Community-Based Health Promotion in Occupational Therapy: Assess Before You Assess

Abstract

In the United States, the role of occupational therapy (OT) in provision of community-based health promotion is supported well in the literature; however, few practitioners are working in this arena. This mixed methods multiphase design study presents an example of a needs assessment process: assess before you assess. Participants included OT practitioners, residents in a low-income community housing complex, and older adult residents in another community housing complex. Methods included phenomenological and nonexperimental cross-sectional survey study design. Data analysis included coding, categorizing, and creating themes; composite scoring, Spearman correlations, and independent t tests for comparing variables. Results indicated that OT practitioners need more guidance and involvement to shift their paradigm from rehabilitation to community health promotion. Conducting needs assessments in three phases supports effective health promotion programming in community settings.

Keywords

health promotion wellness needs assessment older adults community aging in place occupational therapy

Introduction

In the United States, community-based health promotion is an emerging area of practice in occupational therapy (OT) to facilitate “health, well-being, and participation in life through engagement in occupation” (American Occupational Therapy Association [AOTA], 2014, p. S4). While OT practitioners have an opportunity to practice in this area, only two percent of OTs and 1.7% of OT assistants are actually working in community-based settings (AOTA, 2015). Conducting a needs assessment is an important initial process for starting community-based health promotion programs and services; however, there are few resources in the OT literature that guide therapists in the process, making it difficult to enter this practice arena. The purpose of this study is to offer an example of a needs assessment process to provide information that may guide OT practitioners as they develop community-based health promotion programs and services to populations in need.

Health promotion is a method of intervention that addresses “the process of enabling people to increase control over, and to improve, their health” (World Health Organization, 1986). Pizzi and Richards (2017) asserted that participation, not performance, is a primary determinant of health, well-being, and quality of life. According to the Occupational Therapy Practice Framework (AOTA, 2014), the aim of health promotion interventions is to achieve outcomes that can be evidenced in prevention, health, wellness, quality of life, and participation in meaningful occupations. The AOTA (2014) organized concepts related to health promotion in categories within the OT domain and process (Table 1). For the purpose of this study, the authors use health promotion as an intervention service that is emphasized in this study, which showcases a process for a needs assessment.

Table 1.

Categorical Organization of Health Promotion Concepts.

Concepts in domain of OT	Interventions	Outcomes
Health	Health promotion	Prevention
Well-being	Health promotion programs	Health & wellness
Participation		Quality of life
		Participation
		Well-being

Note. OT = occupational therapy.

OTs around the world are beginning to implement health promotion programs (Nielsen & Christensen, 2018; Turcotte et al., 2015). In the United States, several OT leaders have pioneered the expansion of OT into community-based health promotion with older adults through the development of Lifestyle Redesign, an evidenced-based health and wellness program grounded in occupational science (Clark et al., 2015). Researchers used randomized controlled trials to study outcomes of this program, which were published as the Well Elderly I Study (Clark et al., 1997; Jackson et al., 1998) and Well Elderly II Study (Clark et al., 2012). Researchers found in both studies that participants in the occupation-based education groups had better wellness outcomes than control groups. In addition, the Well Elderly II Study showed a cost savings with Lifestyle Redesign. Both studies were published in journals with high impact value, which showcased OT’s significant role in community health promotion and wellness programming.

Despite this high-level evidence, most OT practitioners in the United States are not working in this area. It is, therefore, important to identify perceived needs of practitioners, communities where programming will occur, and the target populations. These three areas need to be assessed to help practitioners make a paradigm shift—the role of OT in community-based health promotion.

OT Practitioners

Historically in the United States, OT practitioners have viewed themselves from a rehabilitation paradigm, providing interventions after an illness, injury, or onset of diseases or health conditions. This paradigm is changing as leaders in OT begin to provide health promotion services before impaired health conditions limit participation in life, which can jeopardize health, well-being, and quality of life (Hildenbrand & Lamb, 2013; Pizzi & Richards, 2017). The goal of health promotion is not to replace rehabilitation; rather, it expands the role of OT to become more comprehensive in addressing needs of populations to promote quality of life.

