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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 54  |  Issue : 2  |  Page : 44-50

Development of a questionnaire on awareness about occupational therapy among health-care professionals: A cross-sectional survey


1 Department of Occupational Therapy and Orthopaedics, Santosh Medical College and Hospitals, Ghaziabad, Uttar Pradesh, India
2 Senior Occupational Therapist, Centre for Addiction Medicine, National Institute of Mental Health and Neuro Sciences, Bangalore, India
3 Department of Orthopaedics, Santosh Medical College and Hospitals, Ghaziabad, Uttar Pradesh, India

Date of Submission04-Jan-2022
Date of Acceptance03-Jul-2022
Date of Web Publication4-Aug-2022

Correspondence Address:
Shivani Bhardwaj
Moh. Mandi, Railway Road, Near Manoj Sharma ward No -13, Pilkhuwa - 245 304, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_1_22

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  Abstract 


Background: Occupational therapists are recognized as essential members of the health-care team. Occupational therapy treatments are required to deliver better services and to promote a comprehensive service approach. Occupational therapy awareness is critical for providing high-quality care to all patients. There is, however, a paucity of studies aimed at determining occupational therapy awareness and knowledge. This study aimed to develop a questionnaire to assess health-care professionals' (HP's) awareness and knowledge of occupational therapy. Objectives: This study aimed to develop a reliable questionnaire to assess HP's awareness and knowledge about occupational therapy. Study Design: This study was based on a cross-sectional design. Methods: The questionnaire was created in three stages. Initially, the first stage was to do a literature review for item generation. The second stage was to circulate a draft of the questionnaire among experts for face validity, and stage three was to test the reliability of items. Results: The generated items underwent face validity by ten experts. After face validation, the final questionnaire consisting of two sections (awareness and knowledge about OT and advocacy) were circulated to fifty health-care professionals. A statistical analysis (Cronbach's alpha) was done to analyze internal consistency, which indicates α = 0.78. Conclusion: This study concludes that the questionnaire is reliable for exploring awareness and knowledge about occupational therapy.

Keywords: Awareness, Assessment, Evidence, Knowledge, Occupational Therapy, Questionnaire


How to cite this article:
Bhardwaj S, Sharma RK, Sethuraman L, Dwivedi A. Development of a questionnaire on awareness about occupational therapy among health-care professionals: A cross-sectional survey. Indian J Occup Ther 2022;54:44-50

How to cite this URL:
Bhardwaj S, Sharma RK, Sethuraman L, Dwivedi A. Development of a questionnaire on awareness about occupational therapy among health-care professionals: A cross-sectional survey. Indian J Occup Ther [serial online] 2022 [cited 2022 Nov 30];54:44-50. Available from: http://www.ijotonweb.org/text.asp?2022/54/2/44/353354




  Introduction Top


Professionalsz in a multidisciplinary team face the challenge of establishing their own identity while working with members from various backgrounds.[1] Research finding suggests that inadequate knowledge regarding occupational therapy (OT) services among health-care professionals (HPs) influences quality patient care.[2] The objective of treatment with a comprehensive approach is faced with multiple challenges in today's time. The goal of OT is to allow patients to engage in everyday activities by iamproving their ability to perform occupations they want, need, or are expected to do or by restructuring the occupation or the environment to better support their occupational engagement.[3] Although OT emerged as a distinct profession nearly a century ago,[4] its specific identity is still ambiguous due to uncommon nomenclature.[5] There are only three occupational therapists (OTs)/1,000,000 people in India,[6] resulting in limited access to OT interventions.[7] A previous study in South India explored awareness of OT in medical practitioners and concluded higher awareness of OT with little knowledge of the practice scope, domains, and settings.[2] Integrative services require adequate knowledge to be imparted to HP and the public.[8],[9] Understanding the team roles is crucial for referral and eliminates confusion.[10] A questionnaire-based Nigerian study explored the awareness and knowledge of OT among medical and health science undergraduates with items of dichotomous options.[9] Studies in Jordan examined the awareness of OT among HP, clients, and general people.[11],[12],[13] The questionnaires used in these studies were not adaptable and were designed to get input from rehabilitation professionals. The South Indian study used a brief questionnaire with only five items.[2] After considering previous research, developing, and designing, a questionnaire in the Indian context is imperative. The developed questionnaire consisted of two sections having ten questions on awareness and knowledge and three on advocacy. Advocacy was a separate section to understand HP's opinions and recommendations about OT in their workplace. It explored “Why and how strongly HP emphasized the role of OT services?” This research was conducted as part of a study in India examining OT awareness and knowledge among HP, including medical, dental, and other HPs. The main objective of the questionnaire was to obtain data concerning HP awareness and knowledge.


