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ThecurrentperceptionoftheOccupationalTherapyprofessioninNewZealand.

NadjaArmitageStudentID:1000037060

AProjectsubmittedinpartialfulfilmentofthedegreeMasterofOccupationalTherapy

atOtagoPolytechnic,Dunedin,NewZealand

[12August2019]

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Abstract

The literature reviewed in relation to the research question indicated that the

OccupationalTherapyprofessionhasalong-standingissuewithhowitisperceivedwithin

thehealth care sector. The literature clearly identified thatOccupational Therapy adds

significant value to health care and patient outcomes, however it also highlighted

persistentproblemswithitsprofessionalidentityandroleidentification.Underlyingcauses

of these historical issues and previous strategies employed to overcome these were

described.

Thisstudyusesinterpretivedescriptivemethodology.Fiveresearchparticipantshavebeen

recruited using a purposive sampling method (snowballing). The research participants

were Allied Health Professionals other than Occupational Therapists. Semi-structured

interviewswereusedtocollectthedataforthisstudy.QUAGOL,a10-stepdataanalysis

method,wasusedtoanalysethedataanddevelopthefindings.

The following four major categories of findings were identified: 1) The Value of

OccupationalTherapy,2)Professionalidentityand3)PromotionOccupationalTherapy.4)

Environment and Systems constructs. The findings showed that, though overall

participants thought thatOccupationalTherapyaddedsignificantvaluetoNewZealand

health care services,historical issues regardingprofessional identityand role confusion

persisted,despitepreviouseffortstoresolvethem.

Akeymessageforoccupationaltherapiststotakeawayfromthisstudyistobeproudof

theirprofessionandthesignificantcontributionOccupationalTherapymakestothehealth

care system and the health and well-being of individuals. To promote Occupational

Therapy effectively on an individual level, Occupational Therapists are encouraged to

clearlydefinetheirownprofessionalidentitybyclearlyunderstandingtheirprofessional

boundariestobeabletoconfidentlyrespondtostereotypicalassumptionsorperceptions

of what the role of Occupational Therapy is. Occupational Therapists are further

encouragedtocommunicatehowtheirrolecontributestoservicegoalstofurthercreate

awarenessof itsprofessionalvalue.Toovercomethehistorical issues theOccupational

Therapyprofession facesanddevelopeffectivepromotional tools, further researchhas

beenrecommended.

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Acknowledgement

IwouldliketoexpressmyspecialthanksofgratitudetoMaryButlerwhohassupported

mewithendlesspatience,understandingandencouragement.

Thankyou!

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TableofContents

Abstract........................................................................................................................2

Acknowledgement........................................................................................................3

CHAPTER1....................................................................................................................7

INTRODUCTIONANDCONTEXTOFTHESTUDY..............................................................7

Introduction...........................................................................................................................7

Statementoftheproblem......................................................................................................9

Marketingincontextofthisstudy........................................................................................10

Researchaimsandobjectives...............................................................................................15

Keytermsused.....................................................................................................................16

Thestructureoftheprojectreport.......................................................................................16

CHAPTER2..................................................................................................................18

LITERATUREREVIEW...................................................................................................18

Introduction.........................................................................................................................18

Searchstrategy....................................................................................................................18

Evaluationofarticles............................................................................................................18

Themes................................................................................................................................19

Conclusion...........................................................................................................................32

CHAPTER3..................................................................................................................34

METHODOLOGY..........................................................................................................34

Introduction.........................................................................................................................34

WhatisInterpretivedescription?.........................................................................................34

Philosophicalandtheoreticalcontext...................................................................................35

Theresearchquestion:.........................................................................................................36

Studydesign.........................................................................................................................36

Ethics...................................................................................................................................38

Confidentiality&Informationstorage..................................................................................39

DataCollection.....................................................................................................................39

DataAnalysis.......................................................................................................................39

Transferability......................................................................................................................41

Dependability.......................................................................................................................41

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Confirmability......................................................................................................................42

Reflexivity............................................................................................................................42

Introduction.........................................................................................................................43

Themes................................................................................................................................43

Summary..............................................................................................................................54

CHAPTER5..................................................................................................................55

DISCUSSION................................................................................................................55

Theimportanceofprofessionalidentity...............................................................................55

Culturalimperialism.............................................................................................................57

Recognition..........................................................................................................................58

Environment........................................................................................................................59

Whatdoesthismean?..........................................................................................................60

Recommendationforfurtherresearch.................................................................................61

Recommendationforpractice..............................................................................................61

Limitationsofthestudy........................................................................................................62

Conclusion:..........................................................................................................................63

Referencelist..............................................................................................................67

Appendices.................................................................................................................71

Appendix1:EthicsApproval.................................................................................................72

Appendix2:..........................................................................................................................73

ParticipantInformationSheet–InterviewsDateInformationSheet.....................................73

Appendix3:InterviewSchedule...........................................................................................75

Appendix4:DataAnalysis....................................................................................................76

Appendix5:Exampleofnarrativereport..............................................................................82

Appendix6:Exampleofconceptualinterviewscheme.........................................................84

Appendix7:Generalconceptscheme...................................................................................86

Appendix8:DataAnalysisStage9........................................................................................93

Appendix9:DataanalysisStage10......................................................................................95

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CHAPTER1

INTRODUCTIONANDCONTEXTOFTHESTUDY

Introduction

This chapter will explain the context underpinning the research project, the aim and

objectivesofthestudyandkeytermsused.

ThereisevidencethatOccupationalTherapyisahighlyeffectiveprofessionworkingacross

abroadrangeofhealthandsocialservices(CollegeofOccupationalTherapists,2016).In

their2016report,theCollegeofOccupationalTherapists(2016)statethattheirresearch

showed“OccupationalTherapistsimprovelivesandsavemoneyforthehealthandsocial

careservicesonadailybasis”.OccupationalTherapistsprovideexpertknowledgeofthe

importance of occupations and routines on peoples’ health and wellbeing (College of

Occupational Therapists, 2016). The College of Occupational Therapists’ (2016) report

highlightedthatthevalueofOccupationalTherapylieswithintheprofession’sabilityto:

• ReducepressureonGPs

AddingOccupationalTherapytoprimarycareisaneffectiveextensionofGP

servicesbyaddingholisticcarethroughfocusingontheeffectsofillness,accident

anddisabilityonfunctionandparticipationindailylife.OccupationalTherapists

arehighlyskilledinpreventionandearlyinterventionstrategiesbysupporting

individualsinpreservinghealthylifestylesresultingindiseaseanddisability

prevention,andreductionofimpactofanillness.OccupationalTherapists

achievethisthroughenablingindividualstoparticipateintheirdailyactivities,

reducingriskfactorsbymodifyingthebuildenvironmentorprovidingstrategies

tomaintainhealthandfunction.Proactivelysupportingpeopletomaintainhealth,

well-beingandfunctionwithintheircommunities,aidstoimprovepopulation

healthandreducethefinancialburdentothehealthcaresystem(Collegeof

OccupationalTherapists,2016).

• Reducetheriskofadmissionandre-admissiontohospitals

OccupationalTherapistsaspartofAccidentandEmergency(A&E)serviceshave

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beenshowntosignificantlyreducethenumberofadmissionsorre-admissions.

TheCollegeofOccupationalTherapists’reportincludedaserviceexampleofan

AdmissionAvoidanceTeamfirstpilotedin2013.In2014,theteamassessed181

patientsofwhom138couldbedischargedwithoutrequiringanacutemedical

bed.In2015,134of175patientsassesseddidnotrequireadmission(Collegeof

OccupationalTherapists,2016).

• Providerehabilitationtoimprovehealthoutcomes

OccupationalTherapyprovidesrelevantrehabilitationgoalsaspartofa

comprehensiveassessmentfocusingonanindividual’sfunctionalabilityresulting

inimprovedfunctionaloutcomesandthereforemaximisingindependence

(CollegeofOccupationalTherapists,2016).

• Contributesignificantsavingsbyreducingcostlycarepackages

OccupationalTherapists’coreskillsarecrucialtopreventativeservicesby

promotingfunctionandindependence.OccupationalTherapythereforeaidsin

thepreventionoftheneedforhospitaladmission,posthospitaltransferto

residentialcareandlevelofhomehelpsupportrequired–demonstratingclear

costbenefitsandpatientoutcomes(CollegeofOccupationalTherapists,2016).

• Effectively facilitate the safe and timely transition of patients from hospital to

home.

The College of Occupational Therapists’ (2016) report stated that Occupational

Therapyisanessentialcomponentoftheprovisionofcontinuouscaretomakethe

transition from hospital to home easier for patients. Occupational Therapy is

uniquely equipped to assess and recommend the likely support and equipment

requiredbyanindividualtosafelyreturnhome.OccupationalTherapistsfunction

as an interface between acute and community care, supporting the smooth

transition of patients across health and social services (College of Occupational

Therapists,2016).

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The need to publish this report to promote the value of Occupational Therapy was

identifiedafterareviewoftheunderstandingandperceptionofOccupationalTherapyby

nationalpolicyleaders,politiciansandseniordirectorsinthehealthandsocialcaresector

wascompleted(CollegeofOccupationalTherapists,2016).Thisindicatedthat,despiteall

theevidenceabouttheefficiencyoftheprofession,therewasstillaproblemwithhowthe

profession is perceived as late as 2016. As this researchwas completed in the United

Kingdom, thequestion tobeasked isdoes thisapplywithinaNewZealandcontext? Is

thereaproblemwiththecurrentperceptionofOccupationalTherapyinNewZealand?

Statementoftheproblem

AftercompletingmyBachelorofHealthScience(OccupationalTherapy)andtheBachelor

ofHealthScienceHonoursprogrammeIhavebeenpractisingasanOccupationalTherapist

in multiple settings including acute, rehabilitation and community in both a DHB and

privatepracticeenvironments.Afterworkingfor2-3years, Istartedtofeel increasingly

frustratedbyfrequentlybeingplacedinapositionwhereneitherotherprofessions,nor

mypatients(ifIamtruthful),seemedtobeabletounderstandwhatOccupationalTherapy

isandthebenefitsorvalueitcanprovidetothewiderhealthcaresystem.Iwasoverruled

by medical staff when assessments showed a patient was unsafe to return home. To

overcomethis,Ioftencollaboratedwithphysiotherapistsasthemedicalprofessionalsat

the time seemed to view their assessments as more valid. Colleagues often reported

similarexperiencesandfeelings.FeedbackfromseniorOccupationalTherapistswasoften

thatthisisthewayitwasandtheonlythingtodowastoacceptthehierarchy.Also,in

conversation, other health professionals often admitted a lack of understanding of

Occupational Therapy and how the profession contributes to patient care. As there is

strongevidencethatOccupationalTherapy isavaluableandhighlyeffectiveprofession

(when allowed to be), I started to ask myself where does this lack of understanding

originatefrom?

PriortobecominganOccupationalTherapist, IcompletedaBachelorofCommerceand

Administration majoring in Marketing and Commercial Law. After graduating, I have

workedforNewZealandcharitiesinavarietyofmarketingareassuchaspublicrelations,

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communications,brandingandadvertising.Atsomepoint,Istartedsteppingoutsideofmy

role as a member of the Occupational Therapy profession and started looking at the

identifiedissuesfromamarketingperspective:Whatiscausingthelackofawarenessand

recognition of the profession? Andwhat causesmembers of the profession to silently

acceptthissituation?Frommyexperiencesandobservations,IwonderedifOccupational

TherapyinNewZealandhasthesedifficultiesasaresultofhowitisperceivedbothbyits

ownmembers,othermembersofthehealthcaresystemandthewiderpublic.Istartedto

askmyself:WhatisthecurrentperceptionofOccupationalTherapyinNewZealand?

Marketingincontextofthisstudy

Duringmytimecompletingthisproject,Ioftenencountereddifficultyinexplainingwhat

marketingmeansinrelationtothisstudy.IntheliteraturereviewinChaptertwo,Creek

(2009) used the example of a well-known Occupational Therapy assessment and

interventionofmakingacupofteatoexplainthedifficultyinunderstandingordescribing

OccupationalTherapytootherprofessionsorpatients/clients.Theauthorexplainedthat

oftenindividualsonlyseetheprocessofmakingacupofteaasnothingbutmakingacup

oftea.AnOccupationalTherapisthowever,understandsthatthemakingofthecupoftea

isaprocessofassessinganindividual’sfunctioning–bethatinaphysicalormentalhealth

setting.OccupationalTherapistsseebeyondthetask,consideringtheinteractionbetween

aperson’sfunctionalcomponents,theenvironmentandthetaskaswellashowthisrelates

toothertasksthepersonneedstoperformwithintheirdailylife.

It is much the same with marketing. Often marketing is perceived as advertisements,

commercials,socialmediachannels,posters,flyersandsoon.However,thesearemerely

promotionaltoolswhicharethetipoftheiceberg(orthecupoftea),theresultofaprocess

includingintensiveresearchandcarefulplanning.DrPhillipKotler,ProfessorofMarketing

andrecipientoftheAwardofExcellenceinHealthCareMarketing,stated:

“Marketingisthehomeworkthatwedobeforewehaveaproduct.”

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Iwouldliketoemphasisethatthisstudyisnotaboutprovidingideasforpromotionaltools

fortheOccupationalTherapyprofession,butratherfocusesonthehomeworkbefore;a

conceptcalledthesegmentation,targetingandpositioningprocess(STP).KotlerandKeller

(2005,p.310)explain that tobeeffectiveallmarketingplansneed tobebasedon this

process.

I. Segmentation

MarketsegmentationisdefinedbyChitty,HughesandD’Alessandro(2012)asamarketing

approach for evaluating amarket so thatmarketing strategies can effectively target a

groupofconsumers(amarketsegment)thathasanidentifiedneedwhichcanbemetby

theservice.Thisisanecessarystepasserviceproviders,suchastheOccupationalTherapy

profession, cannot expect to serve everyone in the market. The market Occupational

TherapyoperatesincanbedefinedastheNewZealandHealthCareandSocialServices

sectorincludingbothhealthcareprofessionalsandserviceusers.Toattractbuyersforits

service, Occupational Therapy needs to identify the group(s) of consumerswithin that

market that have a high need orwant for the service (Chitty, Hughes&D’Alessandro,

2012).ThisiscalledsegmentationandisthefirststepintheSTPprocess.

Segmentationcanbecompleted inavarietyofwaysbyeitherusingdemographicsand

value,orbenefitssoughtandbehaviouralpatterns(Chitty,Hughes&D’Alessandro,2012).

Table1.1.belowshowsabriefsegmentationoftheNewZealandHealthCaremarket.

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Table1.1.ExampleofMarketSegmentationoftheNewZealandHealthCareMarket

Thenextstepofsegmentationistoselectoneormoreofthesesegmentsbasedoncriteria

such as size, purchasing power, accessibility and sustainability (Chitty, Hughes &

D’Alessandro,2012).Thisprocessiscalledtargetingorselectingatargetsegment.

II. Targeting

IntheUnitedKingdom,theCollegeofOccupationalTherapists(2016)chosetoplacetheir

main efforts on communicating the value and benefits of the Occupational Therapy

profession to commissioners as well as those leading and delivering health and social

servicesastheirprimarytargetsegment.Thecollegeidentifiedtheneedtosavecostsas

the target segments need that Occupational Therapy could meet. Additionally, even

thoughwedonotworkwithmembers of this segment, they are theones holding the

purchasepower,makingthissegmentincrediblyimportantfortheOccupationalTherapy

profession. In their report, the College of Occupational Therapists often used practice

examples of how including the profession into health care services can save costs,

especiallyforservicesdealingwithindividuals65yearsandolder.Onepracticeexample

NewZealandHealthcareandSocialServicessector

Serviceproviders Serviceusers

Funding/policybodies Serviceleaders

Servicedeliverystaff

Condition Agegroup

Physical Mental Disability

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highlightedthesavingsof12,692Poundsbyintegratingoccupationaltherapistsintoafalls

response service, reducingadmissions intoemergencydepartments forpeopleover65

(CollegeofOccupationalTherapists,2016).Anotherexamplehighlightedthereductionof

the average length of stay on an elderly ward from 9.5 days to 1 day by including

occupationaltherapistsintheActiveRecoveryTeamundera“dischargetoassess”model

(CollegeofOccupationalTherapists,2016).Thisledmetobelievethattheyhavechosen

thissegmentastheirsecondarytargetsegment,mostlikelyasthissegmentisagrowing

segmentworldwideandisassociatedwithhighhealthcarespending,thereforeshowinga

highneedforaservicethatcancutcostsbyimprovingpatientoutcomes.

HowdoesthisapplytotheNewZealandcontext?Policymakersandserviceleadersalso

holdthepurchasingpowerforOccupationalTherapyserviceswithinNewZealand.Inhis

2015FrancesRutherfordLecture,DrKirkReedhighlightedthetrendofneedingtodomore

withless.Thiswasagainhighlightedinthe2017-2018OccupationalTherapyNewZealand

-WhakaoraNgangahauAotearoa(OTNZ)AnnualReportwhichstatedthatthepressurein

thepublicsectortoprovidemorewithlimitedresourceswillnotchange.Therefore,the

professions’valueofreducingservicecostswhileincreasingpatientoutcomeswillmeet

thesame“need”ofcuttingcostsbyhealthserviceleadersinNewZealand,makingthisan

importanttargetsegment.

Additionally,Figures1.1and1.2showtheNewZealandpopulationchangeovertheyears.

Itclearlyshowsthatthenumberofpeopleover65willcontinuetoincrease,consequently

increasingthestrainonthehealthcareservices.

Figure1.1ElderlyPopulation

(AdaptedfromStatisticsNewZealand,2000)

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Figure1.2NewZealandPopulation:

(AdaptedfromStatisticsNewZealand,2000)

DrKirkReed (2016)highlightedadditional focusareas for theNewZealandhealthcare

systembesidesanagingpopulation.Thefocusareasincluded“increasingincidenceoflong-

term health conditions and the associated complexity of multiple conditions; over

representationofMaoriinnegativehealthstatisticsandsocialfactorslinkedtoincome”.

TheOccupationalTherapyprofession inNewZealandcould investigate thesegroupsof

peopleassecondarytargetsegmentsthatpromotionalactivitiescanbefocusedon.

Thenextstepintheprocessispositioningwherethefocusisonunderstandingtheprimary

targetsegmentofpolicymakersandserviceleadersinmoredepth.

III. Positioning

Positioningrelatestoacustomer’sperceptionofthebenefits,attributesoridentityofthe

service,andtheseelementsareevaluatedandcomparedwithcompetingservices(Chitty,

Hughes&D’Alessandro,2012).Table1.1.showsthatcurrentlythenumberofOccupational

TherapistsislowcomparedtootherAlliedHealthprofessions.Consideringtheabilityof

Occupational Therapy in meeting the need of lowering costs for health services, the

questionarisesastothereasonbehindthis.Isthiscausedbyonlyalackofawarenessof

the profession or does the profession struggle with how it is perceived by this target

segment?

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Table1.1.Numberofpractitionersbyprofession

Numberofpractitionersbyprofession

Year/Profession Occupational

Therapy

Physiotherapy SocialWork Psychology

2016/17 2435° 4906* 5242^ 2757#

*Physiotherapistswithannualpractisingcertificates(PhysiotherapyBoardofNewZealand,2017).

^Socialworkerswithpractisingcertificate(SocialWorkerRegistrationBoard,2017)

°OccupationalTherapistsmightbeworkinginrolesthatdonotrequireacurrentpractisingcertificateareexcludedinabovenumber.

