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PromOTing Occupational Therapy: Words, Images, and Actions

2012; American Occupational Therapy Association; Volume: 66; Issue: 6 Linguagem: Inglês

10.5014/ajot.2012.666001

1943-7676

Karen Jacobs,

Focus Groups and Qualitative Methods

In 1922, the Fred Stone Circus came to the Mineola Fairground for the benefit of the Occupational Therapy Society of New York (Blair, 2011; “Vaudeville on Wheels, Novelty at Benefit,” 1922). You may wonder how a circus can promote occupational therapy. Well, to paraphrase a story that apparently first appeared in Reader’s Digest, if you painted a sign saying “Fred Stone Circus Coming to the Mineola Fairground on Saturday at 2:15, rain or shine, for the benefit of the Occupational Therapy Society of New York,” that’s advertising. If you put the sign on the back of an elephant and Annie Oakley walks it into Mineola, that’s promotion. If the elephant walks through Mayor LaGuardia’s flower bed, that’s publicity. And if you get the mayor to joke about it, that’s public relations. If you tell your friend Nancy about the circus, that’s word of mouth. And, if you planned this chain of events, you promOTed occupational therapy through words, images, and actions.Now, fast forward to 2012. The ways that information flows through societal networks have evolved considerably, and you would now also be using social media outlets such as Facebook, Twitter, LinkedIn, and YouTube to promote this event. You would create an event page on Facebook and ask people to let their friends know about the fundraising event for the Occupational Therapy Society of New York. On LinkedIn, you would start a discussion about how to get more sponsors for the event. You would make a YouTube video of the elephant and Annie Oakley and Photoshop Annie as wearing a T-shirt that says, “I love OT.” Your 140-character tweet would read, “Post your pic w/ @Annie Oakley1860 & elephant #OTCircus.”We live in a world of limited resources that is technologically complex, economically competitive, and growing more politically accountable with consumer power on the rise. The good news is that this is a world of limitless opportunities for occupational therapy, in which an occupational therapy practitioner could beWe must be farsighted if we are to create the future we desire. The Centennial Vision of the American Occupational Therapy Association (AOTA; 2007) provides a set of guideposts to this future. However, we must work diligently—individually and collectively—to ensure that occupation is recognized as our central construct and to communicate how it shapes and informs our methods and outcomes through infusion in education, research, and practice. We must be aggressive in our support of, and advocacy for, scientific inquiry and pragmatic investigation that build the profession’s evidence-based body of knowledge. We must participate in strategic partnerships and interprofessional teams to construct communities where human occupation is recognized as fundamental to quality of life and social participation, as well as central to social, educational, and health care policies in the United States and the global community. We can and will reach this envisioned future by promOTing occupational therapy through our words, images, and actions.Although it has been said that “words connote reality” (Coster, 2008, p. 744), one must learn to use them skillfully because, in words often attributed to George Bernard Shaw, “The greatest problem in communication is the illusion that it has been accomplished.” This means two things: One, we cannot assume that our beliefs are known by an audience, and, two, we cannot assume that our beliefs are shared by the audience. Occupational therapy practitioners and students become accomplished communicators only when they can effectively communicate that occupation is essential to individuals’ and society’s health and well-being. We are health communicators, and the words we use are important as we “share health-related information with the goal of influencing, engaging and supporting individuals, communities, health professionals, special groups, policy makers and the public to champion, introduce, adopt, or sustain a behavior, practice or policy that will ultimately improve health outcomes” (Schiavo, 2007, p. 7).Whether you are an amateur shutterbug, accomplished photographer, or simply one who appreciates art, I am sure you are familiar with the saying, “A picture is worth a thousand words.” A complex idea can be conveyed with just one image. We can use images to convey the power of participation in society as a bridge to health for people, regardless of age or ability. Just imagine a traveling exhibit of our photographs that appears in the hallways of high-visibility venues like airports, libraries, state houses, and schools. Putting images of occupational therapy in the public’s eye helps illustrate what we do as well as its value. Alison Sullivan, assistant professor of occupational therapy