Dissertation/Thesis Abstract

"The Policy Ready Practitioner": A Mixed Methods Assessment of Entry-Level Doctor of Occupational Therapy Programs in the Preparation of Students to Participate in Healthcare Policy
by Walsh, Wendy Elizabeth, Ph.D., University of the Sciences in Philadelphia, 2018, 123; 10904839
Abstract (Summary)

This study addresses the extent to which Entry-level Doctor of Occupational Therapy (ELDOT) graduates are being prepared to advocate for the profession. Providers of ELDOT education and key stakeholders in professional policy issues were surveyed about methods of preparation, effectiveness of preparation, and evaluation of students. How is health policy defined and what health policy skills do graduate students need to effect policy change as future healthcare practitioners? Three core themes concerning health policy and health policy education (HPE) are widespread in medical and nursing literature: Time devoted to HPE, operationalization of the term 'health policy', and need for deep understanding of HPE by teaching professors. No published articles originating in the occupational therapy literature have specifically addressed these areas.

The research used quantitative analysis of academic accreditation standards for ELDOT programs and qualitative assessment of key stakeholder interviews. As of June 1, 2017, sixteen programs across the United States held entry-level doctoral accreditation granted by the American Council on Occupational Therapy Education (ACOTE®). All 16 were asked to join the quantitative study. Of these, nine responded and five agreed to participate, resulting in a final sample population of five programs (n = 5). Statistical Analytical Software ([SAS], v9.4, (SAS Institute, Inc., n.d.) provided analysis for descriptive statistics. For the interviews, 11 key policy stakeholders with a high level of professional expertise and experience were recruited, a satisfactory sample population for qualitative inquiry (Holloway & Wheeler, 2010; Latham, 2017). Questions generated from the three core themes guided the collection of perceptions, observations, and opinions on health policy from stakeholders. Video-recorded interviews were transcribed and uploaded into MaxQDA (v.12.3.3) (VERBI GmbH, 2017) qualitative software for comparative and thematic analysis.

Program data were analyzed to construct a hypothetical framework for measuring policy preparation of student. Based on ACOTE® standards, four factors were examined: Time allocation in programs, resourcing, faculty expertise, and utility of student assessment methods. Key findings were these: 1. ELDOT programs typically have 30 students taking 123 professional level credits 2. HPE accounts for 4.6% of instructional time in programs. 3. Active engagement in the political context occurred in only 10% of programs. 4. Disparate teaching pedagogies existed among programs, 5. Most programs had no additional resources to aid in HPE 6. Geography was not relevant factor.

Due to number of programs participating in the research, these data are not statistically significant. Nevertheless, the analysis can serve as an evaluation framework for participating ELDOT programs and for those seeking future ELDOT accreditation.

The qualitative study used interview data from eleven practitioners involved with occupational therapy at the national and educator levels, and from those practitioners familiar with scope of practice challenges. Qualitative analysis of interview videos, generated 455 unique code phrases which were grouped into three main categories (Global Thinker, Schooling, and Engagement) that are essential for a "policy ready" practitioner. A summary grid revealed high agreement between the stakeholders and a similarity matrix showed moderate similarity of responses (64%). Stakeholders were only able to reach consensus on two policy priorities for the profession. Fifty-five percent of participants reported the use of three policy resources: national organization-provided websites, print (books/journals), and internet searches. Member checking and intercoder agreement (73%) added rigor to this line of inquiry.

There were a few limitations identified. First, given the topic of inquiry, both population and sample size for programs was problematic. An adjusted sample size calculation for statistical significance indicated that 15/16 programs would be needed to run more than descriptive statistics, significantly higher than actual participation. Next, determination of expertise by instructors required creation of a novel rubric to evaluate curriculum vitae (22 point rank-order scale; degree, presentations, publications, experience, research). Third, was the difficult recruitment of programs: multiple modes of contact, time intensive, and invasive for both researcher and potential participants. Fourth, release of the mandate by ACOTE® for the entry-level doctoral degree as the terminal degree for occupational therapists occurred during the data collection phase of this study. There was likely an unknown impact on this study because of this mandate.

Outcomes from this study indicated that ELDOT programs had a proportionate amount of HPE in the classroom outlined by the B.6 ACOTE® standards conflicting with literature themes of not enough time devoted to HPE in curricula. Lack of experiential exposure to direct policy work in favor of traditional assessment methods aligned with stakeholder's perception that ELDOT graduates are not "policy ready", rather "policy aware" without fluency of the soft skills required for legislator engagement.

In conclusion, few evidence-based articles center on the topic of "policy readiness" and the direct preparation of graduates of health professions to engage in the political context.

Indexing (document details)
Advisor:
Commitee:
School: University of the Sciences in Philadelphia
Department: Health Policy and Public Health
School Location: United States -- Pennsylvania
Source: DAI-A 79/12(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Occupational Therapy, Public policy, Curriculum development
Keywords: Acceditation, Advocacy, Curriculum, Health policy, Occupational therapy
Publication Number: 10904839
ISBN: 9780438157439
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