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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 52  |  Issue : 1  |  Page : 12-18

An investigation into medical practitioners' awareness of occupational therapy in South India: A survey


1 Department of External and Regulatory Affairs, NBCOT Inc., Gaithersburg, MD, USA
2 Department of Intensive Care, Apollo Hospitals, Trichy, Tamil Nadu, India

Date of Submission15-Sep-2019
Date of Decision29-Nov-2019
Date of Acceptance02-Dec-2019
Date of Web Publication30-Mar-2020

Correspondence Address:
Dr. Karthik Mani
335, W Side Dr, Gaithersburg, MD 20878
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_25_19

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  Abstract 


Background: Occupational therapists (OTs) practice on both a first contact and a referral basis. Medical practitioners are often the primary referral source for OTs. To make timely and appropriate referrals to OT, it is imperative that the referral sources demonstrate a broader level of understanding of the OT profession. Objectives: The objective was to determine the level of awareness about OT among medical practitioners in South India. Study Design: Survey research design was used to conduct this study. Methods: An electronic survey was developed for this study and sent via E-mail and social media to medical practitioners in South India who were identified through convenience and snowball sampling. Data were collected from June 15, to July 31, 2019. Results: The number of responses received was 116. Eighty-two percent of the respondents reported either being familiar with or having heard about OT. Respondents who are specialists, work in the private sector, and practice their profession in a foreign country were more familiar with the OT profession and referred patients to OT. Gender and years of medical practice did not influence the familiarity level. Conclusions: Although many respondents have heard about OT and recognize it as a profession aligned with the rehabilitation of individuals with disabilities, their responses indicate that they have a limited understanding of the profession's scope of practice, OTs' role in some practice areas, and practice settings in which OT services are delivered. The consequence of this could be missed referrals.

Keywords: India, Occupational Therapists, Physicians, Private Sector, Surveys and Questionnaires


How to cite this article:
Mani K, Velan M. An investigation into medical practitioners' awareness of occupational therapy in South India: A survey. Indian J Occup Ther 2020;52:12-8

How to cite this URL:
Mani K, Velan M. An investigation into medical practitioners' awareness of occupational therapy in South India: A survey. Indian J Occup Ther [serial online] 2020 [cited 2020 May 25];52:12-8. Available from: http://www.ijotonweb.org/text.asp?2020/52/1/12/281637




  Introduction Top


In the health-care industry, it is imperative that health-care professionals are aware of the different disciplines that deliver quality and holistic care to service recipients.[1] Interprofessional awareness between disciplines enables timely and appropriate referral of patients to services.[2] In India, patients often seek the help of medical practitioners for all their health issues.[3] The practitioners, in turn, refer patients to specialists and other services as needed.[4] As allopathic medical practitioners (AMPs) are at the frontline of the medical care continuum, guiding the direction of care, it is imperative for them to demonstrate an awareness of other health professions.

Occupational therapists (OTs) in India treat patients on a referral or a first-contact basis.[5] In many instances, OTs enter the care continuum during the later phase of care because their focus is on the function and quality of life. Hence, patients are often referred to OTs by other health-care professionals. In addition, the lack of awareness of OT among the public prevents service recipients from seeking OT services without physicians' or other health-care providers' directives. As AMPs often refer patients to OT, this study was conducted to determine the level of awareness of OT among them and the factors influencing that awareness.


  Methods Top


This study was conducted adhering to the principles of the Declaration of Helsinki guidelines. The guidelines were reviewed before the survey was sent to the participants. In addition, the survey invitation that was sent to and shared with participants clearly identified that participation in the survey was “strictly voluntary and the responses will be kept anonymous.”

Sample

The study's targeted population was physicians and/or specialists with a minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree and who were practicing medicine in South India (Andhra Pradesh, Karnataka, Kerala, Puducherry, Tamil Nadu, and Telangana). The participants of this study were identified through convenience and snowball sampling. The authors shared the survey link through WhatsApp groups of South Indian AMPs, of which the second author is also a member. The survey link was also shared with individual AMPs known to both authors. The recipients were requested to share the survey with their colleagues and friends who met the inclusion criteria.