IncludingthesetherapistsmightresultinahighernumberofworkingOccupationalTherapiststhanreportedbytheNewZealandBoard

ofOccupationalTherapy(2017).

#Psychologistswithannualpractisingcertificate(NewZealandPsychologistsBoard,2017).

Developing a position statement involves two main steps: First, the characteristics or

identityoftheserviceneedtobeclearlydefinedandrelatedtowhatthetargetsegments

perceive as important service attributes. Second, the point of difference of the

product/service must clearly identified to show how the service can provide these

attributes better than its competitors (Armstrong et al., 2014). Once the positioning

statement has been established a marketing strategy can be developed to reach the

plannedposition(Armstrongetal.,2014).

Researchaimsandobjectives

The aim of this small pilot studywas to focus on the first initial step of developing a

positioningstatementbyinvestigatinghowOccupationalTherapyisperceivedwithinthe

NewZealandhealthcaresystem.Theresearchquestionaskedinthisprojectwasasimple

one:

DoesOccupationalTherapyinNewZealandhaveanimageproblem?

Theobjectivewastocompleteasmallpilotstudytoidentifyiftheneedforalargerpiece

of work using marketing principles to increase awareness, understanding and

opportunitiesfortheOccupationalTherapyprofession.Inordertodothis,itwasnecessary

to first understand whether there really is a problem. This can best be demonstrated

initiallythroughaliteraturereviewtoidentifyifproblemareashavebeenidentifiedand

what they are. This will lead into the research, where the current perceptions of the

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professionbymembersofthemarketsegmentwillbeinvestigated.Thetwopartswillbe

consolidatedinthediscussionchapterandrecommendationsonpossibilitiesforthefuture

willbemade.

Keytermsused

I. OccupationalTherapyprofession:Forthepurposeofthisstudy,thistermrelates

toeveryonewhoholdsaqualificationinOccupationalTherapy.

II. Stakeholders:Thebusinessdictionarydefinesstakeholdersasa“person,groupor

organizationthathasinterestorconcerninanorganization.Stakeholderscanaffect

orbeaffectedbytheorganization'sactions,objectivesandpolicies.Someexamples

of key stakeholders are creditors, directors, employees, government (and its

agencies),owners(shareholders),suppliers,unions,andthecommunityfromwhich

thebusinessdrawsitsresources.”Forthepurposeofthisstudy,thistermdescribes

anypersonthatcomesincontactwiththeOccupationalTherapyprofession.This

includesbutisnotrestrictedtootherhealthcareprofessionals,otheremployeesin

thehealthcaresector,governmentagenciesandpatients/clients.

Thestructureoftheprojectreport

Inadditiontotheintroductionchapter,thisresearchreportincludesaliteraturereview,

methodology,findingsandadiscussionchapter.

Theliteraturereviewexploresliteraturerelevanttotheresearchquestionwiththeaimof

identifyingagapinthebodyofknowledgetoensuretherelevanceofthisresearchproject.

The following themes have been identified: 1) The Value of Occupational Therapy , 2)

ProfessionalIdentity3)PerceptionofOccupationalTherapy.Overall,theliteraturereview

indicatedthattheOccupationalTherapyprofessionhasalong-standingissuewithhowit

isperceivedwithinthehealthcaresector.Eventhough,theliteratureclearlyidentifiedthat

OccupationalTherapyaddssignificantvaluetohealthcareandpatientoutcomes,italso

highlighted persistent problems with its professional identity and confidence. Aspects

thoughttocausetheproblemtopersisthavealsobeenidentified.

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Thethirdchapterdescribesthemethodologyandmethodsusedinthisstudyindetail.This

studyusedinterpretivedescriptivemethodology.Fiveresearchparticipantswererecruited

using purposive sampling method (snowballing). The research participants were Allied

HealthProfessionalsotherthanOccupationalTherapists.Semi-structuredinterviewswere

usedtocollectthedataforthisstudy.QUAGOL,a10-stepdataanalysismethod,wasused

toanalysethedataanddevelopthefindings.

Chapter4willprovideadescriptionofthestudy’sfindings.Thefindingsweregroupedinto

thefollowingcategories:1)TheValueofOccupationalTherapy,2)Professionalidentity,3)

PromotionOccupationalTherapy,4)EnvironmentandSystemsconstructs. InChapter5,

the findings arediscussed in relation to the themes identified in the LiteratureReview

(Chapter 2) and recommendations for further research are identified. Further, the

limitationsofthestudyarehighlighted,andtheprojectreportisconcluded.

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CHAPTER2

LITERATUREREVIEW

Introduction

Thischapterprovidesanarrativeoverviewofarticlespublishedregardingtheperception

(image)of theOccupational Therapyprofession. Theaim is todemonstrate that issues

surroundingtheperceptionoftheOccupationalTherapyprofessionhavebeenatopicof

interestanddebatewithintheprofessionformanyyears.

Searchstrategy

DatabasesincludingCINAHL,ProQuestandOTSeeker,wereusedtocompletethesearch

forrelevantarticles.ThelimitationparameterappliedwasarticleswritteninEnglish.No

publicationtimeframeor locationrestrictionwassetforthesearchtocreateahistoric,

narrativeoverview.Articlesfrom1970to2016wereincluded.Thearticleswerereviewed

bytitleandabstractand, ifdeemedrelevant, itemsincludedintheselectedarticles.All

articlesselectedwerereadthoroughlyandifrelevantwereincludedinthisreviewchapter.

Ifrelevant,articlesincludedinthereferencelistoftheincludedarticleswerealsoincluded.

Table2.1:SearchStrategy

Searchterms Articlesfound Articlesselected Articlesincluded

Occupational Therapy

&Image

164 28 26

Evaluationofarticles

Manyofthearticlesfound,reviewedandincludedareopinionpiecesandnotreportingon

outcomes of research studies. The few articles available reporting on the outcome of

researchstudiesarecompletedinspecificpracticesettingsusingasmallsamplesize,which

makestransferringorgeneralisingthefindingsproblematic.Also,mostarticles included

havebeenpublishedoutsideofNewZealand,makingitdifficulttostatewithconfidence

thatthereportsarerepresentativeoftheNewZealandcontext.

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Themes

The below opinions and statements within the chapter are representative of the

informationprovidedbytheauthorsofthearticlesreviewed.Thefollowingthemeshave

been identified in the literature reviewed: 1) The Value of Occupational Therapy, 2)

Professionalidentityand3)PromotionofOccupationalTherapy.

Thethemeof"TheValueofOccupationalTherapy"focusesonOccupationalTherapybeing

perceivedasaprofessionaddingsignificantvalue to thehealthcaresectorandpatient

outcomes.Thesecondtheme"ProfessionalIdentity"coversOccupationalTherapy'swell-

documented difficulty with professional insecurity and identity confusion as well as

identifyingfactorscontributingtotheissue.Thethirdtheme"PerceptionofOccupational

Therapy" examines statements by stakeholders indicating their understanding and

recognitionofOccupationalTherapy,includingtheeffectivenessofincreasingawareness

oftheprofessionthroughpromotionaleffortsinthepast.

I. TheValueofOccupationalTherapy

Acommonthemetraditionallyidentifiedwithintheliteratureisthatacrossitshistorythe

professionhasbeenperceivedtoaddsignificantvaluetothehealthcaresectorandpatient

outcomes (Smith, 1986; Froehlich, 1992; Hagedorn, 1995; Goren, 2002; Williams &

Bannigan,2008;Turner2011;CollegeofOccupationalTherapists,2016;Reed,2016).

In 1986, Smith's mixed-method study on the perception of Occupational Therapy by

doctorsandwardsistersshowedthatbothhadtheperceptionthatOccupationalTherapy

adds value to the care of stroke survivors and wheelchair users. In her 1992 article,

OccupationaltherapistandAssistantProfessorattheUniversityofNewEngland,Jeanette

Froehlich, stated that Occupational Therapy provides a service that is essential and

valuabletosociety.Threeyearslater,inher1995DrElizabethCassonMemorialLecture,

OccupationalTherapistandauthor,RosemaryHagedorn,statedthattheneedtopurchase

OccupationalTherapy servicesacross thevarious settingsof thehealth care sectorhas

beenwell identifiedandrecognisedbypurchasers(service leaders). Inhis2002opinion

piece,OccupationalTherapist,AdamGoren,highlightedthattheprovisionofpersonalised

servicesisaqualitycloselyassociatedwiththevalueofOccupationalTherapy,makingthe

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professionincreasinglyvaluabletoahealthcaremarketthatisshiftingitspolicyawayfrom

a one-size-fits-all approach to services that meet individual needs. In 2005, Lead

OccupationalTherapistinResearchandDevelopment,HillaryWilliams,andherco-author,

KatrinaBanning,statedthattheOccupationalTherapyprofessionhasvaluableexpertise

andisanassettomultidisciplinaryteams.

Themessagecontinues in2011whenProfessorofOccupationalTherapy,AnnieTurner,

highlighted, in her Elizabeth Casson Memorial Lecture, that Occupational Therapists

provideavaluablecontributiontohealthcareandpatientoutcomes.Thenagainfiveyears

later,theCollegeofOccupationalTherapists(2016)publishedkeymessages(outlinedin

Chapter1)highlightingthesignificantvalueofOccupationalTherapywithinvarioushealth

caresettingsandservices.

Also, in 2016, the Director of National Centre for Interprofessional Education and

Collaborative Practice, Dr Kirk Reed, explained the value of Occupational Therapy by

highlighting the profession's capacity to take the lead in collaboratingwith and across

disciplinesandservices.Healsohighlightedthestrengthof theprofession inbringinga

uniqueperspectivetotheplanninganddeliveryofHealthcareservices(Reed,2016).He

stressedtheprofession'suniqueabilitytobridgemedicalandsocialmodelsbyusingan

enablingapproach(Reed,2016).Otherprofessionalsignificantcontributionsmentionedby

Reed (2016) included the reduction of hospital admissions and overall enabling

independent livingbyfocusingonresilienceandanasset-basedapproach.However,he

stressedthattogoforwardtheprofessionneedstodothingsdifferently,rethinkwhere

Occupational Therapy is going and have a clear purpose behind what Occupational

Therapistsaredoingratherthandoingthingsforthesakeoftheprofession(Reed,2016).

Despite all the positive focus on the value of the profession, there does seem to be a

problemwithitsimage.Thefollowingsectionsdiscussproblemareasrepeatedlyidentified

intheliteratureovertime.

II.ProfessionalIdentity

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OccupationalTherapy'sdifficultywithprofessionalinsecurityandidentityconfusioniswell

documented.TheconfusionregardingthenatureandroleofOccupationalTherapyexists

withintheprofessionandconsequentlywithexternalstakeholders,affectingOccupational

Therapists’practiceandtheperceivedvalueoftheprofession(Finley,1998;Goren,2002;

Friedland& Silva, 2008;Wright&Rowe, 2005;Mackey, 2007; Turner, 2011; Brewer&

Rosenwax,2016).

In1998,Occupational Therapist, LindaFinlay stated, aspartofherPhD thesis that the

diverseapplicationofOccupationalTherapyaddsto‘aprofoundsenseofconfusionabout

thenatureOccupationalTherapy'.FinleyissupportedlaterbyGorenin2002whopointed

out that Occupational Therapists' difficulty in explaining their profession results in

stakeholdershavingdifficultyunderstandingit.Stakeholderswillcontinuetoconnectthe

OccupationalTherapyprofessionwiththeclosestidentifiablethingsuchasbasketweaving,

while an easy to definenameand identity remain absent (Goren, 2002).Goren (2002)

claimsthatthelackof identitycausesasenseofprofessional insecurity inOccupational

Therapists,whichinturncausesatendencyforthepractitionerstobecomeover-identified

with their profession, often at the expense of the profession's practice. Goren (2000)

furtherquestionsthereasonwhyhealth,socialandeducational institutionscontinueto

engageOccupationalTherapyservicesasduetothedifficultyindefiningandquantifying

the nature of the Occupational Therapy profession, the profession struggles to

communicateitsvalueandbenefitsclearlytoservicepurchasers(serviceleaders).

In2005,occupationaltherapistsCathyWrightandNickRowecontinuedGoren'sargument.

Intheiropinionpiece,Wright&Rowe(2005)wrotethatprofessional insecurityandthe

lack of professional identity are limitingOccupational Therapy's ability to trulywork in

genuinepartnershipwithoradvocateforserviceusers,reducingthepractitioners'ability

tofulfiloneofOccupationalTherapy'skeyvalues:client-centeredness.WrightandRowe

(2005)arguedthatthiscausestheprofessiontomaintainaperceptionof"optionalextra"

in the eyes of stakeholders. Wright and Rowe (2005) explained that the profession's

insecurityisdifficulttoovercomeuntiltheprofessioncanprovideacleardefinitionofits

nature.Until thenstakeholderswillcontinuetoconnectOccupationalTherapywiththe

closestidentifiablethingorholdontostereotypicalimages,causingOccupationalTherapy

22

toremaininthepositionofan"optionalextra"(Wright&Rowe,2005).WrightandRowe

(2005)alsopointedoutthatthesestakeholdersoftenfunctionasgatekeepersforreferrals,

whichtheauthors'identifiedasanotherfactorthatincreasesthesenseofinsecuritywithin

theprofession.

In2007,OccupationalTherapyServicesManager,HazelMackey,wrote inanAustralian

Occupational Therapy Journal feature article that identity confusion and professional

insecuritycontinuetobewelldocumented.Mackey(2007)definedprofessionalidentity

astheperceptionofwhatitmeanstobeandactasanOccupationalTherapist.Sheoutlined

thatso far, theprofessionhasattemptedtosculptan identitybydefiningasupporting

knowledge base, build professional autonomy and gain amonopoly over a specialized

practiceareatoidentifytheprofession'sboundaries.In2008,JudithFriedland(Professor

ofOccupationalTherapy)andJenniferSilva(OccupationalTherapist)wrotethatthefact

thatOccupationalTherapists strugglewithprofessional insecurityshowstheneed fora

strongeridentitywithintheprofession.Toestablishastrongidentity,acleardefinitionof

thenatureofOccupationalTherapyisneeded(Friedland&Silva,2008).

Thethemeofprofessional insecurityand identitywasagainpickedupbyAnnieTurner,

ProfessorofOccupationalTherapy,in2011.Turner(2011)wroteinherElizabethCasson

memoriallecturethatOccupationalTherapyhashistoricallyexperienceddifficultieswith

itsidentityandconfidence.Turner(2011)highlightedthatalargepartoftheprofession’s

identity problems arose from the tension between the profession's heritage and the

environmentitdevelopedin.Sheexplainedthatidentityisformedthroughsocialisation

wherelessthanpositiveinteractionswithotherscanresultinapoorsenseofself(Turner,

2011). This issue was identified 13 years earlier by Linda Finley (1998) who wrote

OccupationalTherapistsarechallengedbythecaring-powerrelationshipandaredamaged

bylackofrecognition.Therelationshipwithmedicineandtheemphasisonsciencecreated

dependence and outweighed the focus on prevention and promotion of self-health

(Turner,2011).Turner(2011)explainedthatduetoOccupationalTherapy'sfocusonself-

health, it is aminoritygroupwithin thehealth care system.Asa result, theprofession

lackedguidanceandstatusduringitsdevelopmentwhichresultedinapoorprofessional

identity (Turner, 2011). To gain acceptance, Occupational Therapy started to focus on

23

remediation of impairment instead of promoting self-health, starting to adopt other

professiontheorybasesandtechniquestoappearmorescientific(Turner,2011).Itisthis

dualheritagewhichhascauseddifficultywiththedevelopmentoftheprofession'sidentity

inthepastandthe lengthoftimethis issuehasbeendocumentedisan indicationthat

thingsarenot improving (Turner,2011).Turner's statementappears tohold trueas, in

2016,MargoBrewerandLornaRosenwax, fromtheFacultyofHealthScienceatCurtin

University,wrotethatfewcouldanswerthequestionof‘WhatisOccupationalTherapy'.

a. Marginalisationoftheprofession

TheCambridgeDictionarydefinestheverbmarginaliseas"totreatsomeoneorsomething

asiftheyarenotimportant".Froehlich(1992)namestwoconceptsthathaveanespecially

strongeffectontheidentityofOccupationalTherapists:Ablebodismandsexism.Froehlich

(1992)explainedthatablebodismdescribesthemarginalisationofpeoplewithdisabilities

fromsocietythroughnegativeoruninformedattitudesbypersonswithoutdisabilities.She

continuesbyoutlining thatsexismcommunicates towomenthat theyare lesscapable,

intelligentandimportantcomparedtomen(Froehlich1992).Froehlich(1992)supported

her claim by drawing attention to the gender pay gap and sexual and family violence

statistics, explaining that these facts exemplify the effects of sexism. Even though the

situationhasimprovedsinceFroehlich'sarticle,recentmovementssuchas#metooshow

thatwomenarestillsubjecttotheeffectsofsexism.Twenty-sevenyearsago,Froehlich

wrotethatinaworldthatcontinuestohaveapoliticalandsocialstructuredominatedby

men,sexismconveystowomenthattheyareless(Froehlich,1992).

Froehlich(1992)consideredthatthecombinedeffectofsexismandablebodismiscausing

thelowrecognitionandvisibilityoftheprofession.OccupationalTherapydoesnotonly

serve persons generally undervalued and oppressed by society, such as people with

disabilities,butisalsodominatedbyundervalued/oppressedworkers(women).Themost

debilitating effect of oppression is the internalisation of negative stereotypes by the

membersoftheoppressedgroup(Froehlich,1992).Forwomen,oppressionisknownto

cause doubt of a person's own value and competency. For Occupational Therapists to

becomeaproudandvisibleprofession,theeffectsofablebodismandsexismneedtobe

24

rejectedtocreateapathforOccupationalTherapiststobecomeadvocatesforequalrights

forallpeople,includingitsmembers(Froehlich,1992).

These concepts, if not by name but in meaning, were picked up again in 2001 when

Occupational Therapy Lecturer, Susan Griffin, contributed the experience of the

Occupational Therapy profession being treated with less respect to the fact it is a

predominately female profession. When the idea of professionalism was created, the

motive was to permanently set up male characteristics such as power, control and

possession. Griffin (2001) highlighted that Occupational Therapists were historically

accepting, non-assertive and conflict-avoiding and that the profession accepted a

submissiveposition,sustainingtheprofessions'problemstodrawattentionfrompower

holdersandbeingtreatedlessthanitdeserves.

This issueismentionedagainbyWielding in2011.Herstudyindicatedthatthecultural

socialisationofwomentobepassive,caring,accommodatingandcomplianttoinstitutional

structuresbeinganunderlyingcauseoftheprofession'sself-limitingandoverlyconformist

behaviourwhichinturncontributestoissueswithprofessionalidentityandprofessional

regard.Wilding (2011) also found that occupational therapistswho participated in her

studyidentifiedthatthroughtheprocessofprofessionalsocialisation,studentsandnew

graduatetherapistsreceivedakeymessagethattheyshouldactinaconformistwaywhich

shaped these young therapists' perception of what being an Occupational Therapist

means. Wilding (2011) explained that Occupational Therapists who are assertive are

labelledaswhinging, troublemakersor confronting. Together, thesemessages create a

feeling of powerlessness underOccupational Therapists (Wilding 2011).Wilding (2011)

linksthisfeelingofpowerlessnesstoOccupationalTherapistsfallingsilent.

HeldkeandO'Connor(2004)describepowerlessnessasoneofthefivefacesofoppression.