at the American International College, did just that! She and her students explained what occupational therapy was through images on a bulletin board located in their college that more than 400 students from various health professions passed by daily. Now more than 400 people in Springfield, Massachusetts, know more about occupational therapy. Cassie Britton, an occupational therapy student at the University of New England, created a similar exhibit for display in school settings.Our everyday actions—what we do—can promote occupational therapy and help create new opportunities for the profession. The actions of our colleagues and students, along with the actions of the occupational therapy practitioners who came before us, have built a rich history of promoting the profession. I will share many occupational therapy practitioners’ and students’ everyday actions in this lecture and explain how their actions are helping occupational therapy to be widely recognized.We have a rich history of promoting our profession through words, images, and actions. In doing research for this lecture,1 I spent many hours knee deep in the AOTA/American Occupational Therapy Foundation (AOTF) Wilma L. West Library in Bethesda, Maryland. There I discovered countless gems that were new to me even after all my years of involvement with AOTA. Today, we need to continue using both the new and powerful tools of social media and other, more traditional means of communication to help us promote occupational therapy.In the past 5 years, there has been a fundamental shift toward using social media to reach large audiences. Even if you have not personally set up a Facebook account or bought a smartphone, many of your clients, whether prospective or current, certainly have. Your congressperson has, and billions of other people have, too.According to the Pew Internet Research Center, 65% of Internet users are social media users (Madden & Zickuhr, 2011). These are not just students accessing social media outlets with smartphones, iPads, and notebook computers while sitting in coffee shops. Social media are used by all populations (Chou, Hunt, Beckjord, Moser, & Hesse, 2009).These new opportunities provide us with the powerful means to amplify our profession’s societal footprint. And the rather amazing part is that these new tools are both democratized and personalized—anyone can become an occupational therapy advocate and reach out to a potentially global audience. An example of this is the Occupational Therapy Global Day of Service (OTGDS) that took place on February 25, 2012. We were able to enlist more than 2,500 participants nearly exclusively with social media. Later on in this lecture, I will describe the Occupational Therapy Global Day of Service in more depth.These days, learning to use and apply the tools of marketing, promotion, and communication is as vital to being a good occupational therapy practitioner as keeping up with the evidence literature and best practices.What comes to mind when you hear the term marketing? Do you see advertisements on billboards in Times Square or in a favorite magazine or imagine a 15-second audio spot on Pandora Web radio?Philip Kotler, one of the most renowned contemporary authors on marketing, defined it as “the human activity directed at satisfying needs and wants through an exchange process” (Kotler & Zaltman, 1971, p. 4). Marketing develops markets—that is, customers.Promotion keeps our product line in the minds of our audiences and helps stimulate demand for our services. According to one blogger, “Promotion is really about getting someone interested in what you do so that they’ll do the ‘selling’ for you” (Muse Flash, 2008). That is, we use marketing principles designed to promote ideas such as the following:To understand the promotion of occupational therapy, the focus of this lecture, it is important to understand marketing activities as a whole. For example, inbound marketing is market (customer) research to find outThe other side of the coin, outbound marketing, includes using promotion tools such as advertising, personal selling, publicity, sales promotion, public relations, and word of mouth to promote your services. Outbound marketing is where the concept of promotion lives and is therefore the focus of this lecture.One outbound marketing tool, business cards, is a simple and effective promotion tool that each of us can and should use daily. Make sure you are identified as an occupational therapy practitioner or student, and include a simple definition of occupational therapy using the word occupation in your definition on the card. Give out two cards at a time—one for the person to keep, the other for him or her to pass on to another person.The most important outbound marketing tool is still word of mouth. Studies have shown that clients still trust friends and family members for recommendations (Shore, 2005). A personal experience or the retelling of that experience to a friend or family member still has the greatest impact on a brand