Instrumentation

The authors developed the survey [Appendix A] by reviewing the literature and following survey-writing guidelines.[1],[6],[7] The survey consisted of ten questions that were designed to gather information about the participants' demographics, practice setting, specialty, familiarity level with OT, referral behavior related to OT, and understanding of patient groups who need OT services and OT practice settings. The survey tool was reviewed by five health-care professionals, including OTs and physicians with at least a decade of experience, for clarity and face validity. No revisions were made post review.

Procedure

The survey was conducted through SurveyMonkey™.[8] In June 2019, the survey link was shared via identified WhatsApp groups. Throughout the survey response period, the survey link was also shared with individual practitioners who met the inclusion criteria. Two reminder messages with the survey link were also posted on the same WhatsApp groups. However, most of the practitioners who received the survey invitation via individual messages did not receive the reminders. At the end of the survey response period, all data were exported and tabulated for statistical analysis.

Data Analysis

Descriptive statistics were used to summarize and report the responses received. Data were reported as percentages and aggregate numbers to protect the identity of respondents. Chi-square test and Freeman-Halton extension of Fisher's exact test were performed to determine the association between “familiarity with occupational therapy” and each of the following variables: gender, specialty, practice setting, years of practice, foreign practice, time of first exposure to the term “occupational therapy,” and referral behavior of the participants. When statistical tests yielded significant results (P < 0.05), percentage values were examined to determine the direction of association. All analyses were conducted using Microsoft Excel and an online calculator.


  Results Top


By the response deadline, 116 responses were received. [Table 1] presents the respondents' demographics. Seven percent (n = 8) of the respondents reported that they were very familiar with the field of OT, 25% (n = 29) reported that they were familiar, 50% (n = 58) reported that they have heard about OT, and 18% (n = 21) reported that they were not at all familiar [Figure 1]. For the item on initial exposure to the term “occupational therapy,” 57% (n = 66) reported that they came across the term during their entry level or postgraduate education, 23% (n = 27) reported at work or practice, and 16% (n = 19) reported that they learned about the term through this survey. Two respondents reported that they were exposed to the term during foreign travel, and two other respondents reported that they became aware of the term when working abroad.
Table 1: Respondents' Demographics

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Figure 1: Respondents' Level of Familiarity with Occupational Therapy

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Sixty-eight percent (n = 79) of the respondents reported that they never referred a patient to OT. Twelve percent (n = 14) reported that they occasionally referred, 9% (n = 11) reported that they referred sometimes, and 10% (n = 12) reported that they referred often.

[Figure 2] provides the percentage of respondents who chose different patient groups as suitable for OT services. The top three patient groups selected were (i) individuals who experience difficulties with self-care, work, education, play, and leisure activities (patient group 5); (ii) patients with functional limitations due to orthopedic/neurological dysfunctions (patient group 2); and (iii) children with developmental disabilities (patient group 1). Only 41 and 31 respondents selected “persons with psychiatric disorders” (patient group 3) and “elders with dementia” (patient group 4), respectively. Four respondents chose the “other” response option and recorded “postoperative patients,” “any person who is suffering from disabilities due to occupational hazards,” “selected pervasive developmental disorders,” and “no comments” as their comments.
Figure 2: Respondents' Selection of Patient Groups for the Item on Who Needs Occupational Therapy

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[Figure 3] provides the percentage of respondents who chose each of the practice settings listed as response options for the item on the practice settings of OTs. Three respondents chose the “other” option and one of them recorded “vocational OT center” as his/her comment.
Figure 3: Respondents' Selection of Practice Settings for the Item on Where Occupational Therapists Provide Services

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  Discussion Top


A majority of respondents (82%; n = 95) reported that they either have heard about or are familiar with OT. However, the respondents' responses indicated that they lack an understanding of the scope of OT practice, OTs' role in some specialties, and some practice settings in which OT practitioners deliver OT services. These findings are in alignment with the findings in the literature. [6,9-12]

Many respondents recognized OT as a profession aligned with the rehabilitation of individuals with disabilities as they chose rehabilitation centers as a practice setting for OTs and selected patient groups 1, 2, and 5 as patient groups that need OT services. The low selection of patient groups 3 and 4 indicates that respondents were not very familiar with OT's role in psychiatry and geriatrics.

