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Utility of Model of Human Occupation Screening
Tool in Sweden
Lena Haglund
To cite this article: Lena Haglund (2020) Utility of Model of Human Occupation
Screening Tool in Sweden, Occupational Therapy in Mental Health, 36:3, 244-257, DOI: 10.1080/0164212X.2020.1757558
To link to this article: https://doi.org/10.1080/0164212X.2020.1757558
© 2020 The Author(s). Published with license by Taylor and Francis Group, LLC. Published online: 12 May 2020.
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Utility of Model of Human Occupation Screening Tool
in Sweden
Lena Haglund
Division of Occupational Therapy, Department of Social and Welfare Studies, Link€oping University, Norrk€oping, Sweden
ABSTRACT
Occupational therapists in Sweden are expected to use evi-dence-based practice. To meet this expectation, a helpful tool could be the Model of Human Occupational Screening Tool (MOHOST). The aim of this study was to examine the utility of the Swedish version of MOHOST. Thirty-seven occupational therapists were invited to take part in the examination. A questionnaire covering transferability, feasibility and clinical relevance was developed. The results show that MOHOST-S seems to have suitable utility. The study supports its imple-mentation potential and clinical relevance. It gives a broad picture of the client’s occupational participation and it sup-ports the treatment planning process.
KEYWORDS
Assessment; occupational participation; usefulness of assessment
Introduction
As a profession, occupational therapists (OTs) in Sweden are expected to deliver health care which is in accordance with science and best practice. Furthermore, occupational therapy services should be designed and imple-mented, as far as possible, in consultation with the client (Svensk f€orfattningssamling,2010). In order to fulfill these expectations, it is important that OTs take an evidence-based approach to decision making, taking the best available research findings and/or best practice into consideration when inter-acting with clients. Another central basis for OT services is the Code of Ethics for Occupational Therapists published by the Swedish Association of Occupational Therapists (2018a). The code states, for example, that the object-ive of the profession “is to support a person’s activity and participation in a manner that promotes possibilities to live as full a life as possible” (page 5).
Consequently, an OT must have access to tools that support client-centered work and must obtain both correct and sufficient information on
CONTACTLena Haglund lena.haglund@arbetsterapeuterna.se Rådjursv€agen 49, Link€oping 587 31, Sweden. This article has been republished with minor changes. These changes do not impact the academic content of the article.
ß 2020 The Author(s). Published with license by Taylor and Francis Group, LLC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. 2020, VOL. 36, NO. 3, 244–257
the client’s occupational participation in order to be able to make the best possible decision concerning the client’s needs. “Tools,” in this context, means models of practice, theories,and assessments that help the OT to identify the client’s needs and, if necessary, select an intervention. One model that supports evidence-based practice, has a client-centered approach, supports the generation of treatment goals, and gives a rationale for intervention is the Model of Human Occupation (MOHO), developed in part by Professor Gary Kielhofner more than 30 years ago (Taylor,
2017). Furthermore, the model focuses on engagement and participation in occupations. It explains how a person engages in occupation as a result of a dynamic interaction between volition, habituation, performance capacity and environment. A wide range of MOHO-based standardized assessments have been developed over the years to support the application of the model (Taylor, 2017). Many of these assessments have over the years been trans-lated into Swedish and tested for scientific standards (MOHO web, 2020).
Assessment is the initial step in a treatment planning process, and the primary goal is to determine the client’s need for treatment. The assess-ment procedure is crucial to the planning process since it is the introduc-tory step and it influences all other steps, including goal setting, choice of intervention, etc. Therefore, it is essential that the step is carried out based on a credible and sound scientific basis.
Different data collection methods are used in various MOHO-based assessments. There are assessments that use observation, while others use interviews, semi-structured interviews, and also self-report methods. In some assessments, these methods are even combined. A few assessments focus on occupational skills such as the Assessment of Communication and Interaction Skills (ACIS) (Forsyth et al., 1998) while others, for example, the Model of Human Occupation Screening Tool (MOHOST) (Parkinson et al., 2006), cover the majority of MOHO concepts.
MOHOST is the most flexible assessment related to MOHO (Parkinson et al., 2006) and easy to administer (Taylor, 2017). Furthermore, it pays attention to participation, it supports evidence-based practice, it is client-centered, and it conforms to scientific standards internationally (Forsyth et al., 2011; Maciver et al., 2016). Therefore, there is a value in translating the MOHOST into Sweden and investigating the use of it.