or reputation (Sarel, Rodriguez, Marmorstein, & Barach, 2005). Personal interactions create strong impressions. Our goal must be to communicate the value and benefits of occupational therapy in every interaction.Always identify yourself as an occupational therapy practitioner or student. Lead by example by sharing what you do with everyone wherever you are:For example, introduce yourself to the people sitting next to you on the plane, train, or bus, and give an example of the value of occupational therapy, such as “Occupational therapy helps people stay in their homes by enhancing safety.” I call this the “what’s in it for me?” factor. If those people go home and share this interaction with their friends and family members, 5–10 more people know about the value and benefits of occupational therapy.My challenge to you is to ask your clients to share their own occupational therapy success stories with their friends and family. You, in turn, could submit stories to the local media. It is the job of every one of us to promote occupational therapy, and our clients can help in this task.How can we tailor our words, images, and actions to meet the needs of our various markets? One important fact to keep in mind when tailoring communication is the extent to which demographic and psychographic information and behavioral factors affect the audience’s response, as Kreuter, Farrell, Olevitch, and Brennan (2000) pointed out in their book Tailoring Health Messages. Behavioral factors include beliefs, attitudes toward health care, medical risk factors, health knowledge, skills, resources, and barriers to health. I will offer an example of a campaign that took these factors into account when trying to educate a particular constituency about better health.In a campaign to promote healthier eating among a Hispanic/Latino population, health care consultants took into account socioeconomic, educational, and cultural differences; age and use of media; and reaction to “influencers” such as politicians, faith communities, law enforcement, and Latino community leaders. They also forged partnerships to influence behavior, including highly productive partnerships with restaurants, whom they urged to incorporate healthier menu options. The keys to the campaign’s communications were their link to trusted community members and the incentive they gave to people to improve their own health (Weiss, 2008).Kielhofner, Hammel, Finlayson, Helfrich, and Taylor (2004) posited that “the ultimate rationale for the value of any service is that it legitimately addresses identified client needs” (p. 16). Therefore, part of communicating the value of what occupational therapy has to offer requires making sure that our work closes the gap between a client’s occupational desire and his or her current situation. That is, communication and intervention should be client-centered.For example, a study by Helfrich and Fogg (2007) began with the premise that homeless shelters offered group educational programs that addressed community reintegration but did not “teach independent living skills in a way that allows for practice, integration, retention, and generalization to occur” (p. 314). Further studies by Helfrich and colleagues (Helfrich, Chan, & Sabol, 2011; Helfrich, Peters, & Chan, 2011) noted that there was a positive association between the ability of consumers to choose and control their services and their ability to function independently, and so the researchers sought to use a client-centered, occupation-based intervention to help clients with mental illness at risk for homelessness learn and retain specific life skills. The methodology included allowing participants to choose the modules in which they would take part. Modules included money management, food management, room and self-care, and safe community participation. The results indicated that the participants significantly improved their life skills and retained these skills 6 months later as a result of the occupation-based intervention and their ability to exercise choice. In this example, the intervention was designed to meet the needs of a specific group of individuals; activities were further tailored to each person’s needs. The gaps in specific areas were closed using real-life activities, tailored materials to which the participant could refer, and persistent follow-up to measure retention and satisfaction with the process. One of the most important findings of this research was that people decompensate when they are undergoing transitions; the authors acknowledged that this is an important factor for occupational therapy practitioners to be aware of because we almost always see people in the midst of a transition in their lives (Helfrich, Chan, & Sabol, 2011; Helfrich, Peters, & Chan, 2011). This research adds to our growing body of strong evidence that can be used to demonstrate the value of occupational therapy when promoting our services.To effectively respond to consumer needs, we must have “a true and deep understanding of