Community/Older Adult Needs

Even though few OT practitioners are working in community settings, the need for community health promotion remains. Several factors, such as social, economic, and environmental disadvantages, within communities in which people live, work, and age can adversely affect health (Center for Disease Control [CDC], 2013). For example, low income is correlated with high rates of food insecurity and difficulty accessing resources to manage functional impairments associated with aging (Gleason et al., 2019). Therefore, it is important for health promotion programs to target older adults with low incomes.

The barrier to implementing these programs is the limited contemporary OT literature that describes a needs assessment process for guiding community health promotion program development. This lack of information leaves potential OT program developers and leaders at a disadvantage when trying to initiate health promotion programs; therefore, this study aims to provide information to guide program development by presenting a needs assessment process that illuminates needs of primary populations involved in health promotion programs: OT practitioners who might lead sessions, adult residents with low incomes living in community housing, and older adults with low incomes living in community housing.

Needs Assessment Research Questions

This mixed methods multiphase design (Creswell & Plano Clark, 2011) study illustrates a variety of methods by which to conduct a needs assessment to guide health promotion programming; it is an example of how to assess before you assess. The research questions are the following:

Research Question 1: What are the perceived needs of the OT practitioners for changing paradigms to include health promotion?

Research Question 2: What are the health promotion needs of residents with low income living in community housing?

Research Question 3: What are the health promotion needs of the target population, community dwelling older adults with low income?

Each population is a primary stakeholder; therefore, it is important to understand their perceived barriers/limitations, supports, and overall needs to help program developers implement strategies to support each population as they lead or participate in a health promotion program.

Method

Design

This mixed methods multiphase design (Creswell & Plano Clark, 2011) study used qualitative and quantitative strategies. Multiphase design includes sequential and concurrent elements, making it useful for program development and evaluation (Creswell & Plano Clark, 2011). Methods included a review of literature, phenomenological study using interviews with OT practitioners and three quantitative surveys, the last of which included qualitative questions. Each method was approved individually by the Institutional Review Board (IRB) at a University in the United States. The overall conceptual framework describing research questions, theoretical framework, methods, and validity and reliability are presented in Figure 1.

Figure 1.

Conceptual framework.

The multiphase design described by Creswell and Plano Clark (2011) used for this study was organized into three phases with minor modifications: two preassessment and one assessment that has an element of postassessment within. Figure 2 presents an overview of the three phases of needs assessment process, each phase organized by participant population. The person, environment, occupation [P-E-O] model (Law et al., 1996) was a useful theoretical framework for the needs assessment process and creation of survey questions because it assured assessment of key determinants that impact participation, health, well-being, and quality of life.

Figure 2.

Overview of multiphase design: Three phases of needs assessment process.

Participants and Procedures

Phase I: Qualitative preassessment with OT practitioners

With the guidance of an advisor (first author), two researchers (fifth and sixth authors), who were graduate students at the time, used a qualitative empirical phenomenological approach (Moustakas, 1994) to explore OT practitioners’ perceptions about their experiences with the OT paradigm shift toward health promotion, to understand their needs for professional support for initiating community-based health promotion intervention. In this study, perceived barriers and supports were examined. Researchers used convenience and snowballing sampling (Creswell, 2007). Inclusion criteria were one or more years of experience working with adults over the age of 65, with or without community health promotion experience, and willingness to participate in three interviews. Exclusion criteria were non-OT practitioners and those who did not have experience working as an OT practitioner. Researchers conducted three semistructured interviews with each of five OT practitioner participants following their review and signature of written informed consent forms. Participants were able to select a pseudonym for themselves.

All participants were female occupational therapist practitioners with a range of experiences from 2 to 34 years. Current work settings included inpatient rehabilitation, acute care, acute rehabilitation, orthopedics, and outpatient mental health. Researchers allowed participants to select locations and methods for interviews, which included participants’ homes (two), place of work (one), via email (one), and phone (one). The participant who preferred email explained she did not want to be recorded. The participant who preferred to be interviewed by phone did not describe a reason for this preference. Researchers accommodated participants’ preferences to support participants’ rights and maintain rapport with the interviewer (Helman & Seidman, 2013). Researchers made changes with research protocol for email interviews, which were approved by the IRB. The IRB # for this qualitative study is IRB-201405-480.

