Danish translation, cultural adaptation and initial validation of the Self-Assessment of modes questionnaire (D-SAMQ).

BACKGROUND: The Self-Assessment of Modes Questionnaire (SAMQ) was developed for occupational therapists (OTs) to identify their therapeutic style when interacting with clients. To provide Danish Occupational Therapists (OTs) with access to the SAMQ, a rigorous translation, cultural adaptation and validation are required. AIM: To describe the process of translating and culturally adapting the SAMQ into Danish (D-SAMQ) and examining initial validation of the SAMQ in terms of relevance and comprehensiveness in a Danish context. MATERIAL AND METHODS: A 10-step process for translation and cultural adaptation was followed: (1) Preparation, (2) Forward translation, (3) Reconciliation, (4) Back translation, (5) Back-translation review, (6) Harmonization, (7) Cognitive debriefing, (8) Review of cognitive debriefing results and finalization, (9) Proofreading and (10) Final report. The cognitive debriefing also involved validation. RESULTS: Seven OTs and one OT student were included in the cognitive debriefing. Adaptations were made in eight of twenty cases, and modifications regarding the choice of words, sentence structure, and rephrasing were performed. The participants suggested more contextual details in the case descriptions. CONCLUSION: The SAMQ was translated into Danish (D-SAMQ) and adapted and validated by Danish OTs. The D-SAMQ may enable OTs to identify their therapeutic style, and thereby improve the client-therapist relationship.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children.

INTRODUCTION: Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment. METHODS: Two hundred typically developing Brazilian children aged 3 years were evaluated individually using the Child-Initiated Pretend Play Assessment. RESULTS: The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41 months) and the older children (aged 42-47 months) for elaborate play across both conventional-imaginative play (p = .002), symbolic play (p = .012), and the combined score (p = .005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p = .009) and elaborate play overall (p = .039). There were significant differences between young and older boys for elaborate play with conventional toys (p = .006) and elaborate play overall (p = .025). There were no significant differences for object substitution or imitated actions. CONCLUSION: The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

The perceived meaning of occupations among children: correlations with children's socio-emotional characteristics and executive functions.

INTRODUCTION: Participation in meaningful occupations within our everyday environments contributes to health and wellbeing. Therefore, it is important to study perceived meaning and its inter-related factors. The perceived meaning of occupations is the emotional and cognitive qualities people attach to their occupations. However, research on the perceived meaning of occupations among children is limited. The meaning of occupations may be related to personal factors concerning the child. Hence, this study aimed to assess the correlations between socio-emotional characteristics and executive functions of typically developing children and their perceived meaning of occupations-value, challenge, and sense of time and autonomy. METHODS: A cross-sectional study comprising 80 children (6-13 years old) and their parents was conducted. The parents completed the Strengths and Difficulties Questionnaire (SDQ) and the Behaviour Rating Inventory of Executive Function. The children completed the Perceived Meaning of Occupation Questionnaire and the Verbal Working Memory test. RESULTS: Children with higher scores on the SDQ-internalised behaviours and lower working memory-perceived their everyday activities as more challenging (r = .300, r = -.244, p < .05, respectively). Children with higher scores on the SDQ-prosocial behaviours-attached higher value to their everyday activities (r = .23, p < .05). However, increases in executive function difficulties were found to decrease the perceived value (r = .24, p < .05) and to alter the perceived sense of time (r = . 27, p < .05). CONCLUSIONS: The meaning children attach to their everyday activities changes when they experience socio-emotional and executive difficulties. Therefore, to inspire positive meaning of occupations among children, practitioners should consider the child's socio-emotional and cognitive strengths and difficulties.

Home Environmental Assessment Protocol-Revised Initial Psychometrics: A Pilot Study.

Efficient home assessments are needed for persons with dementia and their caregivers. Pilot studies to establish a content validity index (CVI), measure concurrent criterion validity, and examine test-retest reliability of the Home Environment Assessment Protocol-Revised (HEAP-R). Six experts reviewed the tool and scored content validity items. Twenty-one caregiver/person with dementia dyads engaged with HEAP and HEAP-R to examine concurrent criterion validity. Seventeen occupational therapists viewed 10 videos of home environments to examine reliability. The CVI score was .980. Concurrent criterion validity for domains: hazards (r =.792), adaptations (r = .742), clutter (r = .843), and comfort (r = .958). Test-retest reliability: hazards (r = .820), adaptations (r = .887), visual cues (r = .487), and clutter (r = .696). Pilot data suggest the HEAP-R has preliminary content and concurrent criterion validity and test-retest reliability. Robust psychometric analysis is needed prior to use in clinical practice.

