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The Open Journal of Occupational Therapy

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Full-Text Articles in Occupational Therapy

Examining Occupational Therapy Students’ Responses To Integrative Seminars, Robyn Wu, Chi-Kwan Shea Apr 2020

Examining Occupational Therapy Students’ Responses To Integrative Seminars, Robyn Wu, Chi-Kwan Shea

The Open Journal of Occupational Therapy

The integrative seminar is an innovative teaching-learning approach that focuses on active learning and peer collaboration, characteristics that align with millennial learners’ preferences. The use of integrative seminars has been reported by various health professions with positive outcomes. Course feedback survey data from the first cohort of occupational therapy students who participated in a new four-course integrative seminar series were analyzed. Findings suggest that the format of the courses was engaging for the learners. The students particularly valued the small class; the opportunities for peer collaboration; and the variety of active learning opportunities, including simulations. The students also indicated that …


Approaches To Studying: A Cross-Sectional Comparison Of Occupational Therapy Students In Six Education Programs In Norway, Astrid Gramstad, Lene Angell Åsli, Susanne G. Johnson, Trine A. Magne, Tove Carstensen, Gry Mørk, Linda Stigen, Tore Bonsaksen Apr 2020

Approaches To Studying: A Cross-Sectional Comparison Of Occupational Therapy Students In Six Education Programs In Norway, Astrid Gramstad, Lene Angell Åsli, Susanne G. Johnson, Trine A. Magne, Tove Carstensen, Gry Mørk, Linda Stigen, Tore Bonsaksen

The Open Journal of Occupational Therapy

Students’ approaches to studying have been associated with their academic performance. Although previous research suggests that the cultural and educational context may influence approaches to studying, few studies have investigated differences in study approaches across education programs. The aim of this study was to examine whether approaches to studying differed among occupational therapy students enrolled in six different educational programs in Norway. From a population of 308 students, 187 first-year occupational therapy students in six educational programs in Norway were recruited. The students provided their sociodemographic information and completed the Approaches and Study Skills Inventory for Students (ASSIST), and group …


Patient Perceptions Of Acute Phases Of Rehabilitation Following Shoulder Arthroplasty, Elizabeth Horrall Stith, Lisa Borrero, Laura Santurri, Lori Breeden, Sarah Shemanski Apr 2020

Patient Perceptions Of Acute Phases Of Rehabilitation Following Shoulder Arthroplasty, Elizabeth Horrall Stith, Lisa Borrero, Laura Santurri, Lori Breeden, Sarah Shemanski

The Open Journal of Occupational Therapy

Background: Shoulder arthroplasty is a common procedure, but a lack of research regarding recovery and rehabilitation limits occupational therapists from providing appropriate education and support. The purpose of this study was to explore and understand the patient’s experiences in the acute recovery phase following shoulder arthroplasty.

Method: Twelve participants completed three semi-structured interviews in the first 6 weeks following surgery. A basic-interpretive approach was used before coding interview transcriptions into categories.

Results: The participants initially reported increased reliance on assistance and/or modifications in ADLs routines, such as dressing, bathing, and sleep. Interruption in sleep was reported because …


Development Of The Occupational Performance Inventory Of Sexuality And Intimacy (Opisi): Phase One, Beth Ann Walker, Kasey Otte, Kelsey Lemond, Pamela Hess, Kandyse Kaizer, Tori Faulkner, Davis Christy Apr 2020

Development Of The Occupational Performance Inventory Of Sexuality And Intimacy (Opisi): Phase One, Beth Ann Walker, Kasey Otte, Kelsey Lemond, Pamela Hess, Kandyse Kaizer, Tori Faulkner, Davis Christy

The Open Journal of Occupational Therapy

Background: The occupational therapy profession needs a framework to guide understanding of the occupational nature of sexuality and intimacy, assessment, intervention design, and measurement of outcomes. This study aimed to define the occupational nature of sexuality and intimacy and develop a theoretical and occupation-based screen, in-depth self-assessment, and performance measure.

Method: The Occupational Performance Inventory of Sexuality and Intimacy (OPISI) was developed following DeVellis’s (2017) guidelines for scale development that involved mapping the construct, generating an item pool, determining the format for measurement, and reviewing the initial item pool.

