A multifaceted practice? An investigation of methods used by occupational therapists in municipal services when assessing persons with cognitive impairments

Norway is facing demographic changes which affect municipal health services. Under the Coordination Reform Act, the municipalities have received new responsibilities, such as early assessment of needs for health services and follow up services closer to people’s homes. It is estimated that the number of occupational therapists (OTs) in municipal services should triple in order to meet the health service challenges of the future. Despite its prevalence and significance, the practice of Norwegian OTs working in the context of municipal care is a little explored area. The overall aim of this thesis was to investigate use of methods among Norwegian municipal OTs when assessing persons with cognitive impairments. The thesis includes three studies and the participants were OTs working in Norwegian municipalities. Study I used a quantitative approach, with an online survey investigating what methods and standardised assessment tools 497 OTs used, as well as the rationale for their choices. Study II explored experiences through individual interviews of 14 OTs and study III explored experiences through focus group interviews of 19 OTs. The results indicate that when doing assessments, the participants prefer to use unstructured observations and informal interviews, in addition to standardised assessments. Doing assessments in the context of municipal service was described as multifaceted. Being OTs and belonging in municipal services, they meet many expectations towards OT service, which did not always match their own perspective of what are OT’s responsibilities. Due to future challenges for municipal services, the participants expressed a need and a wish to become more competent when doing assessments. The results indicate that the participants are working under several conflicts on a daily basis. They have to make choices that are influenced by not only what they view as beneficial for people but also what is feasible in their practices. The findings of invites OTs to reflect upon and create awareness of their choices when doing assessments, in addition to which values and attitudes are influencing their practices. This thesis suggests that more use of occupation based standardised assessment tools are needed in order for OTs in municipal practice to work in line with evidence based practice