4.4 Article

The complexities and synergies of engagement: an ethnographic study of engagement in outpatient pediatric rehabilitation sessions

期刊

DISABILITY AND REHABILITATION
卷 43, 期 16, 页码 2353-2365

出版社

TAYLOR & FRANCIS LTD
DOI: 10.1080/09638288.2019.1700562

关键词

Client involvement; client investment; disengagement; motivation; pivotal elements; therapy

资金

  1. Canadian Institutes of Health Research (CIHR) [MOP-133397]
  2. Kimel Family Opportunities Fund through the Holland Bloorview Kids Rehabilitation Hospital Foundation

向作者/读者索取更多资源

The study found that engagement levels of clients and service providers in outpatient pediatric rehabilitation therapy sessions were moderate to high, with providers showing higher levels of engagement compared to clients. Engagement was closely associated with positive emotions, relationships, and collaboration, and had a positive impact on therapy progress.
Purpose: To investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions. Methods: In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement - Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers. Results: Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration. Conclusions: Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing - it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements - positive expectations and positive affect - to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement.

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