Results: The Occupational Therapy Sexual Assessment Framework (OTSAF) was developed to …


Assessing Unmet Needs Of Caregivers After Stroke: Occupational Therapist Practices And Perspectives, Deborah R. Clymer, Hadley A. Fields, Kathy Kniepmann Apr 2020

Assessing Unmet Needs Of Caregivers After Stroke: Occupational Therapist Practices And Perspectives, Deborah R. Clymer, Hadley A. Fields, Kathy Kniepmann

The Open Journal of Occupational Therapy

Background: Family caregivers of stroke survivors often feel unprepared and overwhelmed post discharge with numerous unmet needs. Occupational therapists can play an integral role in addressing family caregivers’ needs. Limited research exists on assessment practices of occupational therapists in identifying caregivers’ needs poststroke. This study explores the practices and perspectives of occupational therapists in assessing unmet caregivers’ needs.

Method: A cross-sectional, mixed methods research design was used to electronically survey 15 occupational therapists. Part 1 of the survey explored participant methods for identifying caregivers’ needs and their views on using formal caregiver assessment tools. Part 2 gathered participant perspectives on …


Pilot Study Of The Just Right Challenge Feeding Protocol For Treatment Of Food Selectivity In Children, Michelle A. Suarez, Elsie Bush Apr 2020

Pilot Study Of The Just Right Challenge Feeding Protocol For Treatment Of Food Selectivity In Children, Michelle A. Suarez, Elsie Bush

The Open Journal of Occupational Therapy

Background. This pilot study investigated the Just Right Challenge Feeding Protocol, a multicomponent treatment protocol for food selectivity that combines escape extinction, positive reinforcement, and systematic desensitization.

Method. This study used a single-subject, multiple-baseline-across-participants design to investigate whether treatment produced increases in the food inventories for seven children. All of the children in the study started with parent report of fewer than 15 foods in their dietary repertoire. A sensory profile for each child provided information for treatment planning and interpretation of the results of the study.

Results. Five out of the seven children accepted significantly more …


A Survey Of Occupational Therapy Services Provided For Adults With Autism Spectrum Disorder, Alisha Ohl, David Schelly, Dustin Brown, Nette Schulze, Maria Smith, Beth Davies Apr 2020

A Survey Of Occupational Therapy Services Provided For Adults With Autism Spectrum Disorder, Alisha Ohl, David Schelly, Dustin Brown, Nette Schulze, Maria Smith, Beth Davies

The Open Journal of Occupational Therapy

Background: We examined the services provided to adults with autism spectrum disorder (ASD) by occupational therapists across the United States.

Method: This cross-sectional study used an online survey, with a combination of structured and open-ended questions, to collect data from a nonprobability sample. Descriptive, inferential, and nonparametric statistics were used to analyze data.

Results: In our sample (N= 57), the majority of the participants spent less than half of their workweek intervening with the adult ASD population. Caregivers were instrumental in both referral and discharge, and Medicaid was the most common payer source. The Adult …


Exploring How Older People Living At Home Alone Occupy Their Time – A Time-Geographic Study, Alison Wicks, Megan Blanchard, Ingeborg Nilsson Apr 2020

Exploring How Older People Living At Home Alone Occupy Their Time – A Time-Geographic Study, Alison Wicks, Megan Blanchard, Ingeborg Nilsson

The Open Journal of Occupational Therapy

Background: Knowing what older people choose to do with their time informs occupational therapists in their everyday practice. This study explored how sixteen older Australians living at home alone without support occupied their time.

Method: People aged 70 years and older living alone in one’s home and receiving no support services were voluntary recruited. The participants completed time-use diaries for 5 days and recorded how, with whom, and where they spent time. Data were coded and analyzed using the software program Vardagen.

Results: The participants reported 217 different daily activities. While patterns of daily participation varied, all …


Effectiveness Of A Multimodal Mindfulness Program For Student Health Care Professionals: A Randomized Controlled Trial, Sharon A. Gutman, Martha Sliwinski, Justin Laird, Jennifer Nguyen Apr 2020

Effectiveness Of A Multimodal Mindfulness Program For Student Health Care Professionals: A Randomized Controlled Trial, Sharon A. Gutman, Martha Sliwinski, Justin Laird, Jennifer Nguyen

The Open Journal of Occupational Therapy

Background: The effectiveness of a multimodal mindfulness program incorporating traditional and nontraditional forms of active and nonactive meditation practices with a sample of occupational and physical therapy students was assessed in this study.

