Karen Stagnitti

Theoretical reflections on the nexus between research, policy and practice

The health field is being subjected to a dictate that policy, practice and research should be informed by evidence. The mere generation of evidence, however, does not mean that policy and practice will act upon it. Utilisation and application of research findings (often equalled with ‘evidence’) is a political process following rationalities that are not necessarily similar to those of researchers. In response to this issue that evidence does not naturally finds its way into policy and practice (and back into research), the concept of ‘knowledge translation’ is becoming increasingly popular. In this article we demonstrate that ‘translation’ can have different meanings, and that current perspectives (both Knowledge Translation and the Actor–Network Theory) do not reflect appropriately on actions that can be taken at the nexus between research, policy and practice in order to facilitate more integration. We have developed seven conceptual categories suggesting different action modalities. Actors and actants in this game should be aware of the complex political nature of these modalities.

Pretend play, social competence and involvement in children aged 5-7 years : the concurrent validity of the child-initiated pretend play assessment

BACKGROUND AND AIMS The aims of this study were to investigate the relationship between pretend play, social competence and involvement in school-based activities in children aged 5-7 years and to determine whether childrens social competence and level of involvement could be inferred from their scores on the Child-Initiated Pretend Play Assessment. PROCEDURE The pretend play skills of 41 primary school-aged children aged 5-7 years were assessed on a one-on-one basis. Classroom teachers of the children assessed the childrens social competence using the Penn Interactive Peer Play Scale and their involvement in school based activities using the Leuven Involvement Scale for Young Children. MAIN FINDINGS Significant positive relationships were found between elaborate pretend play and object substitution scores, involvement scores and peer play interaction scores (P < 0.05, P < 0.01). A significant negative relationship was found between elaborate pretend play scores, and social disconnection and social disruption scores (P < 0.05). Play deficit indicators were significantly negatively related to involvement scores (P < 0.01). This suggests that children with proficient pretend play skills are socially competent with peers and are able to engage in classroom activity. Children who scored poorly on the play assessment were more likely to have difficulty interacting with their peers and engaging in school activities. CONCLUSION Social competence and involvement skills are related to a childs ability to engage in pretend play. A childs social skills and ability to engage in school activities as assessed by teachers can be inferred from their scores on the Child-Initiated Pretend Play Assessment.

The importance of pretend play in child development: an occupational therapy perspective

Play is a complex behaviour and is defined as being more internally than externally motivated, transcending reality as well as reflecting reality, controlled by the player, involving more attention to process than product, safe, usually fun, unpredictable, pleasurable and spontaneous and involving non-obligatory active engagement (Bundy 1997, Stewart et al 1991). Pretend play, which occurs between the ages of 18 months and 6 years, reflects these qualities of play. Using the World Health Organisations classification of body functions and structures, activities and participation (ICIDH-2, WHO 1999), this paper outlines the skills that are essential for pretend play ability and asserts that if there are any impairments in these skills the child experiences a reduced ability to pretend play. This leads to possible participation restrictions in the childs life, such as difficulties in fulfilling usual social roles. Cognitive, social and emotional skills are presented as having the biggest impact on pretend play development, while the motor and sensorimotor skills that enable the child to manipulate objects in the environment are presented as being of secondary importance. Two models are offered which illustrate the importance of pretend play to child development and the sequence of play development. The paper concludes by recommending that occupational therapists address and reduce the participation restrictions that some children experience in learning and social situations by enabling a child to increase activity in pretend play.

In the Footsteps of Wilcock, Part One: The Evolution of Doing, Being, Becoming, and Belonging

ABSTRACT This article will present a critical analysis of the four dimensions of occupation, doing, being, becoming and belonging, and propose clearer understandings of the terms. The concepts have developed and evolved since Wilcock first introduced them as main constructs of Occupational Perspective of Health (OPH), with doing and being receiving the most comprehensive development. However, the concepts of becoming and belonging remain underdeveloped. Given the complex nature of occupation, this comprehensive analysis of each dimension adds greater depth to our understanding, and provisional definitions of each term are provided to guide their ongoing development.

