The range of communication models used by Allied Health Professionals (AHPs) - specifically Occupational Therapists (OTs), Physiotherapists (PTs) and Speech and Language Therapists (SLTs) as part of their advice-giving strategies with parents of pre- school children with Cerebral Palsy (CP): An exploratory study by Aline Macready A thesis submitted in partial fulfilment for the requirements for the degree of MA (by Research) at the University of Central October 2011 ABSTRACT Research purpose To explore the range of communication models used by Allied Health Professionals (AHPs) - specifically Occupational Therapists (OTs), Physiotherapists (PTs) and Speech and Language Therapists (SLTs) - with parents of pre-school children with Cerebral Palsy (CP), and utilise data to develop a coded checklist to be utilised as an instrument for future research in this field. Method In November 2010 three Nominal Group Technique (NGT) sessions with AHPs were conducted. NGT was selected as being the most effective approach to elicit contributions from all participants and generate a list of items relevant and meaningful to the question posed. Uni-professional group NGT sessions were held as previous work had indicated contrasting perspectives across AHPs. The researcher synthesised the generated items and integrated these with previously published conceptual models of interaction to develop a coded checklist. Validation took place by asking participants from the NGT sessions to review the checklist and make relevant comments. Results The NGT sessions generated 57 separate items in total, these were categorised in themes and subthemes. The researcher identified single, dual and multiple strategy approaches. This gave an indication of the complexity of the advice giving strategies used by AHPs in their work with parents. 2 Conclusion This small pilot study has generated some indicative data relating to therapists‟ reported advice-giving practices. It was also possible to compare the items from the three groups and identify some similarities and differences in their way of working with parents. Some careful conclusions were drawn about the conceptual models of communication used by the AHPs, and a coded checklist was created as an instrument for future research. Key words: AHP, parents, Nominal Group Technique, models of communication, advice- giving strategies 3 CONTENT ABSTRACT ......................................................................................................... 2 LIST OF TABLES AND FIGURES ...................................................................... 9 ACKNOWLEDGEMENTS ................................................................................. 11 ABBREVIATIONS ............................................................................................. 12 CHAPTER 1-INTRODUCTION ......................................................................... 13 1.1-HISTORICAL PERSPECTIVES OF PROFESSIONAL –CLIENT RELATIONSHIP ............................................................................................ 14 1.2-MODELS OF DISABILITY ....................................................................... 16 1.2.1-Medical Model ................................................................................... 17 1.2.2-Social Model ...................................................................................... 18 1.3-MODELS OF COMMUNICATION ........................................................... 20 1.3.1-The Expert model: ............................................................................. 21 1.3.2-The Transplant Model ........................................................................ 23 1.3.3-The Family-Centred Model ................................................................ 24 1.3.4-The Family-Friendly Model ................................................................ 26 1.3.5-The Partnership Model: ..................................................................... 27 CHAPTER 2-METHODOLOGY/STUDY DESIGN ............................................. 35 2.1-RESEARCH QUESTION, AIMS AND OBJECTIVES .............................. 35 2.2-REFLECTIONS OF STUDY DESIGN ...................................................... 36 2.2.1-Case studies ...................................................................................... 37 2.2.2-Observations ..................................................................................... 38 4 2.2.3-Interviews .......................................................................................... 38 2.2.4-Focus Group ...................................................................................... 39 2.2.5-Delphi Technique .............................................................................. 40 2.3-DESCRIPTION AND STRENTHS OF NOMINAL GROUP TECHNIQUE 40 CHAPTER 3-METHODS ................................................................................... 42 3.1-STUDY DESIGN ...................................................................................... 42 3.1.1-Inclusion criteria for therapists ........................................................... 45 3.1.2-Inclusion criteria for parents .............................................................. 45 3.1.3-Recruitment of participants ................................................................ 45 3.2-DATA COLLECTION ............................................................................... 47 3.2.1-NGT session PT ................................................................................ 48 3.2.2-NGT session OT ................................................................................ 49 3.2.3-NGT session SLT .............................................................................. 50 3.2.4-NGT session Parents ........................................................................ 51 3.3-DATA ANALYSIS .................................................................................... 53 3.4-VALIDATION OF CODED CHECKLIST .................................................. 56 3.5-REVISED CODED CHECKLIST .............................................................. 57 CHAPTER 4-RESULTS .................................................................................... 58 4.1-OVERVIEW AND ANALYSIS OF THE THREE NGT SESSIONS ........... 58 4.1.1-Data analysis of NGT session with OT .............................................. 58 4.1.2-Data alysis of NGT session with PT .................................................. 61 4.1.3-Data analysis of NGT session with SLT ............................................ 