Occupational Therapy Perspective Research Articles

The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis.

Background Healthy lifestyle is important to decrease health risks in individuals living with chronic pain. From an occupational therapy perspective, human health and lifestyle are linked to occupational engagement in meaningful everyday activities. This study is aimed at investigating the effect of including occupational engagement in chronic pain interventions on lifestyle. Methods In this systematic review (PROSPERO reg. CRD42020159279), we included randomized controlled trials (RCTs) on interventions involving occupational engagement (i.e., occupational performance based on involvement, choice, positive meaning, and commitment) and assessing modifiable lifestyle factors: physical activity, body anthropometrics, alcohol consumption, smoking, stress, and sleep. We sought the databases Ovid MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Scopus, Web of Science, OTseeker, ClinicalTrials.gov, OpenGrey, and the web engine Google Scholar and citations and references of relevant publications. We evaluated methodological quality with the Cochrane risk-of-bias tool 2.0, determined the overall evidence certainty using the GRADE methodology, and performed meta-analysis when two or more trials reported on the outcomes. Results Of the 9526 items identified, 286 were full text screened. We included twelve articles with eleven RCTs comprising 995 adults and assessing physical activity, sleep quality, stress, and Body Mass Index. Sufficient data for meta-analysis was only available for physical activity and sleep quality. The meta-analysis suggested a moderate increase in physical activity after behavioral interventions for fibromyalgia and musculoskeletal pain (SMD = 0.69 (0.29; 1.09)) and a small increase in sleep quality up to 6 months after multidisciplinary self-management of fibromyalgia (SMD = 0.35 (95% CI 0.08; 0.61)). The overall certainty of the evidence was deemed low. Conclusion Including occupational engagement in chronic pain interventions may increase short-term physical activity and long-term sleep quality. Due to the few available RCTs including occupational engagement in chronic pain treatment for adults living with chronic pain, further high-quality RCTs are needed and will likely change the conclusion.

What are the common areas of risk and their characteristics found in intermediate care from an occupational therapy perspective? A scoping review

Introduction Engaging with risk is a certain and unavoidable part of occupational therapy. Intermediate care services are mostly accessed by older people with complex needs, yet little is known in the literature about the extent, type and nature of risk involved in these services. Method A scoping review was systematically conducted to map the common areas of risk (risk domains) from an occupational therapy perspective. Thematic analysis was conducted in order to identify the risk characteristics related to the literature reviewed. Results 25 journal articles were identified and arranged into 10 risk domains: Falls, discharge, practice errors, activities of daily living, pressure care, frailty management, patient handling, loneliness, nutritional care and language barriers. Three risk characteristics were identified: (1) Risk awareness and identifying risk, (2) decision-making under risk and (3) improving safety. Conclusion Occupational therapists play a diverse role in migrating risk for older people which is not fully explored beyond addressing deficits in functional ability and hazardous environments. The process of how risk is controlled and reconciled with occupation and how positive risk-taking is facilitated are implicit and not directly addressed within the literature reviewed. The findings reveal gaps in knowledge and provide a foundation for further research.

P175 Work Ready Champions for Young People: the role of occupational therapy in addressing the pre-vocational and early-employment needs of young people with long term health conditions

