Optimizing Compliance With Home Programming Through Neuroplasticity Education Among Parents of Children Receiving Outpatient OT

A “therapeutic triad ” exists in pediatric care in which there must be communications between parent-child, child-practitioner, and parent-practitioner (Santer, Ring, Yardley, Wyke, p. 2, 2014). Therefore, parents are essential to the implementation of their child’s home programming. Research suggests that there are six themes that explain nonadherence to home programs: (1) beliefs about the condition and/or treatment (2) difficulty of treatment regimen; (3) child’s resistance; (4) relationships within families; (5) preserving ‘normal life’; and (6) input from health professionals. Caretakers reported that input from health professionals influenced their beliefs about their child’s diagnosis and treatment (Santer, et al., 2014). Given the importance of the caregiver’s role, there is a need to identify best practices for educating the caregivers on the importance of adhering to home programs. The purpose of this research study was to understand how a caregiver educational program, utilizing the concepts of neuroplasticity and framed using the health belief model, impacted home program compliance within a pediatric outpatient clinic.

Inclusion criteria included caregivers for a child receiving at least one or more of the following services: occupational, speech, and/or physical therapy who were at least 18 years old. Data was collected utilizing a pre-test prior to and post-test following delivery of the caregiver education program and a two-month follow up survey. The educational program consisted of 20 participants and 5 participants completing the two-month follow up survey. The educational program was based on the Health Belief Model and Kleim’s Tenets of Neuroplasticity. The caregiver educational program focused on seven of Kleim’s tenets of Neuroplasticity including: (1) use it or lose it; (2) use it to improve it, (3) repetition, (4) age matters, (5) salience matters, (6) transference, and (7) time matters (Kleim & Jones, 2008). The Health Belief Model provided the framework for the educational program. The Health Belief Model pertains to how an individual’s personal beliefs or perceptions about health can impact their overall health outcomes (Becker, 1974). The Health Belief Model addresses one’s perceived benefits and barriers to changing behaviors (i.e. completing the home program), one’s self-efficacy regarding the behavior change, and cues to action to promote the behavior change.

Survey results indicate that a majority of caregivers showed improved understanding of neuroplasticity and the importance of home programming after participating in an educational program. The participants’ ability to articulate understanding of specific tenets increased by 22% from pre to post-test. From pretest results 80% of participants understood advocacy for their children, the importance of salient activities, and the importance of carry-over of therapeutic tasks at home. On the two-month follow-up survey, caregivers provided feedback that their feelings towards home programs and the time they spend on home programs with their children has remained the same following the caregiver educational program.

The AOTA 2025 vision is “as an inclusive profession, occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living.’’ Our research supports the 2025 vision by investigating the “the therapeutic triad” and compliance of parents in implementing home programming for their children. Increased compliance with home programming could positively impact the health and well-being of the child enabling successful participate in everyday occupations that matter to them.

References

American Occupational Therapy Association. (2011). Definition of occupational therapy practice for the AOTA Model Practice Act. Retrieved from http://www.aota.org/-/media/COrporate/files/Advocacy/State/Resources/PracticeAct/Model%20Definition%20of%20OT%20Practice%20%20Adopted%2041411.pdf

Becker, M. H. (1974). The health belief model and sick role behavior. Health education monographs, 2(4), 409-419.

Kleim, J. A., & Jones, T. A. (2007). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. Journal or Speech Language and Hearing Research, 51(1). doi:10.1044/1092-4388(2008/018)

Santer, M., Ring, N., Yardley, L., Geraghty, A. W., & Wyke, S. (2014). Treatment non-adherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers’ views. BMC Pediatrics, 14(1), 63-63 1p. doi:10.1186/1471.2431-14-63