who they are, what they want, and what they aspire to be” (Mimoun, 2008, p. 19). The good news is that occupational therapy is and always has been consumer-centric.The history of promoting occupational therapy can be viewed through the use of words, images, and actions. In the next section of this lecture, I am going to highlight examples from throughout the U.S. history of our profession with some international illustrations.Promoting the profession was a key value from the outset. Our membership organization, established in 1917, was originally named the National Society for the Promotion of Occupational Therapy (NSPOT) because, as founding member George E. Barton remarked, “S.P.O.T. suggests the ever alert ‘Johnie’” (Dunton, 1926, p. 435). William Dunton, Jr., was the first chairperson of the Committee on Finance, Publicity and Promotion. In 1921, our association’s name was changed to the American Occupational Therapy Association because Herbert Hall felt these words were “crisper” (“American Occupational Therapy Association Is New Name,” 1921, p. 554). In addition, we were taking initiatives to align ourselves with local and national associations such as the American Hospital Association and service groups such as the Junior League (Smith, 1931). These attempts were very practical because our association had few funds, which limited publicity efforts. It is clear, though, that from its very outset, our professional association has been concerned with spreading awareness of what we do and shaping how we are perceived by the public.Eleanor Clarke Slagle believed that the best way to promote occupational therapy was by networking with interprofessionals—that is, with those outside of occupational therapy. She believed that professionals from other fields should learn from and about each other to improve collaboration and the quality of care for the people we serve. AOTA effectively implemented this approach by holding its annual meetings with the American Hospital Association’s meetings (AOTA, 1923). This was a resourceful approach because we made use of the same facilities, borrowed speakers, received publicity and media attention, and networked with other health care professionals. Slagle also emphasized the development of occupational therapy schools, believing these, too, were an important way to promote occupational therapy.During the early days of the profession, founders and members of AOTA were also publishing in journals such as The Modern Hospital and Maryland Psychiatric Quarterly, which reached other professionals. In one of my favorite articles in The Modern Hospital, “Training Occupational Therapists,” Hudson (1923) wrote, “Occupational therapy is still in its infancy, and there is waiting a rich field of research in the study of the mental and manual processes in each occupation” (p. 396). Already there is a call for science-driven evidence to guide best practice and to promote occupational therapy. Our founders knew that published evidence supporting the effectiveness of our interventions would promote occupational therapy. Evidence-based research and the publication of this research continue to be an important factor not only in improving the effectiveness of our work, but also in attracting attention from the health care community and media.As an aside, I found the article “Occupational Therapy Pioneering in China” (Bliss & Stedman, 1923) particularly interesting because of the five People to People Ambassador Program Occupational Therapy delegations I have led to China and the World Federation of Occupational Therapists’ (WFOT’s) work in promoting the development of occupational therapy in China. Our founders were promoting a globally connected work force nearly 90 years ago!A creative mechanism used to promote occupational therapy was the traveling exhibit, which included photographs and some examples of products created by occupational therapy clients (Figure 1). The growing number of state associations used this exhibit and added their own local photos. Our Canadian colleagues actively used traveling exhibits, too. These exhibits look to me like predecessors of the exhibits promoting occupational therapy that can be found today during National Occupational Therapy Month, during which we reach out to the public and inform it of the benefits of occupational therapy.Although the hot new technology of the time was the radio, a mass communication medium, I could find no evidence that it was used to promote occupational therapy (K. Reed, personal communication, January 20, 2012). The lesson here is an opportunity lost—this is exactly the kind of technology that could have reached a larger group or the general public rather than just the local public.It’s important to realize that any promotional endeavor will be affected by what is happening in the United States and in the world at large. During the Great Depression of the 1930s, for example, the promotion of occupational therapy rapidly declined. There were a limited number of occupational