Health Care Survival Skills: An Occupational Therapist–Disability Peer Led Intervention—Feasibility,Acceptability,and Preliminary Outcomes

BACKGROUND AND PURPOSE: According to the United Nations (2008) Convention on the Rights of Persons With Disabilities, health care is a fundamental human right. People with physical disabilities face significant barriers to health care access, quality, and outcomes (Krahn et al., 2015). The American Occupational Therapy Foundation identified the development of evidence-based interventions to promote health care access, care coordination, and utilization as a research priority, yet the occupation of navigating the health care system is rarely addressed in clinical occupational therapy practice (Magasi, 2012). Thus, the purpose of this study was to describe the development and preliminary feasibility, acceptability, and outcomes of the Healthcare Survival Skills intervention, a novel occupational therapist–disability peer led educational intervention designed to help people with physical disabilities build their capacity to navigate the health care system.

METHOD: This pretest–posttest feasibility study was developed using a community-based participatory research approach. A convenience sample of community-dwelling adults over age 18 with acquired physical disabilities (N = 30) were recruited through clinical and community networks in a large Midwestern metropolitan area. All participants provided informed consent in compliance with institutional review board protocols.

A community-based participatory research approach was used to develop the active elements of this theory-driven manualized intervention. Participants completed the 7.5–10-hr intervention in small group settings of three to eight people. The Healthcare Survival Skills intervention emphasized an occupational therapy–informed process of identification of individual health care needs, priorities, and potential barriers to care; goal setting; and action planning. The occupational therapist group facilitator shared professional knowledge on the occupational therapy process, and the disability partner shared experiential knowledge and real-world strategies. Fidelity was monitored to ensure that the intervention was implemented as intended. Group length varied as a disability accommodation for different learning styles and cognitive processing abilities.

Acceptability to both participants and interventionists was evaluated qualitatively. Participants engaged in qualitative debriefing on completion of the intervention, and interventionists participated in focus groups with occupational therapists (n = 5) and disability peer leaders (n = 5). It was hypothesized that participants would have increased activation (measured using the Patient Activation Measure) at 6 wk and 3 mo and fewer barriers to care (measured using the SPARC-DO) and improved global health (measured using the PROMIS Global Health 6-item short form) at 3 mo. Clinical and demographic data and patient-reported outcome measures were gathered at baseline, 6 wk, and 3 mo.

All qualitative data were analyzed thematically to identify strengths, weaknesses, and recommendations for improvement. Quantitative outcomes were evaluated using repeated measures t tests to determine change over time.

RESULTS: The intervention was acceptable to interventionists and participants. The content was identified as relevant and engaging and the learning activities as appropriately targeted. Scheduling, timing, and length were identified as areas for improvement, but overall engagement and participation were high, and the intervention was deemed feasible to deliver in community-based settings.

Participants showed increased knowledge on how to identify barriers to health care, advocate for their accommodation needs, and communicate with health care providers. Preliminary outcomes indicate increased patient activation among participants. There were no significant differences in more distal outcomes of barriers to care and global health at either 6 wk or 3 mo. A control group design would provide stronger evidence for the beneficial impact of the intervention, but our community-based participatory approach partners in the disability field were loath to do so without potentially beneficial information.

CONCLUSION: The occupational therapist–disability peer led Healthcare Survival Skills intervention has the potential to empower people with physical disabilities by increasing knowledge, confidence, and self-efficacy to navigate the health care system.

IMPACT STATEMENT: Occupational therapy practitioners can lead the development and implementation of evidence-informed interventions to address health care disparities. Interventions are strengthened by partnering with people with disabilities who integrate experiential knowledge to promote social learning and group problem solving.

References

Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(Suppl. 2), S198–S206. https://doi.org/10.2105/ajph.2014.302182

Magasi, S. (2012). Negotiating the social service systems: A vital yet frequently invisible occupation. OTJR: Occupation, Participation and Health, 32(1), S25–S33. https://doi.org/10.3928/15394492-20110906-03

United Nations. (2008). Convention on the Rights of Persons With Disabilities—Articles. Geneva: Author.