Theyexplainthat:

"powerlessness that creates what Freire calls a Culture of Silence. According to

Freire,oppressedpeoplebecomesopowerlessthattheydonoteventalkabouttheir

oppression.Iftheyreachthisstageofoppression,itcreatesaculturewhereinitis

25

forbiddentoevenmentiontheinjusticesthatarebeingcommitted.Theoppressed

aresilenced".

Wilding (2011) wrote that the Occupational Therapy profession has fallen silent. Even

experiencedtherapistsfeelpowerlesswhenwantingtoofferanoccupationalperspective

inamultidisciplinaryteamoperatinginthe'Leviathanofthehealthcaresystem'.Shefound

thatOccupationalTherapistshavetheinaccurateperceptionthatdeficitsintheirpractice

causedthelackofregardandunderstanding.Studentsandnewgraduatesfeelvulnerable

and adopt the profession's conformist behaviour and culture of silence through

socialisation.

In2016,DrKirkReedwrotethatitistimetocastoutthemyththatissuesinleadershipare

caused by the fact that Occupational Therapy is a female-dominated profession and

encourages the development of fearless leadership. He acknowledges that societal

oppressiondisproportionatelyaffectswomen;however,hesaysthatfeministleadership

has much to offer, especially for the Occupational Therapy profession. He further

encourages toput aside the "kiwinotionof the tall poppy syndrome" to create strong

leadershiptoleadtheprofessionintothefuture.

b. Culturalimperialism(medicalmodel&language)

"CulturalImperialisminvolvestakingthecultureoftherulingclassandestablishingitas

thenorm.Thegroupsthathavepowerinsocietycontrolhowthepeopleinthatsociety

interpret and communicate. Therefore, the beliefs of that society are themostwidely

disseminated and express the experience, values, goals and achievements of these

groups."

(IrisYoung,2004).

In the 2009 Annual College of Occupational Therapy Specialist Section Mental Health

Annual Lecture,Creekexplained thatOccupationalTherapy still accepts the ruleof the

medical model. Creek further argued that the medical model is established on a

structuralist understanding in which knowledge is considered context free, objectively

fixedanduniversal(Creek,2009).Incontrast,OccupationalTherapy'sphilosophyshowsa

26

clear influence of pragmatismwhich is reflected in the profession's individualised and

contextualisedpractice(Creek,2009).

OccupationalTherapyeducationisbasedonstructuralistknowledgewiththecurriculum

including theories,modelsandprocesses (Creek,2009)whileexperiencedOccupational

Therapists’ practice expertise is of a pragmatic and intuitive nature and therefore

therapists find it difficult to explain contextual, person-centred Occupational Therapy

practice using objective non-contextual theories andmodels provided to students in a

universitysetting(Creek,2009).Creek(2009)continuesthatastructuralistknowledgebase

providesOccupationalTherapywithtoolstothinkaboutandworkwithhealthconditions

reducingpeoples'abilitytoperformmeaningfultasks;however, itshouldnotgovernor

drive the Occupational Therapy process or goals. Creek (2009) highlighted that this

disconnectbetweentheoryandpracticeisoneofthemainissuesfordevelopingamature

profession.

This isnotanew issue.Mocellin (1995),Creek (1997),Wright (1998)andGoren (2002)

arguedthattheOccupationalTherapyprofession'stendencytousebiomedicalscienceto

validateitselfonlyincreasesthechallengeofbeingunderstood.Goren(2002)statedthat

tosurvivemarketforces,theOccupationalTherapyprofessionassociateditselfwithother,

morepowerfulcultureswithinthebiomedicalmodelasawaytodealwiththecomplexity

oftheprofession.Asaresult,practitionerschangeintomoreidentifiableroleswithgreater

objectively measurable value or which are in some measure more appreciated or

recognized (Goren, 2002). Goren (2002) highlighted the risk of practitioners 'becoming

stuck'inoneoftheserolesandabandoningtheprofessionaltogetherorheavilyinvesting

inanareaofexpertisenearing its sell-bydate.HooperandWood(2002)describedthe

decision to align Occupational Therapy withmedicine as the long conversation where

pragmatism, representing returningpersons'qualityof life,madeway for structuralism

and the understanding of how to fix body parts. In 2008, Friedland and Silva queried

whetherthealignmentwithmedicinedistractedOccupationalTherapyfromitsfocuson

occupationastheessenceoftheprofession.

27

Goren(2002)arguedthatthedualityofcombiningapragmaticpracticewithastructuralist,

scientific language and evidence base is the main cause for Occupational Therapists’

difficultyarticulatingtheirinterventionsclearly.Brenner(1982)claimedthatlanguagethat

is formal and context-free could not express the complexity of expert Occupational

Therapypractice.Mocellin(1995),Creek(1997),Wright(1998)andGoren(2002)argued

thattheOccupationalTherapyprofession'stendencytoattempttousebiomedicalscience

andlanguagetovalidateitselfonlyincreasesthechallengeofcomplexity.

In2009,Creekusedanexampleofawell-knownOccupationalTherapytaskofmakinga

cupofteawithclientsorpatientstohighlighttheconnectionbetweenlanguageusedand

theunderstandingofOccupationalTherapy.SheexplainedthattheOccupationalTherapy

purpose of the task was for the client to 'overcome her anxiety enough to engage in

graduallyexpandingtherangeofsociallyappropriateactivities'(Creek2009).Creek(2009)

highlightedthattheexactprocessofhowthiswasachievedbythetaskofmakingacupof

tea is difficult to express in words as much of the intervention involves non-linguistic

thinking. Creek (2009) explains that the current use of language by the Occupational

Therapyprofessioncausestensionbetweenwhattheprofessionperceivestobethegoal

of intervention by focusing on lived experience and communicating these goals using

languagebasedonabiomedicalvocabularyadaptedtodescribethesegoals.Asaresult,

manyoftheotherprofessionsseethepurposeofthetaskasmakingthecupoftea.

Creek(2002)alsohighlightedtwoconnectedissues.Thefirstonewasthefactthat,dueto

theprofession'sacceptanceoflanguagethathasbeendevelopedbymedicalprofessionals

or psychologists (Creek, 2009), differentiating Occupational Therapy from these

professions is difficult. Much of what Occupational Therapists do cannot be easily

translated into language, therefore using medical/psychological language to describe

OccupationalTherapypracticebecomesreductionistasthewordsusedshapeourthinking

anddoing(Creek,2009).Theotherissuesheraisedisthefastandcontinuousdevelopment

of new Occupational Therapy terms with no clearly defined meaning. Creek (2009)

explainedthatthis indicatesthattheprofessiondoesnotpossessitsownvocabularyto

describe the nature and purpose of its practice. She further highlights that when

28

OccupationalSciencelanguageisused,otherprofessionseitherignoreitor'makefunof

us'(Creek,2009).

TouseYoung's(2004)definitionofculturalimperialism–themedicalmodelistheruling

class within the Western health care systems and its values control how health care

professionals communicate and interpret health. This causes an ongoing issue for

OccupationalTherapy.

III. PerceptionofOccupationalTherapy

Another theme identified in the literature is that stakeholders often have a lack of

understandingoftheroleofOccupationalTherapywhichcanresultinafalseordamaging

perception of the profession. In 1986, Smith conducted a small study on the lack of

referrals to a hospital's Occupational Therapy team in the United Kingdom. The study

showed that doctorswere primarily concernedwith themedicalmanagement of their

patientsandshowedalackofunderstandingand,attimes,lackofinterestinthevaluethat

OccupationalTherapycanprovidetopatientcare.In1989,Blom-Cooperwroteareport

fortheIndependentCommissiononOccupationalTherapybasedintheUnitedKingdom.

Thereporthighlightedthefactotherhealthcareprofessionalsoftendisplaya'falseand

damagingstereotypeofthefunctionofOccupationalTherapists',afactalsohighlightedin

laterstudies.In1992,Froehlichclaimedthatmanyrelatives,friendsandco-workersstill

donotknoworunderstandwhatOccupationalTherapyisandquestionedifOccupational

Therapistsaregoodadvocatesoftheirprofession.

In1994,GreenhillconductedastudyinvestigatingGPs’awarenessoftheroleandservices

of Occupational Therapists prior and post the introduction of the General Practitioner

ContractbytheNationalHealthService(NHS)intheUnitedKingdom.Herfindingsshowed

thatthereisaninconsistencyintheunderstandingoftheroleandbenefitsofOccupational

TherapyamongGPs.In2000,FortunewrotethatOccupationalTherapistsareperceivedas

'gap-fillers' or 'competent all-rounders. In their 2005 study, Wilkinson and Chard

highlighted the fact that secondary students are often not provided with adequate

informationaboutOccupationalTherapycausingalackofawarenessandunderstanding

oftheprofession.In2009,KinnandAasclaimedthatOccupationalTherapistsareexpected

tobeflexibleandshiftbetweenrolestosupportclients.

29

IV. Recognition(lowstatus)

Thelackofrecognitionoftheservicewasalsoacommonthemeovertheyears.In1989,

Blom-Cooper stated that due to the difficulty in measuring outcomes of Occupational

Therapyinterventions,itisaprofessionthatislikelytobeperceivedasperipheralorjudged

asluxuriousbyafinanciallystrainedhealthcaresystem.In1992Froehlichstatedthatthe

profession continues to struggle with having the value of its service recognized, even

though considerable energy has been committed over the last century to develop and

promotetheprofession.In1995,Hagedornstatedthattheprofessioncontinuestofailin

sufficientlyraisingitsawarenessandprofile.Asaresult,recommendationstoemploymore

OccupationalTherapistsarenottakenseriously(Hagedorn,1995).

Inhis2002opinionpiece,GorenvoicedconcernthatOccupationalTherapy,likeanyother

serviceoperatinginanymarket,isrequiredtoconvincepurchasers(serviceleaders)and

usersofitsservicevalue(Goren,2002).Heexplainedthatthisisstronglyconnectedtothe

abilitytoclearlydescribethecharacteristicsoftheserviceandproofofitsvalueformoney

as it is difficult to bemeasured by quantitative scientific data (Goren, 2002). This is a

persistentissueforOccupationalTherapyastheprofessioncontinuestostruggletoclearly

define itself and the Occupational Therapy process is not simply described or

demonstrated(Goren,2002).

In 2005, William and Bannigan reported that occupational therapists often express

frustrationoverthefactthatmembersofotherdisciplinesdonotunderstandtheroleof

theOccupationalTherapist.Therapistsfurtherexpressedthattheyfeelundervaluedand

misunderstood by their team members (William & Bannigan, 2005). Hagedorn (2005)

describedtheprofessionasinvisibleandhavingfailedtoraiseanadequatepublicprofile.

Shedescribedthepublicimageoftheprofessionasdistortedandthattheunderstanding

of the role of Occupational Therapists is restricted to 'limited circles of influence'

(Hagedorn,1995).

In2009,KinnandAasstatethatpreviousresearchindicatedthatoccupationaltherapists

experience job satisfaction if their role is central, however that there seems to be a

connection between a strong sense of self-value and the lack of recognition by others

(Bellner,1995;Duffy&Nolan,2005;Finlay,1998;Mooreetal.,2006;Sachs&Jarus,1994

ascited inKinn&Aas,2009).Eventhoughstudiesshowedthatmanytherapistshavea

30

positive self-image, many described feeling invisible, misunderstood, undervalued and

stereotypedbyahistoricimage(Kinn&Aas,2009).

In2011,Turneragaindrewattentiontothefactthat,throughouttime,membersofthe

Occupational Therapy profession have felt unappreciated and misunderstood by both

colleagues and the public. She claims that at times, Occupational Therapists are not

perceivedasequalsduetotheirstrugglestocommunicateclearlywithinmulti-professional

teamsandtheperceptionofOccupationalTherapistsbeinggapfillers(Turner,2011).Also,

in2011,Wildingstatedthattheoccupationaltherapistswhoparticipatedinherstudyfelt

thattheprofessionisnotawardedtheregardthatitdeserves.Afteraninvestigationinto

serviceleaders'perceptionofOccupationalTherapyin2016,theCollegeofOccupational

Therapistsreportedthattherecontinuestobealackofunderstandingofthevaluethat

OccupationalTherapyisaddingtohealthcareandpatientoutcomes

V.PromotingOccupationalTherapy

In 1986, Smith highlighted the need to improve communication with other health

professionalstoimprovetheunderstandingofandinterestintheOccupationalTherapy

profession. In1994,Greenhill recommended thatOccupationalTherapistsdevelopnew

marketingstrategies,particularlyinformationonOccupationalTherapyservicesandtheir

benefits, to ensure the need and the benefit of Occupational Therapy services can be

identifiedandutilisedaccordingly.Besidemultiplerecommendationsandexamplesover

theyears,in2002Gorenstatedthat'asolutiontotheproblemofmarketingaprofessional

imageandfunctionremainselusive'.

Authorscontinuedtoexaminetheissueandproviderecommendationsforimprovement.

In 2005,Wilkinson andChard recommended increasing the awareness ofOccupational

Therapy as a career choice by providing informationalmaterial to career advisors and

throughcommunicationchannelspreferredbysecondarystudents.In2008,Friedlandand

Silva recommended following the example of Thomas Kidner, the president of the

AmericanOccupationalTherapyAssociation(AOTA)postWorldWar1,whotheauthors

describeasexcellinginhiseffortstopromotetheprofessiontothepublicandotherhealth

careprofessions.Kidnerbelievedintheadoptionofpoliticalreformers’motto"organise,

31

agitate,educate"(Friedland&Silva,2008).DuringhistimeaspresidentoftheAOTA,he

travelledwidelytospeaktoandcreatecloserelationshipswithavarietyofpeople,groups

andassociations including theAmericanMedicalAssociationwhichasa result included

lecturesonOccupationalTherapy intothecurriculumformedicalstudents(Friedland&

Silva, 2008). He further used print media and radio to increase the awareness and

understandingofOccupationalTherapybythepublic.FriedlandandSilva(2008)reflected

on Kidner's work and recommended to continue to apply his strategies to give

OccupationalTherapyapresence.

In 2011, Turner and Wielding provided different explanations for the lack of

marketing/awarenessoftheprofession.Turner(2011)wrotethatOccupationalTherapy

hasalackofpassionandabilitytopromoteitselfandstressedtheimportanceofmaking

strategic'friendships'tocreateawareness.Wilding(2011)ontheotherhandwrotethat

OccupationalTherapyasaprofessionhasoverlypromotedthetraitsofnice,passiveand

complianceasdesirabletraitstothedetrimentofgainingrespectandacknowledgement

oftheprofession.Therefore,Wildingrecommendedfocussingondevelopingtherapists'

skills to be assertive and stand up for their professional convictionswhen opposed or

doubted (Wilding, 2011).Wilding’s statements alignwith Griffin (2001) who called for

Occupational Therapists to improve management skills, negotiation skills, conflict

resolutionandpolicymakingskills.Griffin(2001)urgedtheprofessiontodevelopinternal

powerthroughconfidenceandassertiveness.

However,itseemsthatthesegoalsmightrequiresomeconsciousness-raisingonthepart

of the profession. In 2001, Griffin raised concerns about the ability of occupational

therapiststosupportoneanother.Griffin(2001)claimedthatwhentherapistswhoapplied

well established accepted principles, such as the promotion of independence and the

maximisationofpotential for themselvesor theirprofession, theywereoftenmetwith

hostilityfromtheirpeers.

The journey to find an answer continued and in 2012, Jacobsdescribed in the Eleanor

ClarkeSlagleLecturethepromotionaltoolsandstrategiesusedtopromoteOccupational

TherapynotonlyintheUnitedStatesbutbyOccupationalTherapybodiesacrosstheworld

and the profession's existence. From the early days of the profession, thesemethods

32

includednetworking(suchasaligningtheprofessionwithlocalandnationalassociations

ortheuseof'ambassadors'),encouraginginterdisciplinarywork/educationandpublishing

science-driven evidence that guides best practice with the aim to gain respect and

understandingwithinthescience-drivenhealthcaresystem(Jacobs,2012).Othermethods

intheearlyyears includedtravelexhibitions,notunliketheposterdisplaysusedduring

currentOTmonthcelebrations.Othercommonmethodswereandstillarethedistribution

of professional publications or holding events and conferences as well as the use of

brochures, posters and fact sheets.More recentmethods include National Awareness

campaignsorclientgroup-specificcampaigns.

Jacobs(2012)alsostatedthatoverthecourseofthelast100years,OccupationalTherapy

asaprofessionseemedtohaveunder-utilisednewtechnology.Sheexplainedthatittook

several years after its development until Occupational Therapy was mentioned on

televisionandtothisday,unlikeotherhealthprofessionals,isnotwellrepresentedinfilms

or series alike (Jacobs, 2012). This pattern did not appear to be broken since the

introduction of social media. 90% of member countries of the World Federation of

OccupationalTherapy(WFOT)reportedusingprintedpromotionalmaterialwhileonly62%

ofthesemembercountriesusedmaterialsonlinetopromotetheirprofession,however

many of them indicated they were interested in growing their social media presence

(Jacobs, 2012). Walsh (2018), who investigated the visibility and perception of the

Occupational Therapy profession in selectedmedia outlets, continued to highlight that

OccupationalTherapyshouldhaveastrongerrepresentationinnewsandonlineplatforms.

She encouraged individual practitioners to drive the promotion of the profession by

combiningusinggrassrootsadvocacywithaccessiblesocialmediachannels.

Thepersistentissueswithgettingtheprofessionvaluedandrecognisedacrosstime,and

withinmostcountriesandhealthcaresystemsindicatesthatitistimelytoaskthequestion

again:DoesOccupationalTherapyinNewZealandhaveanimageproblem?

Conclusion

The literature showed that thereare several longstanding issues that contribute to the

imageofOccupationalTherapy.Overall,itseemsthatOccupationalTherapyisperceived

to have value. However, the lack of an easily understood name and definition of the

33

profession makes Occupational Therapy's value and benefit difficult to measure and

promotetoservicepurchasers.Occupationaltherapistscontinuetofeelundervaluedand

misunderstood,strugglingtoexplaintheirpracticetostakeholdersandfeelprofessional

insecurity and identity confusion. It is hardly surprising, therefore that stakeholders

continuetomisunderstandtheprofessionanditsvalue,perceivingOccupationalTherapy

asan‘optionalextra'asdescribedbyWrightandRowe(2005).Thiscreatesaviciouscycle,

whereoccupationaltherapistshavenegativeexperiences,furtherdamagingprofessional

confidenceandidentity.

OccupationalTherapyhasstatusasaprofession,andyetitseemsthatasalargelyfemale

profession, it continues tobeaffectedbyvarious formsofoppression,abelbodismand

sexism.Generally,theseareissuesforvocationswithlowstatusandlackofrecognitionin

apatriarchalsystem.Culturalimperialismandthedominanceofthemedicalmodelover

pragmatismandfocusonwell-beingwereoutlinedasreasonsforoccupationaltherapists

fallingsilentandadoptingconformistbehaviourinsteadofadvocatingfortheirprofession

and patients/clients, further reducing the feeling of confidence. Promotional methods

havebeendiscussedandtheliteraturereviewedshowedthateventhougheffortshave

beenmade,OccupationalTherapyisnotachievingthe levelsofawarenessotherhealth

professionsachievewithinmainstreammediaandthepublic.

The literature reviewed indicates that further research on the image of Occupational

Therapy would be beneficial to investigate if any change has occurred and how

stakeholdersperceiveOccupationalTherapywithinaNewZealandcontext.

