Occupation-Based Practice (OBP) in OT

PURPOSE: The purpose of the study was to gain a better understanding of how occupation-based practice (OBP), the constructs of OBP, and how those constructs are interconnected. Current research has not examined practitioner use of occupation, OBP, the constructs that make up OBP, or the relationship between the constructs. However, there has been research on the positive impact that occupation have on a person’s health and well-being (Molineux, 2004). There is no mechanism to determine whether a therapist, program, facility, educator, or the profession has integrated OBP into their practice. With no agreement of what OBP looks like, a universal definition, or how it can be measured objectively, it is difficult to determine whether the achieved goal of OBP throughout practice has been met. The research questions that were addressed in this study were:

What is OBP and what does it look like?

What are the constructs that make up OBP and how are they interconnected?

What are the facilitators and barriers to using OBP?

DESIGN: This study used a grounded theory design using purposeful sampling to recruit and select participants. Inclusion criteria included occupational therapists who had passed the national board exam, had a minimum of three years of experience, were currently employed at a full-time status, and were in northern Connecticut or western Massachusetts.

METHOD: Due to using a qualitative approach, in-depth interviews, a focus group, and a demographic questionnaire were completed in order to gather rich, in-depth data. Using Charmaz’s (2014) grounded theoretical approach, data was transcribed verbatim and then within NVivo the three-step analysis approach was used (initial coding, focused coding, and theoretical coding/theory development). Initial coding resulted 72 codes, which was then reduced to 15 categories, and finally 3 main codes emerged from the data. Saturation was met after the completion of six in-depth interviews and one focus group.

RESULTS: The three main themes of facilitating doing, being, and becoming, profession’s identity, and facilitators and barriers to use of OBP emerged from the data. From these themes, four main constructs of OBP were developed and include authentic occupation, meaningful and purposeful value, therapeutic intent, and engaged participation. These four constructs can be viewed and measured interpedently, however, are summative in nature and as each increases, as does use of OBP. Four main areas of facilitators and barriers were noted, with multiple areas being a facilitator, a barrier, or both depending on context and therapist. The areas include systems, physical environment, client, and therapist. These include such components of insurance restraints, supplies and resources, client motivation, and therapist experience. The integration of the four main constructs and facilitators and barriers with the three main themes provided the development of the theory of Occupational Therapist’s Dynamic Use of OBP. This theory provides an objective framework that helps determine when a therapist is using OBP versus a medical model approach.

CONCLUSION: There are multiple implications for the findings of this study for practice, education, and further research. By completing this study, there is increased ability to advocate for physical spaces, adding continuing education for increasing the value, understanding, and belief of using OBP, and supporting a change in the current delivery model of services. The three research questions were answered and with the findings of this research the creation of a measurement tool to objectively measure OBP in the clinical setting and academia can be created.

References

Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications.

Molineux, M. (2004). Occupation in occupational therapy: A labour in vain? In M. Molineux (Ed.). Occupation for occupational therapists, (pp. 1-14). Malden, MA: Blackwell Publishing.