Objective: To study the convergent and divergent validity of the Canadian Occupational Performance Measure (COPM).
Design: Cross-sectional study.
Setting: The occupational therapy departments of two ...university hospitals in Amsterdam.
Subjects: One hundred and five consecutive outpatients.
Outcome measures: The COPM is a measure of a client's self-perception of occupational performance in the areas of self-care, productivity and leisure. Outcome measures of the COPM are: the client's most important problems in occupational performance and a total score for performance and a total score for satisfaction for these problems. Problems reported in the COPM were compared with the Sickness Impact Profile (SIP68), the Disability and Impact Profile (DIP) and an open-ended question.
Results: Complete data were obtained for 99 clients. The identification of occupational performance problems with the COPM surpassed the items reported in the SIP68, the DIP and the open-ended question, which confirms the surplus value of the COPM. Divergent validity was further demonstrated by the low correlation coefficients between the total SIP68 scores and the COPM. Seventy-four per cent of the occupational performance problems reported in the COPM had a corresponding item in the DIP and 49% had a corresponding item in the SIP68. Convergent validity was supported by the fact that 63% of the corresponding problems in the DIP were reported to be a disruption of quality of life and 74% of the corresponding problems in the SIP68 were identified as a disability.
Conclusion: The results of this study provide supportive evidence for the convergent and divergent validity of the COPM. The data support the assumption that the COPM provides information that cannot be obtained with current standardized instruments to measure health.
Abstract
Purpose: To explore the relationship between client-centredness (CC) and work in teams in inpatient rehabilitation. Methods: Case study, mixed-method design, with strong qualitative ...component. Methods include ethnographic observations of team and clinical encounters for 6 months; healthcare professional (HCP) interviews. HCP n=45; Observations = 40 encounters & meetings. Results: Based on HCP perceptions, intra-team and organizational factors were identified that influence client-centred practice in rehabilitation. Team factors included relational and communication dimensions affecting work that can hinder or facilitate CC. These dimensions are presented in detail. HCP perceived organizational factors such as workload, schedules and hospital culture to influence their work on teams and with clients. Conclusion: CC is not a "one size fits all". It is affected by similar factors that affect work in teams such as organizational policies, team characteristics and culture. CC can be seen as an outcome of team performance.Implications for RehabilitationClient-centred practice (CCP) is influenced by client, provider and organizational factors. CCP is not just about client-provider communication. How inter-professional teams work together is an important aspect of CCP.Shared knowledge, shared goals and mutual respect characterize the relationships among members in a team. These three dimensions influence, and are influenced by, the nature of team members' communication and the organizational structures and culture in which they take place.Effective teamwork does not automatically lead to enhanced client-centredness. Strategies are needed that ensure teamwork does not merely perpetuate the health professionals' control of the patient or that decisions are the "right" decisions from the health care professionals' perspectives.
The illusion of client-centred practice Gupta, Jyothi; Taff, Steven D.
Scandinavian journal of occupational therapy,
07/2015, Letnik:
22, Številka:
4
Journal Article
Recenzirano
AbstractAim: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession's ...philosophical basis and espoused commitment to client-centred practice. Findings: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession's espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine's expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession's core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. Conclusion: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.
Abstract
Introduction: The aim was to obtain the best available knowledge on stroke survivors' experiences of rehabilitation. The increase in demands for accountability in health care and ...acknowledgement of the importance of client participation in health decisions calls for systematic ways of integrating this perspective. Methods and materials: A systematic review of qualitative studies was performed. A literature search in MEDLINE, CINAHL, PsycINFO, and EMBASE was conducted. Suitability for inclusion was based on selected criteria: published qualitative studies written in English from 1990 to 2008 on stroke survivors' experiences of rehabilitation in a clinical setting. Data analysis entailed extracting, editing, grouping, and abstracting findings. Results: Twelve studies were included. One theme, "Power and Empowerment" and six subcategories were identified: 1) Coping with a new situation, 2) Informational needs, 3) Physical and non-physical needs, 4) Being personally valued and treated with respect, 5) Collaboration with health care professionals and 6) Assuming responsibility and seizing control. Discussion: The synthesis showed that stroke survivors' experiences of rehabilitation reflected individual and relational aspects of power and empowerment. The capacity to assume power and empowerment was a dynamic rather than a progressive issue, and enabling empowerment was a matter of weighing contrasting issues against each other, e.g. the right to decide versus the right not to decide.