34

CHAPTER3

METHODOLOGY

Introduction

Inthischapter,adetaileddescriptionofthemethodologyisprovided,outliningtheprocess

anddesignofthestudy.These,inturn,correspondwiththemethodschosentoachieve

theaimofthestudy.Further,themethodsemployedinthisstudyarediscussed,andthe

justificationgivenonhowthesewillprovideanswerstotheresearchquestion.Finally,this

chapterreviewsethicalconsiderationsandhowthesehaveshapedthestudydesignand

processaswellasstrategiesappliedtoensuretherigourofthestudy.

WhatisInterpretivedescription?

Interpretivedescriptionisacomparativelynewqualitativemethodologyparticularlyuseful

for studies conducted within applied health sciences (Thorne, Kirkham &MacDonald-

Emes,1997;Hunt,2009).Thorne(2016)claimsthat interpretivedescription isuseful to

researcherswhofeelthatthetraditionalmethodologiesdonotmeettheneedsofresearch

questionsintermsofdevelopingandapplyingthefindingstopractice.

Whatinterpretivedescriptionconsiders'interpretation'takesinspirationfromtheformal

interpretivehermeneutictradition,withoutbecomingaconfirmedbeliever.Itrecognises

thataclinicalmindtendsnottobesatisfiedwith'pure'description,butseekstodiscover

associations,relationshipsandpatternswithinthephenomenonthathasbeendescribed.

Italsocarries theassumption that thereareothercaseswith relevantsimilarity,which

moves the findings and analysis closer to general knowledge. Interpretive description

suggests that there is inherent value in a careful and systematic analysis of any

phenomenon,combinedwithapressingneedtoputthatanalysisbackintothecontextof

thepracticefieldwithallitsinherentsocial,politicalandideologicalcomplexities.Inthis

way,itbecomespossibletoshifttheangleofvisionfromwhichonecustomarilyconsiders

thatphenomenon.

35

Interpretivedescriptionwasdevelopedwiththeaimofovercomingthetensionbetween

theoreticalintegrity,andtheproductionofknowledgethatcanbeputtoapplieduse.It

does not aim specifically to contribute to social theorising, whichmeans that it steps

outside of the theoretical traditions of social science. The applied nature of this

methodology means that it cannot be carried out using a prescriptive and restrictive

sequenceofsteps,butratherderivesitsintegrityfromtheneedtomeetanactualpractice

goal.Itfurtherderivesitsstrengthbybeingcarriedoutbyapractitioner/researcher,who

understands both the knowledge and the knowledge gap within the field. As such,

interpretivedescriptionprovides thepotential toexamine theviewsonwhichprevious

evidencehasbeenestablished,whilealsocreatinginsightsthatshapetheapplicationof

evidencetopractice.

Philosophicalandtheoreticalcontext

Interpretivedescriptiondoesnotfollowthetraditionalwaystocreatetheoreticalintegrity.

It was deemed useful for the reader to understand the ontological and theoretical

perspectivethisstudywasbasedonastheviewsaboutrealityandhowapersondevelops

knowledgesignificantlyinfluencethestudydesign,processandfindings.

Thisstudydrawsfromthephilosophicalunderpinningsthatsupporttheperspectivethat

"realitydoesn'texistexternallyasanobjectorentitythatcanbediscoveredbutisrather

sociallyconstructed,subjectivelybypeoplewhoexperienceit"(Mottier,2005ascitedin

Thorne, 2008). Research studies based on this philosophical stance respect the

perspectivesofotherswhilefocusingonthecontextinwhichexperiencesorperspectives

developandbecomemeaningful(Thorne,2008).Thisstudy'sdesignwasbuiltonthebelief

that knowledge cannot be outlined as simply objective or subjective but is established

through interactions between people and their world. The world and its objects are

indeterminate,andknowledgeormeaningisconstructedwhenpeopleconsciouslyengage

withtheworldtheyareinterpreting(Crotty,1998).Therefore,allknowledgeandmeaning

have been developed through interpretation. Consequently, the approach the study's

designwasbuiltonaimedtolearnoftheattitudes,feelingsandperceptionsregardingthe

Occupational Therapy profession through conversation and interaction with the

participants.

36

Both the methodology and its philosophical and theoretical context are purposefully

chosen to align itselfwith the pragmatic approach representingOccupational Therapy.

Pragmatic thinkers assume that knowledge is created within a specific context while

structuralistspresupposethatknowledgeisobjectiveandgeneralizable(Hooper&Wood,

2002). Inearlieryears,OccupationalTherapyadoptedbothpragmatistandstructuralist

beliefsabouthumanknowledge,whichproduceddifferentinterpretationsonappropriate

tools, methods and outcomes. This has been identified as a contributing factor in its

ongoing professional identity issues (Hooper & Wood, 2002). The methodology of

interpretivedescriptionisanopportunityforOccupationalTherapytoproduceknowledge

thatcanbeappliedintheprofessions'practicecontext.

Theresearchquestion:

DoesOccupationalTherapyhaveanimageprobleminNewZealand?

Studydesign

I. SamplingandRecruitment

a. Interviewparticipants:Theinclusioncriteriafortheinterviewparticipantswereas

follows:ParticipantswhoworkwithintheNewZealandHealthCaresectorand

workorhaveworkedwithOccupationalTherapistsinsomeform.Theexclusion

criteriafortheinterviewparticipantswereasfollows:Participantsholdingan

OccupationalTherapytertiaryqualification.

b. Terminologyforsamplemembers:

Theterm‘studyparticipants'isusedtorefertoindividualsincludedinthesample

andrecruitedtoparticipateinthisstudy.ThisisbasedonThorne(2016)whostated

thatthetermstudyparticipantshasbecomesomewhatstandardasitisrelatively

neutralinitsimplicationsanddoesnotcarrytheimplicitunintendedbaggagesuch

as the term of "respondents", "informants" or "co-researchers" used in other

qualitativeresearch.

37

c. Samplesize

Thorne(2016)statedthatmoststudiesusingthisapproachusearelativelysmall

samplefrom5to30participants.However,theapproachisalsoapplicabletolarge

samplesandsinglecasestudies.Asthisstudyisanexploratorystudy,arelatively

smallsamplesizehasbeenchosen.Intotal,fivestudyparticipantswererecruited.

ThisseemedappropriateforastudytocompleteaMaster'sproject.

d. Samplingmethodused

Thorne(2016)statesthattherearethreemainsamplingmethodsassociatedwith

interpretivedescription:conveniencesampling,purposivesamplingandtheoretical

sampling.Thisstudyisusingacombinationofpurposiveandconveniencesampling.

i. Purposivesampling

Thestrategyofpurposivesamplingistotrytoidentify,inadvanceofthestudy,

themaingroupingsorconditionsthatyouwillwanttoincludeinyourstudyso

that the eventful findings you produce have the potential of ringing true or

seeming reasonable to your intended audience (Robinson, 2014 as cited in

Thorne,2016).Aparticularand important formofpurposivesampling is the

strategicidentificationofkeyinformantssuchashaslongbeenthehallmarkof

ethnographicstudy(Pelto,2013ascitedbyThorne,2016).Therationaleforkey

informantsisthatsomemembersofacommunitywillbebetterequippedthan

otherstoprovideyouwithaccesstowhatishappeningandwhyitishappening.

Inhealthpractice,theunderlyingideaofthekey-informantmightcauseoneto

seek out individuals with extended experiential backgrounds or who would

havehadexposuretoagroupofpeoplewithbackgroundssimilartotheirown.

ii. Purposivesamplinginthecontextofthisstudy

Using this samplingmethod, the researcher contacted the administrators of

two private health companies. The administrators of these companies

forwardedtheinvitationtoitsemployees.

38

iii. Conveniencesamplinginthecontextofthisstudy

The researcher used snowball sampling, a formof convenience sampling, in

ordertoreachpossibleparticipants.Theresearcherinvitedtherecipientsofthe

invitation to participate to forward the invitation to peers, colleagues or

managers whom they think would be interested in participating. All five

participantswhocontactedtheresearcherwereincludedinthestudy.

e. ProfileofselectedParticipants

Table 3.1: Demographics of Interview Participants

(Pleasenotethatparticipants’nameshavebeenreplacedbypseudonymstomaintainprivacyand

confidentiality)

Name Jane Sarah Sharon Ellen Theresa

Gender Female Female Female Female Female

Age 26 45 26 33 30

Years

practising

4 15 1 5 4

Jobtitle Physiotherapist Social

Worker

Speech

language

Therapist

Psychologist Physiotherapist

Setting Private

Practice

DHB DHB Private

Practice

DHB

Ethics

EthicsApproval forthisstudywasgrantedbyOtagoPolytechnicEthicsCommitteeon3

February2017(Appendix1).TheOfficeoftheKaitohutohuwasconsultedtoensurethe

research study observes the Treaty of Waitangi and its principles as well as the data

collection from human participants, particularly Māori participants. The Office of the

Kaitohutohusupportedtheethicsapplicationbutadvisedtheresearchertocontactthe

office for further consideration should any of the participants be ofMaori ethnicity or

descent.ThiswasnotnecessaryasnoneoftheparticipantsidentifiedwithMaoriethnicity.

39

Confidentiality&Informationstorage.

Allparticipantsweregivenaninformationsheetandhavesignedaconsentform(Appendix

2). The forms were scanned and kept in electronic form on a password-protected

computer.Thetranscriberalsosignedaconfidentialityformandalltranscriptswerestored

onlineonapassword-protectedcomputer.

DataCollection

Thedatawascollectedthroughsemi-structuredinterviews(Thorne,2016).Theaimofthe

interviewswas togainanunderstandingof theperceptionofOccupationalTherapyby

stakeholderswhowereexternaltotheOccupationalTherapyprofession.Atotalnumber

of five interviewswereconducted.Allof the interviewswereconducted inperson.The

interviews followedan interviewschedule (Appendix3)with semi-structuredquestions

andwererecordedontwodevicesandtranscribedfordataanalysis.

DataAnalysis

TheQualitativeAnalysisGuideofLeuven(QUAGOL)wasusedtoguidethedataanalysisof

thisstudy.TheQUAGOLisatheoryandpractice-basedguidesupportingandfacilitating

thequalitativedata analysis process (DierckxdeCasterle,Gastmans). The guideuses a

systematic,yetnotrigid,two-partprocesswhicheachconsistsoffivestages.

Stage1includedthethoroughreadingandre-readingoftheinterviewstocaptureessential

featuresand identify information relevant for the researchquestionbyunderliningkey

phrases,tentativelyinterpretingthemeaningofsomewordsandpassageswiththoughts

orreflectionsnotedinthemargin(Dierckxetal.,2011)(Appendix4).TheobjectiveofStage

1istogainaholisticunderstandingoftherespondent'sexperience,leadingintostage2

wherethisunderstandingisattemptedtobearticulated.

Stage2 consistedof re-reading the interview transcripts again. Inorder to capture the

essence of the stories a narrative report was written for each interview (Appendix 5)

40

identifyingcentralcharacteristicsofthestoriesthatcouldcontributetoagreaterinsight

intotheresearchtopic(Dierckxetal.,2011)

Instage3,themostimportantinformationwasidentifiedandsortedintoconceptsthat

capturedtheessenceofthestoriesregardingansweringtheresearchquestion(Dierckxet

al.,2011).Theconceptswereillustratedinaschemewiththekeyconceptshighlighted.

The analysis moved away from the participant's experience to a conceptual level by

developing a conceptual interview scheme from the narrative report. The aim of the

conceptualinterviewschemewastoestablishconceptsthatgaveinsightintotheresearch

topicbyclusteringthemostimportantdataintoconcepts(Appendix6).Thisprovideda

moreabstractleveloftheinformationprovidedduringtheinterviews.Theconceptswere

helpfulindevelopingthestructureoftheresearchanswerinstep9(Dierckxetat.,2011).

In stage 4, I used what Dierckx et al. (2011), described as a "forward/ backward

movement".Theinterviewswererereadandcomparedtotheconceptualschemesinorder

todetermineiftheconceptsaccuratelyreflectedtheinterviewdataandtoensurethatno

conceptshadbeenoverlooked(Dierckxetal.,2011).

Stage5expandedonstage4byapplyingthebackwards-forwardsprocessfromwithincase

toacrosscaseanalysisinordertoidentifycommonconceptsthroughouttheinterviews.

Theseconceptswerethenaccumulated inoneoverarchingconceptualscheme.Memos

wereusedtorecordtheanalyticalandreflectiveprocessofdevelopingandrefiningthe

commonconceptsandthecommonconceptualschemeresultinginagreaterconceptual

understandingofthedataasawholewhilemaintainingtheintegrityandindividualityof

eachinterview(Dierckxetal.,2011).

Stage6drewoutthegeneralconcepts(withouthierarchy)basedonalltheinterviewsand

developedconceptschemes(Appendix7).

Instage7,Irevisitedeachinterviewwiththelistofconceptsinhandtodetermineifthe

concepts helped to reconstruct the storyline, highlighting the important passages and

linkingaconcepttothesignificantpartsofeachinterview.Thishelpedtotestthequality

41

of the concepts and explained why some concepts were present in some but not all

interviews(exampleinAppendix4).

Instage8,Iengagedinacross-caseanalysisofallconcepts.Theconceptswereformulated

inmyownwords to furtherdefinetheconceptsanddevelopacleardescriptionof the

meaning,dimensionsandcharacteristicsoftheconcepts(exampleinAppendix4).

Instage9,theconceptswereintegratedintoaconceptualframeworkrespondingtothe

researchquestion.Usingtheinterviewschemesseparately,allconceptswereorganised

andstructuredinaframework.Thisframeworkwasalsoverifiedagainstallinterviewsto

ensureallindividualinterviewstoriesweredescribed.

Instage10,theessentialfindingsweredescribedregardingtheresearchquestions,starting

withthecorefindingsbeforemovingtorelatedandinterconnectedconcepts.Quoteswere

addedwheretheycouldaddfurtherunderstandingandclarity.Eventhoughthisisthefinal

stage, continuous comparison was used to further develop insight into the findings

(Appendix9).

Transferability

Transferabilityisconcernedwiththeextenttowhichresearchfindingscanbeusedinother

contexts,settingsorgroups(Krefting,1991).LincolnandGuba(1985)arguedthattoallow

for comparison the researcher needs to present sufficient descriptive data (thick

description).Tosupporttransferability,detailedinformationonallaspectsoftheresearch

processhavebeenincludedinthisreport.

Dependability

Dependability relates to the ability to show that findings are consistent and can be

repeated (Lincoln & Guba, 1985). This refers to the evaluation of methodological

consistency within the study. This was achieved by drawing on the philosophical and

theoreticalunderpinningsofinterpretivedescriptivemethodologytoinstructtheresearch

designandprocess.Themethodologyandresearchdesignwerepresentedtotheprimary

42

supervisorforscrutinyofthedesignoftheresearchstudyandtoensuretheoreticaland

methodologicalconsistencythroughouttheprocess.

Confirmability

Confirmability refers to the degree to which a study's findings are created by the

participantsandnotbytheresearcher'sbiasabouttheneutralityofthedataandmeasures,

andhowwell thedatacollectedsupportstheresearchfindings (Lincoln&Guba,1985).

Confirmabilityisattainedwiththeestablishmentofcredibilityandtransferability(Lincoln

&Guba,1985). Theuseofmemosdocumenting thedecision trail and the researcher's

thoughts,ideasandassumptionsallowthereadertounderstandandfollowtheprinciples

appliedduringdataanalysis.Thememoswereincludedinthedocumentsdescribingthe

stagesofdataanalysis.

Reflexivity

To maintain objectivity throughout the research project I used memos, outlining my

thoughts, feelingsanddecision-makingprocessduring thedataanalysisprocess. Iused

thesereflectionstokeepmyownexperiencesandpreconceivedideasseparatefromthe

participants'descriptionsinordertoallowthefindingstoemergeoutofthedatacollected

fromparticipants.

43

CHAPTER4

FINDINGS

Introduction

This interpretivedescriptivestudyaimedto identify if thereare issueswiththecurrent

imageoftheOccupationalTherapyprofessioninNewZealand.Thethemesidentifiedin

theanalysiswerecataloguedintofourcategories:

i. ThevalueofOccupationalTherapy

ii. ProfessionalIdentity

iii. Recognition

iv. EnvironmentandSystemconstructs

The category ‘value of Occupational Therapy' highlights the knowledge and insight of

participantsregardingthecontributionandbenefitthatOccupationalTherapycanprovide.

Thesecondcategory,‘Professionalidentity,'highlightsissueswithprofessionalinsecurity,

roleconfusionandboundaryconcernstogetherwiththeprofession'sdifficultyofworking

withinamedicalmodel.Thenextcategory,‘Recognition',highlightsissuescausedbyalack

ofunderstandingofOccupationalTherapyandthepromotionoftheprofession.Thelast

category,‘EnvironmentandSystemconstructs'illustrateshowthephysical&institutional

environment shapes other health professionals' understanding and perception of

OccupationalTherapy.

Themes

i. ThevalueofOccupationalTherapy

AllparticipantsperceivedOccupationalTherapyasvaluable.Participantsuseddescriptive

words suchas "invaluable", "important", "mostuseful thing", "practical" "undervalued"

and"underestimated"whenaskedtodescribeOccupationalTherapy.Severalwaysthat

theOccupationalTherapyprofessionaddsvaluewereidentifiedduringtheinterviews.The

profession'sabilitytoincreaseaperson'sindependencebyrestoringfunctionafterillness

orinjury,willconsequentlyreducesupportservicescostsandthenumberofre-admissions

44

wasidentifiedasvaluabletotheNewZealandhealthcaresystemasitdirectlyrelatesto

contributingtoadecreaseinhealthcareexpenditure.

"So,Ithinkthebiggestthingisgoingtobetryingtoimprovedischargeplanning.

AndIthinkthatisareallykeything,becauseifyoucangetsomeoneindependent

withfunctionaltasksthattheyneedtododayinanddayout,you'regoingtoreduce

theburdenontheirprivatecareagencies,orpublic-fundedcareagenciesthathave

to thenprovidehelp forpeoplewhomaynotneed it. […] that'sasaving for the

healthcaresystem, isn't it?Andgettingpeopledischarged Iguesssooner, rather

thanthinking,they'rejustnotmakinganyfunctionalgainsbecausesomebodyelse

isdoingitforthemallthetime."

The profession's ability to see the bigger picture was also identified as a strength

characterising Occupational Therapy. Participants mentioned that it is helpful that

OccupationalTherapistshaveaholisticpictureofpeopleas itaidsotherprofessions to

target their treatment to the areas that will increase the people’s independence and

enablethemtomanagetheirdailylivestothebestoftheirability.

"AndIthinkthatisthemostimportantthingattheendoftheday,thatsomebody

isabletolivetheirlifeandmanagethatinasindependentamatterastheypossibly

can."

Theprofession's capability toassessaperson's ability and safetywith completingdaily

taskswasdeemedvaluablefordischargeplanning.Anotherstrengthoftheprofessionwas

toassessapersons'independenceversusneedforsupportservicesandthereforereduce

admissionsorreadmissionstohospitals.WithoutOccupationalTherapy'scontributionto

dischargeplanning,participantsthoughtthatmorepeoplewouldbere-admittedtothe

hospital, and more people would struggle in silence. Without Occupational Therapy,

peoplewerebelievedtohaveareducedchancetoreturnhomeorbacktoworkafteran

injuryorillness.

45

"Theymightsay,"Oh,thispersonwillbeokay.Ithinkthey'llmanage."Whereas,the

OTcansay,"well,actually,I'vebeendoingallthesmalldailytasksandtheycan't

manage."Inthatsense,it'sinvaluablebecauseit'spreventingpeoplebeingatrisk."

Collaboratingwithoccupational therapistswasperceivedasveryvaluableandpositive.