Abstract Background/Aims Developing a vocational identity is an important part of adolescent development and vocational morbidities have been recognized in young people with long term health conditions including rheumatic disease. Challenges in educational settings and/or workplaces have been reported by young people. Young people have also identified this area to be a research priority. Occupational Therapy (OT) is well placed to assume a lead role in this area, as it is the only health profession that has occupation at the core of its philosophy and practice. The aim of this study was to explore the pre-vocational and early-employment needs of adolescents and young adults with long-term health conditions from the perspectives of OTs and to examine their current and potential role in addressing these needs. Methods A questionnaire was developed using Qualtrics software and piloted with two OTs and amended accordingly. A snowballing recruitment method via email and Twitter was employed. Initial contact was made via colleagues of the project team and cascaded to OT networks. Data included demographic, involvement in health care planning with education, perceived importance of addressing pre-vocational issues for young people, respondents’ knowledge and confidence, and the role of OT. Results The survey received 130 responses of which, 76 responses had complete data available (59%). A complete case analysis approach was taken. The majority of respondents were in clinical roles, primarily working in hospital or community settings and duration in practice ranged from 10 months to 40+ years. The perceived importance of addressing a wide range of vocational issues was consistently greater than the perceived knowledge and confidence of the professionals to address these. The majority of respondents (75%) perceived a need to address vocational issues for young people in their setting although only 22% reported that there was a designated member of their multidisciplinary team who would address these. The majority of such personnel identified by respondents were OTs but also included youth workers, education officers in the youth justice service and social workers. 63% routinely assessed productive/vocational occupations such as employment/education. Half of respondents (51%) did not know where to signpost/refer young people for vocational/employment advice. The majority (92%) reported not having any training in addressing vocational/employment issues specifically for young people aged 10-24 years and only 20% reported training in this area with adults. The majority (70%) however did perceive a difference in providing such advice to young people compared to adults. The main perceived barrier to addressing this area in practice was limited clinical time. Conclusion This study echoes previous calls for vocational issues to be addressed with young people with long-term health conditions and highlights the need for this to be addressed in both training and service provision. Disclosure J. Hackett: None. L. Lunt: None. C. Pidgeon: None. A. Farre: None. J. McDonagh: Consultancies; Pfizer, CSL-Behring.

Functional independence in left dorsolumbar congenital kyphoscoliosis – An occupational therapy perspective : A case report

Congenital scoliosis is caused by early embryologic errors in formation of vertebral column. The goal of treatment is to improve the children's quality of life and to give them the best chance to develop as an independent adult. The objectives were to assess the effects of occupational therapy (OT) intervention on balance, gait, and activities of daily living (ADL) in a case of congenital scoliosis. A 14-year-old young female studying in 10th standard diagnosed as left-sided dorsolumbar congenital kyphoscoliosis with apex of scoliosis at 11th dorsal segment level was assessed. She presented with lower extremity spasticity, imbalance, and scissoring gait. Assessment was done using the Berg Balance Scale (BBS) and Modified Barthel Index (MBI). Immediate postoperative OT intervention was started inclusive of balance and gait training. Significant improvement was observed on BBS score preoperatively before therapy from score 11 to post therapy score 50 after therapy was initiated and MBI score preoperatively 11 to post therapy 20 after ADL training at 8 months of therapy.

Occupational Therapy Services in School-Based Practice: A Pediatric Occupational Therapy Perspective from Ireland.

Purpose School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development. Methods This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics. Results The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice.

Contemporary Perspectives of Occupational Therapy in Latin America: Contributions to the Glocal Dialogue

ABSTRACT BACKGROUND: The contemporary perspectives of occupational therapy in Latin America focus on an epistemic, political, and plural field under construction and in dispute. It is about the notions of knowing and doing designed to appoint the theoretical and methodological aspects that support the reading and intervention of the complex realities PURPOSE: This paper explores a glocal dialogue about the production and dissemination of knowledge in occupational therapy in Latin America KEY ISSUES: The dialogue includes issues and trends in the global scientific and social scenario, without neglecting aspects of different local realities around the world. By focusing on the profession in Latin America, using different perspectives, such as Critical Occupational Therapy; Occupational Therapy and Social Issues; Occupational Therapy and Culture; Territory and Community Occupational Therapy; Southern Occupational Therapies; and Occupational Science in Latin America. It further discusses the relationship between the theoretical perspectives and the coloniality of knowledge in occupational therapy and the contradictions based on neoliberal models in the production and dissemination of knowledge CONCLUSION: The hegemonic neoliberal model and the glocalisation theoretical framework appeared to support and circumvent the production of scientific knowledge in occupational therapy, and placed Latin America on the periphery of the global debate Keywords: professional practice of occupational therapy; theoretical framework, theoretical perspective, coloniality of knowledge, critical occupational therapy, occupational science.

