Abstract
Introduction: Research exploring the perspectives of older adults and individuals with disability about important outcomes of home modifications indicates a complex interaction of valued outcomes, beyond funding programs' aims of safe and independent living. Client perspectives of service provision and outcomes are considered the most important to inform practice. However, in working towards improved practice, a wide range of stakeholder perspectives is required. Occupational therapist and manager perspectives on home modification outcomes are yet to be explored in the literature. Their perspectives are important to contrast with clients, as their priorities, values and beliefs influence the therapeutic relationship, decision-making process and therefore outcomes for clients. This study therefore aimed to examine occupational therapists' and home modification service managers' perspectives on important home modification outcomes.Methods: The study used an interpretive description approach. We interviewed six managers and conducted two focus groups involving nine occupational therapists. Participants of the two focus groups differed in their levels of practice experience, with an average of 6 and 22 years, respectively. We used thematic analysis to analyse the data.Findings: We identified five themes reflecting the home modification outcomes valued by professionals in home modification practice: (1) providing people with independence and freedom and supporting care; (2) allowing people to be safe and healthy; (3) allowing people to remain at home; (4) enabling inclusion and quality of life and (5) maintaining the look, condition and value of the home. Opinions of therapists and managers appeared to be influenced by their service's priorities. Themes (1), (2) and (3) were the most valued and important outcomes described by participants, while themes (4) and (5) were not described as frequently or valued as highly by most participants. The breadth and depth of responses differed between less- and more-experienced therapists and managers.Conclusion: The home modification outcomes most valued by occupational therapists and managers in this study differed from the outcomes valued by consumers in previous research, with therapists' opinions seemingly influenced by their service's priorities of meeting basic needs. This research highlights the influence of organisational priorities on therapists' practice and the need for person-centred practice to ensure modifications result in outcomes valued by clients. To support person-centred practice, a range of strategies are required such as advocacy for system- and policy-level change, enhanced training and mentoring, the use of person-centred evaluation tools and the development of competencies and credentialing.