Community-Working Occupational Therapists' Involvement in Research and Development Projects in Norway.

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.

Occupational Therapy students' Concepts of Learning: Cross-Sectional and Longitudinal Associations With Deep, Strategic, and Surface Study Approaches.

This study aimed to gain knowledge about the cross-sectional and longitudinal associations between learning concepts and approaches to studying among occupational therapy students. A repeated cross-sectional design was combined with a longitudinal study design. Self-report questionnaires assessed sociodemographic variables, learning concepts, and approaches to studying (deep/strategic/surface). Linear regression analyses (n ranging between 109 and 193 in the analyses) showed that higher transforming concept ratings were consistently associated with higher ratings on the deep study approach, both cross-sectionally and longitudinally. Higher reproducing concept ratings were positively associated with higher strategic approach ratings in the second and third study years. In view of the results, students' understanding of what learning is impacts on their study attitudes and behaviors, which in turn is likely to influence learning outcomes and academic performance.

"Being Holistic Is a Lot to Ask": A Qualitative, Cross-National Exploration of Occupational Therapists' Perceptions and Experiences of Holistic Practice.

Being holistic is often used by occupational therapists to describe their practice and philosophy worldwide. This study explores the perspectives of 33 occupational therapists, working in 13 different countries, on their understanding of holistic epistemology and practice and how they seek to incorporate holism in their work. On the basis of a qualitative study design, individual interviews were conducted with the participants by 18 Norwegian undergraduate occupational therapy students, supported by their supervisors. The authors subsequently analyzed the transcribed data, using a thematic analysis approach. Three principal themes emerged: (1) holism as a broad and narrow concept, (2) being holistic spans from treating body parts to teaching marginalized children, and (3) being holistic is a lot to ask. When talking about holism and holistic practice, participants described their holistic practices in various ways, and their accounts reflected different understandings and cultural contexts. Participants characterized a holistic approach as one emphasizing the importance of occupations and activities and helping patients regain independence in their everyday lives. However, they also highlighted the specific challenges they faced, including cultural factors and inadequate resources. Significantly, participants from both Western and non-Western contexts emphasized the importance of holistic practice, suggesting that a dichotomous understanding of Eastern versus Western philosophical approaches does not necessarily make sense in occupational therapy interventions. Therapists' degree of commitment to client-centered practice appears of greater relevance. With its international perspective, our study sheds light on important areas of contemporary occupational therapy practice, including the difficulties occupational therapists face when seeking to cover "everything" in an effort to be more holistic.

Feasibility of the Perceive, Recall, Plan and Perform system of intervention for persons with brain injury in community-based rehabilitation: a pilot for a multiple-baseline design study.

OBJECTIVES: This paper describes a pilot study investigating the feasibility of the Perceive, Recall, Plan and Perform (PRPP) system for persons with cognitive impairments after acquired brain injury in the context of community-based rehabilitation for older individuals. DESIGN: The feasibility, acceptability and practicability of the research procedures were evaluated by exploring the effectiveness of the PRPP intervention with non-concurrent multiple baseline designs. SETTING AND PARTICIPANTS: Three participants (63+years of age) from two health centres were included. INTERVENTION: In the PRPP intervention, the occupational therapist (OT) supports the participant in applying cognitive strategies in everyday activities to enhance task mastery, with nine sessions of 45-60 min over 3 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES: The participants completed measurements of five everyday tasks in each phase as dependent variables. PRPP assessment stages 1 and 2 served as the primary and secondary outcome measures, respectively. The percentage of mastery of the tasks and the participants' application of cognitive strategies at baseline acted as a control and was therefore compared with the other phases within the participant. The Goal Attainment Scale and Barthel Index served as generalisation measures. The uncertainties and acceptability of the procedures were also investigated with a procedural checklist and qualitative statements reported in the procedures or noted in dialogue meetings with the conducting OTs. RESULTS: The procedures were acceptable for the OT and the participants and were feasible if the steps in the research procedure were clearly understood. The target behaviour should be changed to the use of one task with five measurement points instead of measuring five tasks. This can enable the application of recommended analysis methods. CONCLUSIONS: The outcomes of this study led to a change in the target behaviour and clarification of the research procedure for the planned PRPP intervention study. TRIAL REGISTRATION NUMBER: NCT05148247.