  Methods Top


Development of the Questionnaire

Development was done through item generation, selection, and refinement. Items were generated by reviewing the existing literature. Generated items were refined through deliberations between the authors. Ten OT experts (having a minimum of 15 years of experience after their postgraduation) from across the country were selected based on the location of their workplace. The questionnaire was sent to the experts to rate the items on their relevancy and adequacy, along with their comments. A criterion for adopting changes after obtaining feedback was also established, with the need that two or more experts propose the change.

Validation of the Questionnaire

The criteria for inclusion were set as HP working in hospitals (medical, dental, physiotherapy, psychologist, speech therapist, and nursing). There was no bar on the level of experience, age, and specialty, and the exclusion criteria comprised occupational therapists, administrative people, and technicians.

Electronic written informed consent explaining the study and emphasizing that participation was fully voluntary was included in the questionnaire. The request was sent to 50 HPs using Google Forms by the first author in two hospitals.

The questionnaire consisted of two sections. The first domain was structured to analyze HP's awareness and knowledge about OT, and the second domain was focused on exploring advocacy among HP. The questionnaire's reliability was assessed using an internal consistency test (with a Cronbach's alpha coefficient).

The Institute Ethical Committee approved the study vide no SU/2021/1831[9] dated 17th July 2021. A cover note was included in the study, outlining the specifics and emphasizing the importance of voluntary involvement.


  Results Top


Demographic Characteristics of the Health Professional

There were 50 HPs from different specialties who filled out the questionnaire. Those included from HPs such as general practice (9), orthopedics (5), pediatrics (4), general surgery (8), other medical specialties (16), dental science specialty (1), allied, and other HPs (7) [Table 1].
Table 1: Demographics Details of Health-care Professionals

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Stage 1: Item Generation Process Through Review Literature Search

The 29-item questionnaire, including demographics, was developed after discussion within the author's group. Items were framed as close-ended questions, with each item having customized options as answers. The first section, awareness and knowledge consisted of ten items and the second section consisted of three items.

Stage 2: Content Validity

All ten experts have sent their comments and suggestions to improve the questionnaire. Based on their recommendations, changes were incorporated. The suggestions from experts in the demographic sections were that seven experts felt the item on “area of work” was not needed. The other suggestion was from three experts to split the items to provide better clarity. The question “If working in a hospital or institute attached to a medical college, if yes, then how many bedded hospitals?” was then divided into two parts for better understanding, i.e., “Is your institute attached to a hospital? If no, then the next question If yes, then a drop-down question: how many bedded hospitals?” Four experts suggested rephrasing one of the options in item #1 from reading to books/literature. Six experts suggested rephrasing item #3 from “How OT is differentiated from physiotherapy”? to “How OT is differentiated from other professions?” Four items were deleted from the initial questionnaire as nine experts found them irrelevant. The deleted items were on the (i) Ministry of Health providing referral criteria, (ii) defining the role of HP, (iii) do you feel that the OT profession needs to be upgraded and given a commission in the armed forces, and (iv) do you feel that national OT cadre is required to develop OT profession in India and opening of promoting avenue?

Other minor changes were made to the questionnaire, such as describing each item to provide clarity to the HP based on the suggestions received. As a result, the questionnaire was simplified to 13 items (excluding demographics) and the terminology was modified to ensure that HP could comprehend the items and complete the questionnaire quickly.

The Final Questionnaire

The first part of the instrument asked about general demographic information. Demographics included the age, gender, specialty, experience, and bed strength of the hospital. The final questionnaire comprises two sections with ten items on awareness and knowledge in the first section and the second section, including three items on advocacy [Appendix 1].

