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Introduction: Occupational therapists recommending home modifications in Australia are often required by funding bodies to consider 'value' and 'value for money' (VFM); however, clear guidance on how to define and apply these concepts is not always provided. This paper reports on a qualitative study examining how the concepts of value and VFM are currently understood and operationalised by occupational therapists in Australian home modification practice, with the aim of positively contributing to both policy and practice in this area. Methods: The study utilised constructivist grounded theory to collect and analyse qualitative data from 20 occupational therapists who were currently working across Australia and had professional experience in home modifications. Findings: The grounded theory that was derived from the analysis highlights the unique position that occupational therapists occupy in home modification work as they strive to align the values of different stakeholders to create solutions that all consider to be valuable. In the absence of consistent frameworks or methods for determining value and VFM, evidence also emerged of occupational therapists using a range of individual approaches such as using formal and informal care as metrics, cheapest option approaches, and comparative costing. Conclusion: In addition to a clear need for consistent and transparent approaches to understanding and operationalising VFM in home modifications, there is also a need for further investigation into the value systems that underpin this work. A conceptualisation of occupational therapists as street‐level policy agents has proven useful here as it highlights the position occupational therapists occupy, enacting, making, and, at times, challenging policy in day‐to‐day practice as they work to align the values of the various stakeholders. [ABSTRACT FROM AUTHOR]

Introduction: Comprehensive evaluation and intervention provided by occupational therapists is effective in reducing the presence of fall hazards in the homes of older adults. The purpose of this study was to document known environmental hazards and to update a previous content analysis. A secondary goal reviewed a framework for evaluation and practice. Methods: A comprehensive scoping review of published academic articles was performed from 1996 to 2019 to answer: What environmental hazards have been associated with falls in the homes of community‐dwelling older adults? Data was extracted in a standardised critical appraisal worksheet and content analysis was conducted. A review of a conceptual framework for assessment and intervention was conducted by international experts (n = 6) in face‐to‐face interviews. Results: Fourteen studies met the inclusion criteria for the scoping study. The studies reported 17 in‐home environmental hazards: throw rugs/carpets, clutter, cords/wires, poorly placed light switches, items placed too low, items placed too high, no grab bars, toilet seats too low, uneven floor surfaces, slippery/wet surfaces, snowy/icy surfaces, backless/unsupportive shoes, unsteady stairs, inadequate lighting, inadequate heating/cooling, step stools without railings, and pets. Conclusion: A comprehensive list of specific fall hazards in and around the homes of older adults and a guiding framework offers occupational therapists an evidence‐based foundation for fall prevention efforts. [ABSTRACT FROM AUTHOR]

Introduction: Environmental assessment and modification is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. Environmental assessment and modification has been incorporated into many national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. The aim of this study is to identify factors that support the local adoption of best practice environmental assessment for falls prevention within a rural health service. Methods: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services framework was employed. The setting was a health service in Queensland, encompassing rural and regional populations. An audit, based on best practice, was conducted on eligible medical charts. An online survey of occupational therapists' knowledge, attitudes, confidence and experience of environmental assessment and modification was completed. Focus group discussions were also carried out. Quantitative data were presented using descriptive statistics and discussions were thematically analysed. Results: Twenty‐four occupational therapists were identified as meeting the inclusion criteria. Fourteen participated in the survey and 12 of those surveyed also participated in the focus groups. Fifty‐eight patients' medical charts were audited, which included entries from occupational therapists who completed the survey and focus groups and some who did not. Survey results identified that most occupational therapists were aware of, confident, and experienced in environmental assessment and modification for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of environmental assessment and modification: confidence in, and awareness of evidence; key stakeholders' support and knowledge of occupational therapy; and, perceived impact of time and resources required for implementation. Results also suggested that several contextual issues unique to rural and regional service delivery influenced uptake, including: geographical and sociocultural diversities of communities being served; differing organisational structures which result in occupational therapists being line managed by other professions; and, limited access to professional development. Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change. Conclusion: Occupational therapists reported that they carried out best practice environmental assessment and modification for falls prevention but the medical chart audit provided no evidence of this happening in practice. This discrepancy requires further investigation. This study provided an understanding of factors that influence whether occupational therapists implement best practice environmental assessment and modification in a rural health service. Findings could be used to guide the translation of evidence into practice across similar settings. [ABSTRACT FROM AUTHOR]

Background/aim Increasingly, health-care systems should promote seniors' health and prevent disability. As they enable engagement in meaningful activities within the individuals' living environment, community occupational therapists have great potential to contribute to health promotion and prevention. Despite this potential, little is known about current health promotion and prevention activities in occupational therapy community practice. This study thus aimed to: (1) identify health promotion and prevention interventions used with seniors having disabilities, and (2) explore barriers to integrating such interventions into practice. Methods Secondary data analysis of a qualitative study was carried out using thematic saliency analysis. Eleven community occupational therapists working with seniors having disabilities were recruited in six community health settings in Québec, Canada. Observations of 12 home visits, followed by 12 semi-structured interviews, were conducted with occupational therapists. Results Most interventions involved optimising independence in personal care and mobility. Explicit health promotion interventions were limited and included enabling healthy lifestyles by increasing health literacy and empowerment. Meaningful activities (leisure, community participation) were not targeted. Barriers to integrating health promotion into practice were clients' complex health conditions and limited openness to change combined with organisational and professional obstacles, such as a misunderstanding of occupational therapists' role in health promotion. Conclusions Health promotion and prevention interventions are not intentionally integrated into community occupational therapy practice with seniors having disabilities. As a result, seniors' needs to engage in meaningful activities might remain unmet. Overcoming barriers to integrating health promotion and prevention in practice could help improve population health and wellbeing. [ABSTRACT FROM AUTHOR]