs was facilitated when using the PSC as a tool for dialogue. The dialogue between the patient and HP as well as HPs stroke expertise was perceived as important. The PSC was seen as a systematic routine and a base for egalitarian follow-up, but participants stressed consideration given to each individual. Addressing identified needs and meeting patient expectations were described as challenging given available healthcare services.

CONCLUSIONS

The PSC is a feasible and relevant tool to support egalitarian follow-up and identify patients who could benefit from targeted poststroke interventions. Stroke expertise, room for dialogue and caring for identified needs emerged as important issues to consider when using the PSC. Nutrition, sexuality and fatigue were areas mentioned that might need to be addressed within the discussions. The PSC can facilitate patients in expressing their needs, enhancing their ability to participate in decision-making.

Supporting decision-making by a health promotion programme: experiences of persons ageing in the context of migration

This study is part of the Promoting Aging Migrants' Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants' everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70-83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

Health Literacy and Written Communication in Skilled Nursing/Subacute Facilities

Health literacy is a concern for older adults. Low health literacy can lead to adverse health outcomes; therefore, practitioners should address health literacy with clients. There is limited research addressing occupational therapy (OT) practitioners' knowledge of health literacy and its implementation in written communication in skilled nursing facility (SNF)/subacute settings. Researchers explored practitioners' knowledge and current practices when using written communication with older adult clients in skilled nursing and subacute settings. This was a nonexperimental, descriptive study of OT practitioners using an online survey. OT practitioners reported having knowledge of health literacy and addressing health literacy with clients. Although knowledge and practice scores were higher for occupational therapy assistants than for occupational therapists, no reliable differences were noted between practitioners. Survey measures yielded good internal consistencies (Cronbach's α= 0.8). While the participants reported having knowledge and practice of health literacy, participants reported limited resources and training in this area.

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.

Using the Technology Acceptance Model to explore community dwelling older adults' perceptions of a 3D interior design application to facilitate pre-discharge home adaptations

BACKGROUND

In the UK occupational therapy pre-discharge home visits are routinely carried out as a means of facilitating safe transfer from the hospital to home. Whilst they are an integral part of practice, there is little evidence to demonstrate they have a positive outcome on the discharge process. Current issues for patients are around the speed of home visits and the lack of shared decision making in the process, resulting in less than 50 % of the specialist equipment installed actually being used by patients on follow-up. To improve practice there is an urgent need to examine other ways of conducting home visits to facilitate safe discharge. We believe that Computerised 3D Interior Design Applications (CIDAs) could be a means to support more efficient, effective and collaborative practice. A previous study explored practitioners perceptions of using CIDAs; however it is important to ascertain older adult's views about the usability of technology and to compare findings. This study explores the perceptions of community dwelling older adults with regards to adopting and using CIDAs as an assistive tool for the home adaptations process.

METHODS

Ten community dwelling older adults participated in individual interactive task-focused usability sessions with a customised CIDA, utilising the think-aloud protocol and individual semi-structured interviews. Template analysis was used to carry out both deductive and inductive analysis of the think-aloud and interview data. Initially, a deductive stance was adopted, using the three pre-determined high-level themes of the technology acceptance model (TAM): Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Actual Use (AU). Inductive template analysis was then carried out on the data within these themes, from which a number of sub-thmes emerged.

RESULTS

Regarding PU, participants believed CIDAs served as a useful visual tool and saw clear potential to facilitate shared understanding and partnership in care delivery. For PEOU, participants were able to create 3D home environments however a number of usability issues must still be addressed. The AU theme revealed the most likely usage scenario would be collaborative involving both patient and practitioner, as many participants did not feel confident or see sufficient value in using the application autonomously.

CONCLUSIONS

This research found that older adults perceived that CIDAs were likely to serve as a valuable tool which facilitates and enhances levels of patient/practitioner collaboration and empowerment. Older adults also suggested a redesign of the interface so that less sophisticated dexterity and motor functions are required. However, older adults were not confident, or did not see sufficient value in using the application autonomously. Future research is needed to further customise the CIDA software, in line with the outcomes of this study, and to explore the potential of collaborative application patient/practitioner-based deployment.

Occupational therapists' views on using a virtual reality interior design application within the pre-discharge home visit process

BACKGROUND

A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment in order to enable patients to function independently after hospital discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement, and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualize changes prior to implementing them. Customized VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration, if developed effectively and integrated into the PHV process.

OBJECTIVE

The intent of the study was to explore the perceptions of OTs with regard to using VRIDAs as an assistive tool within the PHV process.

METHODS

Task-oriented interactive usability sessions, utilizing the think-aloud protocol and subsequent semi-structured interviews were carried out with seven OTs who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centering around the parameters that impact upon the acceptance, adoption, and use of this technology in practice as indicated by the Technology Acceptance Model (TAM).

RESULTS

OTs' perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communication and patient involvement, and improve patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully; however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some "fine tuning" may be necessary if the application is to be optimally used in practice.

CONCLUSIONS

Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customizations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context.