Job Satisfaction among Occupational Therapists Employed in Primary Care Services in Norway.

The aging population will place healthcare services under considerable strain in the years ahead. Occupational therapists play a vital role in securing sustainable healthcare services and are increasingly employed by municipalities. To promote sustainable services, the job satisfaction among core professional groups needs monitoring. A comprehensive cross-sectional survey was distributed among municipality-employed occupational therapists in Norway during May-June 2022, to which 617 responded. Job satisfaction was assessed with the Job Satisfaction Scale (JSS), and factors associated with job satisfaction were assessed with linear regression analysis. The mean JSS score in the sample was 51.4. The regression model explained 14.4% of the variance in job satisfaction scores. Having more work experience as an occupational therapist (ß = 0.16, p = 0.02) and having higher perceived influence on the work unit's goals (ß = 0.31, p < 0.001) were significantly related to higher job satisfaction. The study implies that job satisfaction in the occupational therapy profession increases with years of experience and also with the ability to engage with and influence the larger work environment. Thus, to promote job satisfaction, occupational therapists should seek to engage not only with their own work at hand but also with the larger goals and strategies of the organization they work for.

Stable and unstable associations between learning environment factors and study approaches: two consecutive cross-sectional analyses of Norwegian occupational therapy students.

Relationships between learning environment variables and students' approaches to studying have been investigated from many points of view over the last decades. However, few studies have explored whether such relationships are stable over time. In the two consecutive cross-sectional analyses performed in this study, Norwegian occupational therapy students' perceptions of their learning environment and their approaches to studying were assessed in the second (162 students) and third (193 students) year of their study program. Aside from sociodemographic information, the students completed the Course Experience Questionnaire and the Approaches and Study Skills Inventory for Students, with the aim of exploring whether associations between learning environment variables and study approaches were stable across time. The data were analyzed with hierarchical linear regression analyses. Relatively stable associations with students' study approaches were found for the learning environment variables of 'generic skills' and 'appropriate workload'. The learning environment variables of 'clear goals and standards' and 'student autonomy' were directly associated with study approaches in both study years, but the nature of the associations shifted during the study period. Thus, knowledge of stability and change in these relationships could assist faculty in promoting a well-functioning learning environment throughout the study program.

The power of observation. Occupational therapists' descriptions of doing observations of people with cognitive impairments in the context of community practice.

BACKGROUND: Observation is an important method for occupational therapists (OTs) to gather information on people's occupational performance; yet, not much research has been conducted on OTs' descriptions of doing observations in their practices. AIMS: This study aimed to explore community OTs descriptions of doing observations during the assessment of persons with cognitive impairments. MATERIAL AND METHODS: Nineteen OTs participated in focus group interviews. Thematic analysis with an inductive approach was performed. RESULTS: Three themes were revealed during analysis, the value of doing unstructured observations, the importance of doing observations in familiar contexts, and the importance of experience, structure and competence when doing observation. CONCLUSIONS AND SIGNIFICANCE: This study showed that the participants regarded observation as one of OTs' core competencies, and they described doing observations in different ways. The results emphasised the importance of doing unstructured observations in persons' familiar contexts when assessing persons with cognitive impairments. However, the participants highlighted the need for increasing OTs structure and competence through implementing more occupation-based standardised assessment tools for OTs in community services to facilitate evidence-based practice.

Occupational Therapy Interventions for Persons with Cognitive Impairments Living in the Community.

This study describes interventions provided by community occupational therapists for persons with cognitive impairments. Using an online questionnaire, a cross-sectional study was conducted, collecting data from 497 of the 1367 occupational therapists in Norwegian community-based services. The most common interventions provided were environmental modifications (87%), implementation of assistive devices (85%), and training of activities of daily life (ADL) (77%). Two main reasons to carry out these interventions were identified as the initial assessment of clients (89%) and expectations of others. The most preferred interventions were ADL training (77%), cognitive training (63%), and environmental modifications (56%). Chi-squared tests identified a significant difference (p < 0.001) between interventions provided and preferred interventions on all interventions except environmental modifications. The findings provide an insight into interventions provided for persons with cognitive impairments in community services.

