Date Presented 04/12/21
Poverty attributions of health professionals affect how care is provided to this population. Literature indicates a gap in OT student learning to effectively work with individuals living with low income. This study found that a community action poverty simulation was an effective educational tool to address the initial first step of increasing OT students' awareness of their attitudes and their implicit bias of the challenges faced by this population.
Primary Author and Speaker: Priya Bakshi
Contributing Authors: Abigail Herman, Mairead Gormley, Erica Di Meo, Jessica Leonard
PURPOSE: Poverty attributions of health care professionals impact treatment considerations when providing care to this population. College students attributing poverty to individual causes were more likely to hold negative views of and believe stereotypes about people in poverty (Cozzarelli, Wilkinson, & Tagler, 2001). Literature indicates a gap in occupational therapy student learning and preparedness to advocate for individuals living with low income, though, this topic has been explored with other health professional students (Drake & Derrick, 2020; Meaux, Ashcraft, & Gillis, 2019). The purpose of this study was to use a Community Action Poverty Simulation (CAPS) to increase occupational therapy students' awareness of their attitudes and beliefs of the challenges faced by this population.
DESIGN: A mixed methods research design was utilized with a single group pretest-posttest quantitative assessment followed by thematic analysis of students' written critical reflections of the experience. A purposive sample of first year students in the occupational therapy and social work programs was recruited to participate in the Missouri Community Action Network Poverty Simulation facilitated by certified instructors.
METHOD: Participants completed two outcome measures, Poverty Attribution Survey (PAS) to assess poverty attributions (Bennett, Raiz, & Davis, 2016) and Attitude Toward Poverty-Short Form (Yun & Weaver, 2010) pre and post simulation. Inferential statistics were used to analyze the quantitative data. Participants also completed a written critical reflection following the DEAL model (Describe, Examine and Articulate learning). Thematic analysis was used to generate common themes from the reflection. Data triangulation from the two different methodology captured change in student beliefs in all dimensions.
RESULTS: 31 graduate students were recruited; three were excluded due to illegible handwriting on the consent form. The analytical sample of 28 graduate occupational therapy students was predominately young, female, and Caucasian. Five participants reported experiencing at least one year living in poverty. A paired sample t-test was used for statistical analysis of this data. The average score for the individual poverty attribution was statistically significantly lower after participation in CAPS. Average scores for the structural poverty attribution were statistically significantly higher at posttest. There was no difference on the cultural poverty attribution. There was no difference in personal deficit attitudes. Four themes, emerged from the critical reflection - emotional exhaustion, physical exhaustion, structural barriers and personal barriers. The following are quotes representative of these themes: ‘I noticed that in poverty I was working much harder than I am right now in my actual life'; ‘There was not any spare time to do anything but stress about what needed to be done to keep the family safe and fed.' ‘Health was not a priority'; ‘Lack of regular transportation made it difficult to access resources'; ‘Before going into this simulation, I had a view of people in poverty that was not necessarily correct. I viewed them as somewhat lazy and unresourceful, but after this simulation I know that was totally wrong.'
CONCLUSIONS: The CAPS provided an effective initial step in addressing implicit biases occupational therapy students revealed about the attributes of poverty. Participation in the simulation helped them relate and not judge the individual, an emergent step in developing cultural competency and empathy. Lastly, faculty are charged with the responsibility to continue critical conversations and further promote equity, inclusion, and diversity as embraced by AOTA, 2025.
References
Bennett, R., Raiz, L., & Davis, T. (2016). Development and validation of the Poverty Attribution Survey. Journal of Social Work Education, 52(3), 347-359. https://doi.org/10.1080/10437797.2016.1174631
Cozzarelli, C., Wilkinson, A., & Tagler, M. (2001). Attitudes toward the poor and attributions for poverty. Journal of Social Issues, 57(2), 207-227. https://doi.org/10.1111/0022-4537.00209
Meaux, J., Ashcraft, P., & Gillis, L. (2019). The effect of the poverty simulation on BSN student attitudes toward poverty and poor people. Nurse Education Today, 83:104192. https://doi.org/10.1016/j.nedt.2019.08.010 Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0260691719306318?via%3Dihub
Drake, D. & Derrick, S., (2020) Evaluation of an interprofessional poverty simulation experience. Semantic Scholar. Retrieved from https://pdfs.semanticscholar.org/6225/4dcec65f4c889782bf9513ba85d500523187.pdf