The data analysis indicated that gender (χ2, P = 0.70) and time of the first exposure to the term “occupational therapy” (Freeman-Halton Exact, P = 0.87) did not have any association with the familiarity level. Although there was no statistical significance (χ2, P = 0.27) to suggest an association between years of medical practice and familiarity level, introspection of percentage values indicated that respondents with >10 years of practice experience appear to be relatively more familiar with OT than those with < 10 years of experience.

Some factors appear to influence the level of familiarity with OT among respondents. The following section examines them.

General Practitioners versus Specialists

Due to low-frequency values, all responses from specialists (other than general medicine) were merged to create a “specialists” category. In addition, all “very familiar” and “familiar” responses were merged to create a “familiar” category. The data analysis revealed a statistically significant association (χ2, P = 0.002) between the “specialty of practice” and “familiarity with OT.” The introspection of percentage values showed that specialists have heard more about OT than general practitioners. Contrary to this finding, in the UK, Chakravorty reported that general practitioners were more aware about OT than specialists.[13]

The reason behind specialists' increased familiarity with OT could be the additional and in-depth education they obtained when they pursued higher level of education. Furthermore, the specialty degrees may have offered them opportunities to focus on topics pertaining to a specific population (e.g. pediatrics - newborn to 12 years of age), which, in turn, would have helped them learn about other related professions serving a similar population.

As neurology, orthopedics, pediatrics, and psychiatry are the major areas of practice for OT, responses from those specialists were further analyzed.

Neurology

One respondent who identified his/her specialty as neurology reported of having heard about OT and referring patients to OT very often. However, for the item on who needs OT services, the respondent selected all patient groups except patient group 3. This shows that this medical practitioner was not aware of OT's role in mental health.

Orthopedics

Ten respondents who identified their specialty as orthopedics reported that they either have heard of or are familiar/very familiar with the field of OT. Half of the respondents reported that they have referred patients to OT. Six respondents stated that they came across OT during education, three reported “at work or practice,” and one reported “during foreign travel.” Interestingly, one orthopedist who reported that he/she is very familiar with OT and refers patients very often selected only the “other” option to the item related to patient groups and recorded “postoperative patients” as the comment. Another interesting observation is that two orthopedists did not identify “patients with functional impairments due to orthopedic/neurological dysfunctions” as a patient group who needs OT services.

Pediatrics

Seven respondents who identified their specialty as pediatrics reported that they either have heard about or are familiar with OT. All of them reported that they came across the term “occupational therapy” during their education. Four of them reported that they have referred patients to OT. All of them identified “children with developmental disorders” and “patients with orthopedic and neurological dysfunctions” as patient groups who need OT services. They also identified hospitals and rehabilitation centers as practice settings for OTs. Other response options in both items were selected only by a few respondents.

Psychiatry

Two respondents who identified as psychiatrists reported being familiar with OT services and referring patients to OT sometimes. One of them selected all patient groups, except patient group 4, as suitable populations for OT services. The other practitioner identified patient groups 1 and 5 as patient groups who need OT services. Interestingly, the second respondent did not identify patient group 3 despite being a psychiatrist.

The specialty-wide analysis of responses indicated that despite being familiar with OT services, many specialists have a limited understanding regarding the scope of OT services and the variety of practice settings in which OTs deliver services.