Effectiveness of the Perceive, Recall, Plan and Perform intervention for persons with brain injury in community-based rehabilitation: protocol for a single-case experimental design with multiple baselines.

INTRODUCTION: There is a need for standardised interventions in community-based rehabilitation to improve everyday performance for older adults with cognitive challenges due to acquired brain injury (ABI). The Perceive, Recall, Plan and Perform System (PRPP) of intervention has a growing research base. The intervention is suitable for any client with decreased performance in everyday tasks due to ineffective cognitive strategy application to enhance mastery in performance of needed or desired activities. There is no current evidence on the effectiveness of the PRPP intervention for this population. PURPOSE: To describe a protocol for a clinical trial that investigates the effectiveness of the PRPP intervention in the context of community-based rehabilitation for persons (65+ years) with difficulties in task performance due to cognitive challenges after ABI. METHODS AND ANALYSIS: A non-concurrent multiple baseline design across participants with systematic replications (n=6) will be used. Nine sessions of PRPP intervention will be applied by trained occupational therapists in two community-based rehabilitation units. The participants will complete five repeated measurements of everyday tasks as target behaviours. PRPP Assessment stages 1 and 2 serve as outcome measures at baseline, in the intervention period, in the postintervention period and in the follow-up phase. Mastery percentage of the tasks and the participants' application of cognitive strategies at baseline acts as a control and will be compared with the following phases within the participant. Delayed intervention phases act as a control between participants. Goal Attainment Scaling and the Barthel Index will serve as generalisation measures. Data will be analysed using systematic visual inspection of graphical data, descriptions of clinical significance and descriptive statistical analysis. ETHICS AND DISSEMINATION: This trial, including the data management plan, is approved by The Norwegian Regional Ethics Committee (215391). Results will be published in congresses and scientific journals. TRIAL REGISTRATION NUMBER: NCT05148247.

Perceptions of the academic learning environment among occupational therapy students - changes across a three-year undergraduate study program.

INTRODUCTION: Although the learning environment influences students' motivation, learning outcomes, and satisfaction with the study program, less is known about how these factors change as the students' progress through the study program. AIM: The aim of this study was to examine changes in occupational therapy students' perceptions of the academic learning environment during their three-year study program and to examine factors associated with the students' perceptions of the learning environment. MATERIALS AND METHODS: A longitudinal cohort study was conducted throughout the three-year study program. Data were collected annually using the Course Experience Questionnaire (CEQ). In total, 263 students from six occupational therapy programs participated in at least one data gathering point. The number of participants was 186 in the first year, 168 in the second year and 200 in the third year. Of the 263 students who participated in the study, 87 participated in only one point of data collection, 58 at two points and 118 at all three points of the data collection. Data were analyzed with linear mixed models. RESULTS: The results showed statistically significant temporal changes on the "Emphasis on independence", "Good teaching" and "Generic skills" scales. There was a significant decrease in scores from the first to the second year of study and the scores remained at this level in the third study year on both the "Emphasis on independence" and "Good teaching" scales. In addition, associations were found between study effort and educational institution related to the "Appropriate workload" scale, as well as between age and the "Generic skills" scale. CONCLUSION: The temporal changes of the students' perceptions of the "Emphasis on independence" as well as "Good teaching" scales are noteworthy. Both scales indicated a significant decrease in scores, indicating that the students perceived that they were less independent from first to second and third year, as well as a perceived decline in the quality of teaching from first to second and third year. The results of this study are central when planning to facilitate learning, especially related to independence and perceptions of good teaching for students in occupational therapy programs.

Student characteristics associated with dominant approaches to studying: Comparing a national and an international sample.

