The Canadian Enabling Occupation II guidelines contain theory and examples of how to apply client-centredness in occupation-based practice. Little information is available about the feasibility of the guidelines in other contexts. For 18 months, nine Dutch occupational therapists participated in a community of practice to explore, together with three researchers, their experiences with the application of the Enabling Occupation II guidelines. To understand the experiences of Dutch occupational therapists with the application of the Enabling Occupation II guidelines. A qualitative study using four focus group discussions and content analysis. Four themes emerged: (1) an indication that the guidelines of Enabling Occupation II are in line with values and norms of Dutch occupational therapists, (2) the meaningfulness of an intensive process of studying, discussing, applying and reflecting, (3) the struggles faced by the occupational therapists with translating English and getting a grip on concepts and (4) the challenges to implementing the guidelines in practice. Findings indicate that Enabling Occupation II embody values and norms of Dutch occupational therapists. They experience many benefits in their doing, thinking and being when applying the guidelines in practice. Struggles with reading English, getting a grip on concepts and theories, and difficulties in handling obstacles indicate that the application of the guidelines takes effort. An understanding of the philosophy, application, and reflection on professional identity may be prerequisites for appraising the feasibility of adoption of client-centred guidelines cross-culturally.
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Scandinavian Journal of Occupational Therapy. 2015; Early Online, 1–2
ORIGINAL ARTICLE
Application of the enabling occupation II guidelines in a non-canadian
context
BARBARA PIŠKUR
1,2
, ANNERIE ZALMSTRA
2
, MARLUUKE JAKOBS
2
&
RAMON DANIËLS
1,2
1
Faculty of Health, Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Heerlen,
The Netherlands, and
2
Faculty of Health and Care, Department of Occupational Therapy, Zuyd University, Heerlen,
The Netherlands
Abstract
Background. The Canadian Enabling Occupation II guidelines contain theory and examples of how to apply client-centredness
in occupation-based practice. Little information is available about the feasibility of the guidelines in other contexts. For 18
months, nine Dutch occupational therapists participated in a community of practice to explore, together with three researchers,
their experiences with the application of the Enabling Occupation II guidelines. Purpose . To understand the experiences of
Dutch occupational therapists with the application of the Enabling Occupation II guidelines. Method . A qualitative study using
four focus group discussions and content analysis. Findings . Four themes emerged: (1) an indication that the guidelines of
Enabling Occupation II are in line with values and norms of Dutch occupational therapists, (2) the meaningfulness of an
intensive process of studying, discussing, applying and refl ecting, (3) the struggles faced by the occupational therapists with
translating English and getting a grip on concepts and (4) the challenges to implementing the guidelines in practice.
Implications. Findings indicate that Enabling Occupation II embody values and norms of Dutch occupational therapists.
They experience many benefi ts in their doing, thinking and being when applying the guidelines in practice. Struggles with
reading English, getting a grip on concepts and theories, and diffi culties in handling obstacles indicate that the application of
the guidelines takes effort. An understanding of the philosophy, application, and refl ection on professional identity may be
prerequisites for appraising the feasibility of adoption of client-centred guidelines cross-culturally.
Introduction
In occupational therapy, there is dominance of
scholars from English-speaking countries in producing
practice guidelines. The Canadian Enabling Occupa-
tion II guidelines (1), and the revised version (2)
contain theory and examples of how to apply client-
centredness in occupation-based practice. Guidelines
developed in one particular cultural context, however,
may not be feasible in another; client-centred practice
relates strongly to cultural beliefs, values, and norms
(3). For 18 months, nine Dutch occupational thera-
pists participated in a community of practice to
explore, together with three researchers, their experi-
ences with the application of the Enabling Occupation
II guidelines (1). During this period, four focus-group
interviews (4) were conducted to capture the occupa-
tional therapists' experiences.