Participatory capacity development: Report of a community-based training needs assessment in Vietnam

ABSTRACT Training needs assessments can lead to participatory capacity development. However, few reports exist on this from an occupational therapy perspective. The purpose of this paper is to recount the experience and process of a training needs assessment in a mountain area of Vietnam. We visited 10 families and their children with disabilities and interviewed three local project partners to gain insight into their needs for supporting the participation of children with disabilities in daily activities. Four themes were identified through the needs assessment: ‘Getting to know the context’, ‘The life and biggest worries of families with children with disabilities’, ‘Support of children with disabilities and their families’, ‘Wishes and needs for future training’. The outcomes revealed specific needs for improving participation and functioning in activities of daily life from different perspectives. It showed how the needs fit the concepts of occupational therapy as a client-centred profession focusing on participation in daily life.

Estimating domestic assistance requirements in medico-legal practice: Australian occupational therapy perspective

Aim Occupational therapists are experts in determining domestic assistance levels. It is a complex multi-dimensional process resulting in different opinion regarding care hours. Method Therapists providing medicolegal reports on domestic care for the courts within Australia were surveyed. Results 58 occupational therapists responded with most aged between 41 to 50 years of age. There was a strong correlation between years of clinical and medicolegal experience (r = 0.730, n = 58, p = 0.000) as well as between years and numbers of medicolegal assessments conducted in 2017 (r = 0.264, n = 58, p = 0.420). Assessment based on occupational analysis interview combined observation of the claimant performing tasks in their home, medical information, and contextual factors such as family expectations. Translation of data to hours of care was based on therapist’s clinical experience of medical diagnosis (x2 6.89, p = 0.009) and claimant’s statements of performance combined with therapist’s clinical experience (x2 = 5.58, p = 0.18). Therapists providing defendant only reports often use their own time to perform housework as a guide. Triangulation data combined confirmation of the person’s statements through observation of performance, the environment in which they lived, and the occupational therapists own clinical reasoning skill. Conclusion Documenting all the factors influencing the occupational therapist’s decision is the key to understanding clinical reasoning. Implication for rehabilitation When estimating domestic care occupational therapists should: •Provide written documentation that clearly explains the assessment methods used, the results and conclusion made regarding domestic care. •Triangulate data including claimant’s statements of performance, confirmation by observation on tasks, medical report information in the context of the claimant’s environmental and contextual factors. •Be aware their own years of experience do not equate to level of expertise.

"The connection just happens": Therapists' perspectives of canine-assisted occupational therapy for children on the autism spectrum.

The inclusion of a therapy dog has been suggested as a means of facilitating therapy engagement for children on the autism spectrum within occupational therapy sessions. The aim of this study was to seek an understanding of possible benefits and challenges of this practice from the perspectives of occupational therapists, trained in canine-assisted therapy. This study adopted an interpretive descriptive design. Six therapists participated in a semi-structured, telephone interview to describe their experience of working as canine-assisted occupational therapists with children on the autism spectrum. An inductive thematic analysis was used to analyse the data. Two overarching themes emerged. The first captured how therapists incorporated their therapy dog into sessions to accelerate children's initial motivation to engage within the therapy process. Specifically, therapists discussed how involving their therapy dog facilitated the development of a secure relationship, supported autonomous task involvement and increased children's sense of confidence. Second, they identified challenges inherent in their practice, such as the therapist's ability to maintain a goal-directed focus when including a therapy dog. Beyond the challenges within their own practice sessions, therapists reflected on issues thought to impact the occupational therapy profession since starting practice as a canine-assisted occupational therapist. Findings from this study contribute to the current understanding of how occupational therapists incorporate therapy dogs into their practice with children on the autism spectrum. The specific challenges noted by the therapists highlighted the importance of canine-assisted occupational therapy being viewed as an advanced scope of practice within Australia and, therefore, the need for training and practice guidelines to be established.

