Date Presented 3/31/2017
Think-aloud methods were used to explore the clinical reasoning of occupational therapists interacting with clients through videoconferencing. Pragmatic, procedural, interactive, and conditional reasoning styles were all used. Think-aloud methods may help train therapists practicing using eHealth.
Primary Author and Speaker: Emily Nalder
Contributing Authors: Carolina Bottari, Elizabeth Skidmore, Deirdre Dawson
PURPOSE: The purpose of this study was to explore the clinical reasoning styles used by occupational therapists providing an occupation-based intervention online using web-based videoconferencing.
RATIONALE: eHealth, or the use of information and communication technologies to deliver health care, is a rapidly emerging field. Internet and smartphone technologies, which include videoconferencing, can enable individuals to access health care and rehabilitation services from their own home. As more occupational therapists use eHealth to provide clinical services, it is imperative that we understand the clinical reasoning processes used when therapists are interacting with clients using technology.
DESIGN: Data were collected as part of a pilot study examining the feasibility of delivering the Cognitive Orientation to Daily Occupational Performance (CO-OP Approach™). In the context of this pilot feasibility study, we used focused ethnography to examine the clinical reasoning of the occupational therapists delivering the intervention. Participants in this qualitative study were two recently graduated therapists (less than 3 yr of experience) who had been providing therapy using the CO-OP Approach through Skype to clients with traumatic brain injury.
METHOD: Think-aloud methods were used to explore the therapists’ clinical reasoning. The two therapists were interviewed while viewing a recording of their intervention sessions and were instructed to “think aloud” while viewing the tapes and describe everything they were thinking about during the session. Interviews were transcribed and analyzed using thematic analysis.
RESULTS: The therapists perceived that when addressing cognitive, not motor, barriers to participation, the clinical reasoning was similar when working with clients in-person and through videoconferencing. Four previously defined categories of clinical reasoning—pragmatic, procedural, interactive, and conditional—were identified, and therapists provided examples of each with their rationale for using them. Procedural reasoning was more challenging in an eHealth context, as participants were often unable to observe their client’s occupational performance. Metacognitive skills were used in these instances as therapists reflected on their communication style and identified alternative strategies for gathering information about their client’s occupational performance and engagement.
DISCUSSION: These data provide initial evidence of the clinical reasoning processes used by occupational therapists delivering interventions via eHealth and thus interacting with clients through technology. The use of think-aloud methods caused the therapists to reflect on their treatment sessions and provided valuable information on clinical reasoning processes. Think-aloud methods may therefore be useful for training professionals to work with clients using technology and to transition face-to-face interventions to an online delivery method.
IMPACT STATEMENT: These data illustrate unique aspects of providing interventions through technology and will inform the development of specific training for occupational therapists practicing in a technology-mediated environment that will be used when implementing eHealth interventions in research and practice.