Occupational Therapy Roles in an Indigenous Context: An Integrative Review.

BACKGROUND.: Indigenous peoples experience health inequities linked in part to lack of access to culturally-relevant health care. The Truth and Reconciliation Commission of Canada (TRC) calls on all health professionals, including occupational therapists, to reduce health inequities through improved work with Indigenous communities. PURPOSE.: This integrative review of the literature explores how occupational therapists can improve their work with Indigenous peoples. KEY ISSUES.: Communication and building relationships are central to effective work with Indigenous communities, along with reciprocity regarding knowledge exchange. Issues surrounding service provision are a significant concern, yet improvements are unlikely to be effective unless therapists can critically examine the (mainstream) Western cultural assumptions that infuse the profession and their own practices. IMPLICATIONS.: Though nascent, there are identified directions for occupational therapists to meet the TRC's calls for more competent health care. Researchers should explore best ways for therapists to critically interrogate taken-for-granted professional assumptions mired in Western colonialism.

Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument.

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

Referral Prioritization in Home Care Occupational Therapy: A Matter of Perspective.

BACKGROUND.: Prioritizing referrals for home care occupational therapy is somewhat subjective, and public and patient perspectives on waiting list priorities are unknown. PURPOSE.: To explore the views of home care occupational therapists (OTs), older persons (OPs) and adults with disabilities on waiting list priorities, as well as issues and challenges underlying these priorities. METHOD.: We conducted in-depth interviews with 11 OTs, 10 OPs and 9 adults with disabilities. Participants were asked to prioritize referral scenarios while explaining their choices. Directed and conventional content analysis allowed the identification of themes for each group of participants. FINDINGS.: OTs experienced conflicts of values but mainly prioritized referrals based on client safety. OPs sought to maximize client's independence, and persons with disabilities aimed to improve clients' social participation. IMPLICATIONS.: OTs should seek the perspectives of their target clientele on referral prioritization criteria and strive to adjust prioritization practices accordingly.

The Development and Psychometric Properties of the Visuospatial Working Memory Assessment (VWMA) for Children.

The visuospatial working memory plays a crucial role in the occupational performance of children including daily living and academic achievement. Unfortunately, relevant visuospatial working memory tests in the occupational therapy setting are lacking. Therefore, it is of clinical interest to develop new assessment tools in this area. The present study is aimed at summarizing the development of the visuospatial working memory assessment (VWMA) and assessing its psychometric properties. The results revealed that the score of item-objective congruence index (IOC) was 1.0 in overall items of assessment. The Cronbach alpha test confirmed that the internal consistency of VWMA showed good reliability in both types of the assessment, with the total score of computerized tests being .88 and the tabletop tests being .81. The computerized test was found to have excellent test-retest reliability with intraclass correlation coefficient (ICC) values ranging from .88 to .99. The tabletop test was found to have a fair to good test-retest reliability with the ICC values ranging from .51 to .63. As regards construct validity, the results revealed that the tasks in the computerized test identified a significant difference between the control group, normal children, and children with attention deficit/hyperactivity disorder (ADHD) group. The exception to this was the N-back task in which the independent sample t-test of computerized test ranged from 1.61 to 6.23. The results of the tabletop test revealed a significant difference between normal children and the children in the ADHD group over all tasks in which the independent sample t-test ranged from 3.05 to 8.40. In conclusion, good psychometric properties established as regards content validity, internal consistency, test-retest reliability, and construct validity provide evidence to support the position that the new VWMA is appropriate for children.

Structural validity and internal consistency of an ecological observation-based assessment, the Activities of Daily Living Profile.