Interview questions

Using Creswell’s (2007) descriptions of phenomenological research, interview questions targeted participants’ perceptions of their experiences that influence the phenomena of making a shift toward health and wellness promotion in the OT profession.

What needs do you see pertaining to wellness programming?

What experience do you have working with the older adult (65+) population?

What do you see as benefits to health promotion programming in general?

○ Towards this population?

Explain the role of OT in health and wellness promotion and programming.

What barriers have you seen, or anticipate seeing, in providing this type of programming?

How do you view this type of programming influencing the profession of OT?

For the second and third interviews, researchers created follow-up questions to gain thick data and check accuracy of categories that emerged from data of the first interviews. By the third interview, participants were repeating prior descriptions, which is considered saturation (Creswell, 2007), so no new questions were formed.

Phase II: Quantitative preassessment with community residents (2010)

Nkimbeng et al. (2020) suggested that partnering with community organizations is one helpful strategy to recruit participants who have low incomes and functional impairments, which is a population that could benefit from a health promotion program. The researcher (first author) of this study partnered with the local community housing authority to complete a needs assessment of the residents to inform the developing OT health promotion program that was being implemented at a large (124-unit) community housing apartment complex.

The community housing authority is a federally and locally government-funded organization that provides safe, affordable housing and educational self-sufficiency services to people with low socioeconomic status; many residents also have various types of disabilities that limit their ability to generate income. The community housing authority employs resident service coordinators, who advocate for resident needs and help residents access community agencies, programs, and services; however, service coordinators are not providers of services.

The large community housing apartment complex had three shared entries that were unlocked during the day and locked at night. There was a large community room that had a kitchen, dining space for 30 people, sofas, and television. Residents shared hallways that led to their own individual apartment that had a kitchen with dining space, living room, bedroom, and bathroom. Residents had their own security key to lock their apartment and to use with main entries when those doors are locked at night.

The researcher met with the housing authority administrator and two service coordinators to gather general information about residents; however, detailed descriptions about health and wellness needs of residents were unknown. Health and wellness information about residents is not accessible in community housing because the community housing authority does not provide health care services. This lack of health information about residents accentuated the need to conduct a needs assessment, which would be used to guide topics for health promotion programming.

Instrument

The housing authority administrator and service coordinators provided general information about some of the residents they had observed or knew about, such as limited knowledge about nutrition recommendations, falls, mobility limitations, chronic pain, cognitive impairments, vision impairments, social isolation, literacy limitations, and limitations in participation in meaningful activities. The researcher used this information to create a survey that would identify the community housing residents’ specific health and wellness needs using Likert-type and ordinal scales. The researcher designed the survey to compensate for potential limitations in literacy, cognition, and vision. For example, the questions were short, between four to 10 words for most items. The words were mostly one-three syllables and eighth-grade readability level. The font size was 14 to 16 instead of the normal 12 to compensate for vision impairments. No reliability and validity measures were conducted on the initial survey due to the developmental nature of the tools and the small sample size.

The framework for the survey was based upon the P-E-O model (Law et al., 1996) and literature about determinants of health. Table 2 presents a few examples about how the researcher categorized the questions according to the P-E-O model, which would illuminate the transactive nature between each category as they culminate to influence engagement, rather than performance (Law et al., 1996). The researchers also used the survey to inquire about use of assistive devices, balanced diet, community mobility, transportation, reading ability, falls, and homelessness. Demographics were included but no identifying information was collected. A service coordinator placed 124 surveys in residents’ mailboxes (one mailbox for each apartment) and a return envelope was placed in the front lobby in a secure location for convenience and voluntary return. The approval for research number is IRB-201007-008 for the initial study and IRB-201809-039 for repeated data analysis with expert review. Informed consent is not indicated for this exempt research.