The aim of this study was to examine the utility of the Swedish version of the Model of Human Occupational Screening Tools, MOHOST.
Description of the assessment
The MOHOST (Parkinson et al., 2006) is an assessment tool designed to measure occupational participation, regardless of diagnosis. It can be used
for the evaluation of a wide range of clients with psychosocial and/or phys-ical impairments. The MOHOST measures relevant MOHO concepts, and each of the following six concepts (a–f) includes four items: (a) volition or the motivation for occupations, (b) habituation or pattern of occupation, (c) communication and interaction skills, (d) process skills, (e) motor skills, and (f) environment (Table 1).
Each item in the MOHOST (Table 1), in a total of 24 items, is rated on a four-point rating scale concerning effects on occupational participation. An “F” indicates that the item “Facilitates” occupational participation, an A that the item “Allows,” an “I” that it “Inhibits,” and finally an “R” indicates that the item “Restricts” occupational participation.
The MOHOST is primarily an assessment based on observation, however, it allows multiple data gathering methods such as observation in formal or infor-mal settings, semi-structured interviews or discussion with the client, discus-sion with carers and/or the multidisciplinary team, discusdiscus-sion with relatives, and reading medical records. The questions linked with another MOHO-based assessment, namely the Occupational Circumstance Assessment-Interview and Rating Scale (OCAIRS) (Forsyth et al., 2005), are in the User’s Manual for the
MOHOST (Parkinson et al., 2006) recommended as a helpful tool for the semi-structured interview when using the MOHOST. The time needed for gathering information is strongly dependent on which method or methods are used; consequently, no recommended time is stipulated.
The scientific standard for the English version of the MOHOST has been established by several studies. For example, Rasch analyses show that the
Table 1. Model of Human Occupation Screening Tool (MOHOST).
Concept Item
Volition or motivation for occupations Appraisal of ability Expectation of success Interest
Choices Habituation or pattern of occupation Routine
Adaptability Roles Responsibility Communication and interaction skills Non-verbal skills
Conversation Vocal expression Relationships
Process skills Knowledge
Timing Organization Problem-solving
Motor skills Posture and mobility
Co-ordination Strength and effort Energy
Environment Physical space
Physical resources Social groups Occupational demands
assessment can function as a valid and reliable measure of occupational participation (Forsyth et al., 2011).
Furthermore, the positive value of using the assessment in practice has been described by Parkinson et al. (2008) and Kramer et al. (2009) confirmed that MOHOST can be used to measure client change after treatment.
Translation process of the assessment
The User’s Manual for the MOHOST (Parkinson et al., 2006) was trans-lated into Swedish by the author in 2014. Some chapters were transtrans-lated, and some were summarized. The chapter Expanded Criteria was translated entirely. No cases were translated from the Manual. The translated version of the MOHOST was examined by three experienced OTs. One had a Ph.D., and had translated three MOHO assessments previously; one had an MSc in occupational therapy and a specialist certification, had worked in mental health for many years and used MOHO in practice; and the third had a licentiate degree in occupational therapy, had used MOHO in prac-tice and had worked in mental health for many years.
The comments from the three experienced OTs were mainly related to Swedish linguistic expressions caused by incomplete translation work. This resulted in an experimental Swedish version of the MOHOST and a back translation into the source language was completed by a professional transla-tor. This translator had experience in translating occupational therapy papers and articles. A consensus discussion between the author and the translator was then conducted, in order to compare the original version with the back translation. Any small discrepancies were caused by the wording and sen-tence structure. It was concluded that the meaning of the content was the same when comparing the original and the back translation. After that, an initial version of the MOHOST-S was completed, and it was used by 12 OTs who assessed at least four clients each. During this process, the OTs were asked to keep notes if they encountered any problems using the manual. There were very few comments from them, and the comments mainly con-cerned linguistic expressions and spelling mistakes which were considered in the completion of the final Swedish version (Haglund, 2014a), which is for sale from the Swedish Association of Occupational Therapists.
Material and method The questionnaire
A questionnaire containing questions related to the utility of the MOHOST-S was developed. According to Polit and Beck (2004, 2008) the utility of innovation, for example, testing a new assessment in practice, can
be evaluated by studying its implementation potential, clinical relevance, and scientific merit.