INTRODUCTION: Direct observation of everyday task performance is considered the most accurate measure of independence for individuals with executive function impairments. However, few observation-based measures have been shown to have sound psychometric qualities and be clinically applicable. The objective of this study was to investigate the Activities of Daily Living (ADL) Profile's structural validity using exploratory factor analyses and internal consistency in order to identify the minimum set of tasks required to achieve reliable scores in each of three ADL environments (personal, home and community). METHODS: Ninety-one persons with a severe traumatic brain injury aged 16-40 years (convenience sample) were recruited from a university affiliated level 1 trauma hospital. The 17 observation-based tasks of the ADL Profile were administered by one of five occupational therapists, either in the hospital or in the subjects' home and community environments. This measure of independence considers goal formulation, planning, carrying out and verifying goal attainment. RESULTS: Exploratory factor analysis indicated the unidimensionality of the 17 tasks of the ADL Profile. A single factor explained more than 80% of the common variation, which in this case is the concept of independence. Internal consistency of task scores is very high (0.955), suggesting redundancy of the tasks. Approaches used to reduce the number of items, and to optimise the clinical applicability of the tool, showed that a minimum of two tasks per each of three environments (personal, home, community) is required to obtain reliable results that respect the tool's internal structure. Each assessment should contain both simple and familiar and more novel and complex tasks. CONCLUSIONS: Findings show that the ADL Profile is a valid and clinically applicable observation-based measure of independence that considers four important task-related components: goal formulation, planning, carrying out and verifying goal attainment.

Doing Occupational Justice: A Central Dimension of Everyday Occupational Therapy Practice.

BACKGROUND.: The Canadian Association of Occupational Therapists (CAOT) and the American Occupational Therapy Association (AOTA) state that occupational justice is part of the domain of occupational therapy and that occupational justice is "an aspect of contexts and environments and an outcome of intervention" (AOTA, 2014, p. S9). KEY ISSUES.: Despite the increasing focus on justice in the occupational therapy and the occupational science literature, many practitioners in traditional settings do not see its relevance to their everyday practice (Galvin, Wilding, & Whiteford, 2011) or have difficulty envisioning how to enact a justice-informed practice. PURPOSE.: This paper demonstrates how occupational justice is germane to all settings of occupational therapy, and how it can be enacted at micro, meso, and macro levels of occupational therapy practice. IMPLICATIONS.: We argue that occupational therapy is a justice-oriented profession at its core and will discuss how occupational justice can be enacted at all levels of practice.

Quality of life: A universal or a disability specific concept?

BACKGROUND.: Quality of life (QoL) is an important outcome of occupational therapy practice. Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts the individual throughout their lifespan and may substantially affect QoL. Measuring QoL of people with ASD presents a challenge and a debate whether to use general versus disability-specific adapted measures. PURPOSE.: This paper aims to (a) revisit the construct of QoL and discuss specific dilemmas pertaining to its measurement, and (b) discuss implications to the assessment of QoL in individuals with ASD while highlighting the potential contribution of occupational therapy to the development of measures. KEY ISSUES.: We suggest adding the domain of accessibility into QoL assessments, including, physical, sensory, social, and cognitive aspects, and to use disability-specific QoL measures. IMPLICATIONS.: The paper presents a call for occupational therapists to be involved in developing specific ASD disability-oriented measures that consider the unique characteristics of the disorder and environmental supports.

Accurate assessment of functional abilities in pre-schoolers for diagnostic and funding purposes: A comparison of the Vineland-3 and the PEDI-CAT.

AIM: Assessment of functional abilities is an essential component in the diagnosis of neurodevelopmental disorders in young children. Functional abilities, assessed using the Pediatric Evaluation of Disability Inventory-Computer Adapted Test (PEDI-CAT), are used to determine eligibility for early intervention funded under the National Disability Insurance Scheme in Australia (NDIS). This study aims to compare the use of the PEDI-CAT with the Vineland-3, a comprehensive parent interview for the determination of support needs, diagnosis, and eligibility for funding. METHOD: Seventy-five preschool aged children referred for formal diagnosis were assessed with the Vineland-3, and subscale scores reviewed for clinical judgement. These children were also assessed on the PEDI-CAT speedy version and the results on the two tests compared. RESULTS: The PEDI-CAT was less sensitive than the Vineland-3 to the functional difficulties being experienced in this population of preschool aged children. The Vineland-3 had floor effects on some scales and deficits masked by skills in other areas in the same domain, but standard subscale scores allowed skills and areas needing support to be defined. Overall 25% of children clinically in need of support were not identified on the Pedi-cat compared to only 4% using Vineland Domain scores and 3% using Vineland-3 subscale scores. The PEDI-CAT also identified significantly lower levels of support required with only 32% of children found to need very substantial support compared to 40% of children on the Vineland Domain scores, and 59% using subscale scores. CONCLUSION: Based on the results of this study, the Vineland-3 comprehensive interview interpreted using subscale scores as well as domain scores is more sensitive than the PEDI-CAT in identifying young children in need of support as well as the areas and degree of support required.