Table 2.

P-E-O Model Constructs Reflected in the Survey.

Person	Environment	Occupation
Conditions	Modes of transportation	Food and water intake
Mobility	Homelessness	Leaving apartment/building
Reading skills	Time with visitors	Greatest stressors
Overall health	Social isolation/boredom	Greatest pleasures
Happiness

Phase III: Quantitative and qualitative assessment/postassessment with older adults (2015; 2016)

The needs assessment process for the community housing residents living in the large complex helped to target a specific population with the greatest needs for health promotion: community dwelling older adults with low income. The first author researcher directed and led weekly occupation-based wellness sessions (1 time per week) primarily for this older adult population at the large community housing complex for 5 years, which was part of the research project conducted with the first preassessment survey of residents with low incomes. Many of these sessions were interprofessional in nature, including people and learning activities from nursing, exercise science, music therapy, nutrition, community safety coordination, and parks and recreation.

During this time, the number of older adults participating in the wellness sessions at this larger community housing complex gradually decreased because many of them were moving to a new smaller, more secure complex (35 apartment units) that was about a mile away from the larger complex and was specifically built for people over the age of 50. The same service coordinators worked at both complexes, which were under management of the one community housing authority. Service coordinators saw greater resident needs for the health promotion program at the new smaller complex than the larger complex, so they recommended the transfer and continuation of the health promotion program to the smaller housing complex.

The small new complex was more secure than the larger complex because it had main entry doors that were continually locked with keys distributed only to residents and housing authority employees. Each resident had their own secured apartment with entry from a shared hallway; each apartment included a kitchen with dining table space, living room, bedroom, and bathroom.

Instrument quantitative assessment (2015)

For this 2015 older adult assessment survey, the two researchers (first and third authors; the third was a student at that time) used a nonexperimental cross-sectional survey study design. Similar to the 2010 preassessment survey, the P-E-O model (Law et al., 1996) guided the development of 20 questions about personal, environmental, and occupational factors affecting health, well-being, and quality of life, while literature guided specific details about health determinants that can affect aging in place. These concepts were considered useful for determining topics and education strategies for the health promotion program. All the questions were close-ended questions, with the option to expand on an answer if necessary. Participants returned the surveys to a manila envelope in the service coordinator’s office, which was a secure location. The IRB # for this 2015 study is IRB-201504-315 and informed consent was not indicated as the method includes use of a survey.

In 2016, after 8 months of providing weekly occupation-based health promotion education sessions, 1 time per week, at the smaller community housing complex for older adults, researchers repeated the 2015 needs assessment survey. Topics for each session targeted health concerns identified in literature and in the 2015 needs assessment, such as education in safe mobility strategies to prevent falls; nutrition and hydration and healthy meal preparation on a low budget; emotional well-being, and engagement in meaningful activities. With advisement from the first and second authors of this article, the third and fourth authors (graduate students at the time) conducted this 2016 study as part of their academic requirements.

Instrument quantitative and qualitative postassessment (2016)

This 2016 survey was the same format of the 2015 survey but also included five additional program evaluation questions, some of which were qualitative in nature; these questions focused on illumination of favored program topics, participation in the current wellness programming, overall sense of well-being, improvement areas of wellness, and improvement in aspects of wellness. Procedures for distribution were the same as the 2015 survey. The IRB approval of research number is IRB-201605-381. See Supplemental Appendix A for a composite of questions and responses for all three surveys from 2010, 2015, and 2016.

Data Analysis

Phase I: Qualitative preassessment with OT practitioners

The researchers followed Creswell’s (2007) guidelines to phenomenological study approach for data analysis. They transcribed the interviews verbatim and then read the written transcripts multiple times, making notes along the margin to form initial codes and then collapsed them into categories and themes. For data analysis, Creswell (2007) stated that phenomenological researchers should list significant statements from participant experiences associated with the topic; therefore, single statements that were not significant, not related to the phenomena, and reflected by only one participant were excluded. Themes emerged from repeated concepts that included in depth descriptions of participant’s epochs, as well as the narrative essence of their phenomena, which is to bring to light that which appears in consciousness from their personal experiences (Moustakas, 1994).

