Improving Adherence to Occupational Therapy Home Modifications: Key Insights for Better Outcomes

July 15th 2024

Occupational therapy home modifications play a crucial role in enhancing safety, independence, and quality of life for many individuals, particularly older adults. However, the effectiveness of these interventions heavily depends on patient adherence. Recent research has shed light on the factors influencing implementation rates and strategies to improve them, highlighting the importance of client-centered approaches and co-design methodologies.

A systematic review by Harper et al. found that adherence to occupational therapy home assessment recommendations ranged from 55% to 90%. This wide range underscores the complexity of factors affecting implementation.

The review identified several key barriers and facilitators using the Capability, Opportunity, Motivation – Behaviour (COM-B) model:

Barriers to Adherence:

• Capability: Patients’ cognitive and physical abilities may limit understanding or implementation of recommendations.
• Motivation: Perceived lack of need, stigma associated with modifications, and feeling uninvolved in the decision-making process.
• Opportunity: Limited family or caregiver involvement, environmental restrictions, and inadequate service provision.

Facilitators of Adherence:

• Patient-centered care
• Family and caregiver involvement
• Clear communication
• Individualized approach

A critical review by Lo Bianco et al. titled “‘I think I could have designed it better, but I didn’t think that it was my place’: a critical review of home modification practices from the perspectives of health and of design” provides valuable insights into the disconnect between health practitioners and end users in the home modification process. The study highlights a contrast between purported patient-centered care models and human-centered design approaches, leading to inadequate representation of older adults’ goals in typical home modification design processes.

Key findings from Lo Bianco et al.’s study include:

1. A disconnect between health practitioners and end users due to contrasting cultures in patient-centered care and human-centered design.
2. Lack of clarity about the end user’s intended engagement in modifying their environment.
3. Inadequate representation of older adults’ goals in typical home modification design processes.
4. Restriction of client engagement and control due to failure in supporting the reflection of goals in practice.

The study emphasizes that compliance with recommendations is deeply connected to a person’s intrinsic sense of control within the clinical decision-making process. This aligns with the findings of Harper et al., which highlighted the importance of patient involvement in decision-making as a key facilitator of adherence.

To address these issues and improve adherence to home modifications, occupational therapists can implement several strategies:

1. Adopt co-design methodologies: Involve clients in the design process to reinforce engagement and provide better pathways for older adults to maintain control. It is important that the clients view their voice is heard and valued.
2. Utilize human-centered design approaches: Apply these methodologies to gain a holistic understanding of clients’ goals and motivations, rather than focusing solely on physical impairments.
3. Enhance communication: Provide clear, written instructions and visual aids to support understanding and recall of recommendations.
4. Involve family members or caregivers: Create a support network for implementation.
5. Address potential barriers proactively: Consider financial concerns, stigma, and physical limitations.
6. Develop action plans: Break down implementation into manageable steps.
7. Schedule follow-up appointments: Provide ongoing support, troubleshoot issues, and reinforce the importance of maintaining modifications.
8. Consider technology use: Implement reminder apps or virtual follow-ups to support long-term adherence.

By implementing these strategies, occupational therapists can work more effectively with patients to improve adherence to home modifications. The integration of co-design methodologies and human-centered design approaches can lead to better-informed decision-making processes, increased client engagement, and ultimately, improved outcomes and enhanced quality of life for those they serve.

REFERENCES:

Harper, K. J., McAuliffe, K., & Parsons, D. N. (2022). Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review. Australian occupational therapy journal, 69(5), 599–624. https://doi.org/10.1111/1440-1630.12823 

Lo Bianco, M., Layton, N., Renda, G., & McDonald, R. (2020). “I think I could have designed it better, but I didn’t think that it was my place”: a critical review of home modification practices from the perspectives of health and of design. Disability and rehabilitation. Assistive technology, 15(7), 781–788. https://doi.org/10.1080/17483107.2020.1749896

What strategies are you using in your practice to enhance adherence? Is adherence even the right word?

Here are some questions to help you reflect on your practice in this area:

1. How do you currently involve your clients in the decision-making process for home modifications? Are there areas where you could increase client participation?
2. In what ways do you address potential barriers to adherence (such as motivation, capability, or opportunity) before recommending home modifications?
3. How often do you follow up with clients after recommending home modifications? What strategies do you use to support long-term adherence?
4. Have you considered incorporating co-design methodologies in your practice? What challenges might you face in implementing this approach?
5. How do you ensure that your recommendations align with your clients’ personal goals and values, rather than just addressing physical limitations?
6. In what ways do you involve family members or caregivers in the home modification process? How might you enhance their engagement?
7. How do you currently communicate your recommendations to clients? Are there ways you could make your instructions clearer or more accessible?
8. Have you explored using technology to support adherence to home modifications? What opportunities or challenges do you see in this area?
9. How do you address potential stigma or reluctance associated with home modifications? What strategies have you found effective?
10. Reflecting on your recent cases, can you identify instances where a more human-centered design approach might have led to better outcomes?
11. How do you assess and incorporate your clients’ health literacy levels when discussing and planning home modifications?
12. In what ways do you currently measure the success of home modifications? Are there additional metrics you could consider to evaluate both adherence and impact on quality of life?

These questions aim to encourage occupational therapists to critically examine their current practices and consider ways to enhance client engagement, improve communication, and ultimately increase adherence to home modifications. Let me know your thoughts.