American Journal of Occupational Therapy最新文献

Importance: Because handwriting is fundamental to academic success and early literacy development, it is crucial to identify letter formation difficulties. The Letter Form Assessment Version 2 (LFA-2) was developed to measure letter formation fluency but requires validation.

Objective: To examine the LFA-2's interrater reliability, construct validity (factor structure), and concurrent validity.

Design: Observational cross-sectional analysis of data from a longitudinal study.

Setting: School.

Participants: Seventy-eight kindergarten students in Australia (41 boys, 37 girls; M age = 68.5 mo, SD = 4.2) were recruited for construct and concurrent validity studies. A subgroup (n = 16) was used for interrater reliability testing.

Results: Interrater reliability for LFA-2 total was excellent (interclass correlation coefficient = .96, 95% confidence interval [.90, .98]). Interrater agreement coefficients for individual letters scores were good to excellent (Cohen's κ = .71 to 1.00; Gwet's AC1 = .79 to 1.00). Factor analysis established unidimensionality with good total score reliability (ω = .92). Correlations of the LFA-2 total score were moderate to strong with timed and untimed alphabet writing (rs = .32 and rs = .36, respectively), visual-motor integration (rs = .55), fine motor precision (rs = .35), and manual dexterity (rs = .34; all ps < .01).

Conclusions and relevance: Preliminary findings support the LFA-2's reliability and validity for assessing letter formation fluency among beginning writers. Multiple raters using the LFA-2 were reliable in their use of the tool (interrater reliability), and item structure was confirmed to be unidimensional (construct validity). The LFA-2 performed as expected compared with other measures (concurrent validity). Research on larger samples is required to verify these results. Plain-Language Summary: Handwriting is an important skill in early education and supports the development of reading and writing skills. To write by hand efficiently, children need to develop movement patterns that allow them to form letters correctly and from memory. Children can advance their literacy skills once they can perform these letter formation patterns automatically. There are limited assessments of beginning writers' letter formation patterns, making it difficult for occupational therapists and teachers to identify children who need more help with their early handwriting. A new tool, the Letter Form Assessment Version 2 (LFA-2), has been developed to address this need. This study presents the first results of the development and validation of the LFA-2.

This column explores the integration of the Public Health Critical Race Praxis (PHCRP) framework into maternal health occupational therapy to address racial disparities and enhance health care outcomes. The PHCRP framework provides a race-conscious methodology for examining the intersection of race, health, and systemic inequities, making its application in occupational therapy research and practice essential amid the U.S. maternal health crisis, which disproportionately affects Black birthing individuals. We highlight occupational therapy practitioners' responsibilities, emphasizing race-conscious research, culturally informed and responsive interventions, and advocacy for equitable maternal health care policies. By leveraging the PHCRP framework, occupational therapy can take a transformative approach to address the root causes of maternal health disparities, dismantle systemic health care barriers, and improve Black maternal health outcomes. This column intentionally adopts inclusive language to recognize the diverse identities of those who give birth. We use terms such as birthing individuals and mothering to acknowledge the diverse identities, pregnancy, and childbirth experiences of all birthing individuals. Research indicates that these individuals navigate distinct experiences and may prefer gender-affirming terminology, such as transman, nonbinary, or parent, to mitigate gender dysphoria (Kukura, 2022). This inclusive approach is essential for promoting equitable, culturally affirming care because it acknowledges the additional layers of bias, discrimination, and racial inequity often experienced by non-female-identified birthing individuals. Through this lens, we aim to center diverse experiences and advocate for an occupational therapy practice that actively challenges systemic inequities and fosters equitable maternal health care. Positionality Statement (Jordan C. W. Major): As a biracial Black-White, English-speaking, cisgender, heterosexual female with an invisible disability who was born and raised in the United States, my intersectional identity profoundly shapes my perspective, allowing me to uniquely address the nuances of racial, health, and maternal issues in health care. I am an occupational therapy practitioner currently pursuing a PhD in rehabilitation science, studying the impact of type 1 diabetes on Black maternal health. My lived experiences and academic background afford me the opportunity to center the experiences of Black mothers and birthing people through a race-conscious lens and call on my occupational therapy colleagues to do the same.

Importance: Occupational therapy interventions are a crucial part of dementia care and have been shown to be effective in research trials. However, the acceptability and inclusivity of occupational therapy interventions to treat dementia for people from diverse groups are unclear.

