School of Rehabilitation Therapy Graduate Theses

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    Building Capacity in Occupational Therapy Delivery: Supporting Intraprofessional Collaboration Preparation
    (2024-07-08) Avvampato, Teresa Rae-Anna; Rehabilitation and Health Leadership; Finlayson, Marcia
    In Canada, a shortage of occupational therapists (OTs) has led to increased collaboration with OT-assistants (OTAs) to improve access to service. OTs and OTAs in Canada are, however, not adequately prepared for intraprofessional collaboration (IntraPC), affecting the safety, efficiency, and quality of occupational therapy services. The purpose of this three-phased study was to support OT-OTA IntraPC preparation in the Canadian context. Phase 1 involved an environmental scan, including a survey with OT and OTA educators in Ontario, which revealed the need for resources to support OT-OTA IntraPC preparation. Focus groups with educators and recent graduates also emphasized the need for ready-made resources. Participants identified that online resources that provide essential knowledge would be most useful for supporting OT-OTA IntraPC preparation in Canada. Participants also recommended support from accrediting bodies, regulators, and associations for OT-OTA IntraPC and its preparation. In Phase 2, an online training resource was developed based on the needs identified in Phase 1. The resource explored the impact of OT-OTA IntraPC on the quality of occupational therapy services and presented the foundational knowledge, attitudes, and behaviours that OTs and OTAs need to work together effectively. Before its launch, the resources were peer-reviewed by 30 professionals. The results demonstrate that the resource effectively achieved its goal of presenting accurate, valid, and useful content to support OT-OTA IntraPC preparation in a user-friendly manner. In Phase 3, Canadian OT and OTA educators and clinicians evaluated the online resource. The evaluation investigated course access, self-rated competence for OT-OTA collaboration, and participant satisfaction. Participants reported increased self-perceived knowledge, understanding of collaborative practice, and intentions to make practice changes, marking a significant step in supporting OT-OTA collaboration preparation in Canada. In summary, this dissertation disseminates the development and adoption of a free online course designed to support OT-OTA IntraPC preparation in Canada. While the course offers foundational support, this dissertation underscores the need to provide a continuum of evidence-based OT-OTA IntraPC preparation opportunities, which emphasize contact, relationship-building, and mutual goal achievement. Macro-environmental barriers to OT-OTA IntraPC in Canada are also revealed and discussed, and recommendations are presented for health leaders.
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    Missed Opportunties: Advancing Canadian Occupational Therapy Practice for Harm Reduction Among Women who Consume Alcohol
    (2024-07-08) Bitz, Kimberly; Rehabilitation and Health Leadership; Finlayson, Marcia
    Increasingly harmful patterns of alcohol use are being noted among Canadian women, resulting in increased social, economic, mental health, and physical health-related costs. Harm reduction is an approach to alcohol use care that may mitigate negative consequences; however, Canadian occupational therapists may be missing opportunities to address alcohol use through harm reduction. This study aimed to advance Canadian occupational therapy practices for harm reduction among women who consume alcohol by meeting the following objectives: 1. Describe the current state of education for occupational therapy students and the learning needs for practicing occupational therapists related to harm reduction and alcohol use among women. 2. Describe the perspectives and experiences of occupational therapists related to implementing harm reduction strategies for alcohol use. 3. Develop and evaluate a clinical resource to support the use of harm reduction practices within occupational therapy for alcohol use among women. This study involved two phases. In Phase 1, an environmental scan was completed utilizing a mixed methods data collection approach. The scan involved an online search of educational and occupational therapy practice resources, an online survey sent to Canadian university occupational therapy programs, and semi-structured interviews with Canadian occupational therapists. Findings indicated support for the role of occupational therapists within substance use care. Nonetheless, several barriers may contribute to missed opportunities for effective occupational therapy intervention, including occupational therapy scope of practice and professional role clarity, ethical questions and challenges, comfort in engaging clients around discussions about substance use, and knowledge and education. In Phase 2, an online course using a knowledge-to-action framework was developed and evaluated with practicing occupational therapists. Findings from the evaluation indicated that the course positively impacted learning outcomes, most notably participants’ self-reported ability to describe low-risk drinking guidelines, describe the effects of increasing alcohol use and harm among women, and describe the role occupational therapists play in alcohol screening and harm reduction. This dissertation demonstrates that self-directed online education for occupational therapists is a promising knowledge dissemination tool for advancing Canadian occupational therapy practices for harm reduction among women who consume alcohol.
