Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
We examined similarities and differences in cultural values, beliefs, and experiences between OTs in Taiwan and the United States with respect to the delivery of a strategy-training intervention approach to stroke survivors. Findings of this study increase understanding of the distinctions between strategy training and traditional rehabilitation practice and highlight the potential factors that may affect the delivery of strategy training to stroke survivors in different cultural contexts.
Primary Author and Speaker: Feng-Hang Chang
Contributing Authors: Jessica Kersey, Chao-Yi Wu, Minmei Shih, Beth Fields, and Elizabeth Skidmore
PURPOSE: Strategy training is an evidence-based intervention approach designed to reduce disability among people with cognitive impairments (Skidmore et al., 2014). However, the adoption of strategy training in various culture has not been studied systematically. Before translating strategy training to practice, the influence of cultural contexts should be explored to understand the potential opportunities and challenges that the therapists may experience when implementing the approach. The purpose of this study was to examine similarities and differences in cultural values, beliefs, and experiences between rehabilitation therapists in Taiwan and the United States with respect to the delivery of strategy training to stroke survivors.
DESIGN: A rapid ethnographic study (Millen, 2000) was conducted in Taipei (Taiwan) and Pittsburgh, Pennsylvania (USA). Data collection occurred with occupational therapists from two clinical trials focused on strategy training. The recruitment criteria included that the therapists were trained to deliver strategy training to stroke survivors and were currently practicing it for the clinical trials in Taiwan and USA.
METHOD: Semi-structured individual interviews were conducted with the therapists (n = 7) in Taiwan and (n = 7) in the USA. These 45 to 90 minute interviews provided in-depth perspectives on cultural values, beliefs, and experiences related to rehabilitation and strategy training. All interviews were audio-recorded, transcribed verbatim, and uploaded to NVivo 12 Pro for thematic analysis. To increase credibility of the findings, 1) two Chinese-English bilingual licensed occupational therapists and two English-speaking licensed occupational therapists served as independent data analysts, 2) multiple data sources (filed notes, memos and therapy documentation) were included, and 3) the research team together reviewed their analyses in each language and synthesized the results.
RESULTS: Three themes emerged from the multiple data sources: (1) common features of current rehabilitation practice in both countries; (2) differences between strategy training and traditional rehabilitation; and (3) challenges of adopting strategy training in current rehabilitation practice. Traditional rehabilitation in the two countries shared similarities, including therapist-directed intervention and a focus on basic functional training. Therapists in both countries reported that strategy training differed from traditional rehabilitation in its client-driven approach and its ability to empower clients, promote client engagement in the rehabilitation process, and improve generalization of skills to important daily activities. Distinct challenges in implementing strategy training were reported, and there were differences based on cultural context. Illustrative quotes from data sources were expounded to further develop the understanding of these themes.
CONCLUSION: Similarities and differences were found in the values, beliefs, and experiences of delivering strategy training between therapists in Taiwan and USA. Information gleaned from this study may help researchers think about ways in which to adapt strategy training for particular cultural contexts. Findings help occupational therapy practitioners understand the distinctions between strategy training and traditional rehabilitation practice. These implications for research and practice will help increase the translation of this evidence-based approach designed to improve independence and community participation for stroke survivors.
References
Millen, D. R. (2000). Rapid ethnography: time deepening strategies for HCI field research. Paper presented at the Proceedings of the 3rd conference on Designing interactive systems: processes, practices, methods, and techniques, New York City, New York, USA. https://doi.org/10.1145/347642.347763
Skidmore, E. R., Dawson, D. R., Whyte, E. M., Butters, M. A., Dew, M. A., Grattan, E. S., . . . Holm, M. B. (2014). Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation. Clinical Rehabilitation, 28(4), 378-387. https://doi.org/10.1177/0269215513502799