Private Sector versus Government Sector

During data analysis, all “private clinic” and “private hospital” responses were categorized as “private,” and all responses with the word “government” were categorized as “government.” The data analysis (χ2, P = 0.02) revealed a significant association between practice setting and level of familiarity with OT. The percentage values indicated that those who work in the private sector were more familiar with OT than those who work in the government sector. One reason for this could be the increased availability of OT services in the private sector versus the government sector.[14]

Foreign Practice

Of the ten respondents who stated that they practiced their profession in a foreign country, nine reported that they are either familiar with OT or have heard about OT. Not surprisingly, the data analysis revealed a strong association between foreign practice and familiarity with OT (Freeman-Halton Exact P = 0.00038). As OT is a well-established profession in Western and developed countries, anyone who is engaged in health-care practice in the Western world may have likely become familiar with the profession.

Familiarity versus Referral Behavior

The literature identifies a direct relationship between the referral behavior and the level of awareness about OT among health-care professionals.[6],[13],[15] The findings of the current study affirm the relationship. There was a statistically significant association (χ2, P = 0.000000005) between the familiarity level and referral behavior of practitioners. Seventy percent of those respondents who referred patients to OT were either familiar or very familiar with OT. Interestingly, one respondent referred patients to OT despite being not at all familiar with the profession.

Although there was no statistically significant relationship (χ2, P = 0.24) between specialty practice and referral behavior, the percentage values indicated that specialty-oriented practitioners referred patients relatively more than general practitioners. Seventy-seven percent of respondents who identified their practice area as general medicine reported that they never referred patients to OT, whereas only 62% of specialist respondents reported similarly. This is expected as OT services are generally believed to be more suitable for patients who visit specialists such as neurologists, orthopedists, pediatricians, and psychiatrists than those who visit general practitioners.

The statistical analysis did not yield statistical significance (χ2, P = 0.08) to suggest a relationship between the practice setting of respondents and referral behavior. However, the probability value was close to significance. The percentage values clearly indicated that respondents working in the private sector tend to refer patients more than those who are affiliated with government settings. It is important to note that none of the respondents who identified their work setting as a government facility selected the response option “yes-often” for the item on referral behavior. This observation aligns with the finding of decreased familiarity with OT among AMPs in government settings and underscores the need for additional awareness promotion efforts in government settings.

Implications for the Profession in India

The findings indicate that OTs are missing many potential referrals due to a limited awareness of OT among AMPs. Despite having heard about OT, many respondents reported that they never referred a patient to OT. This shows that referral sources need to know more about the OT profession than just having heard about it to refer patients for services.[13] Hence, OT professionals must engage in efforts such as publishing and disseminating case studies, presenting at medical conferences, and conducting in-services in large hospitals to educate AMPs and other referral sources about their profession. In addition, as AMPs with foreign experience tend to have a better understanding of OT, the Indian OT community could use them as ambassadors to spread the value of OT to other stakeholders. Further, official documents, such as practice guidelines and scope of practice, that are suitable to the Indian context of practice, could be published and made available by professional organizations for stakeholder education purposes. The organizations may also adopt and modify international guidelines to suit the local needs.[10]

The results show that the awareness of OT among general practitioners is limited. It is essential to educate general practitioners about OT to minimize referral delay.[13] As all respondents did not report that they came across the term “occupational therapy” during their education, it is unclear whether the entry-level medical curriculum covers an overview of OT. It is important to note that 23% of respondents reported that they first heard about OT at work/practice and 16% of respondents reported that they learned through this survey rather than during their education. OTs in India must advocate for the inclusion of a comprehensive overview of the OT profession in the entry-level medical curriculum to help general practitioners become more cognizant of OT services early in their career.[10],[15] In addition, OTs must also address the dearth of workforce in their profession as more practitioners in the field may contribute to more awareness.

