The Public Health Model promotes three types of prevention: primary, secondary, and tertiary (Cole & Tufano, 2020). Primary prevention is provided to healthy individuals or those who are at risk for developing disease or dysfunction; secondary prevention is provided to individuals who demonstrate early signs of a disease; and tertiary prevention is provided when an individual is in an active state of illness or dysfunction (Cole & Tufano, 2020; AOTA, 2020c; AOTA, 2008). The American Academy of Pediatrics (AAP, 2021) recommends specific guidelines for preventive pediatric health care that includes health supervision, screenings, and anticipatory guidance. When advocating for the integration of occupational therapy into pediatric primary care, it is essential to recognize the unique lens that occupational therapy brings to primary and secondary levels of prevention. Occupational therapy is grounded in the belief that engagement in occupations are fundamental to health promotion and prevention (AOTA, 2017). In the Occupational Therapy Practice Framework, the intervention approach “create and promote” relates to the concept of primary prevention as it “does not assume a disability is present”; rather it is “designed to provide enriched contextual and activity experiences that will enhance performance for all people in their natural contexts of life” (AOTA, 2020a, p. 63). Similarly, the intervention approach “prevent (disability prevention)” relates to the public health concepts of both primary and secondary prevention as it is “designed to address the needs of clients with or without a disability who are at risk for occupational performance problems” and aims to “prevent the occurrence or evolution of barriers to performance in context” (AOTA, 2020a, p. 64). Given the call to action for increased preventative care and health promotion efforts established in Healthy People 2030 and the Affordable Care Act of 2010, there is great opportunity for OTPs to advocate for their role in primary care to help meet current goals of the U.S. healthcare system (U.S. Department of Health and Human Services, 2021; AOTA, 2011; Patient Protection and Affordable Care Act of 2010; AOTA, 2008).
The transtheoretical model (TTM) conceptualizes personal decision making and behavior change processes via transition through six defined stages of change. This model focuses on the individual’s readiness to change and provides strategies for each stage to help facilitate the change process (LaMorte, 2019; Prochaska & DiClemente, 2005; Prochaska & Velicer, 1997). The six stages of change can be applied to the context of primary care providers in relation to their receptiveness of incorporating occupational therapy on their primary care team.
The first stage, precontemplation, is described as having no intention of changing, which may be due to lack of awareness. PCPs who have a very limited understanding of OT’s scope of practice and role in primary care may be in this stage, and therefore have no intentions of incorporating OT into their practice.
The second stage, contemplation, refers to PCPs who recognize OT’s distinct value to pediatric primary care, but still may be hesitant to incorporate OTPs on their primary care team.
The third stage, preparation, refers to PCPs who are ready to take small actionable steps toward collaborating with OTPs in the primary care setting.
The fourth stage, action, refers to PCPs who have recently begun collaborating with OTPs on their interprofessional primary care team, but the change is still new so the interprofessional team dynamics still need improvement and PCPs are still learning about OT’s role in this setting.
The fifth stage, maintenance, refers to PCPs who have now been collaborating with OTPs on their interprofessional primary care team for a long time and have a strong understanding of OT’s role in primary care.
The sixth stage, termination, refers to pediatric primary care providers that have fully integrated occupational therapy into their practice and have reached the point where interprofessional collaboration and referrals are completed seamlessly.
Given that one of the main barriers to integrating OT into primary care is the limited understanding of OT’s scope of practice and role in primary care, this doctoral capstone project targeted PCPs who are in the precontemplation stage. The Transtheoretical Model suggests strategies that facilitate the transition between the stages. Consciousness raising, which increases one’s awareness, is suggested for those who are in the precontemplation stage. This doctoral capstone project applied these principles by educating PCPs about OT’s role in primary care and increasing their awareness regarding patients in their practice who would benefit from OT services.
Adult learning theory guided the development and implementation of the education provided to primary care providers. Knowles (1978) recognized that the learning process for adults differs greatly from that of children; thus coining the term andragogy which is the method and practice of teaching adult learners. The andragogical model is based on several assumptions: “the need to know, the learner’s self-concept, the role of the learners’ experiences, readiness to learn, orientation to learning, and motivation” (Knowles et al., 2005, p. 64-68).
The educator must first help the learners become aware of why they need to know the content being taught. To raise the level of awareness, the educator can use real data or experiences that are relevant to the learner in order to highlight the gaps of where they are now and where they want to be (Knowles et al., 2005, p. 65). When educating PCPs on OT’s role in primary care, it is essential to begin by raising their awareness of current healthcare trends and how the integration into primary care can help meet national objectives set by Healthy People 2030 (U.S. Department of Health and Human Services, 2021), the Triple Aim (Institute for Healthcare Improvement, 2022), and recommended preventative health care for children set by the American Academy of Pediatrics (AAP, 2021).
Adult learners use their own experiences throughout the learning process; thus incorporating real-world examples will engage the adult learner (Knowles et al., 2005, p. 66). In order to integrate PCPs’ interests and ensure that the education had relevance to PCP’s professional and personal life experiences, data and real case scenarios were incorporated when educating them on OT’s role in primary care and specific ways that an OTP can contribute to their practice.