Stage 3

All 50 HPs to whom the link was sent responded to the study. After which, the reliability of items was tested using Cronbach's alpha. The test was performed for sections 1 and 2, which include 13 items. The results of the study showed good internal consistency with a Cronbach's alpha range of 0.63–0.78 [Table 2]. The entire process is described as a flowchart in [Figure 1].
Table 2: Internal Consistency of Questionnaire and Items

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Figure 1: Flow Chart of Study Process, from Item Selection to Testing Reliability of the Scale

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  Discussion Top


This study presents the process of constructing a questionnaire to assess awareness, knowledge, and advocacy about OT among HP. The questionnaire is always considered a great tool because it offers a fast, efficient, and inexpensive method for collecting data since the HPs were work occupied and would find it easier to reply to succinct questions. The questionnaire was selected over face-to-face structured interviews and telephone interviews because it takes less time and limits resource restrictions. Hence, the questionnaire was developed to analyze the awareness, knowledge, and advocacy among HP. The first step was to prepare a questionnaire draft through literature review and discussion within the author group and send it to experts for content validity; the second step was to amend items after receiving comments from experts regarding relevancy and adopting criteria for change. As a result, repetitive or misleading items were eliminated or reframed properly.

The final questionnaire was divided into two sections, the first containing ten questions measuring awareness and knowledge, and the second containing three questions on advocacy. Age, gender, specialty, experience in India and abroad, and bed strength of the hospital, were included in demographics to analyze their association with awareness, knowledge, and advocacy. The first section was developed to evaluate the awareness and knowledge of HP. Item one was based on the source of knowledge about OT, as it was selected to explore the significant contributor to the knowledge source in HP. The second to tenth items were chosen as OT has been an established and distinct profession since its inception;[4] therefore, it became pertinent to include these items in this section. This section elucidated the knowledge of HP perspectives on the said aspect. Another reason for selecting items was to explore referral adequacy for OT.

In the seventh item, the opinion of HP on OT as a vital and indispensable profession was sought by choosing between 1 and 10, where one means not important, and 10 represents the indispensable profession.

In the eighth item, 16 areas of OT practice were listed as options, and the item explored the understanding of HP about OT's work practice in some specific areas.

The second section included questions on advocacy that were developed to assess the participant's perception of OT, i.e., OT plays a significant role in my workplace, how do they feel OT role should be emphasized and why?”

A five-point Likert-type scale (strongly agree, agree, neutral, disagree, and strongly disagree) was used to score the HP's level of agreement on items numbers # 6, 11, and 12.

The number of items in the questionnaire was kept at 13 and structured to reduce the time for completion. As per the literature review, only one published study from India investigated OT awareness in South India. This study questionnaire comprised five questions primarily developed for medical professionals working in South India.[2] Therefore, it became imperative to develop a new questionnaire that was designed by formulating questions on awareness and knowledge. The advocacy section was included to explore the significance of OT services at their workplace and emphasize the role of OT in their workplace.


  Conclusion Top


HPs are continually looking for ways to improve their services. The first step is to understand the constraints originating from a lack of awareness and knowledge in the health-care sector for OT services, which influence effective holistic health-care services. This research aimed to develop a reliable questionnaire to be used in an Indian setting. The scale was assessed using a statistical test, which indicated that it was appropriate and reliable for use among HP in India to explore awareness and knowledge regarding OT.

Acknowledgments

We are grateful to all the experts who reviewed the questionnaire and all HPs who participated in the study. We would also like to thank Tulsi Adhikari, Scientist “E” at ICMR-National Institute of Medical Statistics, for her statistical advice and the experts' insightful comments.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.


  Appendix 1 Top


Questionnaire

Dear Sir/Madam,

This survey intends to gather data from health-care practitioners regarding their level of

awareness about the occupational therapy profession. Please complete this survey only “if

you are a health-care practitioner practicing in India.” Your responses will help to generate

valuable data for the awareness of occupational therapy in India. Your participation in this survey is strictly voluntary, and completing this survey indicates your consent to participate in this study.

Demographic Information

Email *(required)

1: Name

--------------------

2: Age

--------------------

3: Qualification, please mention the specialty if applicable

--------------------

4: Total Number of years of clinical practice

--------------------

5: Have you ever practiced in any other country than India? If yes, how many years?

--------------------

6: Do you provide habilitation/rehabilitation services as part of your clinical

Services. Mark only one oval.

  1. Yes
  2. No
  3. Other --------------------


7: I practice: Mark only one oval.

  1. In a Medical College Hospital/Tertiary care center
  2. In a Teaching Institute
  3. In a hospital
  4. In a Primary Health center/Polyclinics
  5. v. In an NGO/rehabilitation center
  6. vi. In clinic/Owns a Clinic
  7. vii. As freelance practitioner
  8. Other:


8: How many bedded hospitals? Mark only one oval.