Objective: To explore factors contributing to the delivery of acceptable and inclusive community-based occupational therapy interventions for people with dementia from diverse groups in Australia.

Design: Exploratory qualitative study in which interviews and focus groups were used. Data were analyzed with reflexive thematic analysis.

Setting: Community-based occupational therapy in Australia.

Participants: Purposive sampling was used to recruit 26 participants. Eight people with experience of dementia from diverse groups (ethnic minority, sexual minority, and socially or economically disadvantaged groups) participated in individual interviews; occupational therapists participated in focus groups (n = 10) and interviews (n = 8).

Results: Three key themes were developed to support inclusivity: (1) knowing the person at the center of the care, (2) collaboration, and (3) perception of occupational therapy for people with dementia. Acceptable and inclusive occupational therapy interventions for dementia occurred when people from diverse groups felt valued and received tailored interventions, were confident in and partnered with the therapist, and understood the purpose of therapy.

Conclusions and relevance: Therapists require support to apply cultural humility and to build skills to overcome barriers to providing culturally safe and acceptable care. Plain-Language Summary: People from diverse groups include ethnic minority, sexual minority, and socially or economically disadvantaged groups as well as Indigenous populations. We know community-based occupational therapy interventions improve function and quality of life for people with dementia and their families, but we do not know whether they work for people from diverse groups. We asked people with experience of dementia from diverse groups and occupational therapists in Australia what they thought. We found that occupational therapy interventions for dementia are acceptable to diverse groups when the therapist works in partnership, providing an intervention that is meaningful to them. To be inclusive, therapists need to empower people from diverse groups to participate equally in the intervention. They need to make sure families understand the purpose of the intervention. Some occupational therapists may need training to build skills and knowledge as well as support to overcome barriers and to provide acceptable and inclusive interventions.

Importance: Cultural humility may improve the quality of occupational therapy services, but how occupational therapy practitioners apply this approach in their practice contexts has not been clearly described in the literature.

Objective: To describe peer-reviewed rehabilitation literature on the practice of cultural humility and align the findings with occupational therapy practice using the Canadian Practice Process Framework (CPPF).

Data sources: Nine databases were searched, using the term cultural humility to identify relevant peer-reviewed rehabilitation literature. Google Scholar and six journals were hand-searched to identify additional studies.

Study selection and data collection: This substudy of a larger knowledge synthesis was guided by Arksey and O'Malley's (2005) scoping review methodology. Titles, abstracts, and full texts of studies were screened using Covidence. Study descriptors, context, population, and cultural humility elements defined by Tervalon and Murray-García (1998), and recommendations were extracted, analyzed, and mapped onto the CPPF.

Findings: In total, 11 studies were included. Cultural humility elements of self-reflection and critique (n = 7; 63.6%), self-awareness and egolessness (n = 8; 72.7%), and supportive interaction (n = 5; 45.4%) were identified. Most cultural humility elements aligned with the societal (n = 11; 100%) and practice (n = 10; 90.9%) contexts of the CPPF.

Conclusions and relevance: Findings highlight how occupational therapists could integrate cultural humility at each stage and in each context of their practice. Additionally, these insights can inform occupational therapy education on integrating cultural humility into training programs and guiding practitioners in applying cultural humility principles to enhance their practice. Plain-Language Summary: Cultural humility may improve the quality of occupational therapy services. How occupational therapy practitioners apply cultural humility has not been clearly described in the literature. This review describes literature on the practice of cultural humility. The findings were aligned with occupational therapy practice using the Canadian Practice Process Framework. The findings highlight how occupational therapists could integrate a cultural humility approach at each stage, in each practice process and context, and into training programs. The findings also provide a foundation for future research on how to apply cultural humility principles to improve occupational therapy services.

Importance: Lack of consideration of intersectionality by occupational therapy practitioners, faculty, and researchers can result in inequities experienced by students and clients served.

Objective: To determine how intersectionality is represented in the scholarly literature used to inform occupational therapy practice, research, and education.

Data sources: A comprehensive database that includes CINAHL, MEDLINE, and PsycINFO.

Study selection and data collection: Inclusion criteria were peer-reviewed articles published between 2013 and 2023, written in English, and pertinent to the research question. The review used Covidence database and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, resulting in 36 articles identified as meeting all criteria. Any discrepancies were resolved through discussion among the authors.