Participants perceived collaborating with an Occupational Therapist as beneficial as it

providedawiderperspectiveandhelpedinvalidatingtheirownclinicalreasoning.

"So, I'll do […] assessments, but they'll also bedoingawhole loadof functional

assessments.AndsoIguessit'simportantthatwetalktoseeifwhatwe'refinding

kindofmatchesup,oriftherearebiggap,whichmightindicatesomething'sgone

wrongineitherofthoseprocessesorwearecapturingsomethingthatisnotthere

orsomethingdifferent"

ParticipantsdescribedtheflexibilityofOccupationalTherapists toworkacrossdifferent

areas as useful. Occupational Therapists are perceived to be guided by a functional

approachtotreatmentthatcanprovideotherhealthprofessionalswithvaluablesupport

orguidancetotheirtreatmentapproach.

"Ithinkhavingthatflexibilityaroundwhatyoudoprobablymeansthatyou'remore

useful.Ithinkthat'smaybeagoodperceptionthatpeoplecansay,"Allright,well

theOTscandothis.WecanworkwiththeOTsonthis."Becauseyoucanworkacross

allthedifferentareas."

Unfortunately,eventhoughparticipantsdescribedOccupationalTherapistsasusefuland

beneficial,athemeemergedthatshowedthatthisflexibilityofOccupationalTherapycould

alsohindercollaborationasitcreatesroleandboundaryconfusionanduncertaintyofwhat

typeoftasksOccupationalTherapistsperform.

ii. ProfessionalIdentity

ThefactthatthereissignificantconfusionaroundtheroleofOccupationalTherapywas

highlighted.Itwasidentifiedthathealthprofessionalsaswellaspatients/clientstendto

46

associate Occupational Therapists with the tasks that they perform rather than the

profession.Examplesgivenwere"providingequipment"or"assistingintheshower".

"IwouldthinkthatmaybeOTisn'tagenerallyunderstoodprofession,butmaybe

theyaretheonesthat'shelpingmewithmyequipment,orthey'retheonesthat's

helpingme intheshower,orattachedmore,relatedtoatask,ratherthanwhat

profession."

ParticipantsalsohighlightedthatOccupationalTherapistsareoftenconfusedwithother

healthcareprofessionalssuchasnursingstafforassistants.Theperceptionwasthatdue

tothetasks thatOccupationalTherapistsdo, thedifferencebetweenprofessions isnot

obvious.Examplesweregiven,thatnurseshelppatientsshoweranddressandoftenthe

focuson independencethatOccupationalTherapistshavewhenperformingthesetasks

withpatientsisoftennotseenorunderstoodastherapyandthereforepeopleassumethat

OccupationalTherapistsassistnursingstaffwithshoweringanddressingpeople.

"I think that people often confuse occupational therapists with nursing staff or

assistants because they're there to maybe assist them with washing, dressing,

groomingtasks.Whichtheymightnotrealizeisanactualtasktopracticeaspartof

theirtherapy.Theymightjustthinkyou'retheretohelpthem.Andthentheymight

think,well,whyisthispersonmakingmedoit?So,theymightthinkyou'reareally

crappyassistant."

Some comments were made labelling Occupational Therapy as a non-therapeutic

professionbutratheraprofessionholdinganoverarchingkeyworkingrole,coordinating

other health professionals interventions to collaborate in achieving an overall goal.

OccupationalTherapyinterventionsweredescribedasactivitiesthat"leadintotherapy"

orotherhealthcareprofessionals"addtherapyinto".

"[..]thatmightmeanthatyou'relookingafterthemfromthefirstthingthatthey

dointhemorning,whichmightbehavingbreakfast,tohavingashower,toleading

intotheirtherapy,tothenhavinglunch.Andyou'reoftenliaisingthewholedaywith

47

anoccupationaltherapist,becausethat'stheirmainroleistosortofhelpwiththose

activitiesofdailyliving.Andweaddtherapyintoassistthosethings."

The profession's name was identified as a cause of the confusion regarding the

OccupationalTherapyprofession.Theword"Occupational"wasthoughttocausepeople

tointerpretthisasaprofessionrelatedtovocation.

"[…]oftentheymighthavephysio.So,theyalreadyknowwhatphysiodoes,they

mighthaveOTasanadditionalthing.Theystillquitedon'tunderstandwhatthat

role is.Wherea socialworker,obviously, that seemsmore self-explanatory,and

obviouslythat'shelpingthemsortouttheirsocialsituation,andthatkindofthing.

Andspeechisobviouslyself-explanatory,whereasOccupationalTherapyis,kindof

could be anything. And I think people kind ofwonderwhy I need helpwithmy

occupation.ThenameIguessdoesn'tgivepeopleanyclueastowhattheyactually

needtodo.Andso,Ithinkthatinitselfiskindof,changethenameofOTs."

Additionally, participants felt thatpatientsmightnotperceive someof the therapeutic

interventionsofOccupationalTherapistsastherapyasthetasksareeitherseenasbasicor

donothaveahighpriorityforclients/patientsatthetimeofintervention.Oneparticipant

wasunabletoidentifyanybenefitofOccupationalTherapyinaninpatientmentalhealth

setting.

"Andobviously,theydoprovidetherapyaswell,butpeoplemightnotrealizethat

thatistherapy,likeprovidingacertainpieceofequipment.Mightbejust,they're

justseenasanequipmentproviderorsomethinglikethat.WhereasIdon'tthink

theyseeitasanactualtherapist."

ParticipantsreportedthattheydidnotfeelthatOccupationalTherapyhasspecificdomains

that the profession has taken ownership of except for the provision of equipment.

Participants reported that the roleofOccupational Therapists variesbetweendifferent

settingsandoftenbetweenOccupationalTherapistswithinthesamesetting.

48

"I think in here, it's that (cognitive assessments) seems to go more to the

psychologist, whereas another setting the psychologists I guess are not easy to

accesssoOT'swilldoit.Ithinksometimesthere'sabitofoverlapinwhoseroles

whichisabitconfusing."

Thiswasperceivedtocauseafeelingofuncertaintyinotherhealthcareprofessionalswho

would liketocollaboratewithOccupationalTherapists.Oneparticipantmentionedthat

theoverlappingboundarieswithotherhealthprofessionsmaycontributetothedifficulty

withtheprofession'sidentityandtherapists'professionalinsecurity.Itwasassumedthat

thiscausesalackofownershipoftasksandanappearanceofbeingeasilyreplaceable.It

wasalsomentionedthat itcancauseanimositywithotherhealthcareprofessionalsas

they feel Occupational Therapists overstep the professional boundaries of these

disciplines.

"Ithinkjustbecausethey'reacrosssomanydifferentthings,andthere'salsoalot

ofoverlapwithotheralliedhealth,frommyunderstanding,anyway.{…}So,Ithink

itmustbehardsometimes, forOTs, tryingto forgeyourown identity too,when

you'reacrosssomanydifferentthings."

iii. Marginalisationoftheprofession-Culturalimperialism

Some participants' described that the New Zealand health care system operates

predominantlyunder themedicalmodeland that it fosteredahistoricalhierarchy that

favoursprofessionsthatoperatewithinthismodel,suchasdoctorsandphysiotherapists,

tomovetothetopofthehierarchy.Professionsthatoperateonapsycho-socialmodel

suchasOccupationalTherapy,SocialWorkorsmallerprofessionalgroupssuchasSpeech-

LanguageTherapyorPsychologyareperceivedtobelowerinthehierarchy.

"{…}IseeittimeagainaboutthemedicalmodelwhereitcanbeoverruledandIfeel

asthoughwhenthathappens,andit'shappenedtomeasa{…},I'veseenithappen.

Itcanbeveryundermining.Anditcanbeverymuch,youfeelabitdisrespected.It's

notbecauseyou'resayingyou'reanOTorasocialworkerthatyourviewmustbe

listenedto.Butit'swhenitfeelsit'snotlistenedto.You'renotsayingyoushouldn't

49

bedisagreedwithortheteamshouldn'ttalkaboutit.Butsometimes,youcanfeel

as though a medical decision is made without fully trying to understand the

professional's opinionandwhat's behind it. And yet,when theywant you to do

something,theytalkasiftheyknowyourjobinsideout.Andthatyoushoulddothis

becausetheyknowyoushoulddothis.Butactually..."

The effects of this social normwere described as hurting role satisfaction and identity

throughfeelingsofbeingdisrespectedandundermined.

"Is I feel as though, the sensitised identity as a {…} is really absorbed as in the

medicalmodel. And itmakes the job quite vagueanddifficult to get your head

around.{…}itcanbereallydifficultwhenyou'reinthathierarchalsystemwhereit's

justthenorm.It'saccepted.It'singrainedthatthedoctors,andthenurses,andthe

medicalprofessionsknowmorethan(others).It'sreallyhardtochangethat."

iv. Recognition

AlackofunderstandingofOccupationalTherapyimpedesanyeffortstocreaterecognition

fortheprofession.ThelackofunderstandingoftheroleofOccupationalTherapybyhealth

professionals,patients/clientsandthepublicwasaclearthemeemergingfromthedata.

Asaresult,OccupationalTherapywasperceivedasbeingundervalued.

"Ithinkit'sanundervaluedandunknownkindofprofession."

MostparticipantsexplainedthattheyarestillnotclearonwhattheroleofOccupational

Therapyis.ThoughmostparticipantshadworkedwithOccupationalTherapiststhroughout

theircareer,therewasstilluncertaintyandconfusionconcerningtheroleandtasksthat

OccupationalTherapistsperform.Thesetaskswereperceivedtovarybetweenhealthcare

settingsandevenbetweentherapistsleavingasenseofconfusionandinsecurityregarding

thescope,boundariesandvalueoftheprofessionandhoworwhentocollaboratewith

OccupationalTherapists.

"Ican'tsayIknewthejobofwhatanOTdidinsideout.Ididn'tfeellikethat."

50

TherewasacommonperceptionamongparticipantsthattheroleofOccupationalTherapy

istouseabroaderrangeofknowledgetoallowforaholisticapproachwhenassessingthe

practical implications of daily living. Occupational Therapists were recognised for

completingavarietyofspecifictaskssuchashelpingpeopleregaintheirabilitytocomplete

activities of daily living such as showering and dressing to more broader concepts of

returninghomeorbacktowork.

"Myunderstandingofit[OT]istheyhelppeoplewithadjusting,adaptingtochanges

theyhaveintheirlife.{…}howtheyreturnhomesuccessfully,howtheypotentially

returntoworksuccessfully."

However,evenifparticipantscoulddescribetheoverallconceptoftheroleofOccupational

Therapistswithin their setting; there seemed to be a level of uncertainty around fully

understandingtheroleandtasksofOccupationalTherapists.Oneparticipantstatedthat

she was not sure why the tasks Occupational Therapists perform in their service are

Occupational Therapy-specific tasksas they seem tobeable tobeperformedbyother

disciplines.

"IthinkIunderstood,ingeneral,whattheconceptis,maybenotalltheindividual

componentsofit."

Another theme that emerged from thedatawas theperception that understandingof

Occupational Therapy only results when people are exposed to the profession. Some

participantsexplainedthat,atbest,theyhadsomebasicunderstandingofOccupational

Therapy after completing their training, while others had not heard of Occupational

Therapy until starting in a service that employed an Occupational Therapist. The

understandingofOccupationalTherapychangedanddeepenedwithcontinuedexposure

invaryingservicesorsettings.Thehighestlevelofunderstandingwasshownbyhealthcare

professionals thathavehadexperienceofworkingwithanOccupational Therapist in a

rehabilitationsetting.

51

"Again,asIsaid,OTsoneoftheserolesthatIthinkthatuntilyou'reactuallyinvolved

withworkingcloselywithOTorreceivingOT, itcanbeabitmuddyinyourhead

whattheydo."

v. PromotingAwarenessofOccupationalTherapy

ThedatashowedthatOccupationalTherapiststhemselvesarenotperceivedasbeingvery

effective in promoting their profession, mainly due to a lack of assertiveness. One

participantprovidedanexampleofhowOccupationalTherapistsseemtolackconfidence

inspeakinguporansweringquestionswithinamultidisciplinaryorinterdisciplinaryteam

environment.Itwaspointedoutthatattimes,OccupationalTherapistsoftendonotseem

confidentintheirclinicalreasoningskillsandasaresult,struggletoanswerquestionsby

medicalprofessionals.Alackoffocusonmedicalconditionsduringtheeducation/training

ofOccupationalTherapistswasperceivedtobethecauseofthisandwasconsideredas

puttingOccupationalTherapistsatadisadvantageasahealthcareprofessional,mainlyas

itseemstolimitOccupationalTherapists’abilitytocommunicatetheirreasoningclearly

andpromotetheirprofession.

"Whenyou'reinmeetingswithdoctorsandstaff,Idon'tknowwhether...Like,some

OT colleagues have sort of not quiet, felt that they can answer some of the

questions,andthingslikethataswell,andIthinkthatthat'sashame,becauseit's

notfromlackofbrainsoranything likethat. It's justfromlackof,that's justnot

what'staughtinthecurriculum."

Incontrast,thecomplexnatureoftheissuesthatOccupationalTherapistsdealwithwas

identified as a cause of the lack of assertiveness of Occupational Therapists in

communicating their clinical reasoning when answering questions in team meetings.

OccupationalTherapistswereseentodealwithmorecomplexissuesthatdonotallowfor

straightforwardanddefinitiveanswers.

"If I think about like the different services, and the people there. Often, clinical

psychologists are much more confident, a bit like doctors. They're often more

confidentormoreassertiveintheirdecisionmaking,intheirAplusBequalsCkind

52

ofthing,whereasOTis...AndIwouldthinkOTs,physio,maybe,sowe'llgowith

socialworkers,'causeIcan'tthinkthatOT,PT,thatthere'snotnecessarilyaclear

cutanswerforaclearcutproblem."

Onthecontrary,OccupationalTherapistsareperceivedasbeingassertivewhentheyfeel

theneedtoadvocatefortheirpatientsorclients.Thiscanbetoprovideadditionalservices

orareferraltoanotherdiscipline,healthprofessionalorservice.

"Advocating,theyneedmoreinput,whetherotherpeopleneedtobeinvolved,or

when theyneeddifferent services,or, Iguess theones thatprobablyhavemore

experience,andtheyknowwhatapersonneeds,thatthey'renotjustsaying,"Here's

apieceofequipment.We'llleaveitthere,"kindofthing,thattheyhavetheability

toadvocateandsaywhetherit'sappropriate,whetherit'snotappropriate,whether

they needmore, whether they need other services. That probably ... But that's

potentiallyexperienceaswell,butbeingabletoreferontootherpeople,andknow

whenmoreneedsdone."

A different perspective on Occupational Therapy and assertiveness was expressed by

describing Occupational Therapy as a profession that has to master the difficulty of

focusingonrebuildingpeople’s independencewithdailyactivities incultureswherethe

belief that people who are unwell need to be cared for, dominates. They need to be

compassionatetobuildrapportbutalsoassertivetoencouragepeopletocompletetasks

themselves.

"OTs,PTsarecompassionate,butyoustillhavetogetpeopletohelpthemselves,

right?[…].You'renotdoingitforthem.Theyneedtodoitforthemselves,whereas,

withpsychologists, theyhavetotalkabout it, that theydon'talwayshavetodo

something,andwithsocialwork,theycanbecompassionate,becausethey'renot

makingthemdosomething,soOTshavetobetherightamountofempathetic,I

guess, to the situation, but also, a little bit forceful enough to get them to do

something, so maybe more assertive than what I have met in with the social

workers[…]"

53

AnotherreasonidentifiedfortheOccupationalTherapy'sdifficultyinpromotingitselfwas

the fact that health professionalswho promote themselves have often beenmetwith

judgementorhostility.Acommonperceptionwasthatpromotingtheirprofessionlieswith

theindividualprofessionalratherthanbeingtheresponsibilityofgoverningbodies.

vi. EnvironmentandSystemconstructs

The participants described elements of the physical and institutional environment that

impacted on how they perceived the role of Occupational Therapy. The policies and

systemsofhealthserviceswerehighlightedascontrollingfactorswhicheitherenabledor

limitedtheopportunitiesforcollaborationbetweenprofessions

"Inmypreviousrole,wedidn'treallygettoworksomuchacrossteamsasmuch.

Alliedhealthandpsychologywewerekindofseparate[…].Ithinkitwasprobably

moretheservice Iwasworking in. Itdidn't really,maybe'kindofpromotethose

sortsofworkingrelationshipsaswell.[…]Iwasacrossfiveorsixdifferentwards,I

justdidn'treallyhavethosesamerelationships,andwedidn'tprobablyworkreally

thatwelltogether.Notinthesensethatwedidn'tgeton,butthatwejustworked

quiteseparately."

Environmental factors do not occur in isolation, and the participants also mentioned

elements of the built environment such as separate offices and or workspaces as

contributingfactors.

"[…]hereyou'reworkinginaverysimilarenvironment.Youseeeachotherquite

regularly, it's easier just to stop and have an informal chat about something,

whereas,downthereIfound...theSLTofficesdownonthesecondfloorandIdon't

evenknowwheretheOTofficeis."

TheWorldHealthOrganisation(2001)describedenvironmentalfactorsas"allaspectsof

theexternalorextrinsicworldthatformthecontextofanindividual'slife:physical,social

andattitudinal."Thephysicalenvironmentreducingcontactofotherhealthprofessionals

54

with Occupational Therapists reduces the opportunities for exposure that create

understanding and recognition for the profession. Consequently, other health

professionals’perceptionofOccupationalTherapycanbemisinformed,andopportunities

forreferralsmightbelost.

Summary

The findings gained from thedata collected alignwith the findings documented in the

literature to date. An additional theme identified in the findingswas the effect of the

institutionalandbuildenvironmentontheperceptionofOccupationalTherapy.Boththe

findingsoftheliteraturereviewandthestudy'sfindingspointtowardsthatissueswiththe

image of Occupational Therapy are present and current for the Occupational Therapy

professionwithinNewZealand.

55

CHAPTER5

DISCUSSION

Theimportanceofprofessionalidentity

Theaimofthisstudywastocompletethefirststagesofdevelopingapositionstatement

fortheOccupationalTherapyprofession.Asstatedintheintroductionchapter,positioning

relatestoacustomer'sperceptionofthebenefits,attributesoridentityoftheserviceand

how these elements are compared with competing services (Chitty, Hughes &

D'Alessandro,2012).Thetwostepsofdevelopingapositioningstatementaretoclearly

describethecharacteristicsoridentityoftheserviceandhighlightthepointofdifference

and how the service will meet the needs of its target segment (Chitty, Hughes &

D'Alessandro,2012).

Both the literature reviewand the findings identify thatOccupational Therapy canadd

significantvaluetothehealthcaresectorandpatientcare.Thefollowingbenefitsshould

beusedtohighlightthepointofdifferenceoftheOccupationalTherapyprofession,which

isonepartneededtodevelopapositioningstatement.

Thekeyvalueoftheprofessionwasperceivedtobeitsabilitytocutcostsofhealthand

social services by improving individual's well-being and independence (College of

OccupationalTherapy,2016;Reed,2016).OccupationalTherapyachievesthisbyplacinga

strong focus on self-management and enablement, a person-centred approach that

bridgesthegapbetweenthemedicalandsocialmodel.Theprofessionhasastrongfocus

on building resilience using an asset-based approach to build personal competencies

(CollegeofOccupationalTherapy,2016;Reed,2016).Theprofessionisskilledinreducing

hospital admissions, cutting support services’ costs, reshaping care and enabling a

proactive approach to transition home after a hospital stay (College of Occupational

Therapy,2016;Reed,2016).