therapy positions, and little money was available to promote the profession (Dunton, 1933).The second wave of occupational therapy promotion started in 1939. Reader’s Digest published an article called “The Work Cure,” which described getting workers with injuries back to work (Stern, 1939b; see also Stern, 1939c). Edith M. Stern, the author of the article, also collaborated with occupational therapist Meta R. Cobb to publish Betty Blake, O.T.: A Story of Occupational Therapy (Stern, 1939a). The book helped promote occupational therapy as a career (Figure 2). In the current language of social media, Stern and Cobb would be considered “super fans” of occupational therapy because they had their own large followings of readers. They used the technology of the time—magazines, books, and word of mouth—to promote occupational therapy.The profession grew rapidly with the onset of World War II as occupational therapists worked with soldiers who were wounded. In 1944, the Office of the Surgeon General sent a request to the Commanding General of the Army Service Forces for an emergency course at a variety of schools to train approximately 600 OTs (Vogel, Manchester, Gearin, & West, 1968). Not only did our numbers grow, but the profession also gained more national press.In 1948, Gail Fidler and the occupational therapy staff at the Lyons Veterans Administration Hospital in Lyons, New Jersey, created an occupational therapy educational exhibit comprising four detailed dioramas with figures in each box and a recording that explained the meaning of each of the activities (Figure 3). The exhibit’s first public showing was in a store window in Plainfield, New Jersey, during a statewide Mental Health Association Public Education initiative. After that time, it was displayed at several state occupational therapy conferences and at the Veterans Administration facilities (R. Fleming-Castaldy, personal communication, September 14, 2011).By the mid- to late 1940s, the new information transmission medium was television. One can only imagine the potentially wider public impact of Fidler’s diorama exhibit translated to this new medium, perhaps as a public service announcement (PSA) or short documentary. It was not until the late 1960s, however, that stories about occupational therapy appeared on any station (K. Reed, personal communication, January 20, 2012). The lesson is that it is important to understand the newest technology and to use it, when appropriate, to promote occupational therapy. Mobile Web 2.0 technology is now, and it is time to get more of us on board.Although the promotion of occupational therapy tapered off in the 1950s, the profession arrived on the global stage when AOTA became one of the 10 founders of the WFOT. Another type of promotion was the addition of the occupational therapy section to the Strong Vocational Interest Inventory in 1959 (K. Reed, personal communication, January 20, 2012), another AOTA strategy to promote occupational therapy as a career.In the 1960s, AOTA created PSAs to recruit people into the profession. These PSAs were made possible by a grant from the Social and Rehabilitation Service, U.S. Department of Health, Education, and Welfare. Popular entertainers of the time, like Soupy Sales, Bess Myerson, Eli Wallach, Leslie Uggams, Betsy Palmer, and Kate Smith, participated in these PSAs. Here is the PSA by Soupy Sales (AOTA, n.d.-b):Here is the PSA by Bess Myerson (AOTA, n.d.-a):It is interesting how contemporary these messages are after over 60 years! You can listen to these PSAs by contacting the AOTA/AOTF Wilma L. West library at www.aotf.orgThe AOTF was created in 1965 to promote the scientific advancement and to increase public understanding of occupational therapy (AOTF, 2011). I asked Katherine Reed, occupational therapist and historian, to reflect on this time period and describe what lessons we learned to help promote occupational therapy. She suggested that one goal should have been developing occupational therapy academic programs in each state, because “that’s what brings in the resources, particularly in a state-funded institution,” which, as she points out, increases each state’s awareness of occupational therapy:As Reed pointed out, occupational therapy students are a significant means of conveying what occupational therapy is.In the early 1980s, AOTA wisely chose to “target their promotional efforts towards groups who could further directly affect the acceptance, education, or employment of [occupational therapy practitioners]” (Kotler & Clarke, 1987, pp. 231–232). The association created a series of brochures aimed at specific key audiences: for the school audience, “Occupational Therapy Makes Learning Possible” (1983); for the pay audience, “Occupational Therapy Makes Good Sense” (1984); and for the client audience, “Occupational Therapy: Improving Function” (1986; W. Krupnick, personal communication, January 4, 2012). This promotional campaign represented a range of goals, including attracting clients and garnering