Results
The fi ndings reveal:
(1) An indication that the guidelines of Enabling
Occupation II are in line with values and norms
of Dutch occupational therapists. The nine occu-
pational therapists in this study experienced
many benefi ts in " doing, thinking, and being",
when applying the guidelines.
Correspondence: Barbara Piš kur, MSc, Senior Researcher & Lecturer, Faculty of Health, Centre of Research Autonomy and Participation for Persons with a
Chronic Illness, and Department of Occupational Therapy, Zuyd University, Nieuw Eyckholt 300, Heerlen, The Netherlands. Tel: +3145 400 6451.
E-mail: barbara.piskur@zuyd.nl; piskur.barbara@gmail.com
(Received 27 November 2014; accepted 19 January 2015)
ISSN 1103-8128 print/ISSN 1651-2014 online Ó 2015 Informa Healthcare
DOI: 10.3109/11038128.2015.1015604
Scand J Occup Ther
Downloaded from informahealthcare.com by 84.86.55.97 on 04/05/15. For personal use only.
(2) The meaningfulness of an intensive process of
studying, discussing, applying. and refl ecting. This
loop of learning has been considered as valuable
to come to an understanding of the underlying
philosophy of client-centred practice and its
application in practice. Occupational therapists
regarded refl ection on their values, convictions,
and interpretation of concepts, as well as reflec-
tion on their resistances and prejudices, as a vital
part of their learning process.
(3) The struggles faced by the occupational therapists with
translating English and getting a grip on concepts.
Language played a major role in the learning
process, highlighting the importance of under-
standing the full meaning of concepts and ideas.
Dutch words did not always seem to capture the
same meaning as the English words. Developing,
as a profession, mutual language to express ideas
about client-centredness in occupation-based
practice was regarded as a necessary step for
Dutch occupational therapists.
(4) The challenges to implementing the guidelines in
practice. Enabling Occupation II offers a frame
of reference for practice; it is not a protocol or
intervention method. Application of the guide-
lines did not just take effort, but was simply not
possible without reconsidering professional
identity. Although the process led to stronger
professional identity, participants had felt
troubled by the conception of the professional
role caused by the variety of activities and tasks
of occupational therapy and the overlap wit-
nessed with other disciplines. Organizational
constraints had been challenging their motiva-
tion to intervene in a client-centred way.
Discussion
This study is a fi rst exploration of experiences of
Dutch occupational therapists with the Enabling
Occupation II guidelines, allowing for a positive indi-
cation of their feasibility in a non-Canadian context.
An understanding of the philosophy, application,
and refl ection on professional identity may be
prerequisites for appraising the feasibility of adoption
of client-centred guidelines cross-culturally. The
nine occupational therapists were " forerunners",
convinced of the benefi ts of client-centred and
occupation-based practice, and motivated to go
through a learning process. Integration of the guide-
lines into treatment protocols might, for the average
occupational therapist, be easier to handle. However,
one can question the quality of application if a thor-
ough understanding of the underlying concepts and
theories is lacking, and refl ection on (and transfor-
mation of) professional identity is missing.
Refl ective group discussions have been meaningful
in enhancing professional development in this study
as well in other studies, e.g. Duggan (5). More
research on how to apply the guidelines and how to
assist occupational therapists in implementing them
in a Dutch context is warranted. Additionally,
research could focus on conditions within the institu-
tions and the environment (e.g. policy), to enhance
client-centred practice.
Acknowledgements
The authors wish to thank all the participants
(occupational therapists of the Enabling Occupation
community of practice) who took part in this study.
Funding: This research study was supported finan-
cially by Zuyd University of Applied Sciences.
Declaration of interest: The authors report no
confl icts of interest. The authors alone are responsible
for the content and writing of the paper.
References
1. Townsend EA, Polatajko HJ. Enabling occupation II: advanc-
ing an occupational therapy vision for health, well-being &
justice through occupation. Ottawa: Canadian Association of
Occupational Therapists; 2007.
2. Townsend EA, Polatajko HJ, Enabling occupation II. Advanc-
ing an occupational therapy vision for health, well-being &
justice through occupation. 2nd Edition. Ottawa, ON:
CAOT; 2013.
3. Iwama M. Are you listening? Cross-cultural perspectives on
client centered occupational therapy practice: A view from
Japan. Occup Ther Now 1999;1:4–6.
4. Krueger RA, Casey MA. Focus groups: a practical guide for
applied research. 4th Edition. Thousand Oaks, CA: Sage
Publications; 2009 p.17–138.
5. Duggan R. Refl ection as a means to foster client-centred
practice. Can J Occup Ther 2005;72:103–12.
2B. Piš kur et al.
Scand J Occup Ther
Downloaded from informahealthcare.com by 84.86.55.97 on 04/05/15. For personal use only.
... While some investigators mainly based their actions on a single strategy (8/22) such as educational meetings (5/8), (Chard, 2006;Clemson, Donaldson, Hill, & Day, 2014;Doyle & Bennett, 2014;Eriksson, Erikson, Tham, & Guidetti, 2017;Hammond & Klompenhouwer, 2005), educational materials (1/8) (Nipp, Vogtle, & Warren, 2014), audit and feedback (1/8) (Kristensen & Hounsgaard, 2014), or communities of practice (1/8) (Piskur, Zalmstra, Jakobs, & Daniels, 2015), most used multifaceted strategies (13/22) (Bazyk et al., 2015;Cook, McCluskey, & Bowman, 2007;Dopp, Graff, Rikkert, Nijhuis van der Sanden, & Vernooij-Dassen, 2013;Dopp et al., 2015;Dunleavy, 2015;Forhan & Law, 2009;Kolehmainen et al., 2012;Lowe, Rappolt, Jaglal, & Macdonald, 2007;Lysack, Leach, Russo, Paulson, & Lichtenberg, 2013;Lysack, Lichtenberg, & Schneider, 2011;Mackenzie et al., 2018;Petzold et al., 2012;Sakzewski, Ziviani, & Boyd, 2016;Wimpenny, Forsyth, Jones, Matheson, & Colley, 2010) that combined two or more of the following: educational meetings, communities of practice, educational materials, educational outreach visits or academic detailing, monitoring the performance of the delivery of health care, audit and feedback, tailored interventions and local consensus processes (Effective Practice and Organisation of Care (EPOC), 2015). In this review, the educational meeting was the most frequently used strategy (18/22). ...
... Most studies (13/22) used questionnaires on knowledge, attitudes, beliefs or practices as an assessment tool either alone (8/13) (Cook et al., 2007;Doyle & Bennett, 2014;Dunleavy, 2015;Forhan & Law, 2009;Hammond & Klompenhouwer, 2005;Mackenzie et al., 2018;Nipp et al., 2014;Petzold et al., 2012) or with one or more other data collection tools (5/13) (Bazyk et al., 2015;Dopp et al., 2013;Kolehmainen et al., 2012;Lysack et al., 2013;Lysack et al., 2011). Other data collection techniques included written reflections (Bazyk et al., 2015;Chard, 2006;Wimpenny et al., 2010), face-to-face interviews (Chard, 2006;Clemson et al., 2014;Kolehmainen et al., 2012), focus groups (Dopp et al., 2013;Eriksson et al., 2017;Kolehmainen et al., 2012;Kristensen & Hounsgaard, 2014;Piskur et al., 2015), chart reviews (Kolehmainen et al., 2012;Lysack et al., 2013;Lysack et al., 2011;Sakzewski et al., 2016), clinical vignettes (Dopp et al., 2015), audit and feedback (Kristensen & (Wimpenny et al., 2010). The questionnaires used were mainly non-standardised (9/13) (Bazyk et al., 2015;Cook et al., 2007;Dopp et al., 2013;Hammond & Klompenhouwer, 2005;Kolehmainen et al., 2012;Lysack et al., 2013;Lysack et al., 2011;Mackenzie et al., 2018;Nipp et al., 2014) whereas a few used a standardised scale (1/13) (Forhan & Law, 2009) or both standardised and non-standardised scales (3/ 13) (Doyle & Bennett, 2014;Dunleavy, 2015;Petzold et al., 2012). ...
... Moreover, having good knowledge of the illness addressed by the intervention, even self-perceived knowledge, was shown to statistically improve practice (Dopp et al., 2013;Dopp et al., 2015). Guidelines in line with therapists' values and norms also had a perceived positive influence on practice (Piskur et al., 2015). However, only one of these studies (Clemson et al., 2014) had a good MMAT score. ...
Introduction: In knowledge translation, implementation strategies are more effective in fostering practice change. When using these strategies, however, many determinants, such as individual or organisational factors, influence implementation. Currently, there is a lack of synthesis concerning how these determinants influence knowledge implementation (KI). The aim of this systematic review was to document how determinants influence KI outcomes with occupational therapists. Method: Following the PRISMA statement, we systematically reviewed the literature on KI in occupational therapy across 12 databases: MEDLINE, Embase, CINAHL, AMED, PsychINFO, Cochrane Library, FirstSearch, Web of Science, ProQuest Dissertations & Theses, ERIC, Education Source and Sociological Abstracts. Eligible studies reported KI strategies specifically with occupational therapists. Selected studies were appraised for quality with the Mixed Methods Appraisal Tool. Using the Consolidated Framework for Implementation Research (CFIR), we categorised reported mentions of CFIR (sub-)constructs to identify the determinants studied most often, how they were documented and what influence they had on outcomes. Results: Twenty-two studies were analysed for this review. CFIR (sub-)constructs were mentioned 81 times, and seven (sub-)constructs received at least 5% of these mentions (4/81). These were as follows: (i) Adaptability of the practice; (ii) Learning climate; (iii) Leadership engagement; (iv) Available resources; (v) Knowledge and Beliefs about the Intervention; (vi) Individual Stage of Change; and vii) Executing the KI strategy. The Inner setting domain was the most documented and the domain with the most (sub-)constructs with at least four mentions (3/7). Most studies used questionnaires as assessment tools, but these were mainly non-standardised scales. The data were too heterogenous to perform a meta-analysis. Conclusion: Seven (sub-)constructs mentioned most often would benefit from being assessed for salience by researchers intending to develop a KI strategy for occupational therapists. Future research aimed at improving our understanding of KI should also consider using standardised tools to measure the influence of determinants.
... While some investigators mainly based their actions on a single strategy (8/22) such as educational meetings (5/8), (Chard, 2006 Doyle & Bennett, 2014;Eriksson, Erikson, Tham, & Guidetti, 2017;Hammond & Klompenhouwer, 2005), educational materials (1/8) (Nipp, Vogtle, & Warren, 2014), audit and feedback (1/8) (Kristensen & Hounsgaard, 2014), or communities of practice (1/8) (Piskur, Zalmstra, Jakobs, & Daniels, 2015), most used multifaceted strategies (13/22) (Bazyk et al., 2015;Cook, McCluskey, & Bowman, 2007;Dopp, Graff, Rikkert, Nijhuis van der Sanden, & Vernooij-Dassen, 2013;Dopp et al., 2015;Dunleavy, 2015;Forhan & Law, 2009;Kolehmainen et al., 2012;Lowe, Rappolt, Jaglal, & Macdonald, 2007;Lysack, Leach, Russo, Paulson, & Lichtenberg, 2013;Lysack, Lichtenberg, & Schneider, 2011;Mackenzie et al., 2018;Petzold et al., 2012;Sakzewski, Ziviani, & Boyd, 2016;Wimpenny, Forsyth, Jones, Matheson, & Colley, 2010) that combined two or more of the following: educational meetings, communities of practice, educational materials, educational outreach visits or academic detailing, monitoring the performance of the delivery of health care, audit and feedback, tailored interventions and local consensus processes (Effective Practice and Organisation of Care (EPOC), 2015). In this review, the educational meeting was the most frequently used strategy (18/22). ...