The questionnaire included 19 questions and used a variety of response options: yes/no options, numerical response scales, and short written answers. The first three questions collected demographic information. Question number four identified OTs who did not meet people for assess-ment in their daily work. If they did not work with assessassess-ments, they did not respond to any further questions in the questionnaire. They concluded their participation in the study after question number four.
The implementation potential comprises the transferability, feasibility, and cost and benefits of the assessment. Transferability implies the fit of innovation in a specific setting. Questions focusing on transferability in this study are, for example: How often is the MOHOST-S used? Time required for using MOHOST-S? Used method for gathering data? Feasibility con-cerns the practical part of the implementation of the innovation in practice, and it is consistent with OT functions. Feasibility also refers to the neces-sary skills for using innovation. Examples of questions focusing on feasibil-ity in the questionnaire are: Compared to other assessments you are using, what benefits and disadvantages do you see with the MOHOST-S? Do you think there is anything that should be changed in the manual? The cost and benefits of the innovation in practice, the last aspect of implementation potential, were not investigated in the present study.
The clinical relevance concerns aspects regarding the assessment’s poten-tial to give support in solving problems and decision-making in practice. To what degree does the innovation support practitioners in their daily work? Examples of questions related to clinical relevance are: Has the assessment supported you in your problem-solving process regarding the clients’ need for intervention? Has your style of communication with the client been affected? Do you think you will use MOHOST-S in the future? Would you recommend that colleagues use the MOHOST-S?
Scientific merit is focused on validity, reliability, and generalizability of the innovation. International studies support this aspect of the MOHOST. The present study, however, does not focus on this aspect of the utility of the Swedish version of the MOHOST.
Data analysis
Data collected from the yes/no options and numerical response scales in the questionnaire were analyzed using descriptive statistics. The short-written answers were mainly in short phrases. Answers for each of the questions were compiled, and answers with the same intention were clus-tered together.
Participants
In the present study, 65 persons who had had the opportunity to use the MOHOST-S for at least six months received the questionnaire by email. Twenty of those persons were OTs who had attended a two-day course with the purpose of learning how to use the MOHOST-S. These were group A. On the first day of the course, MOHO was the main theme, and on the second day, the participants learned about the MOHOST-S. For example, two films were used which were rated individually by the participants and then discussed in class.
The remaining 45 persons, group B, had purchased the assessment more than six months earlier. They had ordered the assessment by sending an email to the Swedish Association of Occupational Therapists.
An email was sent to each person (n¼ 65) separately, explaining the aim of the study and requesting participation. The study questionnaire was attached. It could be downloaded to the responder’s computer and the answers could be filled in. If they wanted, they could reply to the author and attach the completed questionnaire or they could print the completed questionnaire and send it to the author by post, or print the original ques-tionnaire, answer the questionnaire in pencil and send it by post to the author. A reminder was sent once. No questionnaire was sent back by post. All were attached to an email reply.
Results Participants
Seventeen (85%) of the 20 OTs in group A, and 30 (67%) of the 45 persons who purchased the MOHOST-S, group B, responded to the questionnaire. All those who had purchased the MOHOST-S and replied had an occupa-tional therapy education. In total, 47 OTs responded to the questionnaire (72%). Fourteen of the 17 OTs in group A answered that they had used the assessment, as did 23 of the 30 who had purchased the MOHOST-S, group B. Consequently, the investigated group consisted of 37 OTs (Figure 1). Description of participants
All except six of the OTs had a Bachelor of Science in Occupational Therapy; eight also had a Master’s degree in occupational therapy; two had a Council certification as a specialist in occupational therapy. The number of years of experience as an OT ranged from less than one year up to 36 years, while the mean number of years was 12 (Table 2).
How much knowledge the OTs had about the MOHO was assessed by themselves on a three-point rating scale running from “1 ¼ I have little
knowledge of the MOHO” to “3 ¼ I have a good understanding of the MOHO and use the model now and then in my work.” Group A, the group who had completed the course, rated their knowledge higher than group B. One occupational therapist reported that she had little knowledge, while almost two-thirds stated that they had a good understanding of MOHO (rated 3) compared to just over one-third in group B (Table 2).
Thirty-two of the OTs indicated that they used other MOHO-based assessments available in Swedish. On a supplementary question about
Group A Group B MOHOST-S course n = 20 Purchased MOHOST-S n = 45 Responded to the quesonnaire n = 17 Responded to the quesonnaire n = 30 Conducted assessments n = 14
Did not conduct assessments n = 3
Conducted assessments n = 23
Did not conduct assessments n = 7
Figure 1. Selection of participants.
