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Critical Review Form 3- Qualitative Studies, Essay Example

Pages: 4

Words: 1066

Essay

This study’s goal was to determine how OT professionals in The Netherlands, Belgium and Germany promote the autonomy of their clients with persistent mental illness.

The authors noted that while there are studies on autonomy in the literature, few of them attend to the issue of the methods used by OTs to consider the client’s autonomy in everyday life. Since OT as a profession is moving toward more client-centered practices, understanding how client autonomy affects OT care is an important step.

Again, with OT practices moving toward client-centered care, it is important to understand the methods by which an OT can consider the client’s needs in determining a care plan. Thus, this is definitely appropriate for clinical and practice use.

The constant comparative method takes initially collected data and compares it to the categories that emerge from data collection efforts. This was done with a multi-stage questionnaire approach in which the first survey measured OT attitudes toward client autonomy. The second questionnaire more directly addressed the research question of how OTs considered client autonomy in their practices. The OTs received feedback after each one, offering them an opportunity to respond and react.

The philosophy was not explicitly explored, but was present by implication. The researchers stated that they believed that the growing client-centered focus in OT requires taking client autonomy into consideration when constructing treatment plans. They cited studies that noted that mental illness raises barriers and stigmatizes clients,  and that there is a need to explore those issues with the strategies used in healthcare professionals.

The researchers used semi-structured interviews/surveys of participating OTs in 3 neighboring countries, with the survey questionnaires sent in the participants’ native languages.

The participants were 60 OTs working in The Netherlands, Germany, or Belgium, and were selected using a snowball technique.  Inclusion criteria were 2+ years of experience as an OT working with clients with persistent mental illness, and interest in personal autonomy of such clients. A total of 60 participants (15 from The Netherlands, 20 from Germany, 25 from Belgium) were chosen from 48 different institutions. The authors stated that by including OTs from 3 separate countries, a broader perspective on the research question could be obtained.

The participants are described carefully in this report. While my practices is not in a metal hospital (as 90% of the participants did) mental illness is common enough that it is relevant to anyone’s practice.  Also, the issue of client autonomy is important no matter what clients you serve.

Authors explicitly stated that participant and client confidentiality were maintained, and that appropriate consent was obtained.

The questionnaires were filled out by clients at their work (or possibly home). The study had a 100% response rate.

One issue that became clear was that different OTs defined autonomy differently. Thus, the pilot study resulted in changes to the survey instruments.

This was conducted as a mailed survey, so there is no real control over the specific conditions under which the participants responded to the survey.

As a qualitative study, the analysis of the survey results were based on a categorical and thematic assessment of the survey results. This was described in detail, including presenting the main categories and subcategories in the survey results. In addition, the authors presented snippets of responses to help illustrate the categories described.

The overall discussion of results was excellently presented and provided a good summary of OT attitudes. The conclusions drawn showed that OTs tend to focus more on the barriers presented by the clients’ circumstances rather than the autonomy of the clients.

The process was well described, although not every single decision in the decision tree was explained in detail. However, that lack did not seem to undermine the confidence in the results.

The study moved from the categories and subcategories presented to describe how the OT participants attempted to make use of their understanding of autonomy in their practices. The flow of information from the specifics of the OT responses led to noting some key differences among the 3 countries. For example, there was a difference in educational level of the OTs (Germany 3 years; Belgium & The Netherlands, 4 years), but also on issues such as religion, particularly in Belgian OTs working at religion-based institutions; lack of home visits in German and Belgian OTs, and the lack of use of process and OT models in Germany and Belgian OTs (as opposed to Dutch OTs who all mentioned such processes and models)

The key focus of the OT responses were that client motivation was crucial. They noted different strategies to promote client autonomy ranging from goal-setting by the OT, and to negotiating with the client..

Credibility: the authors used only one method of generating results, namely that of mailed questionnaires. Some effort at triangulation came from having two consecutive questionnaires, but they addressed somewhat different topics rather than the same.

Transferability:  It seems likely that the results are sufficiently universal that they can be extended to other contexts.

Dependability: The data collected is definitely consistent with the findings presented. This study appears to have that dependability in place.

Confirmability:  Again, while the study is nicely done, it consisted only of mailed surveys sent to the OTs. Thus it is unclear whether there are sufficient audit points. On the other hand, there was a clear attempt to make the surveys used appropriate by doing pilot studies to refine the questions in such a way that they reflected the desired topics.

The authors also noted that the use of surveys and questionnaires in particular limited the types of responses OT participants could provide. The authors note that as a potential limitation of their study.

The authors also noted that the large amount of data meant that they focused more on similarities among OTs in the three countries rather than their differences.

I think this study provides insight into understanding that considering client autonomy, particularly of mentally ill clients, requires more than a change in clinical practice, but (as the authors note) also a change in social attitudes toward mental illness.

The authors concluded that OTs working with menially ill clients are interested in promoting client autonomy, but that to do so requires addressing societal barriers the clients face, client motivation, and their mental illness in order to improve such autonomy. the authors called for more training of OTs in skills needed to address these issues, and the development of new therapies and tactics. They also concluded that client motivation and empowerment was crucial to treatment and to generate a more client-centered practice.

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