Occupational therapists in the government sector must make efforts to promote the visibility of the profession in government settings with the help of professional organizations and subject matter experts. They may communicate the value of OT to AMPs, administrators, and relevant others in government settings by aligning OT outcomes with public health outcomes, such as reduced falls, low risk for injuries, reduction in the number of outpatient visits, and self-empowerment of patients to manage their health. In addition, they may explore practice opportunities for OTs in government programs and schemes.[16]

Alheresh and Nikopoulos, in their study on the awareness of OT among health-care professionals in Jordan, highlighted OTs' lack of role clarity as a factor that could contribute to poor awareness.[10] This could be applicable to the Indian scenario as well. To overcome the issue, OTs in India must develop an increased understanding of their profession's philosophy. In addition, they must develop the ability to effectively articulate (i) the focus and purpose of OT interventions to patients and other stakeholders and (ii) how OTs consider multiple variables when planning interventions.[17]

As interprofessional education (IPE) may assist in familiarizing OT to future generations of medical practitioners while helping OT students learn about other professions, the OT educational community in India may seek or establish opportunities for IPE. This will also help the Indian OT community join the global movement toward IPE, as it is believed that IPE is critical to achieve universal health care.[18]

Limitations

A low number of responses limits the generalization of the findings. In addition, only one region of India was covered in this survey, which limits the generalizability of the results across the nation. As the respondents were not asked to identify their practice location, the authors were unable to determine the percentage of responses from each state and explore its implications.

Recommendations

  • Other modes of survey administration can be explored to gain more responses
  • A detailed survey may have elicited more information, such as the percentage of cases referred to OT, reasons for referring patients to OT, and why a practitioner has never referred any patients to OT despite being familiar with or having heard about OT
  • The survey may be repeated across the nation with a larger sample size
  • The survey may be repeated targeting certain specialists, such as pediatricians, neurologists, and psychiatrists.



  Conclusions Top


Although medical practitioners in South India have heard about OT, they have a limited knowledge and understanding related to the profession's scope of practice, practice areas, and practice settings. The limited awareness contributes to missed referrals. Efforts such as (a) stakeholder education, (b) inclusion of a detailed overview of OT in the entry-level medical curriculum, (c) publication of official documents such as scope of practice, and (d) IPE are recommended.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.


  Appendix Top


Appendix A: Medical Practitioners' Awareness about Occupational Therapy in South India Instructions

Dear Doctor,

This survey intends to gather data from medical practitioners (physicians and specialists) regarding their level of awareness about the occupational therapy profession. Please complete this survey only “if you are a medical practitioner (anyone with an MBBS qualification or above) practicing in South India ” (Andhra Pradesh, Karnataka, Kerala, Puducherry, Tamil Nadu, and Telangana). Your responses will help generate valuable data for the occupational therapy community in India.

Your participation in this survey is strictly voluntary and completing this survey indicates your consent to participate in this study. Please do not provide your name or contact details anywhere on this survey.

1. Gender

  • Male
  • Female.


2. Please identify your specialty (general medicine, pediatrics, etc.)

(Textbox).

3. How long have you been a medical practitioner?

  • 0-5 years
  • 5 years 1 day-10 years
  • 10 years 1 day-15 years
  • 15 years 1 day-20 years
  • 20+ years.


4. Please identify the type of practice setting(s) you are currently working in (private hospital, government hospital,

nongovernmental organization, outpatient clinic, etc.)

(Textbox).

5. Have you ever practiced your profession outside India?

  • Yes
  • No
  • Other (please specify).


6. How familiar are you with the field of occupational therapy?

  • Very familiar
  • Familiar
  • Heard about occupational therapy
  • Not at all familiar.


7. When did you first come across the term/title/words “occupational therapy?”

  • During my education (MBBS or postgraduate education)
  • At work/practice
  • Through this survey
  • During foreign travel
  • Other (please specify).


8. Have you ever referred a patient to occupational therapy?

  • Yes-often
  • Yes-sometimes
  • Yes-occasionally
  • No.


9. In your view, who needs occupational therapy? (check all that apply)

  • Children with developmental disabilities
  • Patients with functional impairments due to orthopedic/neurological dysfunctions
  • Persons with psychiatric disorders
  • Elders with dementia
  • Individuals who experience difficulty with self-care, work, education, play, and leisure activities.