Table 2. Descriptions of participants (n ¼ 37).
Group A (n ¼ 14) Group B (n ¼ 23) Totals Education Diploma Degree 2 (14%) 4 (17%) 6 (16%) Bachelor’s Degree 12 (86%) 19 (83%) 31 (84%) Master’s Degree 4 (28%) 4 (17%) 8 (22%) Council certification 2 (9%) 2 (6%) Years of experience 0–5 years 4 (28%) 5 (22%) 9 (24%) 6–10 years 2 (14%) 5 (22%) 7 (19%) 11–15 years 3 (22%) 8 (35%) 11 (30%) 16–20 years 4 (28%) 2 (9%) 6 (16%) >21 years 1 (7%) 3 (13%) 4 (11%)
Level of knowledge of MOHO
Little knowledge 1 (7%) 4 (17%) 5 (14%)
Reasonable knowledge 4 (28%) 10 (43%) 14 (38%)
which other assessment they had used, they could name several. Occupational Circumstance Assessment-Interview and Rating Scale (OCAIRS-S) (Haglund, 2014b) was listed 18 times, followed by the Worker Role Interview (WRI-S) (Ekbladh & Haglund, 2012), Dialogue about Working Ability (DWA) (Norrby & Lindahl, 2017), Occupational Self-Assessment (OSA-S) (Sj€oberg, 2012), Assessment of Communication and Interaction Skills (ACIS-S) (Haglund & Kjellberg, 2012), and Assessment of Motor and Process skills (AMPS) (Fisher & Bray Jones, 2010). Six OTs mentioned three assessments, eight mentioned two, and finally, 18 men-tioned one assessment (Table 3).
Implementation potential Transferability
The MOHOST-S was used at least once a week by 8 (22%) OTs, once a month by 22 (59%) and rarely by 7 (19%) OTs. The difference between group A and B were marginal (once a week: group A 23%, group B 20%; once a month: group A 61%, group B 59%; and rarely: group A 18%, group B 21% respectively).
In a question regarding how information was gathered, the OTs were asked to rank their principally used method from 1 to 3, where 1 repre-sented most used. “Semi-structured interview,” followed by “Observation” was most often used. Discussions with team members/carers or relatives were not used at all. Ten OTs only ranked two alternative methods used (Table 4).
The time required for assessment was reported as a “Reasonable amount of time” by 25 OTs (68%) (group A, 57%; B, 73%). Twelve stated that it took a “Long time.” No OTs rated the third finally alternative answer “excessively long time” to the question of time required for assessment. Feasibility
On the question of what benefits and disadvantages the OTs saw with the MOHOST-S compared to other assessments they used, 15 OTs did not write any comments at all. Eighteen wrote one comment, mentioning 14
Table 3. Use of other MOHO-based assessments (n ¼ 32).
Assessment Totals Group A (n ¼ 14) Group B (n ¼ 23)
OCAIRS-S 18 6 (43%) 12 (52%) WRI-S 13 5 (39%) 8 (35%) DOA 10 5 (39%) 5 (22%) OSA-S 6 2 (14%) 4 (17%) ACIS-S 4 2 (14%) 2 (9%) AMPS 1 1 (4%) Totals 52
benefits and four disadvantages; two made two comments and noted three benefits and one disadvantage, and two OTs made four comments and noted five benefits and three disadvantages. In total, there were 30 com-ments, 22 benefits (group A, n¼ 11; B, n ¼ 11) and eight disadvantages (group A, n¼ 2; B ¼ 6). The most commonly occurring response concern-ing benefits was “Gave a wide picture of the client” (n ¼ 11), “Allows mul-tiple data gathering methods” (n ¼ 5), and “Supports documentation” (n¼ 3). Other benefit comments were: “Easy to apply” (n ¼ 2), and one wrote, “Supports reporting back results to client.” Regarding disadvantages, the most frequent responses were “Difficult to get into” (n ¼ 5, all belong-ing to group B) and the other responses were “Requires too much insight into the client’s situation” (n ¼ 2) and “Takes time to perform” (n ¼ 1).