Phase II: Quantitative preassessment with community residents (2010) and Phase III: Quantitative and qualitative assessment/postassessment with older adults (2015; 2016)

Residents from the community preassessment in 2010 and the older adult assessment in 2015 and 2016 were described using prevalence for six categorical variables that were derived from the data, with summation of total number of responses for chronic conditions, stressors, and activities. The mobility difficulty composite score was a summation of participants’ responses to questions related to method of walking, transportation (self or assisted), frequency of falls, and frequency of leaving their apartment or the building (higher score indicates more mobility difficulty). The poor diet composite score was a summation of participants’ responses to questions about fruit/vegetable intake, water intake, and balanced meal (higher score indicating poorer diet). The researchers summated participants’ responses about happiness, number of visitors, and boredom (higher score indicating poorer mood) to create a composite for poor mood score. Prevalence of most common conditions, stressors, and activities were presented. Spearman correlations between composite variables were estimated. Box plots with minimum, 25th percentile, median, mean, 75th percentile, and maximum were used to describe composite variables for 2015 and 2016. Independent t tests were used to compare composite variables between 2015 and 2016.

Results

Phase I: Qualitative Preassessment With OT Practitioners

Findings from the qualitative interviews with practitioners revealed an overarching essence statement with three themes, which emerged from repetitive, or emphasized, concepts from participants. Because practitioners’ experiences were grounded in rehabilitation and not health promotion, they perceived there to be more barriers than supports when implementing community-based health promotion programming.

Barriers

In the first theme, participants asserted there were many barriers, which included reimbursement, subjective meanings, accessibility, societal views, occupational therapy focus, and time. Their experiences within a rehabilitation model were reflected in the majority of their statements; a brief synopsis of each is provided here.

Reimbursement

“Mary” said health promotion and prevention “are not something that insurance companies will typically pay for; and I’m not good at grant writing.” All participants reflected this concern.

Subjective meanings of health promotion

The concept of health is subjective in nature and varies according to each individual’s perceptions and experiences. Both “Janessa” and “Mary” described difficulty with targeting individual perceptions of health when health promotion programs are typically provided to groups of people.

Lack of professional identity in society

“Janessa” suggested OT will lose its identity even more if the OT profession diversifies services too much. All participants shared this concern.

Time

Two practitioners expressed concern about adding another project onto their workload, which is already substantial.

Benefits

The second theme that emerged from participants’ perceptions of their experiences was acknowledgment of benefits of OT’s role in health promotion programs. The benefits they highlighted the most are described here.

Aging in place

“Rachel” specified that OT can help them remain strong enough to do their self-care and mobility activities to help them age in place. All participants acknowledged OT can help them remain independent in the community.

Decreased costs

“Jane” said, “If we shift our focus more to health promotion versus just fixing a problem once it already has occurred, we could save a lot of money.” Two participants described potential to save health care costs.

Quality of Life

Participants reflected connections between independence in occupations, meaning, and purpose with quality of life. “Janessa” said “Having a purpose to life makes one want to live it.”

Expansion of OT

“Janessa” stated this could be a “strong niche . . . it would challenge us to be out in the community more.” All participants expressed positivity about expanding the role of OT in general.

Practitioner needs for expanding the role of OT

The final theme highlighted particular needs of the OT practitioners and the profession for expansion into health promotion.

Education

Mary and Jane described the importance of educating OT practitioners about their role in community health promotion. Mary stated, “It’s a specialty area . . . We could take it to the next level.” Mary and Jane indicated education of OT practitioners is important for expanding the role of OT in health promotion.

Defining health promotion niche

All five participants emphasized interest in health promotion but indicated there is need for occupational therapy as a whole to further define an OT niche. Tina displayed enthusiasm by stating, “I would love to see OT branch out to help in the area of prevention, working with health aging . . . we could really find a niche in the area and shine.” They reflected on their experiences with rehabilitation after there had been a problem. Janessa further stated, “Rarely do we work on the health part of it before they become unhealthy.”

