Exploring parental and occupational therapists' perceptions of the utilisation of the occupational therapy service at three paediatric outpatient units in the Western Cape Province, South Africa
Background: The Western Cape's Comprehensive Service Plan (CSP) is committed to "treating the right patient at the right level right, with the right skills and at the right cost" (Page 1, Tygerberg Hospital Annual Report, 2007). Occupational therapy (OT) Managers in the Metro District, Western Cape Province are in the process of aligning the OT services to the new CSP document. A major problem is the high default rate (non attendance) and irregular attendance (patient attends but skips sessions) amongst paediatric out-patients. In order to properly improve the OT paediatric services, it is vital for the OT managers to know the reasons for the poor utilisation of the OT services at the paediatric out-patient units. Purpose of study: The irregular attendance and high default rates (where patients stop attending the OT sessions completely) among children are a major problem at three OT out-patient units in Cape Town, Western Cape Province. The occupational therapists who work at these units are adamant that this impacts negatively on the child's progress. This study sought to explore the factors influencing the utilisation of the OT service in these three OT paediatric out-patient units in the hope of providing relevant information to the OT managers of these units in order to rethink the current service and make appropriate changes to improve adherence and treatment progress. Study design: This was an exploratory study using qualitative research methods. In-depth interviews were conducted with ten parents of children who have to attend the OT out-patient services. One group discussion was conducted with the occupational therapists that provide the services at the out-patient units. Sampling: Purposive sampling methods were employed to select four occupational therapists (at least one from each unit) and ten parents (at least three from each unit, with at least two who attended poorly and one that attended regularly). Analysis: Thematic analysis was used to interpret the data. The data was coded and categorised according to themes that emerged during data analysis. Results: The results of this study revealed that the factors that impact the utilisation of the OT service at the three OT units is complex. Factors that influenced the utilisation of the OT services in this study were related to the OT service such as staff attitude, relationship between the occupational therapist and the mothers as well as their child, communication between the mother and the occupational therapist, treatment progress, parent involvement in the OT programme and access to the OT service. Other factors such as the mothers' perception of the severity of the child's health condition, family support, work factors and family support were important factors related to the mother. The findings also revealed that environmental factors namely stigma, discrimination and travelling to the OT units impacted utilisation of the OT service. The participants made recommendations on how to improve the service. Conclusion: This study describes the complexity of what impacted the utilisation of the OT services and how closely interlinked these different factors are. It is evident from the findings of this study that a comprehensive, client centred approach is required to properly deal with the factors that negatively impact the utilisation of this service. Recommendations: A multi-faceted approach is required. Important issues to address are the shortage of occupational therapists across the levels of health care in the Western Cape Province; improving on the client centred approach in OT intervention programmes; advancing advocacy against stigma and discrimination against children with disabilities; and making public transport more accessible to children and their mothers.