Date of Award

2017

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Master of Public Health

School

School of Medical and Health Sciences

First Supervisor

Dr Julie Dare

Second Supervisor

Dr Celia Wilkinson

Third Supervisor

Dr Janet Richmond

Abstract

Reorientation of the Australian health care system to meet the increasing burden of disease requires health workers to develop a focus on disease prevention and health promotion. In Western Australia (WA) a priority area for the promotion of health involves increasing the physical activity levels (PAL) of children in accordance with Australia’s Physical Activity and Sedentary Behaviour Guidelines. There is substantial support in the literature for paediatric occupational therapists, who assist children to participate in a range of meaningful occupations, to incorporate the promotion of children’s PAL into their service. However, there is a dearth of research world-wide regarding occupational therapists’ capacity for and involvement in health promotion, with no studies concerning their promotion of children’s PAL.

This study aimed to develop an understanding of paediatric occupational therapists’ involvement in, and capacity for, implementing health promotion activities to increase the PAL of children in WA aged 0-18 years. The application of the Building Health Promotion Capacity theoretical framework throughout the study enabled robust analysis of participants’ capacity for health promotion. A mixed methods design was employed with qualitative data illustrating and verifying the initial quantitative findings. Self-report questionnaires were completed by 86 paediatric occupational therapists in WA, representing 28% of the total population. This elicited cross-sectional quantitative data of participants’ involvement in and capacity for promoting the PAL of children, as well as barriers to their involvement. Following these, in-depth interviews were completed with 9 paediatric occupational therapists and thematically analysed to determine barriers and enablers to promoting children’s PAL.

Quantitative data revealed the majority of participants were involved in promoting the PAL of some of the individual children with whom they worked. In addition, half of the participants who worked with all children in a community setting had incorporated community-level strategies to increase children’s PAL. Reflecting an alignment with the Ottawa Charter for Health Promotion, participants implemented a combination of strategies relating to creating supportive environments, developing personal skills, and strengthening community action. Participants rated their capacity positively in relation to having the necessary knowledge, skill and commitment to promote children’s PAL; however, having access to necessary resources rated close to neutral. Analysis of quantitative and qualitative data revealed significant enablers to paediatric occupational therapists’ promoting children’s PAL include holding a belief in its importance and having confidence in their clinical skills and knowledge. Common barriers were a lack of resources, including time due to a heavy clinical workload and inadequate funding. In addition, commitment to increasing children’s PAL was impacted by competing clinical priorities, which were influenced by the priorities of each child’s family, limited recognition of occupational therapists’ competency, and a lack of managerial and political support for primary prevention activity.

This study raises awareness of the important contribution paediatric occupational therapists in WA have made towards promoting children’s PAL. Common barriers reveal the need for ongoing efforts to increase awareness amongst occupational therapists and health services’ management of the importance of a preventative approach to delivering health services. This study provides foundation information and valuable insights regarding paediatric occupational therapists’ views and experiences implementing health promotion activities in WA, which can be used to inform paediatric occupational therapy practice and education, and inform initiatives for building the health promotion capacity of a multidisciplinary workforce.

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