Psychometric Evaluation of the Occupation-Centered Intervention Assessment

PURPOSE: The Occupation-Centered Intervention Assessment (OCIA) was developed using the Occupational Therapy Intervention Process Model (OTIPM) as the theoretical guide (Fisher, 2009; Jewell, 2015) along with a thorough literature review of historical and current occupational therapy literature on the concepts of adaptation and occupation from the late 1800s through 2013. Themes emerged from the literature that pertained to development of interventions that were authentic to the occupational therapy profession. The three themes of personal, contextual, and occupational relevance were arranged into an assessment tool designed to capture occupation-centered practice. The purpose of this study was to evaluate the validity, utility, and reliability of the OCIA for interventions used with older adults in skilled nursing facilities.

DESIGN: Methodological research design provided the backbone to all four phases of this study (Portney & Watkins, 2009). Phases I–III (utility and validity) incorporated a broad qualitative approach that allowed for concepts and themes to emerge from a questionnaire, expert feedback, and focus groups, while Phase IV included statistical analyses for interrater reliability.

METHOD: Participants for Phases I–III consisted of three experts in research and geriatric practice, 26 occupational therapists and occupational therapy students who expressed an interest in designing and critiquing occupation-centered interventions, and five occupational therapists enrolled in a doctoral program, and following an offer of assistance, an additional reviewer was specifically invited to provide thorough feedback to examine the amount of fit to the OTIPM. Phase IV participants included 19 graduate occupational therapy students who watched an online tutorial about the OCIA, read the guide description, watched 10 video clips of occupational therapy interventions, and scored the OCIA.

RESULTS: Seven common elements emerged in Phases I–III from a thematic analysis. Changes to the OCIA included increasing objectivity for scoring through inclusion of numbers, decreasing the number of levels, and providing more examples of the levels in the description guide. Additionally, the personal and occupational relevance themes underwent minor changes to more accurately reflect occupation-centered practice. However, the main constructs of the OCIA remained intact. Overall, Krippendorff’s alpha indicated an adequate level of agreement (.756) for all ratings. Regarding the subdomain measures, alphas indicated moderate to adequate agreement (α_person = –.729; α_context = .683; α_occupation = .769).

CONCLUSION: Taken as a whole, from participant feedback after review of the tool, use of the tool, and statistical analysis, results indicate that the OCIA has adequate validity, utility, and interrater reliability for measuring occupation-centered practice for older adults within skilled nursing facilities. However, the moderate agreement rating of contextual relevance indicates a need for an improved description guide with clearer descriptions and examples. Additionally, raters may need additional training in order to use the OCIA as an assessment tool. Future research needs include examining the fit of the OCIA for other patient populations and demographics.

IMPACT STATEMENT: It is imperative to adequately measure and describe occupational therapy practice. The OCIA provides one option to validly, reliably, and quickly capture the breadth and depth of occupation-centered practice.

References

Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and implementing top-down, client-centered, and occupation-based interventions. Fort Collins, CO: Three Star Press.

Jewell, V. (2015). Occupation-centered practice in skilled nursing facilities: Myth or reality? (Doctoral dissertation, Texas Woman’s University, Denton, TX). ProQuest Digital Dissertations, AAT3712477.

Portney, L. G., & Watkins, M. P. (2009). Foundation of clinical research: Applications to practice (3rd ed.). Upper Saddle River, NJ: Pearson Education.