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    Understanding the Lived Experiences and Perceived Impacts of Incarceration on the Well-being of Adult Family Members
    (2024-05-16) MacNaull, Sara; Rehabilitation and Health Leadership; Cramm, Heidi
    In Canada, there are nearly 35,000 individuals in custody in correctional institutions on any given day. As a result, countless immediate and extended family members are impacted by incarceration. My research study aimed to better understand the experiences of adult family members and how their experience impacts their well-being, including their physical health, mental health, life satisfaction, and emotions. I employed a two-phased approach to data collection to inform the creation of a resource for community organizations. Grounded in Interpretive Phenomenological Analysis (IPA), Phase One data collection included a web-based questionnaire and in-depth interviews with 15 adults living in Ontario who have an adult family member currently incarcerated in Canada. The data revealed that adult family members are profoundly affected by their loved one’s incarceration. The findings were categorized into internal and external dimensions of their experience. The internal dimensions speak to their experiences in their minds, bodies, and souls, including the mental and emotional impact, the focus on their incarcerated family member, and accepting the past to move forward through incarceration. The external dimensions speak to how their experience affects their relationships with their incarcerated family member, family, friends, the community, the correctional system, and society. In Phase Two, a Working Group comprised of six employees from community organizations in the correctional or criminal justice field that provide services in Ontario was convened. Rooted in human-centred design thinking, the Working Group focused on empathy for families, the challenges organizations face supporting families, and generating ideas to inform a resource for community organizations that support family well-being within and beyond the correctional field. Informed and inspired by participant interviews and the Working Group discussion, a resource was created to increase understanding of the experiences of adult family members affected by incarceration. Feedback from study participants was requested and integrated to refine the final resource. The resource will be disseminated to individuals and organizations across Canada in English and French to support family well-being and eliminate the stigma experienced by family members.
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    Patient Function as a Health Indicator of Team-Based Primary Care: A Study of Why, What, and How for Health Leaders
    (2024-04-24) Cutforth, Gregory S. O.; Rehabilitation and Health Leadership; Donnelly, Catherine; Miller, Jordan
    Background: Team-based care is core to primary care transformation initiatives aimed at strengthening primary care as the foundation of health systems to improve patient and provider experience, reduce healthcare costs, and improve health outcomes for patients. To assess impacts, performance measurement should include health indicators of patient health outcomes. Efforts to measure patient function, a biopsychosocial model of functioning and disability health, in primary care have been largely unsuccessful. This research aims to explore the concept of patient function as a health indicator of team-based primary care and how it can be practically measured to inform quality improvement. Methods and Results: The research was conducted through 3 concurrent phases. In phase 1, a qualitative study explored patients’ and primary care teams’ understanding of patient function and perspectives on the utility of function as a health indicator. The findings suggest patients and teams understand the concept of function, perceive value in function as a health indicator, and measurement and reporting of function should reflect the complex nature of primary care. In phase 2, a Delphi study was employed to identify patient function health indicators for use in in primary care. These findings suggest that identifying patient function health indicators in primary care is complex and all domains of function are important. Five valid and reliable measures of function were deemed to be appropriate and feasible health indicators in primary care, of which the SF-12 ranked the highest. In the third phase, 3 frameworks were described from the quality improvement and implementation science literature that health leaders could use to implement patient function health indicators to inform quality improvement for primary care teams. A quasi-fictitious case scenario was used to demonstrate how the frameworks could be practically used to develop theory-informed implementation strategies. Conclusion: Patient function health indicators are important to patients and primary care teams. There are valid patient-reported measures of function that can be used as health indicators in primary care. Healthcare leaders can use quality improvement and implementation science theory to inform effective strategies to implement patient function health indicators with primary care teams to drive quality improvement.
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    Student leadership: Preparing student health professionals to lead
    (2024-02-01) Anderson, Rhona L.; Rehabilitation and Health Leadership; Finlayson, Marcia
    Healthcare environments are complex adaptive systems that require practice-ready clinicians who are prepared to collaborate with others and influence processes. Preparing practice-ready clinicians requires attention to leadership development in health professions programs. Although many health professional student leadership learning opportunities exist, most occur in academic settings, removed from healthcare practice. An alternate way to build leadership in student health professionals is through clinical education (i.e., fieldwork). This dissertation aimed to advance student leadership development in clinical education. It consisted of a four-phased process, involving a mixed methods study grounded in pragmatism. In phase 1, we conducted a concept analysis (Rodgers, 2000) of student leadership, which included extraction from 126 articles. It resulted in a proposed definition of student leadership and revealed a need for interprofessional approaches and strategies for its development in clinical settings. Phase 2 involved a qualitative descriptive study, with 15 semi-structured interviews and 1 focus group, to explore perspectives concerning student leadership development among rehabilitation professionals (occupational therapists, physical therapists, and speech-language pathologists), student rehabilitation professionals, and clinical educators from academic and clinical environments. Using a qualitative content analysis approach, Phase 2 added to an understanding of student leadership, including what enables its development and needed clinical education tools. For Phase 3, we used the findings from Phases 1 and 2 to create a student leadership development framework and three tool sets. The tool sets are designed to provide an understanding of the state of student leadership culture in the practice environment, promote clarity regarding the language of student leadership, and offer illustrative narratives and active learning plans for students to implement in their clinical learning. In Phase 4, attempts were made to evaluate the products, however, there was limited response, most likely stemming from pandemic-related factors. Regardless, this dissertation has contributed to our understanding of student leadership, and it offers intentional methods that may be used by clinical educators from multiple professions to develop student leadership in clinical settings. Importantly, the results of the dissertation can enhance the integration of health education and healthcare environments and provide a clear and organized approach to student leadership development.