Six OTs gave feedback that there was a need to develop the manual fur-ther with more detailed descriptions. One OT from group A and three from group B stated that the concept “Volition” needed to be investigated further. And, two OTs from group B pointed out that the item “Adaptability” which is a part of the concept Habituation (Table 1) needs to be described more accurately in the Swedish version of MOHOST.
Clinical relevance
The results for clinical relevance are shown in Table 5. All except four of the OTs stated that using the MOHOST-S had influenced their communi-cation with the client. The use of the MOHOST-S was also supportive in the problem-solving process when determining the client’s need for treatment.
Thirty-two (86%) of the OTs found that the MOHOST-S had a positive impact on their ability to report to other team members about the clients’ occupational participation. Communication with authorities outside the healthcare system regarding the client’s situation was also facilitated.
All OTs reported that data from the MOHOST-S was helpful when writ-ing notes in the clients’ medical records or when write reports to other authorities.
Table 4. Data gathering methods.
Method
Rank 1 Rank 2 Rank 3
Group A Group B Group A Group B Group A Group B
(n ¼ 14) (n ¼ 23) (n ¼ 14) (n ¼ 23) (n ¼ 14) (n ¼ 23) Totals
Semi-structured interview (OCAIRS-S) 7 12 5 9 4 4 41 (40%)
Observation 3 7 5 8 4 10 37 (37%)
Discussions with client 3 4 3 4 2 2 18 (18%)
Reading medical record 1 1 2 1 5 (5%)
Most of the OTs (89%) stated that they would continue to use the MOHOST-S in practice. The four OTs who responded “No” belonged to group B. Three of them, however, would recommend that colleagues used the assessment, one would not so recommend. In total, 36 OTs would rec-ommend the use of the assessment.
Discussion
The main finding is that the Swedish version of the MOHOST is usable in practice. The results show that MOHOST-S is an appropriate and valuable assessment to incorporate into OT practice. It seems to help OTs to work in accordance with the Svensk f€orfattningssamling (2010). And, the findings contribute to the evidence-based practice in occupational therapy in Sweden; to base the decision to select an assessment on evidentiary studies and evidence, in this case, utility, helps OTs to be evidence-based practitioners.
The aim was not to investigate the difference between OTs who had learned the MOHOST-S by studying the manual by themselves compared to those who had attended a course regarding how to use MOHOST-S. Still, since the results gave the opportunity to present the two groups separ-ately, it was decided to investigate this. The groups, however, were very similar to each other. One inference could be that the manual included suf-ficient information for using the MOHOST-S in practice, and it is not necessary to participate in a course. The main difference was regarding knowledge of MOHO. Group A said that they had more knowledge than group B, and that was to be expected. Group A had learned about the model for one day during the course. It seems, however, that at least some knowledge of MOHO is enough to find the MOHOST-S suitable for practice.
OCAIRS-S (Haglund, 2014b) is available in Swedish. It may have con-tributed to the result that the semi-structured interview was the most used method for data gathering followed by observation. There were few, how-ever, who stated that they used other possible methods, and some methods
Table 5. Clinical relevance (n ¼ 37).
Questions
Yes No
Group A Group B Group A Group B
(n ¼ 14) (n ¼ 23 (n ¼ 14) (n ¼ 23) Totals Influence communication with client 13 (93%) 20 (87%) 1 (7%) 3 (13%) 37 Determine client’s need for treatment 13 (93%) 21 (91%) 1 (7%) 2 (9%) 37 Influence communication with team 12 (86%) 20 (87%) 2 (14%) 3 (13%) 37 Influence communication with other authorities 12 (86%) 20 (87%) 2 (14%) 3 (13%) 37
Influence recording 14 23 37
Use MOHOST in the future 14 19 (83%) 4 (17%) 37
were not mentioned at all. At the same time, the OTs stated that a good advantage of the MOHOST-S is that it gave a broad picture of the clients’ situation compared to other assessments because it provided the opportun-ity to use several methods for data gathering. However, is a semi-structured interview and observation enough to get a relatively good picture? Why do OTs not choose to use any other methods? Other researchers (Parkinson et al., 2006,2008) have indicated that one of the benefits of the MOHOST-S is that it permits multiple data gathering methods.
The results show that more than a third of the OTs responded that they found the time required for the assessment reasonable, and this is also reported by Hawes and Houlder (2010).