From student to therapist : follow up of a first cohort of Bachelor of occupational therapy students

AIM This study aimed to investigate the perception of graduate students on their preparation for practice, at 7 months post graduation. METHOD Using an anonymous postal questionnaire, 18 respondents (58% response rate) provided data on the nature of current employment, the experience as a graduate therapist, and perceptions of their undergraduate experience in preparing them for practice. RESULTS Fifty percent of the respondents were practising in a rural environment. There was a significant positive relationship between respondents perception of their curriculum and fieldwork experiences and their preparation for practice (rho = 0.52, p < 0.05, and rho = 0.55, p < 0.05, respectively). Of the fieldwork experiences, respondents rated block placements as more beneficial to practice than non-traditional placements. However, a correlational analysis showed the non-traditional placement was significantly related to preparation for practice (rho = 0.54, p < 0.05). On a seven-point Likert scale, respondents rated themselves from 5.2 to 5.7 for perceived self-competence as a newly graduated practitioner with community-based graduates having the higher rating. Confidence in clinical decision-making was rated 5.0 to 5.6 with community-based graduates having higher rating. Respondents reported a positive perception that the undergraduate program prepared them to enter the workforce and practise as an occupational therapist (mean ratings 5.5 to 6.2). CONCLUSION Respondents felt adequately prepared to enter the occupational therapy profession and workforce. Strengths and weaknesses in their preparation are discussed as well as the need for further research.

Rethinking policies for the retention of allied health professionals in rural areas: A social relations approach

OBJECTIVE Retaining allied health professionals in rural areas is a recognised problem. Generally the literature has concentrated on three elements: practitioner needs, community needs and organisational needs. There has been little attempt to focus other types of social relations in which health practitioner retention and recruitment takes place. The aim of this paper is to question the present dominant hierarchical approach taken in relation to the retention of allied health professionals in rural localities. METHODS The data derives from a survey in Southwest Victoria, Australia. The sample was purposive rather than representative as it was intended to be exploratory in nature rather than definitive. RESULTS The data indicates that there is a greater tendency for allied health professionals in private practice to be retained in rural areas than those in the public sector. CONCLUSION The paper concludes by raising some questions about the pertinence of present models for regional health initiatives since they are locked into a bureaucratic model where relationships are hierarchical and asymmetrically controlled.

Pretend play of children with cerebral palsy.

ABSTRACT Background and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the childrens motor severity level and their elaborateness of play with conventional-imaginative and symbolic play materials and a number of object substitutions in symbolic play. This indicated that children with greater motor limitations had diminished play ability. In this sample, 35% of the children showed typical play styles, identified by good scores in elaborate pretend play actions, number of object substitutions, and ability to self-initiate play, whereas 65% showed delay in their play. Implications: The type of pretend play deficits that might be expected in children with cerebral palsy were described. Furthermore, suggested directions for therapeutic intervention to enhance pretend play performance in cerebral palsy children were proposed.

A study on fine motor skills of Iranian children with attention deficit/hyper activity disorder aged from 6 to 11 Years

The aim of this study was to compare the fine motor skills of two groups of Iranian children. Of the 55 male Tehranian children aged 6 to 10 years, 29 children were typically developing and 26 were identified as attention deficit hyperactivity disorder (ADHD) using the Diagnostic and Statistical Manual of Mental Disorder. All children were assessed using the Raven Intelligence Test and nine fine motor tasks. There were no significant differences between the groups based on intelligence. In eight of the fine motor tasks, there was a significant difference between the groups. These tasks were cutting, placing dots in a grid pattern without direction, threading beads, drawing a line within 1 and 2 minutes, finger movements and Purdue pegboard. Boys who have been identified as ADHD have poorer fine motor skills compared to typically developing boys of the same age. Children aged 6 to 10 years who have been identified as ADHD will require more attention to their fine motor skill performance to enable greater participation in daily living tasks in Tehran such as writing, fine arts and dressing which require fast and quick hand motor skills. There are still limitations in this area; therefore, research in fine motor skills and ADHD children are recommended for future research.

The meaning of leisure for well-elderly Italians in an Australian community: Implications for occupational therapy

AIM   This paper documents a study that aimed to discover the meaning of leisure experiences for an ageing Italian community in a large regional centre in Victoria, Australia. METHODS   This qualitative investigation used a phenomenological study design, and data were collected through semistructured interviews with 10 well-elderly Australian Italians. RESULTS   Participants engaged in numerous leisure occupations that were meaningful to them and directly impacted on positive subjective experiences and health outcomes. CONCLUSION   This paper adds to an understanding of how leisure impacts on the health of well-elderly Australians and how occupational therapists can use leisure effectively in interventions for successful ageing.

Scope of practice of occupational therapists working in Victorian community health settings

BACKGROUND/AIM Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role. METHOD An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims. RESULTS Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority. CONCLUSION Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised.