From paper to practice - academics and practitioners working together in enhancing the use of occupational therapy conceptual models
South African Journal of Occupational Therapy
INTRODUCTION Occupation-based practice is gaining momentum in the profession of occupational therapy 1, 2, 3, 4, 5 . This is happening despite the pervasive presence of the biomedical model in most health care settings where South African occupational therapists are employed 6 . Occupation-based practice is in its essence holistic, aiming for improved occupational performance 7 ; instead of the impairmentfocused biomedical approach to practice. With occupation-based practice and biomedical
... and biomedical practice viewing health in different ways, tension often develops between theory and practice 8 , underlying the so-called "academic-practice gap" 1 or theory-practice gap. Occupation-based practice is supported by theory on occupation from occupational science 9,10 , and specifically occupational therapy conceptual models 10 (henceforth referred to as 'models'). These models provide explanations for the interaction of the person with his environment through occupations; providing practitioners with a framework for decision-making around occupation based intervention 10, 11, 12, 13 . The application of models in the occupational therapy process requires of and allows practitioners to make use of theory in their decision making. Model use also enhances occupation-based practice, by encouraging practitioners to choose occupation-based outcomes 9 and tools of outcome measurement 9 . Explaining practice and the occupational therapy process, which often proves to be a complex and even tedious process, is simplified in that models provide practitioners with a language to do so 14, 15 . It further holds a variety of benefits to practitioners (and ultimately clients too), ranging from increased professional resilience and career longevity 16 , to clarifying professional identity 9,16 . Ultimately, the profession benefits from the use of models in that it guides us to offer an occupational therapy process that boldly reflects our profession's 'unique contribution' through occupation-based practice 9 . These benefits notwithstanding, a number of factors play a role in practitioners' choice to use models or not, their choice of models and their proficiency in applying these models 17, 18 . Undergraduate training impacts on practitioners' confidence in their own use of models, which is problematic in view of limited literature about instruction of occupational therapy students on the use of models in practice 17 . Once in practice, the unavailability of role models and the pervasiveness of the medical model in occupational therapy practice, or at least some occupational therapy practice settings, hinder practitioners to apply occupation-based theory 6,17 . On top of this, there are limited resources for continued training in model application in practice 17 . Whilst Owen 6 found in her study on South African practitioners that their use of models increased with years of practice; results from other countries indicate that the use of models declines with increased years of practice 19 . An encouraging finding, supported by Elliott, Velde and Wittman 20 and Wong and Fisher 21 , is that although practitioners tend to admit to limited model use, they generally realise its value. With universities and practitioners placing different premiums on theory and model use 16, 22 , the theory-practice gap is perhaps most intensely experienced by undergraduate students in clinical fieldwork practice. In this process of "learning to think like a therapist" 23:46 , they are pressed between the academic expectations of Introduction: Occupational therapy students are exposed to occupational therapy conceptual models in lectures, and are expected to practice application of these models during clinical fieldwork placements. During fieldwork, they are exposed to practitioners' approaches to the use of occupational therapy conceptual models, and are often confronted with a gap between theory and practice. The objective of this study was to investigate the use of conceptual models by occupational therapy practitioners in the Free State, South Africa, to inform collaborative efforts in the process of reinforcing the link between theory and practice, by enhancing the use of occupational therapy conceptual models. Methods: A cross sectional study was done in two phases: by means of a questionnaire survey, with practitioners responsible for fieldwork supervision of students; and a workshop survey completed by practitioners attending a workshop on occupational therapy models. Results: Results in the first phase describe the perceptions of 22 supervising practitioners around occupational therapy conceptual models; and their own and students' application thereof in practice. These results were used as the basis to design a workshop on the application of occupational therapy conceptual models. In the second phase, workshop survey questionnaires completed by 20 participants, indicated that they perceived the workshop as enabling with regard to applying new occupational therapy conceptual models with more confidence and competence, and that they felt more confident to supervise students in applying occupational therapy conceptual models during fieldwork. Conclusion: This study and its resulting workshop show how collaboration between practitioners and academics can improve the link between theory and practice, benefiting practitioners' professional identity and ultimately impacting on undergraduate training.