The literature reviewand findings also identified areasof improvementbyhighlighting

somelong-standingissuesthathavepersistedtothisdateandeventhoughtheprofession

hasattemptedtoresolvetheseissues,theywerenotabletoberesolved.Consideringthe

aimofthestudyofdevelopingapositioningstatementfortheprofessionandtheneedto

56

haveacleardescriptionoftheservice'scharacteristicsoridentity,themainissueidentified

is the profession's difficulty defining identity. The literature review highlighted the

followingissueswiththeprofessionalidentityofOccupationalTherapy:

a)acontinuedconfusionoverthenatureofOccupationalTherapybothwiththeprofession

andfromexternalstakeholders

b)professionalinsecuritycausedbytheambiguousprofessionalidentity

c) an incorrect association of the profession with other disciplines due to lack of

understandingoftheprofession

d)thetensionbetweentheprofession'sheritageanditsenvironment

Thestudy'sfindingsconfirmedtheseissues,revealingthatOccupationalTherapycontinues

to struggle. Figure 5.1 shows the four factors identified to contribute to the issues of

professionalidentityoftheprofession:1)themarginalizationoftheprofession,2)issues

arisingfromculturalimperialism,3)thelevelofrecognitionoftheprofessionand4)the

environmenttheprofessionworksin.

Figure5.1:FactorsinfluencingOccupationalTherapy’sprofessionalidentity

Professionalidentity

Marginalisation

CulturalImperialism

Recognition

Environment

57

Themarginalisationoftheprofession

The literature review highlights two concepts thought to cause marginalisation of the

profession: abelbodism and sexism (Frohlich, 1992). Abelbodism is related to the

oppressionofpeoplewithdisabilities(Frohlich,1992).Sexismwasdescribedasthelesser

treatment of women and female values (Frohlich, 1992). A comparison was drawn

emphasising that both groups, women and people with disabilities, are perceived as

passiveanddependentandtheircontributionsundervalued(Frohlich,1992,Griffin,2009,

Wielding, 2011). Members of oppressed or marginalised groups often internalize the

negative stereotypes they are confrontedwith, causing them to doubt their value and

competence(Wielding,2011).Itcanaccordinglybearguedthatbothconceptscontribute

to the issues with developing a strong professional identity by causing Occupational

Therapists to feel disempowered and adopt conformist ways and falling silent. The

questionwasraisedhowaprofessionconsistingofmembersofanoppressedgroupwho

isworkingwithclientsofanotheroppressedgroupcanbeexpectedtobecomeaproud

and visible profession (Frohlich, 1992). Working towards overcoming (or at very least

becomingawareof)bothablebodismandsexismisimperativeforthedevelopmentofa

strongandclearprofessionalidentityofOccupationalTherapy.

Culturalimperialism

Another aspect that affects the profession's identity is the current dominance of the

medicalmodel, scientific evidence and language (Mocellin, 1995; Creek, 1997;Wright,

1998;Goren,2002;Friedland&Silva,2008;Creek,2009).Thefindingsofthisstudyshow

that the dominance of the medical model continues to cause issues for Occupational

Therapy, identifying that this causes feelings of being disrespected and undermined,

furthernegativelyaffectingtheprofession'sidentity.

Scientificevidenceisbasedonastructuralistunderstandingofknowledgewhichdoesnot

accommodate the pragmatic and contextualisedOccupational Therapy practice (Creek,

2009).Theliteraturereviewandthisstudy'sfindingsidentifiedthattheprofession'strend

to use biomedical language only increases the issue of being misunderstood. In the

literature review, thiswas acknowledged as a disconnect between theory andpractice

58

(Creek,2009).OccupationalTherapystudentsareprovidedwithascientific,structuralised

knowledge base that they are expected to use to express their clinical reasoning.

ConsideringthatmostofOccupationalTherapypracticeispragmaticandcontextual,this

causesproblemsfortherapiststoclearlycommunicatetheirclinicalreasoningandbenefits

oftheirinterventionsusingobjective,context-freeevidenceandlanguage(Creek,2009).

In the attempt toovercome this barrier, theprofessionhas adopted languageusedby

disciplines that are more anchored in the medical model, making the differentiation

betweenOccupationalTherapyandtheotherdisciplinesdifficult(Creek,2009).Inanother

attempt,theprofessionhasstartedtodevelopitsprofession-specific language,whichis

eitherignoredormisunderstoodbyotherprofessions.

The findings of this study identified that these issues still exist by identifying that

occupationaltherapistsareperceivedtolackconfidenceinansweringquestionsfromthe

medicalteamandspeakinguptopromotetheirprofession.However,thereisadifference

inreasoningprovidedbytheliteraturereviewandthefindingsofthisstudyastowhythis

is.Theliteratureveryclearlyoutlinesthedisconnectbetweentheoryandpractice,andthe

useofbiomedicallanguageasthecause.Thefindingspointtowardsagapineducation,

recommendingthattheOccupationalTherapistfurthermovestowardthemedicalmodel

bybeingtaughttounderstandthemedicalconditionstheyworkwith.Itwouldbeworth

investigatingthecauseofthedifficulty incommunicationfurtherbecause,todevelopa

strongandclearidentitytheprofession,promoteitselfandovercomethedominanceof

themedicalmodel, the professionwill need to be able to communicate its value and

benefit.

Recognition

Theliteraturereviewidentifiedthatmanypeopleincludinghealthcareprofessionalsdo

not understand the role and value of Occupational Therapy and often use false and

detrimental stereotypes such as describing Occupational Therapists as gap-fillers,

peripheral and luxurious in a financially strained system (Blom-Cooper, 1989; Turner,

2011). The study's findings indicated that this lack of understanding causes the lack of

recognitionoftheprofessionitselfaswellasitsvalue.Anissuethathasbeenacommon

59

themefortheprofessionovertheyears.Thisoftenleavestherapistsfeelingmisunderstood

andundervalued.Turner(2011)explainsthatsocialisationandpositiveinteractionswith

others are required to develop a clear and strong identity. Occupational Therapist's

feelings of being undervalued combined with the negative stereotypes and low value

attributedbyotherprofessionalscanonlybedescribedas lessthanpositive interaction

contributingtotheissueswiththeirprofessionalidentity.

Environment

TheCanadianModelofOccupationalPerformanceandEngagementsplitstheenvironment

intofourdifferentareas:Physical,institutional,culturalandsocial(Townsend&Polatajko,

2007).Themodelplacestheenvironmentasanoutercirclearoundapersonshowingthat

person and their occupational performance are influenced by the context of the

environmentwhich functions either as an enabler or a barrier (Townsend&Polatajko,

2007.Applying thismodel to theprofession that isusing it, severalbarriershavebeen

identifiedinthephysicalenvironment.Theimpactofthephysicalenvironmentshowedto

be an important theme within the study's findings, especially when considering

OccupationalTherapywithinhospitalsettings(bothacuteandrehabilitation).Thefindings

showedthatunderstandingofOccupationalTherapyiscurrentlycreatedthroughexposure

tomembersoftheprofession.Unfortunately,thefindingsshowthatthebuiltenvironment

doesnotseemtopromotethisexposurebutratherkeepsprofessionsseparated.Allied

health professions andmedical teams are in separate offices or even floorswithin the

hospitalbuildinganddonotinteractwitheachother.Thisseemstobelessofanissuein

rehabilitationandcommunitysettings.However,onacutewards,thelackofexposureto

OccupationalTherapycurrentlyleadstoreducedconsultationorjointsessionsresultingin

possiblylongerstaysorunsafedischargesforpatientsduetolackofunderstandingofthe

roleofOccupationalTherapyandwhatitcancontribute.

Theotherissuewiththebuiltenvironmentofcurrenthealthcarefacilitiesisthatitisnot

set up for occupational practice. This causes difficulty for Occupational Therapists to

completeassessmentsandinterventionseffectively.Itcouldevenbesaidthatthemedical

modelhasastronginfluenceonthebuiltenvironmentofhospitalsandcarefacilities.This

60

contributes to Occupational Therapists having difficulty in communicating the value

assessments and interventions, further promoting feelings of being invisible and

misunderstood,whichinturnaffectstheirprofessionalidentity.

The College of Occupational Therapy's (2016) report highlighted that if Occupational

Therapyisintegratedeffectivelywithinservicestheresultisbetterpatientoutcomesand

financialsavings.Itcan,therefore,besaid,thatthisisanimportantissuetohighlightwhen

planningforthefutureoftheprofession.

Whatdoesthismean?

TheliteraturereviewshowedthatpreviousattemptstopromoteOccupationalTherapydid

notincreaseawarenessandrecognitiontoallowOccupationalTherapytobeaproudand

visibleprofession.Theprofessionhassomeclearstrengths,whichfunctionasapointof

differenceintermsofvaluethattheprofessioncanprovidecomparedtoitsalliedhealth

competitors.

Itisnecessarytobreakthehistoricalcyclethattheprofessionhasfounditselfinalmost

sinceitsinceptionandtodevelopaneffectivepromotionalstrategythatwillenablethe

professiontosecureitssurvivalintheincreasinglycompetitivehealthcaremarket.Itcan

do thisbypositioning itselfasan invaluableprofession,and it is recommended for the

profession to look to its members in order to understand their perception of their

professionandidentifyanyissuestheymightexperiencewiththeirprofessionalidentity

within the context of the New Zealand health care system. This may enable the

professionalbodiestosupporttheirmembersindevelopingaclearandstrongidentityby

overcomingthehistoricalissuesidentifiedinboththeliteraturereviewandthisstudy.Only

oncetheprofessionitselfisclearaboutwhoitisandwhatithastoofferwillpromotional

effortstakeeffect.

61

Recommendationforfurtherresearch

ToovercomethehistoricalissuestheOccupationalTherapyprofessionfacesanddevelop

an effective positioning and promotional strategy, further research has been

recommended:

• Furtherresearchshouldexploreoccupationaltherapists’currentperceptionof

theirprofession.

• Furtherresearchshouldinvestigatehowtheprofessionitselfwoulddescribeits

identity.

• Thisstudycouldberepeatedusingamaximumvariancesamplingmethodanda

largersampletoconfirmthestudy'sfindingsarerepresentativeofitspopulation's

thoughtsandopinions.

• Futureresearchmightalsobedoneintohowstakeholderswouldcompare

OccupationalTherapyanditscompetitorsinthetwomainpointsofdifferenceof

reducingcostsofhealthcareservicesandimprovingpatientoutcomesby

increasingindependence.

Recommendationforpractice

Occupational TherapistWendyE.Walsh (2018)hasagainpickedup themeshistorically

appearing in both the literature over time and this study. These themes included the

profession'spersistentidentitycrisis,theneedtocommunicateaclearidentitynotonlyby

makinguseofpubliccommunicationchannelsincludingsocialmediaplatformsandforthe

therapist to be politically savvy and driven to promote the profession and remain

competitiveinthemarketplace(Walsh,2018).Walshfurtherpromotesthecombination

ofgrassrootsadvocacy(whichhastraditionallybeenappliedinthepast)withsocialmedia

channels,describingthisaskeytosafeguardingafootholdinthehealthcaremarket.

Ingeneral,encouragingoccupationaltherapiststopromotetheirprofessionasindividual

advocates is a valuable recommendation forpractice. The continued issuesaround the

identityoftheOccupationalTherapyprofessionhavelessenedtheeffectivenessofthese

efforts. This is not to say that Occupational Therapists should dismay and give up

promotionaleffortsaltogether.AkeymessageforOccupationalTherapiststotakeaway

62

from this study is tobeproudof their profession as there is plentyof evidence in the

literaturethatOccupationalTherapistsaremakingasignificantcontributiontothehealth

caresystemandthehealthandwell-beingoftheindividualstheyworkwith.Topromote

Occupational Therapy effectively on an individual level, Occupational Therapists are

encouragedtoclearlydefinetheirownprofessionalidentitybyclearlyunderstandingtheir

professionalboundariestobeabletoconfidentlyrespondtostereotypicalassumptionsor

perceptionofwhattheroleofOccupationalTherapyis.OccupationalTherapistsarefurther

encouraged to communicate how their role contributes to the service goals from

increasinghealthoutcomes,reducinghospitalstays,andre-admissionstonameonlyafew.

Lastly,OccupationalTherapistsareencouragedtocreateawarenesswithintheprofession

about these historical issues in order to support each other as therapists and enable

change.However,topromoteOccupationalTherapyasaprofessionusingchannelsthat

can reach a larger audience, itwould be prudent to complete furtherwork. Thiswork

shouldaimtocreateaclearanddefinedidentityoftheprofessionasmultiple,individual

identitiescommunicatedtoalargeraudiencecanfurtherenhancetheconfusionaboutthe

profession,furtherfeedingintothehistoricalcycleofpromotionaleffortswithonlylittle

effect.

Limitationsofthestudy

Thereareseverallimitationstothisstudy.

I. LackofpreviousresearchinaNewZealandcontext

Eventhoughthereisagoodbodyofliteratureontheperceptionandimageof

OccupationalTherapyavailable,onlylimitedliteraturecouldbefoundonthe

topicwithinaNewZealandcontext,historicallyorcurrent,leavinguncertainty

astotheknowledgefoundationandtheinterpretationofthefindingsofthis

study.

II. Samplingsizeandprofile

Thesamplesizeusedforthisstudyissmall;onlyfiveparticipantswererecruited

using convenience sampling. Considering the size and make-up of the

63

populationofthisstudy,itcannotbesaidwithcertaintythattheoutcomeof

thestudyisatruereflectionofthepopulation'sperceptionoftheOccupational

Therapyprofession.

III. DataCollectionProcess

ThedataforthisstudywascollectedbyanOccupationalTherapist.Asthestudy

investigated the perception of the Occupational Therapy profession,

participants may not have been fully comfortable describing their true

perceptions.

IV. Resourceconstraints

ThisstudywascompletedasaMaster'sproject.Assuch,thereweretimeand

financialconstraintswhichimpactedthestudy,forexamplesamplesizeand

makeup,andlocationofdatacollection.

Conclusion:

Theresearchquestionthisstudywasinvestigatingwas"DoestheOccupationalTherapy

professioninNewZealandhaveanimageproblem".Theliteraturereviewshowsthateven

thoughOccupationalTherapyaddssignificantvaluetothehealthcaresectorandpatient

outcomes, it further indicated areas of the long-standing struggle for Occupational

Therapy.Themainissueidentifiedisthedifficultydefiningthenatureandidentityofthe

profession. A repeating cycle of inter-related aspects of the profession shows that it's

professional identity is reinforcing, and in turn is causedby, themarginalisationof the

profession,issuesarisingfromculturalimperialismsuchasthedominanceofthemedical

model,thelevelofrecognitionoftheprofessionandtheenvironmenttheprofessionworks

in. Even though much effort has been made over the years to resolve the issue,

OccupationalTherapycontinuestostruggleinpromotingitsprofession.

Using a marketing perspective and terms, the issue lies with the positioning or the

profession in themarketplace.ChapterOne introducedamarketingconceptcalledSTP

process (segmentation, targeting and positioning), which is the underlying foundation

64

work that all effectivemarketing campaigns are based on. Chapter one discussed the

segmentation and targeting aspects, identifying that its primary target segment is the

purchasersofOccupationalTherapyserviceswithintheNewZealandhealthcaresector.

The third step, positioning, is related to a customer's perceptionof the identity of the

service, and how customers evaluate and compare these elements to other services

(Chitty,Hughes&D'Alessandro,2012).

Positioningincludestwosteps:First,thecharacteristicsoridentityoftheserviceneedsto

beclearlydefinedandrelatedtowhatthetargetsegmentsperceiveasimportantservice

attributes. Second, thepointofdifferenceof theproduct/servicemustbe identified to

highlight how the service can provide these attributes better than its competitors

(Armstrong et al., 2014). The second step has already been achieved as the value of

OccupationalTherapyhasbeenidentified.

However, step one of clearly defining the profession's nature is something that

OccupationalTherapyhasstruggledwithforalongtime.Withoutbeingabletodefinea

positioningstrategythatclearlydistinguishesOccupationalTherapyfromitscompetitors

indicatesthatOccupationalTherapydoeshaveanimageproblem.

Furtherresearchisrecommendedtoinvestigatetheseissuesfurthertobeabletoprovide

recommendations on how occupational therapists can increase their opportunities to

promote their profession. It is recommended to re-produce this study using a larger

sample, including a wider variety of the profession's stakeholders with a focus on

stakeholderswithpurchasingpower.Thiswouldprovideamorein-depthunderstanding

ofthecurrentperceptionoftheOccupationalTherapyprofessionbythisgroup.Further,a

studyshouldalsobecarriedouttoinvestigatetheperceptionofoccupationaltherapistsof

theirprofession.Thiswouldprovidetheopportunitytoidentifyareasofexcellenceaswell

asareasofgrowth.

Meanwhile,atake-awaymessageforoccupationaltherapistsinAotearoa/NewZealandis

tobeproudof theprofession and the contribution itsmembersmakewithin theNew

Zealand health care system in general and to their patients or clients' outcomes.

OccupationalTherapists should feelencouraged touse the information in this study to

65

understand how the repetitive cycle of professional insecurity is fuelled and use this

knowledgetotakestepsintobecomingmoreconfident,speakingoutandproudlystanding

upfortheirprofessionandthevaluableworkitsmembersdo.

66

67

Referencelist

Armstrong,G.,Adam,S.,Denize,S.,&Kotler,(2014).PrinciplesofMarketing.Australia:

Pearson.

Blom-Cooper,L.(1998).OccupationalTherapy:anemergingprofessioninhealthcare.

London:Duckworth

Brewer,M.L.,&Rosenwax,L.(2016).Caninterprofessionalpracticesolvethevexing

question of ‘What is Occupational Therapy’? Australian Occupational Therapy

Journal,63,221-222.doi.org/10.1111/1440-1630.12310

Chitty,W.,Hughes,A.,&D’Alessandro,S.(2012).ServicesMarketing.Australia:Oxford

UniversityPress.

Clark,F.(2010).High-definitionOccupationalTherapy:HDOT(InaugralPresidential

Address). American Journal of Occupational Therapy, 64, 848-854. doi:

10.5014/ajot.

Clark,F.A.(2010).Powerandconfidenceinprofessions:LessonsforOccupationalTherapy.

Canadian Journal of Occupational Therapy, 77, 264-269. doi:

10.2182/cjot.2010.01.77.5.2

CollegeofOccupationalTherapists(2016).UrgentCare:ThevalueofOccupationalTherapy.

Retrievedfromhttps://www.rcot.co.uk/

Creek,J.(2009).AnnualLecture:Somethinglostandsomethinggained.MentalHealth

OccupationalTherapy,14,45-51.

Crotty,M.(1998).Thefoundationsofsocialresearch.Meaningandperspectiveinthe

researchprocess.Australia:Allen&Unwin.

deCasterle,D.,Gastmans,C.,Bryon,E.,&Denier,Y.(2012).QUAGOL:Aguidefor

qualitativedataanalysis.InternationalJournalofNursingStudies,49,360-371.doi:

10.1016/j.ijnurstu.2011.09.012

Finley,L.(1998).Thelifeofanoccupationaltherapist:Meaningandmotiveinanuncertain

world.UnpublishedPhDThesis.MiltonKeynes,UK:TheOpenUniversity.