10. Where do occupational therapists provide services? (check all that apply)

  • Hospitals
  • Rehabilitation centers
  • Outpatient clinics
  • Nongovernmental organizations for people with disabilities
  • Patients' home
  • Schools/special schools
  • Other (please specify).




 
  References Top

1.
Kimberly AW. Nurse Practitioners' Awareness and Knowledge of Occupational Therapy Services [Dissertation]. Ann Arbor: D'Youville College; 2010. p. 96.  Back to cited text no. 1
    
2.
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. 2
    
3.
Gautham M, Binnendijk E, Koren R, Dror DM. 'First we go to the small doctor':First contact for curative health care sought by rural communities in Andhra Pradesh, Orissa, India. Indian J Med Res 2011;134:627-638.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Bhat R. Characteristics of private medical practice in India: A provider perspective. Health Policy Plan 1999;14:26-37.  Back to cited text no. 4
    
5.
All India Occupational Therapists Association. OT: Definition and Practice. All India Occupational Therapists Association; 2017. Available from: http://aiota.org/about_ot. [Last accessed on 2019 Sep 03].  Back to cited text no. 5
    
6.
Olaoye OA, Emechete AA, Onigbinde AT, Mbada CE. Awareness and knowledge of occupational therapy among Nigerian medical and health sciences undergraduates. Hong Kong J Occup Ther 2016;27:1-6.  Back to cited text no. 6
    
7.
Alotaibi N, Shayea A, Nadar M, Abu Tariah H. Investigation into health science students' awareness of occupational therapy: Implications for interprofessional education. J Allied Health 2015;44:3-9.  Back to cited text no. 7
    
8.
Online Survey Development Software. San Mateo, CA: SurveyMonkey Inc. Available from: http://www.surveymonkey.com. [Last accessed on 2019 Jun 14].  Back to cited text no. 8
    
9.
Bonsall A, Mosby A, Walz M, Wintermute, K. Health care professionals' knowledge of occupational therapy. Am J Occup Ther 2016;70:7011510189p1.  Back to cited text no. 9
    
10.
AlHeresh R, Nikopoulos CK. The role of the occupational therapist in Jordan: A survey of the members of the healthcare team exploring their knowledge about occupational therapy in rehabilitation hospitals. Disabil Rehabil 2011;33:778-786.  Back to cited text no. 10
    
11.
Jamnadas B, Buns J, Paul S. Understanding occupational therapy: Nursing and physician assistant students' knowledge about occupational therapy. Occup Ther Health Care 2002;14:13-25.  Back to cited text no. 11
    
12.
Patel A, Shriber L. Nurse practitioners' knowledge of occupational therapy. Occup Ther Health Care 2001;13:53-71.  Back to cited text no. 12
    
13.
Chakravorty BG. Occupational therapy services: Awareness among hospital consultants and general practitioners. Br J Occup Ther 1993;56:283-286.  Back to cited text no. 13
    
14.
Mani K, Sundar S. Occupational therapy workforce in India: A national survey. Indian J Occup Ther 2019;51:45-51.  Back to cited text no. 14
  [Full text]  
15.
Darawsheh WB. Awareness and knowledge about occupational therapy in Jordan. Occup Ther Int 2018;2018:2493584.  Back to cited text no. 15
    
16.
Mani K. The rights of persons with disabilities bill 2014: Practice opportunities for occupational therapists in India. Rights Pers Disabl Bill 2016;48:29-32.  Back to cited text no. 16
    
17.
Mani K. Identify crisis of occupational therapy in India. VOTC Ther Newsl 2015;68:1-2.  Back to cited text no. 17
    
18.
Tomblin Murphy G, Gilbert JH, Rigby J. Integrating interprofessional education with needs-based health workforce planning to strengthen health systems. J Interprof Care 2019;33:343-346.  Back to cited text no. 18
    


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