BACKGROUND: Productive approaches to studying (deep and strategic learning) are associated with a variety of favourable academic outcomes, and may be of particular importance for students in multifaceted and complex disciplines such as occupational therapy. AIM: To explore associations between student characteristics and their dominant approaches to studying in two samples of occupational therapy students: a national sample of Norwegian first-year students, and an international sample of students in different year cohorts (Australia, Hong Kong, Singapore and Norway). MATERIALS AND METHODS: A total of 180 (national sample) and 665 (international sample) students were included in the study. Approaches to studying were measured with the Approaches to Study Skills Inventory for Students (ASSIST). Data were analyzed with adjusted multinomial regression analyses. RESULTS: Age, gender and prior higher education were not associated with the dominant study approach. More time spent on independent study (international sample: OR = 1.07/1.08, p < 0.01/<0.001) and having current study program as the top priority line of education at enrolment (national sample: OR = 2.89, p < 0.05) predicted productive study approaches. CONCLUSIONS AND SIGNIFICANCE: Factors such as age, gender and prior higher education seem to be of limited importance for understanding students' dominant approaches to studying.

Student perceptions of the learning environment in Norwegian occupational therapy education programs.

BACKGROUND: To support students' motivation towards constructive and persistent study efforts, their learning environment needs attention. AIM: To develop knowledge about occupational therapy students' perceptions of the learning environment and assess whether identified differences between education programs were stable or changed across the 3 years of study. METHODS: Norwegian occupational therapy students completed the Course Experience Questionnaire (CEQ) while in their first, second, and third years of study. Differences between programs were analysed with multivariate and univariate analysis of variance. RESULTS: Among the first-year students, perceptions of the learning environment differed significantly between the six programs on five out of six scales. Apart from a continued difference on overall study satisfaction, the initial differences were no longer significant 1 year later. Differences on three scales (emphasis on independence, appropriate workload, and generic skills) were present in the third year of study. CONCLUSIONS AND SIGNIFICANCE: Students' perceptions of the learning environment became more similar over time, during the first 2 years of study, possibly reflecting that the students have become more accustomed to the student role and to the culture and requirements of the education programs. However, differences between study sites re-occurring in the third year suggest that group-based comparisons of learning environment perceptions across time may be inconclusive.

Predictors of students' participation in a learning environment survey with annual follow-ups.

BACKGROUND: Longitudinal research is one effective way to gauge changes in a student cohort over time, however attrition in these studies is typically high, which can result in study bias. This study explored learning environment factors, approaches to studying, and academic performance as predictors of occupational therapy students' consistent participation in data collection conducted over three years of their professional program. METHOD: A longitudinal study of Norwegian occupational therapy students (analyzed n = 240) was conducted. Logistic regression analysis was used to explore occupational therapy students' perceptions of the learning environment, their approaches to studying, and exam grades as they related to the likelihood of consistent participation at three annual surveys. RESULTS: Annual response rates varied between 55.1%, and 65.6%, and consistent participation was observed among 49.2%. The fully adjusted regression models showed that higher strategic approach scores increased the odds of consistent participation (adjusted OR: 1.04, p < 0.01), whereas higher surface approach scores decreased the odds of consistent participation (adjusted OR: 0.95, p < 0.05). Neither sociodemographic factors, learning environment factors nor academic performance predicted participation over time. CONCLUSIONS: Researchers can anticipate relatively high levels of attrition in longitudinal studies of occupational therapy students, but attrition seems to be largely proportional between groups. However, completers in longitudinal studies may be somewhat more well-organized and academically oriented than drop-outs.

Factors Associated with the Establishment of New Occupational Therapist Positions in Norwegian Municipalities after the Coordination Reform.