Fortune,T.(2000).Occupationaltherapists;Isourtherapytrulyoccupationalorarewe

merely filling gaps. British Journal of Occupational Therapy, 63(5), 225-230.

doi.org/10.1177/030802260006300507

68

Friedland,J.,&Silva,J.(2008).EvolvingIdentities:ThomasBessellKidnerandOccupational

Theory intheUnitedStates.AmericanJournalofOccupationalTherapy,62,349-

360.doi:10.5014/ajot.62.3.349

Froehlich,J.(1992).ProudandvisibleasOccupationalTherapists.AmericanJournalof

OccupationalTherapy,46,1042-1044.doi:10.5014/ajot.46.11.1042

Greenhill,E.D.(1994).Areoccupationaltherapistsmarketingtheirserviceseffectivelyto

thefundholdinggeneralpractitioner?BritishJournalofOccupationalTherapy,57,

133-136.doi:10.1177/030802269405700408

Griffin,S.(2001).OccupationalTherapistsandtheconceptofpower:Areviewofthe

literature. Australian Occupational Therapy Journal, 48, 24-34.

doi.org/10.1111/j.1440-1630.2001.00231.x

Goren,A.(2002).OccupationalTherapyandstrictlydefinedareasofdoubtand

Uncertainty. British Journal of Occupational Therapy, 65(10), 50-52,

doi.org/10.1177/030802260206501007

Hagedorn,R.(1995).TheCassonMemorialLecture1995:Anemergentprofession–a

personal perspective. British Journal of Occupational Therapy, 58, 324-331.

doi.org/10.1177/030802269505800802

Heldke,L.,&O’Connor,P.(2004).Oppression,PrivilegeandResistance.Boston:McGrawHill

Young, I. (2004). Five Faces of Oppression. Retrieved from

https://mrdevin.files.wordpress.com/2009/06/five-faces-of-oppression.pdf

Hocking,C.(2005).The2004FrancesRutherfordLecture:Evidencefromthepast.New

Zealand Journal of Occupational Therapy, 52(1). 4-16. Retrieved from

https://openrepository.aut.ac.nz/bitstream/handle/10292/12682/Edited%20Manu

script%20-%20Possibilities%20for%20the%20future.pdf?sequence=7&isAllowed=y

Hooper,B.,&Wood,W.(2002).PragmatismandStructuralisminOccupationalTherapy:

TheLongConversation.TheAmericanJournalofOccupationalTherapy,56,40-50.

doi:10.5014/ajot.56.1.40

Jacobs,K.(2002).PromotingOccupationalTherapy:Words,imagesandactions(Eleanor

ClarkeSlagleLecture).AmericanJournalofOccupationalTherapy,66,652–671.

doi:10.5014/ajot.2012.666001

Krefting,L.(1991).Rigourinqualitativeresearch:Theassessmentoftrustworthiness.

69

The American Journal of Occupational Therapy, 45(3), 214-222.

doi:10.5014/ajot.45.3.214

Kinn,L.G.,&Aas,R.W.(2009).Occupationaltherapists’perceptionoftheirpractice:A

phenomenological study.AustralianOccupational Therapy Journal, 56,112-121.

doi:10.1111/j.1440-1630.2007.00714.x.

Kotler,P.&Keller,K.L.(2005)MarketingManagement.NewDelhi,India:Prentice-Hall

Lincoln,Y.S.,&Guba,E.G.(1985).NaturalisticInquiry.NewburyPark,CA:Sage

Publications.

Mackey,H.(2007).‘Donotaskmetoremainthesame’:Foucaultandtheprofessional

identitiesofoccupationaltherapists.AustralianOccupationalTherapyJournal,54,

95-102,doi:10.1111/j.1440-1630.2006.00609.x

NewZealandPsychologistsBoard.(2017).AnnualReporttotheMinistryofHealth.Forthe

year 1 April 2016 to 31 March 2017. Retrieved from

http://www.psychologistsboard.org.nz/cms_show_download.php?id=525

Occupational Therapy New Zealand - Whakaora Ngangahau Aotearoa (OTNZ).

(2018). Annual Report. Retrieved from https://www.otnz.co.nz/otnz-wna/otnz-

wna-documents/annual-reports/

OccupationalTherapyBoardofNewZealand.(2017).AnnualReport2017.Retrievedfrom

https://www.otboard.org.nz/wp-content/uploads/2018/02/2017-Annual-

Report.pdf

Reed,K.,(2016).FrancesRutherfordLecture2015:Possibilitiesforthefuture:Doingwell

togetherasagentsofchange.NewZealandJournalofOccupationalTherapy,63,4-

13. Retrieved from

https://openrepository.aut.ac.nz/bitstream/handle/10292/12682/Edited%20Manu

script%20-%20Possibilities%20for%20the%20future.pdf?sequence=7&isAllowed=y

PhysiotherapyBoardofNewZealand(2017).AnnualReport2017.Retrievedfrom

https://www.physioboard.org.nz/sites/default/files/Physiotherapy%20Board%20A

nnual%20Report%202016-2017.pdf

Smith,L.A.(1986).HowdootherprofessionsviewOccupationalTherapy?TheBritish

JournalofOccupationalTherapy,49,51-52.doi:10.1177/030802268604900211

70

SocialWorkersRegistrationBoard.(2017).SWRBAnnualReport2016-1017.Retrieved

fromhttps://swrb.govt.nz/download/swrb-annual-report-2016-2017/

StatisticsNewZealand.(2002).PopulationageinginNewZealand.Retrievedfrom

http://archive.stats.govt.nz/browse_for_stas/people_and_communities/older_peo

ple/pop-ageing-in-nz.aspx

Thorne,S.(2016).InterpretiveDescription:QualitativeResearchforAppliedPractice.

UnitedStates:LeftCoastPressInc

Thorne,S.,ReimerKirkman,S.,&MacDonald-Emes,J.(1997).Interpretivedescription:A

noncategoricalqualitativealternativefordevelopingnursingknowledge.Research

in Nursing & Health, 20, 169-177. doi.org/10.1002/(SICI)1098-

240X(199704)20:2<169::AID-NUR9>3.0.CO;2-I

Townsend,E.A.,&Polatajko,H.J.(2007).EnablingOccupationalTherapyII:Advancingan

OccupationalTherapyvision forHealth,well-being& justice throughoccupation.

Ottawa,Ontario:CAOTPublicationsACE

Turner,A.(2011).TheElizabethCassonMemorialLecture2011:OccupationalTherapy-A

ProfessioninAdolescence?TheBritishJournalofOccupationalTherapy,74,314-

322,doi:10.4276/030802211X13099513661036

Walsh,W.E.(2018).InvestigatingpublicperceptionofOccupationalTherapy:An

environmentscanof threemediaoutlets.TheAmerican JournalofOccupational

Therapy.72,doi:10.5014/ajot.2018.024513

Wielding,C.(2011).RaisingawarenessofhegemonyinOccupationalTherapy:Thevalueof

action research for improvingpractice.AustralianOccupationalTherapy Journal,

58,293-299.doi:10.1111/j.1440-1630.2010.00910.x.

Wilkinson,J.,Chard,G.(2005).ImagesofOccupationalTherapyamongSecondary

School children. The British Journal of Occupational Therapy, 68, 135-139, doi:

10.1177/030802260506800307

Williams,H.,&Bannigan,K.(2008).Asimpletricktomarketourselves.TheBritishJournal

ofOccupationalTherapy,71,225.doi.org/10.1177/030802260807100601

Wright,C.,Rowe,N.(2005).Protectingprofessionalidentities:Serviceuserinvolvement

andOccupationalTherapy.TheBritishJournalofOccupationalTherapy,68,45-47,

doi:10.1177/030802260506800108

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Appendices

72

Appendix1:EthicsApproval

73

Appendix2:

ParticipantInformationSheet–InterviewsDateInformationSheet

Produced:24November2016“ThecurrentanddesiredperceptionoftheOccupationalTherapyprofessioninNewZealand”AnInvitationI moved to New Zealand in and completed a Bachelor of Commerce and Administration, majoring inMarketingandCommercialLawatVictoriaUniversityWellington.IhaveworkedinvariousMarketingrolesincluding communications/media liaison, event management, fundraising/sponsorship, branding andadvertising.In2010,IstartedtrainingasanOccupationalTherapistandgraduatedwithaBachelorofHealthScience(Honours)in2013.SincethenIhaveworkedasanOccupationalTherapistinvarioussettingsincludingacutecare,rehabilitationandcommunity.Thisbackgroundhasledmetohaveapassionateinterestintheimage of Occupational Therapy and ultimately I aim to develop a strategy to promote the image ofOccupationalTherapyinNewZealandinwaysthatwillhelpourclientstobetteraccesstoservices.Ihavetaken the opportunity provided by doing a Master’s of Occupational Therapy to closely examine theperspectiveofkeystakeholdersontheimageofOccupationalTherapy.Whoisinvitedtoparticipateinthisresearch?IwouldliketotakethisopportunitytoextendaninvitationtoallseniormembersoftheNewZealandHealthCaresectorstoparticipateinthestudy.HowdoIagreetoparticipateinthisresearch?Yourparticipationinthisresearchisvoluntary(itisyourchoice)andwhetherornotyouchoosetoparticipatewillneitheradvantagenordisadvantageyou.Youareabletowithdrawfromthestudyatanytime.Ifyouchoosetowithdrawfromthestudy, thenyouwillbeofferedthechoicebetweenhavinganydatathat isidentifiableasbelongingtoyouremovedorallowingittocontinuetobeused.However,oncethefindingshavebeenproduced,removalofyourdatamaynotbepossible.Toagreetoparticipatetotheresearchpleasereplytotheinvitationstatingthatyouwouldliketoparticipateinthestudyanddatesandtimesyouwouldbeavailable.Youwillreceiveaconfirmationemail,whichwillincludeaconfirmeddate,timeandlocationoftheinterview.Further,youwillneedtosigntheconsentform.Youcaneitherbringbothformstotheintervieworemailtheformstoarmin2@student.op.ac.nzIfIagreetotakepart,whatwillbeinvolved?Youwillbeaskedtoparticipateinoneinterviewsession.WithinthesessionyouwilldiscussyourperceptionoftheimageofOccupationalTherapyandhowthesecomparetotheimageofotherselectedalliedhealthprofessions.Theinterviewwillberecordedandlatertranscribed.Allinformationsharedduringtheinterviewwillbeheldconfidentialandwillonlybeusedforthepurposeofthisstudy.WhatdoIdoifIwanttoparticipate?If you would like to participate, please reply to this invitation by emailing Nadja Armitage(armin2@student.op.ac.nz)byxx.xx.2017Canparticipantschangetheirmindsandwithdrawfromtheproject?Youcandeclinetoparticipatewithoutanydisadvantagetoyourselfofanykind.Ifyouchoosetoparticipate,youmaywithdrawfromtheprojectatanytime,withoutgivingreasonsforyourwithdrawal.Youcanalsowithdrawanyinformationthathasalreadybeensupplieduntilthestageagreedontheconsentform.Youcanalsorefusetoansweranyparticularquestionandaskfortheaudio/videotobeturnedoffatanystage.WhoshouldItalktoifIhaveanyconcernsaboutthisresearch?ThisresearchhasbeenpassedbytheEthicsCommitteeatOtagoPolytechnic.Anyconcernsregardingthenature of this project should be notified in the first instance to eithermyself as the primary researcher(armin2@student.op.ac.nz) or to my Project Supervisor, Dr Mary Butler, PhD, RNZOT, GDTE,mbutler@op.ac.nz034796073

74

ConsentFormInterviews

Projecttitle:ThecurrentanddesiredperceptionoftheOccupationalTherapyprofessioninNewZealandProjectSupervisor:MaryButler

Researcher:NadjaArmitage

• I have read and understood the information provided about this research

projectintheInformationSheetdatedddmmmmyyyy.• Ihavehadanopportunitytoaskquestionsandtohavethemanswered.• Iunderstandthatnoteswillbetakenduringtheinterviewsandthattheywill

alsobeaudio-tapedandtranscribed.• Iunderstandthattakingpart inthisstudyisvoluntary(mychoice)andthatI

maywithdrawfromthestudyatanytimewithoutbeingdisadvantagedinanyway.

• IunderstandthatifIwillhavetheopportunitytocheckthetranscriptsandmakeanychangesIwishwithintwoweeksofreceivingthetranscript.

• Iagreetotakepartinthisresearch.• Iwishtoreceiveasummaryoftheresearchfindings(pleasetickone):Yes!No!

Participant’ssignature: Date:.......................................................................................................................Participant’s name:.......................................................................................................................

Participant’s preferred contact details for summary of research findings:

.....................................................................................................

.....................................................................................................

.....................................................................................................

.....................................................................................................

ApprovedbytheOtagoPolytechnicEthicsCommitteeon(typethedateonwhichthefinalapprovalwasgranted)

Note:TheParticipantshouldretainacopyofthisform.

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Appendix3:InterviewSchedule

INTERVIEWSCHEDULE

ResearchQuestion:DoesOccupationalTherapyinNewZealandhaveanimageproblem?Aimoftheinterview:Tounderstandtheparticipants’perceptionofOccupationalTherapyandcompareittothemainAlliedHealthprofessionsthatOccupationalTherapyhaveprofessionaloverlapwith.

NameofParticipant:Date:Consentform:☐yesVerbalconsent:☐yes

Introduction:•Introductionresearcher•Introductiontopic•Consentforparticipation,recordingandnotetaking•Purposeoftheinterview

Startofinterview:Introductoryquestion:•Canyoutellmealittlebitaboutyourcurrentrole?•Howlonghaveyoubeenworkinginyourcurrentrole?•HowdoyouworkwithOccupationalTherapistsinyourcurrentrole?Mainquestionsontopic:•CanyoudescribeyourfirstexperienceorcontactwithOccupationalTherapy/OccupationalTherapist?•(whenyouthinkbacktothatmoment)WhatwasyourfirstimpressionofOccupationalTherapy?•WhatdidyouknoworunderstandaboutOccupationalTherapypriortoyourfirstcontact/experiencewiththeprofession?(HaveyouheardofOTbeforethismoment?)•Sincethisfirstexperience-WhatisyourunderstandingofwhatroleorpurposeofOccupationalTherapynow?Arethereanykeyexperiencesthatyourememberthatchangedyourunderstanding?•if/Howhavetheseexperienceschangedyourimpression/thoughts/feelingsaboutOccupationalTherapy?•WhatdoyouconsideristhevalueofOccupationalTherapy?•HowwouldyoudescribeyourunderstandingofPhysiotherapy?Howwouldyoudescribetheprofession?•HowwouldyoudescribeyourunderstandingofSocialWork?Howwouldyoudescribetheprofession?•HowwouldyoudescribeyourunderstandingofPsychology?Howwouldyoudescribetheprofession?•Whatdoyouthinkofthecurrentstaffratioswithinyourteam?Follow-upquestions:Youmentioned…..•Canyoutellmemoreaboutthis?•Couldyouclarifythis?

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Appendix4:DataAnalysis

77

78

79

80

81

82

Appendix5:Exampleofnarrativereport

NarrativeInterviewReport

Whataretheessentialcharacteristicsoftheinterviewee’sstorythatmaycontributetoabetter

insight intotheresearchquestion:DoesOccupationalTherapyinNewZealandhaveanimage

problem?

The interviewee described that she feels thatworking togetherwithOT in her current role as

aNeuroPsychologistisbeneficialasOTsarecompletingfunctionalassessmentswhichcomplement

thepaper-basedassessmentsthatNeuroPsychologistscompletewithintheservice.However,the

intervieweementionedthatattimesthereseemstobea lackofunderstandingofeachother’s

roles.TheintervieweestatedthatshedidnotworkcloselywithOTsinpreviousrolesasaClinical

Psychologistwhichshepartly ledbacktoconfidentiality issuesbutmostlytohowtheparticular

servicewassetupandprocessesnotpromotinginterdisciplinarywork.However,theinterviewee

alsocommentedthatworkingalongsideOTsasaClinicalPsychologistwouldbevaluableforthe

patients.

TheintervieweedescribedOTasaprofessionthathelpspeopletoadjust,adapttochangesintheir

life.Intheinterviewee’scurrentsettingthisinvolvesfocusingonoutcomessuchasreturninghome

ortowork.Theintervieweecommentedthateventhoughshefeelsshehasagoodunderstanding

of the work OTs do in her current setting but that the work would look different in another

setting.ThewordtheintervieweeusedtodescribeOTwasdiverseandcommentedthatshedid

notappreciatehowmanydifferentthingsOTsareacross.Shefurthercommentedthatthereisa

lot of overlap between the OT and other allied health profession and that together with

the diversity aspect the interviewee thinks this might cause difficulties for OTs in forging

theirownidentities.

TheintervieweethinksthatpatientsdonotalwaysunderstandwhatOccupationalTherapyisand

thattheydon’talwaysrealisethattheywouldbenefitfromOTinputsuchassupportwithreturning

homeorbacktowork.

The interviewee said that Occupational Therapy seems to be perceived as a support

serviceprovidedadditionaltothemedicaltreatment.Sheexpandsbyexplainingthatthis isnot

specifictoOTbutappliestoallalliedhealthprofessions.TheintervieweedescribedOTasbeing

reallyquiteunderestimated.Shefeltthatthismightbecausedbythe lackof informationbeing

providedabouttheprofession,particularlyinmediasuchassocialmediaandTV.Shedidnotfeel

83

thatOTscontributedinanywaytothis,butitismoreduetothesetupofthesystemtheyworkin.

Shefurthercommentedthatallhealthprofessionalsarenotverygoodinpromotingthemselvesas

peopleareputoutbyhealthprofessionalswhoputthemselvesforwardtoomuch.Theinterviewee

pointedoutthatotherhealthprofessionalshavemoreclearlydefinedrolesandthatduetothe

diversity of OTs and the overlap with these professionals, OTs cross over professional role

boundariesandthereforeloseownershipofwhattheydo.

The interviewee stated that she did not hear about OT until she completed an allied health

workshopandthattheOTdegreesseemtobemorepromotedasacareeroptionatAustralian

universitiesthanNewZealanduniversitiesatthetimeofherstudies.

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Appendix6:Exampleofconceptualinterviewscheme

ConceptualInterviewScheme

WhatdoesthismeanfortheimageofOccupationalTherapyinNewZealand?

Overlap,identity&Collaboration

• OTcomplementsNP

• Lackofunderstandingofeachother’sroles

• Workingtogetherdependsonsetting/role(CPvsNP)

• WorkingwithOTsinCProlewouldbevaluableforpatients

• Servicesetupandenvironmentalsetupcanfunctionandenablerorbarrierforcollaboration

• Dependsonpatient

• Comparefindingsofassessmentstogeteachother’sperspectivesandcheckvalidityoffindings.

• Setupofservicedetermineinterdisciplinarywork

• OverlapbetweenotheralliedhealthandOT

• Crossoverwithotherprofessions/crossingintoothersexpertise=lossofownership

• OverlapanddiversitymightcausedifficultyforOTforgingidentity.

• Otheralliedhealthprofessionalshaveamoredefinedrole

PerceptionofOT

• Helpingpeopletoadjust/adapttochanges

• Helppeoplereturnhome/toworksuccessfully

• Acrossmanythings

• WorkofOTsdifferentindifferentsettings

• Beneficial

• valuable

• Functional(assessments)

• Goodindeterminingsupportthatpersonneeds,impactofmentalhealth,communityaccessand

doingstuff.

• OTsattimesdonotunderstandbenefitandpurposeofNPassessments

• WithoutOTpeoplemightstruggleinsilenceorreturntohospital

• Valueofprofessionunderestimated

Awareness&Lackofunderstanding

• DifficultyunderstandingwhatOTsroleisindifferentsettings

• LackofunderstandingofOTbyprofessionalsandpatients

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• LackofunderstandingofbenefitofOT

• OTperceivedassupportserviceasmanyotheralliedhealthprofessions

• Additionaltomedicaltreatment

• LackofappreciationofrangeoftasksOTdo

• Lackofinformationonprofession

• Lackofinformationinmedia

• UnderstandingofOTthroughexposure.