Summary of practitioner needs

Throughout the qualitative portion of this study, participants recognized that OT can contribute positively to community health promotion. The limitation, as they perceive it, is that the barriers to expanding this role outweigh the benefits. They perceived that the OT identity associated with rehabilitation prevents expansion into, and reimbursement for, health promotion. From their experiences in traditional rehabilitation, they perceived a need to better educate practitioners and define the niche of health promotion.

Phase II: Quantitative Preassessment With Community Residents (2010) and Phase III: Quantitative and Qualitative Assessment/Postassessment With Older Adults (2015; 2016)

Both the community housing residents’ preassessment in 2010 and the older adult assessments in 2015 and 2016 measured self-reported wellness indicated by chronic conditions, mobility, diet, and mood. The older adult assessment also included measures of stressors and activities. The preassessment 2010 survey was completed by 47 residents (38% return rate), 21 (45%) male and 26 (55%) female, with an average age of 65.8. The older adult assessment survey had 13 respondents (37% return rate) in 2015 and 12 (34% return rate) in 2016 with an average age of 73.9 (SD = 8.2) and ranged from 63 to 87; most (80%) were female. Complete results from the surveys are found in Supplemental Appendix A.

In the 2010 survey, 20 medical conditions were included; the number of medical conditions was reduced to 10 in the latter surveys. Figure 3 shows the self-reported occurrence of the 10 medical conditions for both assessments. In the 2015 and 2016 surveys, balance, breathing, mobility limitations, and pain (36% to 44%) were more common for the older adult target population and hearing, heart disease, and diabetes (16%–24%) were less common. The older adults had an average of three conditions with a range from zero to eight. Around three fourths of both communities could walk. Frequency of falls was about the same for both communities, with around half not having any falls in the past 5 years.

Figure 3.

Conditions.

Residents were asked to select up to 14 stressors in their lives and up to 15 activities they liked to do. Figure 4 shows the most common stressors and activities selected. Over 40% of respondents indicated worries about falling and physical limitation as stressful and over half indicated that money was a source of stress. Watching TV was by far the most common activity (84%). Over half indicated they spent time with family, church, social engagements, relaxing, or being with friends.

Figure 4.

Stress activities.

As well as total conditions, stressors, and activities, three more composite variables were created. Poor mobility was measured through physical limitations, ability to leave residences, and transportation. Poor nutrition was measured by asking about meals, fruits and vegetables eaten, and water consumed. Poor mood was measured using Likert-type scales for rating happiness, boredom, and visitors. Number of stressors was correlated with poor mobility (r = .607, p = .001) and number of medical conditions (r = .628, p < .001). Mobility was also correlated with conditions (r = .667, p < .001). The distributions of the composite variables created from the survey for 2015 and 2016 separately are shown in Figure 5. There was no significant difference between 2015 and 2016 composite values.

Figure 5.

Composites 2015 and 2016 surveys.

Synthesis of Results

The multiphase design enabled researchers to identify threads that connected the three populations for health promotion teaching and learning purposes, which supported program development. For example, OT practitioners perceived health promotion interventions to be different from traditional rehabilitation services they are more familiar with. However, after merging data between the quantitative and qualitative strands, the needs identified by community residents and older adults were actually similar to needs of patients or clients in traditional rehabilitation settings, such as the need for addressing falls; malnutrition, dehydration, and healthy meal preparation on a low budget; and occupational deprivation. The high rates of sedentary activity among community residents and boredom among older adults showcased occupational deprivation as a need, which positions OT practitioners well for implementing occupation-based health promotion education.

The multiphase design verified the health-related problems concerning populations with low income. The Phase III assessment of older adults (2015; 2016) and Phase II preassessment (2010) of residents living in community low-income housing showed consistency with literature related to health-related problems: falls (Bergen et al., 2016), nutritional vulnerability (Porter Starr et al., 2015), and participation in meaningful activities (Stav et al., 2012). The needs for occupation-based education addressed perceived needs found in Phase I preassessment of OT practitioners who felt that OT needs to define its niche in health promotion; use of occupation defines the niche that is uniquely OT. Like Lifestyle Redesign wellness program (Clark et al., 2015), it is important to use occupations as goals and means, regardless of service delivery setting.