Perceptions, Competencies and Motivation for Study Choice: Occupational Therapy and Social Work Student Perspectives

Caring for others is one of the most important attributes for individuals who want to be occupational therapists or social workers. Students are not necessarily aware of the challenges and responsibilities of the helping relationship. Deeper insights are needed into these aspects in order to train and prepare students to become competent, work-ready professionals. This study therefore aimed to describe student beliefs about their chosen profession, the competencies they perceived were most important to develop, and their motivators for their choice of profession. In this explorative study, 51 first-year students from occupational therapy (22 students) and social work (29 students) participated in individual semi-structured interviews. The interviews were transcribed and analysed thematically. Although participants had difficulty defining their future profession, they agreed it was all about helping people. A range of competencies was identified, such as establishing interpersonal relationships, sensitivity to difference, communication, flexibility, and teamwork. Differences emerged according to the chosen profession, such as creativity and imagination for occupational therapy students, and administrative skills and the desire to effect change for social work students. Concerning the choice of profession, most participants wanted to help others and engage in human relationships. Diversity and variety of tasks were also attractive elements of both professions. From the beginning of the program, educational institutions should describe more clearly occupational therapy and social work, so that students can develop a realistic vision of their future profession.

Parental Perspectives of Occupational Therapy in an Equine Environment for Children with Autism Spectrum Disorder

This paper reports on the qualitative phase of a mixed methods study of occupational therapy in an equine environment for children with autism spectrum disorder (ASD). The study’s quantitative phase found that this intervention improved the occupational performance, social motivation, social communication, and self-regulation of some children with ASD. The study’s qualitative phase, reported herein, subsequently aimed to describe parental perspectives on children’s experiences of the intervention and its influences on everyday life. Using a qualitative descriptive research approach, five parents participated in two rounds of semi-structured interviews. Interview data were analyzed using theoretical thematic analysis. Although parents expressed some concerns about the intervention, overall they found the intervention to be appropriate and acceptable. Next research steps include creation of a manual for the intervention and assessment of feasibility across a broader range of practice sites, occupational therapists, children with ASD, and their parents.

The impact of person–environment–occupation transactions on joint attention in children with autism spectrum disorder: A scoping review

Introduction Individuals with autism spectrum disorder demonstrate difficulty with joint attention, affecting social and occupational performance. Studies of joint attention in children with autism spectrum disorder employ a variety of instrumentation, environments and occupations. From the occupational therapy perspective, current literature lacks a rigorous analysis of the transactions of person, environment and occupation embedded within the procedures of these studies. The goal of this scoping review was to investigate how these components transact to affect occupational performance. Method Using the Person–Environment–Occupation model as an evaluative lens, a scoping review was completed to summarize person, environment and occupation transactions in studies examining joint attention in children aged 6–12 years with autism spectrum disorder. Results Six studies were included. Findings indicated that simplified social environments and demonstrations of joint attention promoted higher joint attention performance in children with autism spectrum disorder, at the cost of ecological validity. Maintaining ecological validity in complex social environments resulted in lower joint attention performance. Conclusion The Person–Environment–Occupation model can be used to develop an occupational therapy perspective on literature from outside the discipline. There is a relationship between the person, environment, occupation transactions and joint attention in children with autism spectrum disorder.

The Engaged Child in Occupational Therapy

Achieving optimal outcomes for children in occupational therapy settings is influenced, in part, by their engagement. The nature of child engagement from the occupational therapy perspective remains relatively unexplored. A qualitative research methodology was adopted, using an interpretive description approach. Thirty-two occupational therapists participated in five focus groups and six individual interviews that were thematically analyzed. Four themes emerged from the data: (i) signs of child engagement and disengagement; (ii) it's about the child feeling safe; (iii) a sense of meaning and purpose; and (iv) service and therapist factors influencing child engagement. Helping the child feel safe; providing meaningful experiences; and being flexible and responsive were key means of connecting with, and supporting, child engagement. Strategies occupational therapists reportedly used to engage the child aligned with the tenets of self-determination theory (autonomy, relatedness, and competence).