64 5 4.2-COMPARISONS BETWEEN THE NGT GROUPS .................................. 67 4.2.1- Comparative findings ........................................................................ 68 4.2.2-Comparative group findings of strategy approaches ......................... 70 4.3-SUMMARY OF FINDINGS ...................................................................... 73 4.4-CODED CHECKLIST DEVELOPMENT AND VALIDATION .................... 75 4.4.1-Coded checklist validation and analysis ............................................ 80 4.5-REVISED CODED CHECKLIST .............................................................. 85 4.6-MAPPING REVISED CODED CHECKLIST AGAINST CONCEPTUAL MODELS OF COMMUNICATION ................................................................. 88 4.6.1-Expert model: .................................................................................... 91 4.6.2-Transplant model ............................................................................... 91 4.6.3-Family Centred model ....................................................................... 92 4.6.4-Family-friendly model ........................................................................ 92 4.6.5-Partnership model ............................................................................. 93 CHAPTER 5-DISCUSSION .............................................................................. 94 5.1-DISCUSSION OF FINDINGS .................................................................. 94 5.1.1-Expert model ..................................................................................... 96 5.1.2-Transplant model ............................................................................... 97 5.1.3-Family-centred model ........................................................................ 98 5.1.4-Family-friendly model ........................................................................ 99 5.1.5-Partnership Model ............................................................................. 99 5.2-REFLECTIONS ON STUDY CONDUCT AND RECRUITMENT ........... 101 6 5.2.1-AHP recruitment .............................................................................. 102 5.2.2-Parent recruitment ........................................................................... 103 5.3-ETHICAL CONSIDERATIONS .............................................................. 104 5.3.1-Informed consent ............................................................................. 105 5.3.3-Respect for all participants .............................................................. 105 5.3.4-Confidentiality .................................................................................. 105 5.3.5-Data collection and analysis ............................................................ 105 5.3.6-Researcher bias .............................................................................. 106 5.3.7-Method ............................................................................................ 106 CHAPTER 6-CONCLUSION AND RECOMMENDATIONS ............................ 107 6.1-CONCLUSION....................................................................................... 107 6.1.1-Strengths and limitations of the research study ............................... 107 6.2 RECOMMENDATIONS FOR CLINICAL PRACTICE ............................. 110 6.3 RECOMMENDATIONS FOR FURTHER RESEARCH QUESTIONS .... 112 6.3 SUMMARY OF KEY FINDINGS ............................................................ 113 CHAPTER 7- REFERENCES ......................................................................... 114 CHAPTER 8-APPENDICES............................................................................ 120 APPENDIX 1- INFORMATION SHEET FOR PARENTS ............................. 120 APPENDIX II- INFORMATION SHEET FOR AHPS .................................... 123 APPENDIX III- CONSENT FORM FOR PARENTS ..................................... 127 APPENDIX IV-CONSENT FORM FOR AHPS ............................................. 129 APPENDIX V-AMENDED INFORMATION LETTER FOR AHPS ................ 131 7 APPENDIX VI-NGT QUESTION FOR PARENTS AND AHPS .................... 133 APPENDIX VII-SCRIPT FOR NGT SESSIONS .......................................... 134 APPENDIX VIII-TRANSSCRIPT NGT SESSION WITH PT ......................... 136 APPENDIX IX-FLIPCHART NGT-PT ........................................................... 138 APPENDIX X-TRANSCRIPT NGT SESSION OT ........................................ 139 APPENDIX XI-FLIPCHART NGT-OT .......................................................... 141 APPENDIX XII-TRANSCRIPT NGT SESSION WITH SLT .......................... 142 APPENDIX XIII-FLIPCHART NGT-SLT ....................................................... 144 APPENDIX XIV-EVALUATION OF AHDC WORKSHOPS .......................... 145 APPENDIX XV-THEMES FROM ALL THREE NGT SESSIONS ................. 149 APPENDIX XVI-CODED CHECKLIST COLLATED RESPONSES FROM THERAPISTS .............................................................................................. 153 APPENDIX XVII-REVISED CODED CHECKLIST ....................................... 160 8 LIST OF TABLES AND FIGURES Table 1.1 Binary Opposites page 18 Fig 1.1 The Dynamics of the helping process page 27 Table 1.2 Summary of models of communication pages 29 – 30 Table 2.1 Case study research characteristics page 34 Fig 3.1: Original study design page 42 Fig 3.2 Revised study design page 50 Fig 3.3 Data analysis plan flow chart page 53 Table 4.1 NGT- OT item generation page 57 Fig 4.1 OT strategy approaches page 58 Table 4.2 NGT – PT item generation page 60 Fig 4.2 PT strategy approaches page 61 Table 4.3 NGT – SLT item generation page 63 Fig 4.3 SLT strategy approaches page 64 Table 4.4 colour key page 65 Table 4.5 NGT item group comparisons page 67-68 Fig 4.4 group strategy approach comparisons page 68 Table 4.6 comparison group strategy approach and frequency page 69 Table 4.7 Coded Checklist for therapists to make comments pages 74 – 77 Table 4.8 coded checklist response: verbal instruction page 79 Table 4.9 coded checklist response: written information page 80 Table 4.10 coded checklist response: practical demonstration page 81 Table 4.11 coded checklist response using assistant/ video recording/loan equipment page 81 9 Table 4.12 coded checklist response: working in partnership page 82 Table 4.13 coded checklist approach: combination of activities page 83 Table 4.14 revised checklist map against conceptual models of communication pages 87-88 Fig 6.1 Total combined strategy approaches page 105 Fig 6.2 Models of communication used by AHPs page 107 10