A Practice Development Programme to Promote the Use of the Model of Human Occupation: Contexts, Influential Mechanisms and Levels of Engagement Amongst Occupational Therapists

Abstract

This study evaluated a multifaceted, organisation-wide practice development (PD) programme in one National Health Service mental health and learning disabilities trust. Method: Individual differences in integrating the Model of Human Occupation in occupational therapists' daily practice were examined through in-depth qualitative, multimethod realistic evaluation. A stratified sample of all occupational therapists (n = 74) was achieved using a self-report survey. Semi-structured interviews at three time points, practice observation and documentation audit continued until saturation appeared highly likely and categories were well elaborated (n = 10). Findings: The findings indicated that environmental contexts, particularly the support of the immediate team, and the therapist's personal circumstances influenced MOHO use. The mechanisms that acted as catalysts for practice change were Building Confidence, Finding Flow, Accumulating Reward, Conferring with Others, Constructing Know-how and Channelling Time. Four stages of MOHO integration, characterised as In the Hangar, On the Runway, Take-off and In the Air, were identified. Conclusion: Most studies of the uptake of PD treat people as relatively homogeneous, but they are not. Greater attention to individual differences, the mechanisms underpinning successful engagement and influencing contexts may result in better outcomes from PD investments. A degree of tailoring PD approaches to individual circumstances would be beneficial.