Community-based occupational therapy is an increasingly important domain of work for occupational therapists. In Norway, this has been emphasized by the Coordination reform (2012), which assigned municipalities increased responsibility to protect and promote the health of their inhabitants. However, even if approximately 400 positions have been established between 2012 and 2017, little is known whether they have contributed to increased and/or more equal coverage across municipalities. To explore this matter, survey data was gathered among members of the Norwegian Occupational Therapy Association during 2017. Data was analyzed statistically (descriptive, comparative and associative) with SPSS 25. Results suggest large regional variations in the establishment of new positions. Moreover, most new positions were established in medium-sized municipalities that already had (an) occupational therapist(s) in the community. Number of prior positions, as well as being in the process of merging with another municipality were the only significant predictors for the establishment of new positions during regression analysis. Findings suggest that no levelling-out of geographical distributions of OT-coverage has occurred, even if new positions might have contributed to level-out workload (number-of-patients-per-therapist). Further, we discuss implications of our findings for policy-making and recruitment of Occupational Therapists for rural positions.

Psychometric properties and associations between subscales of a study approach measure.

The purpose of this study was to (i) confirm the factor structure of the Approaches and Study Skills Inventory for Students (ASSIST) in the current sample of undergraduate occupational therapy students and (ii) explore the pattern of associations between the 13 ASSIST subscales. Occupational therapy students (n = 171) across Norway completed the ASSIST. A three-factor structure was confirmed. Several positive associations were found between the deep and strategic approach subscales, whereas several surface approach subscales were negatively associated with the deep and strategic approach subscales. In conclusion, the study showed that the Norwegian ASSIST has a well-functioning three-factor structure in line with its theoretical underpinnings, and it can therefore readily be adopted as a study process measure in Norwegian occupational therapy education programs. In view of the associations between subscales, there is support for a higher-order concept of "productive" study approaches that encompasses both deep and strategic behaviors. The analysis of associations also suggests that students demonstrating unproductive study behaviors may need guidance and intervention that extends beyond the first detected problematic behavior.

Associations between learning environment variables and students' approaches to studying: a cross-sectional study.

BACKGROUND: Aspects of the learning environment may be related to students` approaches to studying, but few studies have investigated these relationships in the context of occupational therapy education. OBJECTIVE: To examine associations between occupational therapy students' perceptions of the learning environment and their approaches to studying. METHOD: One hundred eighty-seven first-year occupational therapy students in Norway (response rate 61.3%) participated in this study. Aside from sociodemographic information, the students completed the Course Experience Questionnaire and the Approaches and Study Skills Inventory for Students. Associations between learning environment variables and study approaches were investigated with hierarchical linear regression analyses. RESULTS: Higher scores on Generic skills were associated with higher scores on the deep and strategic approach scales (ß ranging 0.18-0.51), while lower scores were associated with higher surface approach scale scores (ß = - 0.24). Lower scores on Clear goals and standards and Appropriate workload were associated with higher surface approach scores (ß ranging - 0.16 - -0.42). CONCLUSION: By improving aspects of the learning environment, there may be a potential for influencing occupational therapy students' approaches to studying. Based on this study, emphasizing how generic skills developed in the study program may become useful in practising a profession, ensuring clarity of goals and standards, and maintaining an appropriate workload on students appear to be important.

The conflicted practice: Municipal occupational therapists' experiences with assessment of clients with cognitive impairments.

BACKGROUND: The practice of Norwegian occupational therapists (OTs) in municipal practice is a little explored area and with the Coordination Reform Act from 2012, Norwegian OTs in municipal practice have received responsibilities concerning clients with cognitive impairments. The aim of this study was to explore municipal OTs experiences with assessment of clients with cognitive impairments. METHOD: Fourteen individual interviews with OTs who worked with clients with cognitive impairments, were conducted. An inductive thematic analysis, using text condensation and coding, was performed. RESULTS: The results revealed three themes; power of occupation, advantages and disadvantages of assessments used and the need for competencies within municipal services. The participants emphasized using observation in the assessment process and reflected on pros and cons of the standardized assessment tools they used. They expressed a need for competence development, although it was difficult to prioritize to do so. CONCLUSION: This study illustrated a conflicted practice related to choices OTs make in their practices. They valued the importance of working occupation based, however, they chose to use impairment based standardized assessments. They expressed a need to engage in professional development, but due to heavy workloads, the limited power they experienced and lack of knowledge, this was difficult.

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice.

BACKGROUND: With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments. METHOD: An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR = 36%) Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%). CONCLUSION: The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.