Beyond the Home: Practitioners’ Perceptions of Environmental Factors Impacting Community Participation

PURPOSE: Explore essence of how home health occupational therapy (OT) practitioners perceive and classify environmental factors affecting their clients’ community participation.

RATIONALE: Future growth of community-based OT services under health care reform focuses on social model of health emphasizing sociocultural and political environments. The OT profession needs to be aware of sociopolitical factors affecting participation that contributes to the Centennial Vision’s (American Occupational Therapy Association, 2007) ability to meet society’s occupational needs. Current research specific to home health clients and OT practices that support causal effects between environmental factors and community participation levels is limited and requires in-depth exploration for better understanding of how home health OT practitioners perceive and classify environmental factors affecting practice.

DESIGN: Phenomenological method conducted in two phases: Phase 1, initial discussion group to refine semistructured questions; Phase 2, six one-on-one individual interviews.

PARTICIPANTS: Criterion sample of OT practitioners performing ≥8 home health visits/mo, ≥1 yr experience treating clients ≥19 yr of age. Exclusion criteria: OT practitioners with Phase I study discussion group were researcher’s colleagues. Six participants for Phase 2 one-on-one interviews obtained via state association’s member Listserv, referrals from other practitioners and first to meet inclusion criteria.

METHOD: Obtained institutional review board and consent of participants. Data used verbatim transcriptions conducted in two phases: Phase 1 initial discussion group to refine and modify proposed semistructured questions for Phase 2 interviews exploring practice patterns addressing environmental factors. Descriptive data used demographic information gathered from all participants.

ANALYSIS: Stevick–Colaizzi–Keen method analysis for verbatim transcriptions and notes. Two validation methods for Phase 1: member check and triangulation from transcription significant statements and themes, participants, observation, and reflective notes. Three validation methods for Phase 2: triangulation, clarifying researcher bias, and member check.

RESULTS: Phase I yielded three new questions focusing on participants’ understanding of environment and probe into practice patterns. Phase 2 findings found five themes: (1) distinction between home and community environment places; (2) OT knowledge addressing occupational performance within home; (3) role of OT in community participation; (4) clients, families, and health care policies limiting community participation; and (5) societal influence on home health OT practice.

DISCUSSION: Current evidence and study outcomes reveal OT practices focusing primarily on immediate physical home environment. Other environmental factors such as safety, family supports, transportation, and physical accessibility within the home and community direct OT practice toward client limitations versus the social influences restricting scope of occupations available to the client, for example, belief that older clients’ lack of interest versus societal systems toward ageism lowers community participation.

IMPACT STATEMENT: Need for evidence-based practices challenging traditional OT community-based practices in light of recent national governmental health care policies that center on the social determinants of health to meet society’s occupational needs.

SYNOPSIS: Qualitative study reveals home health OT practitioners address the physical built home environment that limits scope of practice to promote community participation and sociopolitical environmental factors are typically not addressed, requiring change in home health practices.

References

American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. http://dx.doi.org/10.5014/ajot.61.6.613