reimbursement for our services. It was during this time that AOTA Fact Sheets were created, and they continue to be an important resource to the profession (see www.aota.org/factsheets).In 1986, the AOTA public relations department focused on the biggest problem the profession faced at that time—surplus jobs for occupational therapy practitioners. Their task was to increase the public’s awareness of occupational therapy so that more people would choose it as a career (F. Whiting, personal communication, January 3, 2012). We learned, then, that Slagle’s vision and Reed’s recommendation had been right on and that we should have been encouraging the development of occupational therapy academic programs earlier.In the 1990s, AOTA launched a National Awareness campaign. The agency involved in this campaign came up with a remarkable series of advertisements that were built on one of the profession’s biggest weaknesses: the confusion in the public mind between the words occupation and job. They addressed that problem brilliantly. They interviewed OT professionals, asking them how they described themselves and what they do. “Well, I teach my clients skills,” said one. Skills for what? “Skills for living,” was the reply, and this became the tag line: “Occupational therapy: Skills for the job of living.” Members loved the new tagline. For the first time, they found a way to capture and communicate the essence of what they do and why it is important. These advertisements appeared in magazines such as People, Better Homes and Gardens, and Ladies Home Journal, among others (F. Whiting, personal communication, January 3, 2012). They were also made into posters, which you can still find hanging in many occupational therapy departments (Figure 4).A humorous cautionary tale that surfaced during the National Awareness campaign was about the dangers of not considering alternative ways of interpreting your words. AOTA set up a toll-free phone number that included real words: 1–800–6-OT-TALK. What they failed to consider, however, was that some people might interpret the “O” as “zero,” not recognizing the abbreviation OT. It was a particularly glaring mistake, in this case, because 1–800–6-0T-TALK connected callers to a sex chat line in Florida (F. Whiting, personal communication, January 3, 2012).In 2001, AOTA launched the National School Backpack Awareness Day campaign. This campaign, which will enter its 12th year, is our longest social marketing initiative. Thousands of occupational therapy practitioners and students have used the “Pack It Light, Wear It Right” tagline to reach hundreds of thousands of students and their families, schools, and administrators to underscore our role in helping students actively engage in promoting healthy living choices. A campaign such as this increases our visibility and our credibility among a population that might otherwise not know what it is that we do. For example, we reached an MTV audience when backpacks were featured on the show Big Urban Myth. By the way, MTV found to be true the “myth” that a backpack worn incorrectly or too heavy can be a contributing risk factor for discomfort, fatigue, muscle soreness, and musculoskeletal pain!The year 2001 also saw an occupational therapy character cast in a well-known television show, Providence—an excellent opportunity to reach a wide audience with information about the role of occupational therapy. I recall how excited I was to see occupational therapy portrayed fairly accurately and what a boon it was for informing the public about the value of occupational therapy. Occupational therapy is also portrayed in India in a television soap opera, Yahan Main Ghar Ghar Kheli, in which a main character is an occupational therapist (Desi Tashan, 2012).The branding for the AOTA (2007) Centennial Vision encourages each of us to promote our profession with the tagline “Occupational Therapy: Living Life to Its Fullest.” AOTA uses an integrated marketing communication approach so that all audiences have a congruent, sustainable, and high-level brand experience with the profession. AOTA has also created promotion tools for our use, including sales promotion, fact, and tip sheets; a podcast series with the brand title; and a social media presence on sites such as OTConnections, Facebook, Twitter, Pinterest, and YouTube. These and other resources help us all better communicate with others both inside and outside the profession.The WFOT and its member countries have also created materials and developed strategies for promoting occupational therapy. In 2012, I helped WFOT with an updated survey asking member countries to share how they promote occupational therapy. The audiences for over 90% of the promotion materials were the general public, specific client groups, and prospective occupational therapy students. Over 90% of the member countries used printed materials and publications, national association conferences and events, and presentations to individuals and groups as promotion strategies (Figure 5