The occupational therapy practitioner's role in health promotion, injury prevention, and role participation for the older worker.

As the population of individuals aged sixty-five and older continues to grow, the number of older individuals participating in the workforce rises alongside, with projections estimating as many as 72 million older workers by 2030. Due to this rapid increase in the number of older workers, new challenges to worker health and to health-related productivity will arise in the coming years. Occupational therapy practitioners are uniquely suited to address many of these challenges given their background in activity analysis, assessment and modification of job demands, health promotion and successful aging. However, there is need for continued research in this area to expand the role of the occupational therapy practitioner in prevention and return-to-work interventions focused on the older worker, and to advocate for the value occupational therapy practitioners can contribute to this field.

[Overview of the assessment practices of occupational therapists working in Quebec]. / Portrait des pratiques évaluatives des ergothérapeutes œuvrant au Québec.

BACKGROUND.: In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented. PURPOSE.: This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles. METHOD.: A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec. FINDINGS.: In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties. IMPLICATIONS.: Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.

DESCRIPTION.: L'évaluation du client est primordiale dans la pratique de l'ergothérapie, notamment pour établir les priorités de traitement et pour vérifier l'efficacité des interventions. Les pratiques évaluatives des ergothérapeutes sont cependant peu documentées. BUT.: Dresser un portrait des pratiques évaluatives des ergothérapeutes du Québec selon les dimensions personne-environnement-occupation et les clientèles. MÉTHODOLOGIE.: Une enquête transversale a été réalisée à l'aide d'un sondage en ligne envoyé aux ergothérapeutes du Québec. RÉSULTATS.: En pédiatrie, les ergothérapeutes utilisent majoritairement des outils standardisés des aptitudes physiques et neurologiques. L'évaluation d'adultes cible principalement les aptitudes physiques et la productivité. Auprès des aînés, l'évaluation repose surtout sur les aspects fonctionnels, particulièrement les aptitudes physiques, les soins personnels et la sécurité à domicile, et sur le dépistage des difficultés cognitives. IMPLICATIONS POUR LA PRATIQUE.: L'évaluation ergothérapique serait généralement axée sur les aptitudes physiques. Pour assurer une approche holistique, l'occupation et l'environnement devraient être davantage considérés dans l'évaluation.

The "What Now?" Workbook: Its potential utility following life-changing events.

BACKGROUND.: Following a life-changing event, such as a serious illness, people can experience a disruption of meaning and identity, making it difficult to move forward. The "What Now?" Workbook was developed to enable exploration of the personal meanings of specific occupations to facilitate future planning. PURPOSE.: The aim of this study was to investigate the utility-usability and usefulness-of the workbook in practice. METHOD.: Five occupational therapists trialled the workbook at a specialist cancer centre in England. Qualitative data were gathered via a focus group, an interview, and questionnaires. The data were subject to a realist thematic analysis. FINDINGS.: The findings showed the workbook to have actual and potential utility for service users in this setting, as perceived by their occupational therapists, by helping them to explore occupations, their loss, meanings, and future possibilities as part of an occupational therapy intervention. IMPLICATIONS.: The workbook appears to offer a structured yet flexible way to explore personal meanings of occupations, enabling service users to gain insights and move forward following a life-changing illness.

Reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version for children with physical disabilities.

INTRODUCTION: Occupational therapy supports individuals to participate in meaningful activities. Participation in activities should be assessed with appropriate tools. The aim of the present study was to establish the reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version (CPAS-P) for children with physical disabilities. METHODS: The participants were 304 parents of 6- to 12-year-old children with physical disabilities. Confirmatory factor analysis (CFA), internal consistency, convergent validity of the CPAS-P with the Vineland Adaptive Behavior Scale (VABS), and test-retest reliability were measured. RESULTS: Confirmatory factor analysis showed acceptable values for all indices of fit, namely goodness of fit index (GFI), adjusted GFI, normal fix index, comparative fit index, incremental fit index (i.e., greater than 0.90), and the value of root mean square error of approximation was 0.07, which was acceptable. High Cronbach's alpha coefficients (above 0.9) were reported for the total score of each scale (diversity = 0.94, frequency = 0.94, with whom = 0.92, enjoyment = 0.95, and parent satisfaction = 0.95). The convergent validity of the CPAS-P with the VABS was moderate to good and the test-retest reliability (ICC) for the total scores ranged from 0.90 to 0.96. CONCLUSION: The CPAS-P had good psychometric properties for parents reporting the activities of their 6- to 12-year-old children with physical disabilities and can be utilized in clinical practice.