Discussion

To help OT practitioners shift their paradigm to community health promotion, this multiphase design conducted across multiyear phases was a valuable example of a needs assessment of three different populations, which supported concurrent program development and evaluation. Creswell and Plano Clark (2011) described the multiphase design as having interconnections between the research questions for each study phase, which are centered around the main program objective. In this study, the main objective for the health promotion program was to identify perceived needs of each population for program development.

Strengths of Multiphase Design

This multiphase design process had several strengths like those described by Creswell and Plano Clark (2011), such as flexibility with timing, sequencing, and methods while developing and evaluating the health promotion program. For example, researchers used quantitative surveys and added qualitative questions for both summative and formative evaluation purposes. Second, researchers were able to write individual study manuscripts for their educational purposes while still contributing to the overall multiphase study. Finally, the multiphase design allowed for in-depth research over several years of concurrent program implementation, which supported overall program evaluation needs.

Drawbacks of Multiphase Design

Creswell and Plano Clark (2011) also described challenges of multiphase design, including integrating concurrent and sequential approaches, having enough time and resources, team collaboration, connecting concepts between quantitative and qualitative strands, translating research to practice, and submission of several IRB requests for protocol approval. In this study, it was challenging to identify threads related to needs of participants from quantitative and qualitative strands. It was also challenging to translate results into practice; there was a continuous struggle to shift writing focus between disseminating results of each study phase and disseminating the overall multiphase results and process as an example of how to conduct a needs assessment.

Recruitment of experts was helpful to review the merged data to identify themes and help with conceptual organization. Also, we had separate teams of three researchers and writers for each phase, which enhanced communication, task assignments, timelines, and IRB protocol submissions.

Implication

Using a multiphase design for community needs assessment is a manageable method and aligns with AOTA task force efforts to help OT practitioners make a paradigm shift toward health promotion with six action items related to marketing, education, policy and programs, leadership, and research (Hildenbrand & Lamb, 2013).

Recommendations

Include OT practitioners in multiphase design needs assessment process for development and implementation of health promotion programs.

Include OT practitioners in Train the Trainer sessions.

Use the Lifestyle Redesign program (Clark et al., 2015) and Well Elderly Study II (Clark et al., 2011) for program development and marketing outcomes to reimbursement agencies.

Consider using Pizzi’s new E-HOW model (Pizzi & Richards, 2017)

Limitations

Use of a 3-point Likert-type scale is not sensitive enough to measure changes over time, but easy enough for respondents who have cognitive challenges. The survey instruments were not piloted for reliability and validity due to the developmental nature and small sample size; however, they are grounded in evidence and designed for participants with a wide array of abilities and limitations. Small sample sizes limit generalizability of results; however, the multiphase design process is transferable for needs assessment and program development.

Conclusion

To expand the role of OT into community-based health promotion, it is important to recognize the perceived needs of practitioners who may implement such programs, community populations, and target populations. Conducting needs assessments in multiple phases can promote development of community-based programs and activities. OT practitioners in the United States are encouraged to use AOTA resources to shift their paradigm toward health promotion. The focus of this study is on OT practice; however, the needs assessment multiphase design process can be applied in other countries, professions, and settings to assess before you assess.

Supplemental Material

Appendix_A_Full_Survey_Results-mgk-11-7 – Supplemental material for Community-Based Health Promotion in Occupational Therapy: Assess Before You Assess

Supplemental material, Appendix_A_Full_Survey_Results-mgk-11-7 for Community-Based Health Promotion in Occupational Therapy: Assess Before You Assess by Sclinda L. Janssen, Marilyn Klug, Sara Johnson Gusaas, April Schmiesing, Danielle Nelson-Deering, Haley Pratt and Breann Lamborn in Journal of Applied Gerontology

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Sclinda L. Janssen

Supplemental Material

Supplemental material for this article is available online.

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