Annie Carrier

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.

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

Abstract 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.

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.

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 clients 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.

Standardized referral form: Restricting client-centered practice?

Abstract Background: To increase homecare efficiency, the Ministry of Health and Social Services in Québec, Canada, encourages standardization of practices, including those of community occupational therapists (COTs). The impact of standardization is not known and might reduce client-centeredness. Aim/objectives. To explore the content and use of a referral form to standardize COTs’ practice. Material/methods. An institutional ethnography inquiry was conducted through observations of work and interviews with 10 COTs working in three homecare programs. Secondary informants were also interviewed and documents collected. Data were analyzed using institutional ethnography procedures. Findings. The referral form, completed by the COTs’ colleagues, includes categories primarily related to safety or autonomy in personal care and mobility. The form organizes COTs’ work, including information collection and interactions with clients and caregivers. Seen as consultants, COTs assess needs and make recommendations to keep clients at home safely for as long as possible, an important element of the homecare discourse. Conclusion/significance. The impact on COTs’ potential to be truly client-centered revealed by these findings merits serious consideration by other health professionals. Concerted efforts by professionals to question and act upon contextual barriers to client-centeredness are needed.

Influence of societal and practice contexts on health professionals’ clinical reasoning: a scoping study protocol

Introduction In a context of constrained resources, the efficacy of interventions is a pivotal aim of healthcare systems worldwide. Efficacy of healthcare interventions is highly compromised if clinical reasoning (CR), the process that practitioners use to plan, direct, perform and reflect on client care, is not optimal. The CR process of health professionals is influenced by the institutional dimension (ie, legal, regulatory, administrative and organisational aspects) of their societal and practice contexts. Although several studies have been conducted with respect to the institutional dimension influencing health professionals’ CR, no clear integration of their results is yet available. The aim of this study is to synthesise and disseminate current knowledge on the influence of the institutional dimension of contexts on health professionals’ CR. Methods and analysis A scoping study of the scientific literature from January 1980 to March 2013 will be undertaken to summarise and disseminate research findings about the influence of the institutional dimension on CR. Numerous databases (n=18) from three relevant fields (healthcare, health law and politics and management) will be searched. Extended search strategies will include the manual search of bibliographies, health-related websites, public registries and journals of interest. Data will be collected and analysed using a thematic chart and content analysis. A systematic multidisciplinary team approach will allow optimal identification of relevant studies, as well as effective and valid content analysis and dissemination of the results. Discussion This scoping study will provide a rigorous, accurate and up-to-date synthesis of existing knowledge regarding: (1) those aspects of the institutional dimension of health professionals’ societal and practice contexts that impact their CR and (2) how these aspects influence health professionals’ CR. Through the synergy of a multidisciplinary research team from a wide range of expertise, clinical pertinence and an exhaustive dissemination of results to knowledge-users will be ensured.

How to find lessons from the public health literature: Example of a scoping study protocol on the neighborhood environment

Background: As key determinants of many favorable health and quality of life outcomes, it is important to identify factors associated with mobility and social participation. Although several investigations have been carried out on mobility, social participation and neighborhood environment, there is no clear integration of these results. This paper presents a scoping study protocol that aims to provide a comprehensive understanding of how the physical and social neighborhood environment is associated with or influences mobility and social participation in older adults. Methods: The rigorous methodological framework for scoping studies is used to synthesize and disseminate current knowledge on the associations or influence of the neighborhood environment on mobility and social participation in aging. Nine databases from public health and other fields are searched with 51 predetermined keywords. Using content analysis, all data are exhaustively analyzed, organized, and synthesized independently by two research assistants. Discussion: A comprehensive synthesis of empirical studies provides decision-makers, clinicians and researchers with current knowledge and best practices regarding neighborhood environments with a view to enhancing mobility and social participation. Such a synthesis represents an original contribution and can ultimately support decisions and development of innovative interventions and clear guidelines for the creation of age-supportive environments. Improvements in public health and clinical interventions might be the new innovation needed to foster health and quality of life for aging population. Finally, the aspects of the associations or influence of the neighborhood environment on mobility and social participation not covered by previous research are identified. Conclusions: Among factors that impact mobility and social participation, the neighborhood environment is important since interventions targeting it may have a greater impact on an individuals mobility and social participation than those targeting individual factors. Although investigations from various domains have been carried out on this topic, no clear integration of these results is available yet.

Clinical Reasoning Process: Cornerstone of Effective Occupational Therapy Practice

This chapter provides a description of occupational therapists’ clinical reasoning. First, we present the clinical reasoning process integrative framework, including its internal and external factors of influence. Then, because of its core importance for effective practice, we discuss ways to learn about and improve clinical reasoning. Specifically, we propose a procedure inspired by Kolb’s experiential learning model and Vermersch’s explicitation technique to explicate and reflect upon one’s clinical reasoning process. This reflection reinforces one’s knowledge base, fosters expertise development, and optimizes clinical reasoning.

Enabling students’ self-regulation and teachers’ feedback in concept mapping

released as mp3 files through the virtual learning environment and uploaded into iTunes, which enabled their download via the RSS feed. A questionnaire was used to obtain quantitative data about student usage. A response rate of 50.0% was achieved. What lessons were learned? The lecture audio files of basic science modules represent a popular learning resource and provide an additional method for student engagement. Data from the questionnaire revealed a high level of student use, with 64.6% and 51.5% of CBS and N&E students, respectively, accessing the audio files. Surprisingly, although high numbers of students have access to mobile devices, the vast majority of students accessed the audio files via their home PC (76.7%) and only a minority of students used campus PCs (18.0%) or smartphones (5.3%). Further analysis revealed that students accessed the audio files for several reasons, including: to write up or amend lecture notes (68.4%); to review difficult lectures (70.4%); to catch up on missed lectures (50.5%), and to aid revision (62.5%). Although the level of engagement is welcome and reveals clear enthusiasm for the additional resources, the high proportion of students accessing the resources via their home desktop PC provides important information regarding the usage and future development of learning resources. The audio files generated in this study are often likened to podcasts; however, a podcast is a self-contained package that can be listened to without requirements for additional material. As these audio files are recorded during live lectures, they should be used in conjunction with the lecture slides if students are to gain maximal benefit. Thus there is a clear distinction between podcasts and the audio files provided in the present context. By using the audio files alongside the lecture slides, students can follow the audio and add or amend notes as they listen to the recording. This explanation of usage explains why few students access the material via mobile devices. Furthermore, it provides important guidance for the production of learning resources that promote flexible learning. For students to engage in flexible learning, resources that do not rely on additional material should be developed. Overall, 70.4% of respondents found the lecture audio to be useful in supporting their learning and 68.7% would like such a resource made available for other modules. Because of its simple technical requirements, high uptake and positive outcomes, it is envisaged that this development will be rolled out across more MBChB modules in the future. REFERENCE