The inter-rater reliability of the Powered Mobility Device Assessment Training Tool.

INTRODUCTION: The prescription of powered mobility devices for clients is an important role for occupational therapists. However, the skill of may powered mobility device users to drive their devices remains unknown and clients are provided with only brief education on their use. Few assessments exist to guide mobility device use assessment, and none of these incorporate the training clients need. The aim of this paper was to investigate the inter-rater reliability of a new assessment and training tool called the Powered Mobility Device Assessment Training Tool (PoMoDATT). METHOD: The PoMoDATT comprises an initial interview and then Part A- cognitive skills, Part B physical and psychosocial skills and Part C driving skills and behaviours. The assessment outcome is a profile of the client's physical, cognitive and psychosocial skills related to powered mobility device use. The driving assessments of 24 powered mobility device users were video-recorded, and four experienced occupational therapists scored the clients on the 26 items of Part C of the PoMoDATT. RESULTS: Following clarification of three items which included re-scoring and data re-analysis, the inter-rater reliability for the PoMoDATT Part C items ranged from ICC (2, 1) 0.641 to 0.938 suggesting moderate to excellent agreement. CONCLUSIONS: The PoMoDATT Part C has demonstrated adequate inter-rater reliability to support its use by occupational therapists to assess powered mobility device user's capacities and abilities and to highlight ongoing training needs.

Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service.

INTRODUCTION: Environmental assessment and modification is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. Environmental assessment and modification has been incorporated into many national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. The aim of this study is to identify factors that support the local adoption of best practice environmental assessment for falls prevention within a rural health service. METHODS: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services framework was employed. The setting was a health service in Queensland, encompassing rural and regional populations. An audit, based on best practice, was conducted on eligible medical charts. An online survey of occupational therapists' knowledge, attitudes, confidence and experience of environmental assessment and modification was completed. Focus group discussions were also carried out. Quantitative data were presented using descriptive statistics and discussions were thematically analysed. RESULTS: Twenty-four occupational therapists were identified as meeting the inclusion criteria. Fourteen participated in the survey and 12 of those surveyed also participated in the focus groups. Fifty-eight patients' medical charts were audited, which included entries from occupational therapists who completed the survey and focus groups and some who did not. Survey results identified that most occupational therapists were aware of, confident, and experienced in environmental assessment and modification for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of environmental assessment and modification: confidence in, and awareness of evidence; key stakeholders' support and knowledge of occupational therapy; and, perceived impact of time and resources required for implementation. Results also suggested that several contextual issues unique to rural and regional service delivery influenced uptake, including: geographical and sociocultural diversities of communities being served; differing organisational structures which result in occupational therapists being line managed by other professions; and, limited access to professional development. Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change. CONCLUSION: Occupational therapists reported that they carried out best practice environmental assessment and modification for falls prevention but the medical chart audit provided no evidence of this happening in practice. This discrepancy requires further investigation. This study provided an understanding of factors that influence whether occupational therapists implement best practice environmental assessment and modification in a rural health service. Findings could be used to guide the translation of evidence into practice across similar settings.

Mobile three-dimensional visualisation technologies for clinician-led fall prevention assessments.

The assistive equipment provision process is routinely carried out with patients to mitigate fall risk factors via the fitment of assistive equipment within the home. However, currently, over 50% of assistive equipment is abandoned by the patients due to poor fit between the patient and the assistive equipment. This paper explores clinician perceptions of an early stage three-dimensional measurement aid prototype, which provides enhanced assistive equipment provision process guidance to clinicians. Ten occupational therapists trialled the three-dimensional measurement aid prototype application; think-aloud and semi-structured interview data was collected. Usability was measured with the System Usability Scale. Participants scored three-dimensional measurement aid prototype as 'excellent' and agreed strongly with items relating to the usability and learnability of the application. The qualitative analysis identified opportunities for improving existing practice, including, improved interpretation/recording measurements; enhanced collaborative practice within the assistive equipment provision process. Future research is needed to determine the clinical utility of this application compared with two-dimensional counterpart paper-based guidance leaflets.