Integration of services for sexual and reproductive health (SRH) and HIV has been widely promoted globally in the belief that both clients and health providers benefit through improvements in ...quality, efficient use of resources, and lower costs, helping to maximize limited health resources and provide comprehensive client‐centered care. This article builds on the growing body of research on integrated sexual SRH and HIV services. It brings together critical reviews on issues within the wider SRH and rights agenda and synthesizes recent research on integrated services, drawing on the Integra Initiative and other major research. Unintended pregnancy and HIV are intrinsically interrelated SRH issues, however broadening the constellation of services, scaling up, and mainstreaming integration continue to be challenging. Overcoming stigma, reducing gender‐based violence, and meeting key populations’ SRH needs are critical. Health systems research using SRH as the entry point for integrated services and interaction with communities and clients is needed to realize universal health coverage.
Background
Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM ...racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV.
Methods
Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention.
Results
On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter.
Conclusion
Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities.
Introduction
Goal-setting in client-centred occupational therapy is often problematic. The Assessment of Client's Enablement was developed to measure the gap between an occupational therapist's and ...client's ratings of occupational performance. This study examines the reliability and convergent validity of the assessment.
Method
The assessment was used by 22 occupational therapists with 44 clients. Convergent validity was examined between the assessment (client, occupational therapist and gap scores), Canadian Occupational Performance Measure performance and Functional Independence Measure scores. Test–retest reliability was assessed by intraclass correlation coefficient. Forty-four clients participated in the test–retest reliability study.
Findings
Good-to-moderate correlation was found in the assessment scores (intraclass correlation coefficients of 0.86, 0.95 and 0.78 for client, occupational therapist and gap scores, respectively). The validation study was completed by 34 clients. The correlation between Canadian Occupational Performance Measure and Assessment of Client's Enablement scores was significant (client score, Spearman’s Rank Order Correlation (rs) = 0.47; occupational therapist score, rs = 0.45). The correlation between Functional Independence Measure and the assessment's occupational therapist scores was significant (rs = 0.43).
Conclusion
The study confirms the reliability and convergent validity of the Assessment of Client's Enablement. The assessment requires less time to administer than similar instruments and requires no formal training, making it feasible in rehabilitation settings.
Background/Aim: Translating knowledge to practice, also called ‘knowledge translation’, is increasingly recognised as a driving force to strengthen and improve the healthcare system. How knowledge ...translation fits with occupational therapy practice deserves examination.
Methods: This paper will explore how an action process model, the Knowledge‐To‐Action Process, may advance knowledge translation in occupational therapy. Occupational therapists typically view knowledge in a broad sense, encompassing research, tacit knowledge, expert opinion and client evidence. The Knowledge‐To‐Action Process facilitates application of client, therapist and research knowledge to occupational therapy practice.
Results: Examination of knowledge translation through the lens of the Knowledge‐To‐Action Process creates awareness of the value of client, therapist and research knowledge. It also highlights opportunities as practitioners to implement knowledge translation.
Conclusions: Models able to flexibly reflect an occupational therapy perspective of knowledge have a potentially vital role in successful knowledge translation. Furthermore, these models allow therapists and other stakeholders to analyse complex situations and identify targeted knowledge translation strategies.
Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary ...health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers’ perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.
Purpose:
This study presents the development and initial validation of a Listening Scale (LS) that was used to assess the listening skills of a sample of Hong Kong counseling professionals and the ...potential penetration of psychoanalysis among this sample.
Method:
A total of 217 Hong Kong social workers, psychologists, and counselors were surveyed to develop and assess the scale’s internal psychometric properties.
Results:
Factor analysis confirmed a single factor structure for the LS, with 8 items. Internal reliability was good and discriminative validity was supported by comparisons with background information.
Discussion:
The LS shows promise as a meaningful, reliable, and valid measure. The LS could be useful to assess important dimensions of the practice of counseling professionals and to better assist their client-centered practice, and as a formative instrument for use by counseling professionals. Finally, the LS can assess the penetration of psychoanalysis where the psychoanalytic theory is not strong.
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