Date Presented 04/13/21
This literature review examined the evidence within the scope of OT practice addressing client development of self-advocacy and synthesizing the content of effective OT interventions addressing client development of self-advocacy to identify common features vital to successful outcomes. Additionally, this study aims to determine the quality of available empirical evidence of OT interventions designed to promote and support client self-advocacy.
Primary Author and Speaker: Laura Vanpuymbrouck
Additional Authors and Speakers: Olivia Easterbrooks-Dick
Contributing Authors: Alison Teasdale
PURPOSE: Self-advocacy revolves around concepts of knowledge of self and knowledge of one's rights (Test, Fowler, Wood, Brewer, & Eddy, 2005) and is a relatively new addition within the OTPF. We use the OTPF (2014) definition of self-advocacy as ‘advocating for oneself, including making one's own decisions about life, learning how to obtain information to gain an understanding about issues of personal interest or importance, developing a network of support, knowing one's rights and responsibilities, reaching out to others when in need of assistance, and learning about self-determination' (p. S45). These skills can contribute to access and full participation in society and therefore there is an ever-increasing need for therapeutic interventions in OT that address the development of these skills. However, what are the components and research evidence of interventions that address the self-advocacy skills? To answer this, a narrative review of literature on interventions targeting self-advocacy development is critical to inform and promote self-advocacy interventions within the profession.
DESIGN: A systematic review of the literature was performed to identify self-advocacy interventions within the profession. Due to the limited literature from OT, the study analyzed interventions from other allied health professions. We used PRISMA guidelines (Moher, Liberati, Tetzlaff, Altmann, The PRISMA Group, 2009) to search abstracts. Included articles were: peer-reviewed, published 2005 to present, from OT or allied health professions, and addressed self-advocacy or empowerment skills. Exclusion articles were: non-English, dissertations, and interventions related to self-determination instead of self-advocacy as defined above.
METHOD: Multiple databases were searched using key phrases and combinations. These included PubMed, Ebscohost, PsycINFO, Google Scholar, and Sagepub. Professional journals were also searched: American Journal of Occupational Therapy, the Canadian Journal of Occupational Therapy, the Scandinavian Journal of Occupational Therapy, the Australian Occupational Therapy Journal, the British Journal of Occupational Therapy, and the Japanese Association of Occupational Therapy. Search terms included: self-advocacy, self-determination, occupational therapy, advocacy, empowerment, interventions, and allied health. The search resulted in 1184 reviewed abstracts. Using the inclusion/exclusion criteria 7 articles were identified. The study utilized the Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) scale (Pearson et al., 2007) to determine study quality and assess the interventions used.
RESULTS: Of the 7 articles reviewed, 3 involved OT services, while the remaining were non-occupational therapy specific. We identified the need for increased attention to improving the rigor of studies with many of these lacking reports of attending to necessary features of high-quality research. All interventions used were: group vs individual; community-based; and, were 8-12 weeks in length. Multiple diagnostic groups were included and both qualitative and quantitative outcome measures were used with no assessment used by multiple studies.
CONCLUSION: This review provides insight into the content of effective self-advocacy interventions which can guide the development of future interventions. The OTPF acknowledges self-advocacy as being a domain under the scope of practice of occupational therapists; therefore, it is necessary to ensure occupational therapists are equipped to address self-advocacy skill development with clients. These results suggest a needed increase of well-designed intervention research studies to support the use of self-advocacy interventions by OT practitioners.
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Pearson, A., Srivastava, R., Craig, D., Tucker, D., Grinspun, D., Bajnok, I., ... & Gi, A. A. (2007). Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare. International Journal of Evidence-Based Healthcare, 5(1), 54-91. Retrieved from http://search.ebscohost.com.ezproxy.rush.edu/login.aspx?direct=true&db=psyh&AN=2007-05820-003&site=ehost-live
Test, D. W., Fowler, C. H., Brewer, D. M., & Wood, W. M. (2005). A content and methodological review of self-advocacy intervention studies. Exceptional Children, 72(1), 101-125. https://doi-org.ezproxy.rush.edu/10.1177/001440290507200106