• UnderstandingofOTinonesettingdoesnotmeanunderstandingofOTroleinanothersetting.

• Patientsdonotalwaysrealisetheyneedhelpwithdailytasksorreturningbacktowork.

• Systemcontributestowardslowawarenessofprofession

• Healthprofessionalsgenerallynotgoodinpromotingthemselves

• Selfpromotionnotwellperceivedinthehealthcaresystem

• OTnotwellpromotedintheeducationsystem

Memonotes:

• Difficultnottouseliteraturereviewheadingstoorganisethemes.

• Difficultyfindingtitlesforcategories/themesforinformationgatheredinthisinterviewasthekey

pointsseemtorelatetoeachotherandittooktimetoseeconnections/themesthatwerenotguidedby

Literaturereview.

• Changeof"workingtogether"tocollaborationtoalignconceptnamesamongconceptschedules.

• ChangingdescriptionofOTtoperceptiontoalignconceptnamesamongconceptschedules.

• MovedpointsfromInstitutionalsetupintocollaborationastheenvironmental/servicesetupwas

identifiedtofunctionasabarrierorenablerforcollaboration,sodoesnotneedtobeaseparatepoint.

FurtherIaddedidentitytotheconceptbutnot100%surehowthislinksinorifitneedstobeasperate

point.Howdoesitrelatetoroleconfusion?Shouldtherebeaseparateconceptcalledroleconfusion

and identity and leave overlap and collaboration as a separate concept

whentransferringtheseconceptstothegeneralconcepttheme?

• Isittooeasytojustlabelacategory"perceptionofOT'?Mightneedfurtherthought.

• Thereisalinkbetweenlackofunderstandingandawarenessandperception

• Differencebetweenconceptofperceptionandlackofunderstandingisperception=interviewee's

perceptionwhilelackofunderstandinggeneralaspect.

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Appendix7:Generalconceptscheme

Overlap,roleconfusion/identity&collaboration

• UnsureofhowtocollaboratewithOTasNewGrad

• JointsessionwithOThelpful

• Goodtohaveanotherperson/professionsperspectivethatlinkswithownfocus.

• Level of collaboration depends on environment and service set up. Some setups promote

collaborationothersareabarrier.

• Confidence in own role determines ability to collaborate (New Graduate vs Experienced

Practitioner)

• PatientsquitereceptiveasOTrelatedtodailytasks

• OToverlapswithotherprofessions/disciplinescausesconfusion

• Changingroleboundariesbetweensettingsisconfusing

• Changingroleboundariesmakecollaborationdifficult

• RoleconfusioncausesmanagementtoperceiveOTasreplaceable.

• ConfusionoverOTroledefinitionandboundaries

• Flexibilitystrengthbutalsocauseconfusion

• OTcomplementsNP

• Lackofunderstandingofeachother’sroles

• Workingtogetherdependsonsetting/role(CPvsNP)

• WorkingwithOTsinCProlewouldbevaluableforpatients

• Servicesetupandenvironmentalsetupcanfunctionandenablerorbarrierforcollaboration

• Dependsonpatient

• Comparefindingsofassessmentstogeteachother’sperspectiveandcheckvalidityoffindings.

• Setupofservicedetermineinterdisciplinarywork

• OverlapbetweenotheralliedhealthandOT

• Crossoverwithotherprofessions/crossingintoothersexpertise=lossofownership

• OverlapanddiversitymightcausedifficultyforOTforgingidentity.

• Otheralliedhealthprofessionalshaveamoredefinedrole

• Workingtogethermeansaccesstobroaderknowledgeandlearningfromeachother

• WorkingtogetherisgettingasecondopinionofadisciplinesimilartoPT.

• Workingtogetherbringsbetteroutcomesforpatients.

• BoundariescrossoverbetweenOT/PT

• Doingassessmentstogether

• Jointsessions

• Sortoflikephysio

• Professionyouchosewhenyoudidn’tgetintoPT

87

• OTassistingPT

• OTspecificdomains

• Upperlimb

• Wheelchairs

• TypeandlevelofCollaborationdependsonservicesetting&environment

• OTsmorekeyworkerrole

• Dependsonsetting(Workingalongsideinateamvsworkingclosewiththembutspendinglesstime

withOT,liaise)

• Managingreferralstootherservices

• Confusedwiththerapyassistanceornursingstaffininpatientsetting

• A good introduction might reduce role confusion/increase understanding of OT among

patients/clients.

• WorkingwithOTgoodexperience

• Appreciatingbouncingideasofeachother

• ShortfallswithsystemareblamedonAHprofessionals.

• Jointassessments

• Initialassessments

• Homevisit

• Serviceandenvironmentalsetupinfluencelevelandtypeofcollaboration

Awareness&Lackofunderstanding

• Patientsconfusedbyname

• UnderstandwhatOTis/doesafterexposureasitrelatestotheirdaytodaylife

• LackofunderstandingofOTknowledge,skillsandexpertise

• Lackofunderstandingofskillsmeanspeopledon’tthinkofOTsforreferringforcertainassessments

• OTnotwellknownoutsideofhealthcare

• OTnotoftentalkedaboutascareerchoice

• OTspragmaticanddonotenjoypromotingthemselves

• Noknowledgeuntilfirstexposureatplacement

• GoodunderstandingdevelopedthroughworkingwithOTs

• LackofunderstandingmeansOTsareunderutilised.

• DifficultyunderstandingwhatOTsroleisindifferentsettings

• LackofunderstandingofOTbyprofessionalsandpatients

• LackofunderstandingofbenefitofOT

• OTperceivedassupportserviceasmanyotheralliedhealthprofessions

• Additionaltomedicaltreatment

• LackofappreciationofrangeoftasksOTdo

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• Lackofinformationonprofession

• Lackofinformationinmedia

• UnderstandingofOTthroughexposure.

• UnderstandingofOTinonesettingdoesnotmeanunderstandingofOTroleinanothersetting.

• Patientsdonotalwaysrealisetheyneedhelpwithdailytasksorreturningtowork.

• Systemcontributestowardslowawarenessofprofession

• Healthprofessionalsgenerallynotgoodinpromotingthemselves

• Selfpromotionnotwellperceivedinthehealthcaresystem

• OTnotwellpromotedintheeducationsystem

• LackofexperienceinownprofessioninfluencingworkwithOT

• LackofunderstandingofOTasanewgrad

• UnderstandingofOTimprovedwithexposure

• ExperienceofworkingwithOTgenerallygood.

• PatientsunderstandtasksthatOTsdoratherthanjobtitle

• Notworkinginhospitals,youdon’tgetexposuretoOT=lackofunderstanding/awareness

• Nameismisleading

• Nameissuitableforreturntoworkprogramme

• Unknownprofession

• Randomprofession

• Notwellmarketed

• LessknownasPT,lessreferredtobydoctors

• Notpubliclyadvertised

• Changeofperception/understandingthroughexposure

• OnlyunderstandingofOTthroughexposure

• Patients/clientsunsureofwhatOTis.

• Patients/clientsdonotperceiveOTastherapy

• Seenasanorganisationalpersonincommunitysetting

• Perceptionofwhattherapyis

• Occupationsseenasmenialorbasicbypatients

• Practicingoccupationsnotofhighimportancetopatients

• Increaseunderstandingthroughexposure

• NoindepthunderstandingofwhatOTdoesevenwithexposure

• UnderstandingofOTmuddyuntilexposure

• PeopleunderstandOTthroughexposure

• PeoplehavegoodunderstandingofPT

• Medicalteamhaslackofunderstandingofalliedhealthroles/reasoningattimes

• Lackofunderstandingofalliedhealthprofessionsbythemedicalstaffcauseofissues

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• LackofpromotionduetoOTspragmaticmentality

• Patientsperceptionofrehabasphysicalbasedcontributestoreducedawarenessandunderstanding

ofOT

• Alliedhealthprofessionsthatarenotbasedwithinthemedicalmodelarelosingtheiridentitiesby

beingabsorbed/suffocatedbythehealthcaresystem

• Currentsystemcanmakerolevagueanddifficulttonavigate

• CurrenthierarchicalsystemleavesAHprofessionalsoftenoverruled

• MedicalstaffseentoknowmorethanAH

• Beingoverruledbymedicalmodelcanfeelundermininganddisrespectful

Interviewee'sPerceptionofOT

• Helpfulwithgoalsettingwhichimprovesoutcomes

• OT focuses on person's function, tasks andwhat is important to them as well as how this can

beachieved.

• Practical

• Overall(bigpicture,drawingfromotherprofessionsandbringitalltogether)

• Combinationoffunctionalandcognitivefocus

• Practicalandfunctionalapproach

• Identifyingwhatisimportanttopeople

• WorkingwithOTspositive

• OTperspectivehelpful

• FirstperceptionthatOTdomainliesinvocationalarea

• PerceptionofOTdependsonexperienceofthepersonwithindividualpractitioners

• OTyoungprofession(justlikeSLT)comparedtoPT

• EquipmentclearOTdomain

• Helpingpeopletoadjust/adapttochanges

• Helppeoplereturnhome/toworksuccessfully

• Acrossmanythings

• WorkofOTsdifferentindifferentsettings

• Beneficial

• valuable

• Functional(assessments)

• Goodindeterminingsupportthatpersonneeds,impactofmentalhealth,communityaccessand

doingstuff.

• OTsattimesdonotunderstandbenefitandpurposeofNPassessments

• WithoutOTpeoplemightstruggleinsilenceorreturntohospital

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• Valueofprofessionunderestimated

• Assessmentandprovisionofequipment&supportservicesperceivedasmainOTdomainduring

firstyearsofpractice.

• InmorespecialistareaOTattimeshaveadditionaldomainsbutnotconsistently.

• Helpfulforbothpatientsandcollaboration

• Professionthatmakespeopledostuff

• OTsencourageindependence(makingthemdostuff)

• OTgoodabilitytolistentowhatpatientsneedandhowtomakeitwork.

• Goodcommunicators

• Goodadvocates/mediators

• Seedifferentpointofviews

• OTnotawellunderstoodprofession

• OTarespectedprofession

• Abilitytobeassertiveimpactedbydealingwithcomplexissuesthatdon’thaveeasyanswers

• Needtobalancerapportbuilding/empathyandencouragingindependence

• OTs are respected when they are experienced, advocate for their patients & connect them

withservices

• Requiresmoremedicaltraininginordertocommunicatetheirreasoningmoreclearly

• Helpful

• Interesting/uniqueapproachtotreatment

• Maketasksworkbetter

• Workingtogetherisverybeneficialbyprovidingbroaderknowledgeanduniqueperspectiveusing

functionalapproach.

• Undervalued

• Challengethelevelofindependenceofpatientsinahospitalsetting

• Getpatiencetovalueindependence

• Reducingburdenonhospitalsandcarefacilities

• Functionalapproach

• Treatmentapproach

• Broaderrangeofknowledge

• Uniqueperspective

• Functional(pointofview,focus,approach,tasks,restoring)

• Holistic

• Bigpicturethatismissedbyotherhealthprofessionals

• Enablepeopletolivetheirlife(asindependentlyaspossible).

• Findingalternatives

• Leadingintotherapy/Happeningbeforetherapy

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• therapyaddedtoOTtoassist/therapybasedonfunctionalgoal

• Educationsystemnotonpar

• Educationmorepractical

• Educationlackingemphasisonillnessandinjury

• Educationshapesperception

• WhatyoustudyifyoudidnotgetintoPT

• Restrictedtocertainsettings.

• Importantpartofrehab

• UnclearOTdomains

• Wheelchairs&ReturntoWorkOTdomain

• Undervalued

• NeedsclearerroledistinctionbetweennursingstaffandOT

• Improvedischargeplanning

• PerceptionofOTchangedovertimethroughexposure

• Firstperception:equipment

• Laterperception:therapeuticfocusbutnotsure100%ofunderstandingofOT

• OThasnon-physicalfocusthatdoesnotalignwithpeople'sperspectiveofrehabilitation

• Physiotherapistsareregardedhigherthanotheralliedhealthprofessions

• Approachable

• Comfortabletoworkwith

• Handson

• Practical

• Meetingpracticalneeds

• Gettingpeopletodothings

• Invaluable

• Biggerpicture-focusingondailytasks

• OT'swiderperspectiveofpatientneedsishelpful

• Preventrisk

• Offerslightlydifferentviewonthings

• PTregardedhigherthatOT

• Differentview

• OTlessalignedwithmedicalmodel

• SystemcausesdifficultyforOT.

92

Memonotes:

• OverlapbetweenprofessionsmakescollaborationwithotherdisciplinesbeneficialasOTcandraw

fromknowledgeofotherdisciplines(andviceversa)anddrawitalltogetherinaholisticpicture.Onthe

othersidetheoverlapcausesroleconfusion,unclearroleboundaries,etc..

• FurtherIaddedidentitytotheconceptbutnot100%surehowthislinksinorifitneedstobea

speratepoint.Howdoes it relate to role confusion? Should therebe a separate concept called role

confusion and identity and leave overlap and collaboration as a separate concept

whentransferringtheseconceptstothegeneralconcepttheme?

• Isittooeasytojustlabelacategory"perceptionofOT'?Mightneedfurtherthought.

• Thereisalinkbetweenlackofunderstandingandawarenessandperception

• Differencebetweenconceptofperceptionandlackofunderstandingisperception=interviewee's

perceptionwhilelackofunderstandinggeneralaspect.

• ?Addingsubthemesduringreviewinginterview1&Lynn-

o Perception: OT has value, strength of OT in its approach, OT not perceived as

therapy,education,CharacteristicsofOccupationalTherapists

o Understanding:creatingthroughexposure,confusionofOTdomain,professionalname

o Collaboration:WorkingwithOccupationalTherapy,Difficultywithsystembasedinmedical

model:

• Difficultyseparatingcontentintoconceptsastheyseemtointerrelate/overlap.

• AligningOTwithmedicalmodel-?EasiercommunicatingvslosingOTidentity.

93

Appendix8:DataAnalysisStage9

Interview1 Interview2 Interview3 Interview4 Interview5

Overlap/Crossover Overlap/Crossover Overlap/Crossover Overlap/Crossover Overlap/Crossover 2

Boundaries Boundaries Boundaries Boundaries Boundaries 1

Confusion Confusion Confusion Confusion Confusion 1

Joint(session/work) Joint(session/work) Joint(session/work) Joint(session/work) Joint(session/work) 3

Assessment Assessment Assessment Assessment Assessment 5

Perspective Perspective Perspective Perspective Perspective 3

Understanding Understanding Understanding Understanding Understanding 4

Working

with/together

Working

with/together

Working

with/together

Working

with/together

Working

with/together

5

Environment Environment Environment Environment Environment 2

Service/system Service/system set

up.

Service/system Service/system Service/system 3

AlliedHealth AlliedHealth AlliedHealth AlliedHealth AlliedHealth 4

OTDomain OTDomain OTDomain OTDomain OTDomain 2

Role Role Role Role Role 5

knowledge knowledge knowledge knowledge knowledge 4

Interdisciplinary Interdisciplinary Interdisciplinary tea

m

Interdisciplinary Tea

m

Interdisciplinary 2

Separate Separate Separate Separate Separate 3

Skills Skills Skills Skills Skills 0

Pragmatic Pragmatic Pragmatic Pragmatic Pragmatic 0

Settings Settings Settings Settings Settings 4

Medical Medical Medical Medical Medical 4

Promotion Promotion/promote

Promotion Promotion Promotion 0

Perceive/Perception

Perceive/Perception

Perceive/Perception

Perceive/Perception Perceive/Perception 4

Exposure Exposure Exposure Exposure Exposure 2

Name Name Name Name Name 2

Helpful Helpful Helpful Helpful Helpful 4

benefit/beneficial benefit/beneficial benefit/beneficial benefit/beneficial benefit/beneficial 3

Practical Practical Practical Practical Practical 3

Functional Functional Functional Functional Functional 4

Value Value Value Value Value 3

Equipment Equipment Equipment Equipment Equipment 5

Education Education Education Education Education 2

View View View View View 4

Approach Approach Approach Approach Approach 2

94

Support Support Support Support Support 3

Holistic Holistic Holistic Holistic Holistic 2

Placement Placement Placement Placement Placement 3

Vocational Vocational Vocational Vocational Vocational 1

Positive Positive Positive Positive Positive 1

Experience Experience Experience Experience Experience 4

Differentarea Differentarea Differentarea Differentarea Differentarea 1

Underestimated Underestimated Underestimated Underestimated Underestimated 2

Together Together Together Together Together 5

Advocate Advocate Advocate Advocate Advocate 1

ADL ADL ADL ADL ADL 2

Showering Showering Showering Showering Showering 3

Dressing Dressing Dressing Dressing Dressing 1

Disciplin Discipline Discipline Discipline Discipline 1

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Appendix9:DataanalysisStage10

ThevalueofOccupationalTherapy

• Invaluable

• Important

• mostusefulthing

• practical

• undervalued

• underestimated

• ability to increaseaperson’s independenceby restoring functionafter illnessor

injuryreducesupportservicescosts

• seethebiggerpicture/holisticpicture

• independenceversusneedforsupportservices

• Collaboratingvalidateclinicalreasoning.

• flexibility

• functionalapproach

• roleandboundaryconfusionanduncertainty

ProfessionalIdentity

• confusion

• association with tasks that performed rather than the profession: providing

equipment,assistingintheshower.

• confusedwithotherhealthcareprofessions

• non-therapeuticprofession/keyworkingrole/leadintotherapy/addtherapyinto.

• nameacauseoftheconfusion

• therapytasksperceivedasbasic/unabletoidentifyanybenefit

• nospecificdomains

• rolevariesbetweendifferentsettingsandtherapistswithinthesamesetting.

• appearanceofbeingeasilyreplaceable.

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Marginalisationoftheprofession

• New Zealand health care system operates under medical model/historical

hierarchy

• ThelackofunderstandingoftheroleofOccupationalTherapyacleartheme

• MostparticipantsstillnotfullyclearonwhattheroleofOccupationalTherapy.

• broaderrangeofknowledgetoallowforaholisticapproach

• level of uncertainty around fully understanding the role and tasksOccupational

therapists.OccupationalTherapyspecifictasksseemtobeabletobeperformedby

otherdisciplines.

• understanding of Occupational Therapy only results with exposure to the

profession.

• Atbest,somebasicunderstandingofOccupationalTherapyaftercompletingtheir

training,

PromotingAwarenessofOccupationalTherapy

• Not very effective in promoting own profession, lack of assertiveness, lack of

confidence, not confident in their clinical reasoning skills, struggle answering

questionsbymedicalprofessionals.

• complex nature of the issues was also identified as a cause of the lack of

assertiveness

• occupationaltherapistsassertivewhenadvocatingfortheirpatientsorclients.

• Needtobecompassionatetobuildrapportbutalsoassertivetoencouragepeople

tocompletetasksthemselves.

• healthprofessionalswhopromotethemselvesoftenbeenmethostility.

• perceptionthatpromotingtheirprofessionlieswiththeindividualprofessional

Environment&Systemconstructs

• elementsofthephysicalandinstitutionalenvironmentthatimpactedonhowthey

perceivedtheroleofOccupationalTherapy.

• The policies and systems of health services either enabled or limits the

opportunitiesforcollaboration

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• separateofficesandorworkspacesascontributingfactors.