Perceived barriers to implementing occupation-based intervention

Occupation-based intervention (OBI) is defined as an intervention using a clients’ occupation and purposeful activities as a treatment medium to achieve the client’s goals. Several barriers to practising OBI have been reported in previous studies. However, limited research has been done to identify these perceived barriers to applying OBI in Malaysia’s various occupational therapy practice areas.

Objective

This study aimed to identify perceived barriers to applying OBI in Malaysia’s three main occupational therapy practice areas including physical, psychiatry and paediatric.

Method

A cross-sectional study design was employed, and participants were recruited using a purposive sampling strategy. Data was collected using an online survey from a Delphi study.

Results

Two hundred ninety-eight Malaysian occupational therapists aged between 22 and 56 years old participated in this study. The study identified several perceived barriers from the client factors, the contextual factors, occupation as treatment modalities and logistical issues. A statistically significant difference was found in the perceived barriers of applying OBI between different areas of occupational therapy practice (p=.013), working experience (p=.003), and position of occupational therapists (p=.001).

Conclusion

This study suggests that perceived barriers to applying OBI were influenced by the area of practice, working experience and position of the occupational therapists. The results highlight the need to identify potential solutions to applying OBI through research and education.

Keywords:
Occupational Therapy; Scope of Practice; Activities of Daily Living

Demographic characteristics	n (%)
Gender
Male	86 (28.9)
Female	212 (71.1)
Area of occupational therapy practice
Physical dysfunction	122 (40.9)
Paediatric	112 (37.6)
Psychiatric & mental health	64 (21.5)
Years of experience
Less than five years	90 (30.2)
More than five years	208 (69.8)
Type of institution
Governmental organisation	218 (73.2)
Non-governmental organisation	80 (26.8)
Working location
Urban / city area	228 (76.5)
Sub-urban / rural area	70 (23.5)
Position
Support staff / Junior OT	168 (56.4)
Professional / Senior OT	130 (43.6)

Statements	Agree to totally agree n (%)
Category 1: Client Factors
The client is more impressed and motivated by sophisticated and advanced equipment.	66 (22.1)
The client does not understand the purpose of the occupation-based intervention.	128 (43.0)
The client’s understanding of the recovery process. e.g., the client is not ready to engage in occupations until they gain the maximal level of strength and are fully recovered is an issue in applying occupation-based intervention.	188 (63.1)
Category 2: Occupational Therapist Factors
Rarely use a client-centred approach in practice.	48 (16.1)
Skill and knowledge in applying a client-centred approach are lacking.	114 (38.3)
Lack of creative skills to practise occupation-based intervention.	102 (34.2)
Lack of skill in grading activities/tasks/occupations.	76 (25.5)
Basic skills in task/activity analysis are lacking.	82 (27.5)
Rarely use occupation-based assessment in daily clinical practice.	72 (24.2)
Limited knowledge and understanding of occupation-based intervention.	110 (36.9)
Not sufficiently well prepared and well trained to practise occupation-based intervention.	106 (35.6)
Category 3: Contextual Factors
Malaysian cultural value of relying on family members to serve “the sick/dependent client” is a challenge to implement the occupation-based intervention.	258 (86.6)
Bureaucracy and power differential in Malaysia Healthcare System; e.g., occupational therapists must follow the doctor’s order.	130 (43.6)
The dominance of the biomedical model in healthcare delivery makes it difficult to practice occupation-based intervention.	186 (62.4)
Lack of awareness about the role of occupational therapists by other professionals limits referral for occupation-based intervention.	254 (85.2)
Multidisciplinary members always perceive that movements and strength are essential requirements for function.	270 (90.6)
Multidisciplinary members do not understand the purpose of the occupation-based intervention.	228 (76.5)
Lack of cooperation from other multidisciplinary members makes it difficult to practise occupation-based intervention.	222 (74.5)
Category 4: Occupation as Treatment Modalities
Limited evidence on the efficacy of the occupation-based intervention.	70 (23.5)
Occupation-based intervention is less practical in an acute care setting.	184 (61.7)
Providing good, observable, and measurable outcomes in the domain of occupation is difficult.	164 (55.0)
Category 5: Logistical Issues
Practising occupation-based intervention consumes a lot of time.	206 (69.1)
Practising occupation-based intervention is difficult due to time constraints and heavy workloads.	202 (67.8)
Lack of specific guidelines on occupation-based intervention.	172 (57.7)
Providing a similar context and environment in which the client’s occupations take place is challenging.	232 (77.9)
The department is not set up to practise occupation-based intervention.	186 (62.4)
Appropriate equipment and resources for practising occupation-based intervention are lacking.	238 (79.9)

Variables	Mean ± SD	t stats (df) /F stats (df)	p-value
Working experience
Less than five years	72.02 ± 10.27	3.00 (296)	0.003^†
More than five years	67.67 ± 11.97
Type of institution
Governmental organization	69.37 (11.55)	0.93 (296)	0.353†
Non-governmental organisation	67.95 (11.91)
Working location
Urban/city area	68.48 (14.00)	-1.35 (296)	0.178†
Suburban/rural area	70.63 (14.00)
Position of OT
Support/junior OT	71.68 (10.39)	4.70 (296)	0.001†
Professional/senior OT	65.51 (12.28)
Area of Occupational Therapy Practice Physical dysfunction Paediatric Psychiatric and mental health	68.33 (10.95) 67.57 (12.35) 72.71 (10.98)	4.41 (2,295)	0.013^‡

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Author’s Contributions

All authors read, reviewed and then approved the manuscript.

Brasil

Brasil

Perceived barriers to implementing occupation-based intervention1 1 This study was approved by the Research Ethics Committee of Universiti Teknologi MARA (Approval no.: 600-IRMI (5/1/6)) and Medical Research and Ethics Committee (MREC) (Approval no.: NMRR-18-2913-44105 (IIR)).

Percepção de barreiras para implementar intervenções baseadas em ocupação

Abstract

Introduction

Objective

Method

Results

Conclusion

Perceived barriers to implementing occupation-based intervention¹ 1 This study was approved by the Research Ethics Committee of Universiti Teknologi MARA (Approval no.: 600-IRMI (5/1/6)) and Medical Research and Ethics Committee (MREC) (Approval no.: NMRR-18-2913-44105 (IIR)).