Client Understanding, Expectations, and Intern Performance in Occupational Therapy

Investigating Clients' Understanding and Expectation Reasonableness in Occupational Therapy and Interns' Performance in Health Education and Chief Complaint/Expectation Interviews.

This study aims to investigate psychiatric clients' understanding of occupational therapy (OT), the reasonableness of their expectations regarding OT services, and OT interns' performance in Occupational Therapy Knowledge (OTK) health education and chief complaint/expectation interviews. The project includes developing assessment instruments for client OT knowledge, expectation reasonableness, and intern communication/education performance, followed by data collection in real clinical settings. Clients, clinical supervisors, and external experts will contribute ratings to evaluate instrument validity and reliability. The study will provide foundational evidence for improving OT health education, communication training, and clinical teaching practices.

This study examines (1) psychiatric clients' understanding of occupational therapy (OT), (2) the reasonableness of their expectations toward OT, and (3) OT interns' performance in OTK health education and chief complaint/expectation interviews. The project includes instrument development and clinical data collection in the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital.

Substudy 1: Client OT Knowledge and Expectation Reasonableness

Substudy 1 consists of two phases. Phase 1 focuses on developing two tools-the OT Knowledge Assessment and the OT Expectation Reasonableness Scale. A team of clinical OT experts and a psychometrics specialist will identify key domains, generate items, and establish scoring guidelines. Content and face validity will be evaluated by external experts and psychiatric clients.

The OT Knowledge Assessment will measure clients' understanding of OT concepts and service scope. The OT Expectation Reasonableness Scale will assess whether clients' expectations for OT processes and outcomes are clinically appropriate.

Phase 2 collects data from psychiatric clients. OT interns will conduct initial interviews exploring clients' chief complaints and expectations. Clients will complete the OT Knowledge Assessment, and both clinical supervisors and external experts will independently evaluate expectation reasonableness using standardized scoring guidelines. Descriptive statistics will summarize clients' knowledge levels and expectation patterns.

Substudy 2: Intern OTK Health Education and Interview Performance

Substudy 2 includes three phases. Phase 1 develops two performance measures: the OTK Health Education Performance Scale and the Chief Complaint/Expectation Interview Performance Scale. Preliminary domains include communication clarity, individualized education, understanding-checking, information-gathering, clarification, and empathy. Expert review will ensure content and face validity.

Phase 2 evaluates 30 OT interns who will conduct initial interviews with psychiatric clients after receiving standardized training. Clinical supervisors will provide real-time ratings, and external experts will score audio recordings and transcripts. Combined evaluations will provide a more comprehensive assessment of intern performance.

Phase 3 examines reliability of the new scales. Inter-rater reliability (supervisors vs. experts) and intra-rater reliability (experts' repeated scoring) will be assessed using weighted Kappa and intraclass correlation coefficients (ICC).

Inclusion Criteria:

1. Occupational Therapy Students: Currently completing a clinical internship in psychiatric occupational therapy.
2. Clinical Supervisors: Willing to participate in the study.
3. Psychiatric Clients:

(1) Age 20 years or older. (2) Diagnosed with a psychiatric disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

(3) Able to understand simple questions and follow three-step commands.

Exclusion Criteria:

1. Occupational Therapy Students: Unwilling to be audio-recorded.
2. Clinical Supervisors: No exclusion criteria.
3. Psychiatric Clients: Unwilling to be audio-recorded.