The development of a design and construction process protocol to support occupational therapists in delivering effective home modifications

Occupational therapists are experts in analysing the transaction between the person and the home environment and they use design and construction methods to redress any imbalance caused by the ageing process or disability. This skill is recognised by many, including governments, who utilise the expertise of occupational therapists to deliver housing modification programmes. However, the role of the occupational therapist within housing modifications services has been criticised. It is claimed that therapists' professional practice is disorganised and not founded on theoretical principles and concepts underpinning the profession. This thesis explores the development of, and a proof of concept for, a design and construction process protocol for home modifications, which seeks to address the issues highlighted above. Using a multi-method research design, the study involved three distinct phases. The first phase involved an on-line survey which was completed by 135 occupational therapists practising in the field of home modifications in the UK. Through a series of open and closed questions, the existing home modification process used by occupational therapists was explored. The second phase comprised a directed content analysis of the qualitative data generated from the online survey. Using the Occupational Therapy Intervention Process Model (Fisher, 2009) and the Design and Construction Process Protocol (Cooper et al., 2008) as the theoretical frameworks, the Home Modification Process Protocol was developed. To identify the benefits of using the Home Modification Process Protocol in occupational therapy practice, the final phase of the study used a single holistic case study design to test the concept of using the protocol in practice. The results of the first phase revealed that existing home modification processes used by occupational therapists throughout the UK lack the theoretical framework that underpins their professional practice, which is evident in other areas of clinical practice. The second part of the study revealed that a 4 phase, 9 sub-phase design and construction process protocol for home modifications could be developed using an inductive and deductive approach to the thematic analysis of the qualitative data, collected during the first phase of the study. The final phase revealed that as a concept, the Home Modification Process Protocol improved participants' understanding of their intervention as a design and construction process and importantly, it provided a theoretical framework for them to understand and articulate their practice as occupational therapists. Overall, the study found that the Home Modification Process Protocol potentially provides occupational therapists working in this area / field with a design and construction process to guide their professional practice. As the Protocol is underpinned by a combined occupational therapy and design and construction theoretical framework, it also has the potential to offer other professionals involved in modifying home environments a more systematic and effective approach to designing and delivering services for older and disabled people in their own homes.