The motivation and opportunities for weight loss related to the everyday life of people with obesity: A qualitative analysis within the DO:IT study

Background Unsuccessful weight loss or weight loss maintenance is due to different barriers and physical limitations related to participation in everyday life. It will, therefore, be relevant to investigate the field from an occupational therapy perspective, since occupational therapists are uniquely trained in focussing on people’s resources, meaningfulness and participation in everyday life. Aim The aim was to explore what motivates people to lose weight from an OT perspective and which opportunities people with obesity experience in their everyday lives to achieve and maintain lost weight. Material and Methods A descriptive phenomenological study including 21 semi-structured individual interviews was conducted as part of the DO:IT study. Results The data analysis led to the identification of three main themes: The influence of external circumstances on the desire for weight loss; use of time in everyday life; and changes in habits, routines and structure. Conclusion People who are overweight or obese are motivated to lose weight because of health issues and feeling more comfortable with their body. The opportunities for weight loss lie in creating habits, routines and structuring everyday life activities to facilitate a healthier lifestyle. Significance The findings indicate that an occupational therapist should be part of weight-loss interventions.

Describing and measuring the ‘switch-on’ effect in people with dementia who participate in cognitive stimulation therapy: A mixed methods study

Introduction Cognitive stimulation therapy is an evidence-based group intervention for promoting cognition and quality of life in people with dementia. This New Zealand study aimed to describe and measure the ‘switch-on’ effect, a recently reported benefit involving enhanced participation. Method A convergent parallel mixed methods design was implemented. Interviews guided by qualitative descriptive methodology were conducted with four community-dwelling men with mild dementia and their wives, before, during and after cognitive stimulation therapy. Concomitantly, participants with dementia were scored on the Volitional Questionnaire following a single-subject A–B design. Qualitative and quantitative data were analysed using NVivo-assisted thematic analysis and descriptive statistics respectively and conjointly. Findings ‘Switch-on’ was found to be multi-dimensional in nature, with increased engagement and expanded scope in Doing, Feeling, Relating, and Thinking and Reflecting. ‘Switch-on’ occurred with a noticeable onset within 3 weeks, which was sustained and consolidated towards completion of cognitive stimulation therapy in both group and home environments. Three men showed concurrent improvements on the achievement sub-scale of the Volitional Questionnaire. However, the measure did not effectively capture ‘switch-on’ due to its ceiling effect. Conclusion Findings about ‘switch-on’ suggest broader, under-researched benefits of cognitive stimulation therapy that merit further exploration from an occupational therapy perspective.

Les enjeux éthiques de l’enseignement en ergothérapie : des injustices au sein des départements universitaires

Si les enjeux éthiques de l’enseignement sont bien documentés dans les écrits, tel n’est pas le cas des enjeux éthiques que pose l’enseignement en ergothérapie. Aucune étude n’a été menée sur le sujet au Québec. Pour pallier cette lacune, une recherche a été réalisée. Cet article en présente les résultats. Puisque l’état des connaissances sur le sujet est limité, un devis qualitatif a été utilisé. Onze ergothérapeutes-enseignantes ont participé à un entretien individuel semi-dirigé pour discuter des enjeux éthiques que soulèvent leurs enseignements. Six unités de sens émergent des données : 1) l’équité entre les étudiants : un défi ; 2) la santé et le bien-être des étudiants et des enseignantes : un portrait troublant ; 3) des injustices au sein du corps enseignant : l’éléphant dans la pièce ; 4) l’identité professionnelle tiraillée par des conflits de rôles ; 5) la présence de conflits d’intérêts préoccupants et 6) l’équilibre occupationnel : un mythe plus qu’une réalité. Les résultats rejoignent en général ceux documentés dans les écrits. Cela dit, un élément peu documenté dans les écrits émerge, soit la présence d’une culture académique hiérarchisée où l’autorité épistémique est détenue par les professeurs-chercheurs au détriment des autres types d’enseignants et des milieux cliniques. Ainsi, bien que la profession ergothérapique valorise la justice occupationnelle, les départements universitaires sont dominés par une injustice épistémique qui, par ricochet, engendre une injustice occupationnelle, ce qui d’un point de vue ergothérapique est préoccupant. Aussi, le contexte universitaire est lié à une surcharge de travail peu propice à l’agir éthique et à la pratique réflexive.