  1. less than 50
  2. 50–100
  3. 100–500
  4. more than 500


  5. Section – I (Awareness and knowledge)


Q1: How did you get to know about occupational therapy? Mark only one oval.

  1. University curriculum
  2. Work practice
  3. Patient
  4. Books/Literature
  5. Internet
  6. Colleague
  7. Other: ---------------------------


Q2: Are you aware of Occupational therapy as an independent profession that can assess, evaluate, diagnose and intervene? Pls, specify the reason in the other option—Mark only one oval.

  1. Yes
  2. No
  3. Other


Q3: Occupational Therapy is differentiated from other professions as. Check all that apply.

  1. Occupational therapy focuses on providing independence in ADL
  2. Occupational therapy focuses on Improving or restoring occupational performance
  3. occupational therapy focuses on functional ambulation rather than gait training
  4. Occupational therapy enhances functional performance rather than a specific movement


Q4: Do you work and practice with an occupational therapist? Mark only one oval.

  1. Yes
  2. No


Q5: If yes, how often do you refer a client to an occupational therapist. Mark only one oval.

  1. Whenever the case warrants
  2. when the client requests such a referral
  3. often
  4. Seldom


Q6: I feel knowledgeable about the occupational therapy profession. Mark only one oval.

  1. Strongly disagree
  2. Disagree
  3. Neither agrees nor disagree
  4. Agree
  5. Strongly agree


Q7: In my opinion, Occupational therapy is a vital and indispensable profession

in the health-care team. Mark only one oval.

Not important 1 2 3 4 5 6 7 8 9 10 Indispensable

Q8: Please tick the box next to the following areas of practice if you think that they are related to occupational therapy: (check all that applies)

  1. Activitaies of daily living
  2. Sensory integration
  3. Hand therapy
  4. Ergonomics
  5. Splinting
  6. Cardiopulmonary/respiratory training
  7. Home safety assessment, evaluation, and modification
  8. Psychosocial intervention
  9. Community-based rehabilitation
  10. Acute care interventions
  11. NICU early interventions
  12. Geriatric care
  13. Assistive technology
  14. Handwriting skills
  15. Driving rehabilitation
  16. Disability certification


Q9: In my opinion, who needs occupational therapy? (Check all that applies)

  1. Persons with developmental disabilities
  2. Persons with functional impairments due to orthopedic/neurological dysfunctions
  3. Persons with psychiatric disorders
  4. Elders with dementia
  5. Individuals who experience difficulty with self-care, work, education, play, and leisure activities.
  6. Rare disorders


Q10: Where do occupational therapists provide services? (Check all that applies)

  1. Hospitals
  2. Rehabilitation centers
  3. Outpatient clinics
  4. Nongovernmental organizations for people with disabilities
  5. Home-based occupational therapy
  6. Schools/special schools
  7. Teleconsultation
  8. Other (please specify)


  9. Section – II (Advocacy)


Q11: In my opinion, occupational therapy plays a significant role in my workplace. Mark only one oval.

  1. Strongly agree
  2. Somewhat agree
  3. Neither agree nor disagree
  4. Somewhat disagree
  5. Strongly disagree


Q12: In my opinion, more emphasis on the role of occupational therapy is needed in my workplace. Mark only one oval.

  1. Strongly agree
  2. Somewhat agree
  3. Neither agree nor disagree
  4. Somewhat disagree
  5. Strongly disagree


Q13: more emphasis on the role of occupational therapy is needed in my workplace.

Check all that apply.

  1. Due to a better prognosis
  2. For prevention of further ailments
  3. For a patient-centric approach
  4. For patients to have an independent living approach
  5. For increased functional outcomes.




 
  References Top

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2.
Mani K, Velan M. An investigation into medical practitioners' awareness of occupational therapy in South India: A survey. Indian J Occup Ther 2020;52:12-18.  Back to cited text no. 2
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4.
Gordon DM. The history of occupational therapy. In: Crepeau EB, Cohn ES, Schell BA, editors. Willard and Spackman's Occupational Therapy. 11th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 202-213.  Back to cited text no. 4
    
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Dunford C, Street E, O'Connell H, Kelly J, Sibert JR. Are referrals to occupational therapy for developmental coordination disorder appropriate? Arch Dis Child 2004;89:143-147.  Back to cited text no. 10
    
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Abstract
Introduction
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