... Most studies (13/22) used questionnaires on knowledge, attitudes, beliefs or practices as an assessment tool either alone (8/13) (Cook et al., 2007;Doyle & Bennett, 2014;Dunleavy, 2015;Forhan & Law, 2009;Hammond & Klompenhouwer, 2005;Mackenzie et al., 2018;Nipp et al., 2014;Petzold et al., 2012) or with one or more other data collection tools (5/13) (Bazyk et al., 2015;Dopp et al., 2013;Kolehmainen et al., 2012;Lysack et al., 2013;Lysack et al., 2011). Other data collection techniques included written reflections (Bazyk et al., 2015;Chard, 2006;Wimpenny et al., 2010), face-to-face interviews (Chard, 2006;Clemson et al., 2014;Kolehmainen et al., 2012), focus groups (Dopp et al., 2013;Eriksson et al., 2017;Kolehmainen et al., 2012;Kristensen & Hounsgaard, 2014;Piskur et al., 2015), chart reviews (Kolehmainen et al., 2012;Lysack et al., 2013;Lysack et al., 2011;Sakzewski et al., 2016), clinical vignettes (Dopp et al., 2015), audit and feedback (Kristensen & (Wimpenny et al., 2010). The questionnaires used were mainly non-standardised (9/13) (Bazyk et al., 2015;Cook et al., 2007;Dopp et al., 2013;Hammond & Klompenhouwer, 2005;Kolehmainen et al., 2012;Lysack et al., 2013;Lysack et al., 2011;Mackenzie et al., 2018;Nipp et al., 2014) whereas a few used a standardised scale (1/13) (Forhan & Law, 2009) or both standardised and non-standardised scales (3/ 13) (Doyle & Bennett, 2014;Dunleavy, 2015;Petzold et al., 2012). ...
... Moreover, having good knowledge of the illness addressed by the intervention, even self-perceived knowledge, was shown to statistically improve practice (Dopp et al., 2013;Dopp et al., 2015). Guidelines in line with therapists' values and norms also had a perceived positive influence on practice (Piskur et al., 2015). However, only one of these studies (Clemson et al., 2014) had a good MMAT score. ...
-
![Ruth Duggan]()
Client-centred practice embraces important concepts about partnership and justice that promote client participation in meaningful occupations. It is important to understand how occupational therapists can engage in and continue to develop client-centred practice within the constraints of everyday settings. An action research study was undertaken by a group of four occupational therapists to describe insights gained, and to show the effectiveness of participation in reflective education to help foster client-centred practice. The six main insights generated by the group involve: congruence, understanding the potential, environmental factors, personal factors, expectations, and lifelong learning. Although actual change to daily practice was limited, group members felt the reflective group discussion provided them with a launch pad to start a journey toward more client-centred practice. This may be the key to moving beyond simply changing the face and language of occupational therapy practice toward a deeper understanding and implementation of client-centred practice to improve client outcomes. Suggestions are provided for implementing reflection to help continue to develop your own practice.
Are you listening? Cross-cultural perspectives on client centered occupational therapy practice: A view from Japan
- M Iwama
Iwama M. Are you listening? Cross-cultural perspectives on client centered occupational therapy practice: A view from Japan. Occup Ther Now 1999;1:4-6.
Enabling occupation II: advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa: Canadian Association of Occupational Therapists
- E A Townsend
- H J Polatajko
Townsend EA, Polatajko HJ. Enabling occupation II: advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa: Canadian Association of Occupational Therapists; 2007.
Advancing an occupational therapy vision for health, well-being & justice through occupation
- E A Townsend
- H J Polatajko
Townsend EA, Polatajko HJ, Enabling occupation II. Advancing an occupational therapy vision for health, well-being & justice through occupation. 2nd Edition. Ottawa, ON: CAOT; 2013.
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