On the structure and contents of occupational therapist paradigms : empirical studies of occupational therapy students' and occupational therapists' views on occupational therapy

Abstract

The ambition of this thesis is to contribute, from a paradigm theoretical frame of reference, to the development of occupational therapy knowledge in Sweden.

The specified thesis aim was to identify and characterize occupational therapy students' and occupational therapists' perceptions of occupational therapy, especially regarding world view and field of action view in Törnebohm's sense.

The thesis includes five sub-studies. The first and second studies are based on newly enrolled and qualified occupational therapy students' written answers to essay-questions. The third study comprises occupational therapists' audio- and video-taped thematic discussions and involves a focus group approach. Study four concerns occupational therapists' exam papers and study five occupational therapists' personal accounts of the meaning of health.

In study one the newly enrolled occupational therapy students were shown to possess varied information about occupational therapy, but to have difficulty in joining the information together into a coherent unity. Three themes were identified in the material: Notions of some concepts fundamental to occupational therapy; Notions of the setting of occupational therapy, and Notions of the operational reality of occupational therapy.

In study two a major finding was that the qualified occupational therapy students' notions gave expression to a constant application of a holistic health perspective which, in contrast to that of newly enrolled occupational therapy students, resulted in numerous examples of interrelations within, but also between, themes belonging to different paradigm components. According to Törnebohm this is characteristic of paradigms.

In study three the results showed several unifying factors within the two paradigm components world view and field of action view, and the dissimilarities were limited to specifications within the unifying factors, with regard to the respondents' notions. The unifying factors could be described as a potential local ideology for the group. A major finding is that the lasting core of occupational therapy work consists of three components: concern for uniqueness of patients; concern for details of everyday life; and concern to set free willpower/facilitate autonomous actions.

In study four the occupational therapists' interest in research subjects related to the field of action view components of paradigms and in applied research on strategical matters, dominated throughout the material. The interest in research subjects related to the world view components of paradigms, and in basic research on ontological matters, however, was shown to have increased in the last five-year period.

In study five the results showed a strong tendency towards holistic health conceptions and also towards a phenomenological view of the body. If this tendency should be taken to reflect current basic views within the profession, it would indicate a movement away from biomedical frames of reference on the theoretical level. This would seem to imply consequent movements on the practice level away from organ-focused interventions to the benefit of interventions in the person/context dimension of occupational performance.