Five OTs indicated that it was difficult to understand the manual. All belonged to group B. Explanations may be that they had too little know-ledge of MOHO, that they were not familiar with MOHO-based assess-ments or that they had tested the MOHOST-S too few times. It might have been of interest to investigate this group more thoroughly; however, only a few had this difficulty.
MOHOST-S seems to be clinically relevant (Table 5). It supports OTs in communicating with clients and determining clients’ needs for treatment and facilitates communication both within and outside the health care sys-tem. This result is in line with other studies (Hawes & Houlder, 2010; Parkinson et al., 2008; Taylor et al., 2013). Furthermore, most of these OTs would use the MOHOST-S in the future and would recommend it to colleagues.
Finally, a reason for the support of utility, especially clinical relevance, of the MOHOST-S may be that it has been linked to the International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001). Each item in the MOHOST-S has been related to domains and categories in ICF in a linking project as delineated by two occupational therapists in Sweden, familiar with the assessment, the MOHO, and ICF. The linking of the assessment makes it possible, for example, to integrate the rating of the assessment to an ICF structured documentation system and to enhance communication between professions in a multidisciplinary team that is using the ICF as a shared framework (Taylor,2017).
Methodological weaknesses
The results in this study are based on participants who had chosen to use the MOHOST-S. They had chosen to take part in a course or to purchase it and had also chosen to reply to the questionnaire. A central bias may be that they were a selected group: for example, they did not want to criticize
their own choices. They may have belonged to a cohort that previously had decided to base their practice on MOHO and MOHO-based assessments. Only five OTs had not used other MOHO-based assessments. Or perhaps they belong to the group of practitioners who are fond of testing innova-tions in general (Pink, 2009)?
It might also have been of interest to investigate the cohort which did not respond at all (n¼ 18) to the questionnaire. Was the lack of response because their experience was that the MOHOST-S was not use-ful or appropriate? Furthermore, what was the reason that ten occupa-tional therapists who had had the opportunity to use the MOHOST-S for 6 months did not respond? Would their experience and opinion of the MOHOST-S affect the results of the present study in any direction? In addition, another shortcoming of the present study may be the test-ing period. Was 6 months a reasonable amount of time for investigattest-ing the utility of MOHOST-S? Most of the OTs used the MOHOST-S once a month; are the results based on too few applications? Would a follow-up after 1 year have resulted in a greater response rate and another pic-ture of the utility of MOHOST-S? It may be assumed, however, that the results are based on a reliable number of performed assessments. Thirty of the OTs had used the MOHOST-S several times, at least once a month.
It could also have been of interest to have knowledge regarding the OTs’ main area of practice. Are the results applicable in all areas or is the MOHOST-S more applicable in certain areas? With reference to instruc-tions in the Manual (Parkinson et al., 2006) the assessment can be used in both psychosocial and/or physical areas. Did the investigated group repre-sent these areas and the main areas of practice for OTs in Sweden; munici-pal elderly care (26%) and county hospitals (12%) (The Swedish Association of Occupational Therapists, 2018b)? In relation to this, it can be asked if the study had highlighted different practice areas and different groups of clients would it have resulted in extended use of multiple data gathering methods than this study show?
Regarding the utility of innovation, it can be questioned whether trans-ferability, feasibility, and clinical relevance are suitable to investigate before the scientific merit is established, as Burke and Gitlin (2012) stated, “The process of developing, testing, and implementing research-based interven-tions is complex, costly, and time consuming” (page 85). Therefore, it can be argued that the development must be relevant to practice, the practi-tioners must find the development usable if they are to get involved. From this perspective, an implication may be that questions related to the investi-gated aspects (transferability, feasibility, and clinical relevance) represented a relevant beginning.
Future research, however, should explore whether the MOHOST-S has scientific merit, and the cost and benefit aspects must also be taken into consideration. Additionally, future research should explore the clients’ per-spectives on the MOHOST-S. The assessment must reflect a meaningful view of occupational participation based on clients’ experiences.
Conclusion: As regards transferability, feasibility and clinical relevance, this first study conducted on the Swedish version of the MOHOST sup-ports its use by OTs to gain relevant information on occupational partici-pation, and therefore it can be a valuable tool when making decisions regarding the client’s need for intervention. It helps the OTs to put evi-dence-based theory into practice since the assessment is based on MOHO, an evidence-based conceptual practice model (Taylor, 2017).
Acknowledgments
The author would like to acknowledge all the OT’s who participated in the study.
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