Sensory processing in children with a history of maltreatment: an occupational therapy perspective

ABSTRACTChildren with a history of maltreatment exhibit differences in a variety of domains, including sensory processing. However, little is known about how domain-specific sensory processing deficits differ by the type of maltreatment experienced. The focus of the current study was to investigate the relationship between abuse, neglect, or no maltreatment on seven sensory domains in a sample of adopted children. Caregivers of 408 adopted children (M= 7.89, SD= 2.03) reported their child’s history of maltreatment (abuse, neglect, or no maltreatment) and sensory processing abilities (Short Sensory Profile). Seventy-nine percent of the sample had sensory processing dysfunction (definite difference = 41%; probable difference = 38%). Children with a history of abuse (n = 147) had impairments in tactile sensitivity (84.4%) and taste/smell sensitivity (47.6%). Children with a history of neglect (n = 125) scored differently in underresponsive/seeks sensation (Neglect = 83.2%; Abuse = 57.8%). Both groups had significant differences in underresponsive/seeks sensation and auditory filtering. In summary, children with a history of adversity had domain-specific sensory processing differences that varied by the type of maltreatment experienced. These findings suggest that children may benefit from evaluation by an occupational therapist taking their specific history of maltreatment into account. Implications for allied health and mental health providers are discussed.

Effectiveness of an Occupational Therapy Program on Cancer Patients with Dyspnea: Randomized Trial

Background: Dyspnea is one of the leading causes of loss of autonomy among patients with advanced cancer. The management of these symptoms relies exclusively on pharmacological measures.Aims: To assess the effectiveness of a “occupational therapy program” to improve both personal functionality and respiratory function in patients with dyspnea.Methods: Experimental, prospective, longitudinal, and randomized study. A total of 102 individuals from the inpatient oncology unit of the University Salamanca Hospital Complex were participated in this study. In addition to pharmacological treatment, the intervention group participated in the occupational therapy program.Results: The study yielded statistically significant differences between the members of the experimental group and those of the control group in functionality levels, as well as statistically significant differences in the BODE global respiratory index scores (p < 0.001), and in the dyspnea level scores (p < 0.001) between both groups.Conclusions: Comprehensive respiratory rehabilitation program from an occupational therapy perspective improve functionality and overall respiratory function levels in cancer patients suffering from dyspnea.

Historical and developmental perspectives of occupational therapy

This paper describes the emergence of the occupational therapy as a social activity and its appreciation as a profession. The article also presents peoplewho were significant in establishing the direction of the therapy’s development. The historical perspective provided introduces the original developmental path of the occupational therapy. The presented perspective is a result of own scientific research, based in particular on the English literature. Therefore, the descriptions presented in the article should be treated as one of several possible ways of interpreting historical and developmental perspectives of occupational therapy.

The Student Perspective on Role-Emerging Fieldwork Placements in Occupational Therapy: A Review of the Literature

Role-emerging fieldwork placements are increasingly being used in entry-level occupational therapy programs. However, published reviews have yet to focus on synthesizing the experiences and perspectives of students. This review aims to identify the opportunities, challenges, and future directions of role-emerging fieldwork placements based on the student perspective. A literature review using scoping review methods was conducted, including an electronic database search, hand-searching of journals, and citation tracking. Descriptive and thematic analyses of the articles were performed. Thirty articles were identified through the literature search. Themes that emerged related to opportunities were professional and personal development, independence and autonomy, client-centeredness, and new occupational therapy perspective. Themes that emerged related to challenges were defining a professional role, lack of structure and support, and high level of responsibility. Future directions centered on recommendations for future students and establishing roles within sites. Students benefited from the self-directed nature and client-centered practice in their role-emerging fieldwork placements, while the challenging environment contributed to their overall development. Students recognized a need for occupational therapy services in the wider community and saw role-emerging settings as legitimate career opportunities. Future research is encouraged to explore peer models, student-initiated role-emerging fieldwork placements, and postgraduate experiences.