Findings: A data abstraction chart was developed, and analysis resulted in themes of education, practice, and research with specific subthemes. Findings revealed that the lack of an intersectional approach in education is often viewed negatively by diverse students, who experience a lack of belonging. Suggested strategies focused on reducing isolation and revising curricula to reflect student diversity. Intersectional issues in practice showed access disparities and a lack of occupational participation for diverse clients. Suggested strategies included consideration of the multilayered identities of clients using cultural humility and consideration of context. Strategies for research focused on using a collaborative approach to represent the intersectional lived experience of diverse populations.

Conclusions and relevance: Despite limited studies, intersectionality was identified as a lens for occupational therapy educators, practitioners, and researchers and as an important strategy to address issues faced by diverse students, resulting in more effective client-centered care. Plain-Language Summary: This study reviewed literature from occupational therapy and other health professions to determine how the concept of intersectionality is used to inform practice, education, and research. The study is needed because common Western-based practice is based on an individual, White, upper-middle class, able-bodied, cisgender perspective, which does not match the demographics or needs of clients. Results show that the intersectional identities of students and clients are often not being considered. Literature is emerging to provide educational, practice, and research strategies to address the diverse needs of occupational therapy students and clients by identifying and considering multiple and intersectional identities and the effect of context. The results challenge occupational therapy educators, practitioners, and researchers to consid

Inclusion and belonging are fundamental human needs and key to the engagement and well-being of occupational therapy practitioners, scientists, educators, and learners. Despite this, the profession has struggled throughout its history to act on its values as focused on wide-ranging perspectives of occupational engagement in diverse cultural contexts. Issues of diversity, equity, inclusion, justice, and accessibility (DEIJA) innervate contemporary discourse, but there is a real danger that these conversations remain at a superficial level and stop short of attempts at genuine disruption of the deeply rooted colonial systems that exist in the profession. In this column, we use Jacques Derrida's concept of hos[ti]pitality to problematize DEIJA initiatives by asking whether occupational therapy can be genuinely inclusive or if minoritized persons will always be "guests" who are expected to reciprocate their presence. We then extend this theoretical approach to inform practical ideas to disrupt hos[ti]pitality in education, practice, and research, promoting antiracist and inclusive educational settings and deconstructing barriers to more authentic inclusion of marginalized identities. Although occupational therapy cannot be fully and unconditionally hospitable, we suggest that generative disruption at both the micro and macro levels can lead to a sense of solidarity that benefits the profession and the people and communities we serve.

Importance: Belonging is a dynamic contextual construct valued within occupational therapy and connected with students' academic success and career transitions. Although belonging has been measured in higher education, there is no specific tool to measure it in occupational therapy education.

Objective: To create the Professional Belonging Scale for Occupational Therapy Students (PBSOTS) and assess its validity and internal consistency reliability for measuring belonging among occupational therapy and occupational therapy assistant students.

Design: Scale development and preliminary psychometric study.

Setting: Academic programs.

Participants: The study took place in three phases from 2022 to 2023. Phases 1 and 2 involved occupational therapy experts in diversity, equity, inclusion, belonging, and assessment. Phase 3 included 162 students from accredited occupational therapy education programs in the United States.

Outcomes and measures: Scale items were developed on the basis of the literature, expert interviews, and a student focus group and were revised based on calculated content validity index ratings (cutoff = .78) and expert feedback. Next, student data were analyzed for an exploratory factor analysis and to determine internal consistency reliability.

Results: Of an initial 24 items, 5 were removed, 5 were revised, and 1 was added, resulting in a 20-item scale with an α value of .92. Four factors had eigenvalues greater than Kaiser's criteria of 1 and explained 61.13% of the variance.

Conclusions and relevance: On the basis of preliminary validity and internal consistency reliability testing, the authors suggest further developing and researching the PBSOTS. Plain-Language Summary: Belonging is valued within occupational therapy and is connected to students' academic success and career transitions. However, there is no specific tool to measure belonging in occupational therapy education. This study used the Professional Belonging Scale for Occupational Therapy Students (PBSOTS), a self-assessment that was created by the authors to measure students' sense of belonging in occupational therapy education programs. The authors recommend further developing and researching the PBSOTS so that the self-assessment can be used to inform occupational therapy education programs about students' sense of belonging.