Method: Thirty-six participants were randomly assigned to an intervention or control group. The 8-week mindfulness program consisted of one weekly 40-min in-person group session and four weekly 10-min online guided meditations. Pre and postintervention measures included the Perceived Stress Scale (PSS), Student Stress Management Scale (SSMS), mindfulness activity log, open-ended qualitative questionnaire, GPA, and counseling visit frequency.

Results: Statistically significant differences, with large effect …


How To Be A Good Peer Reviewer, Diane Powers Dirette Apr 2020

How To Be A Good Peer Reviewer, Diane Powers Dirette

The Open Journal of Occupational Therapy

No abstract provided.


Quilting And Sharing: Promoting Lifelong Learning And Service To Others, Jennifer Fortuna Jan 2020

Quilting And Sharing: Promoting Lifelong Learning And Service To Others, Jennifer Fortuna

The Open Journal of Occupational Therapy

Lynne Hall, an occupational therapist, educator, and quilter based in Kalamazoo, MI, provided the cover art for the Winter 2020 issue of The Open Journal of Occupational Therapy (OJOT). “Four Patch Posy” is a 45” x 55” quilt made from cotton. In her 50th year of occupational therapy practice, Lynne’s philosophy is rooted in lifelong learning and service to others. The quilt aesthetic provides Lynne a creative medium to serve in her community. With her person-centered approach, Lynne facilitates human potential in the clients, students, and community members she serves. Success in both occupational therapy practice and quilting require a …


Developing Tailored Program Proposals For Occupational Therapy In Primary Care, Katie Smith, Mackenzie Day, Sherry Muir, Sue Dahl-Popolizio Jan 2020

Developing Tailored Program Proposals For Occupational Therapy In Primary Care, Katie Smith, Mackenzie Day, Sherry Muir, Sue Dahl-Popolizio

The Open Journal of Occupational Therapy

No abstract provided.


Self-Regulation As Key Factor In Protection Against The Harmful Effects Of Adverse Childhood Experiences: Critical Role For Occupational Therapists, Rondalyn Whitney Jan 2020

Self-Regulation As Key Factor In Protection Against The Harmful Effects Of Adverse Childhood Experiences: Critical Role For Occupational Therapists, Rondalyn Whitney

The Open Journal of Occupational Therapy

No abstract provided.


Comparing Learning Platform Impact On Low Vision Education For Occupational Therapists, Jaimee D. Perea, William Sit Jan 2020

Comparing Learning Platform Impact On Low Vision Education For Occupational Therapists, Jaimee D. Perea, William Sit

The Open Journal of Occupational Therapy

This pilot study examines the impact of face-to-face, remote, and hybrid learning platforms on satisfaction, confidence, and knowledge-application of occupational therapy practitioners during a synchronous low vision continuing education program. Fifteen participants were divided into three groups, each corresponding to one learning platform. They engaged in two 45-min learning sessions and completed pre, post, and follow-up surveys to measure the impact of the learning platform on the dependent variables of satisfaction, confidence, and knowledge application. No significant differences were found between learning platforms for the three variables, but improvements from pre to follow-up survey were found to be significant for …


Master’S And Doctoral Occupational Therapy Students’ Perceptions Of Research Integration In Their Programs, Jeffrey Sargent, Ashley Wermers, Lauren Russo, Kristin Valdes Jan 2020

Master’S And Doctoral Occupational Therapy Students’ Perceptions Of Research Integration In Their Programs, Jeffrey Sargent, Ashley Wermers, Lauren Russo, Kristin Valdes

The Open Journal of Occupational Therapy

This is a pilot study with the intent of identifying occupational therapy doctorate (OTD) and master’s (MOT) students’ perceptions of research in their coursework. A cross-sectional study was conducted through a survey of OTD and MOT students. The Student Perception of Research Integration Questionnaire (SPRIQ) was emailed to graduate occupational therapy programs in the United States. An unpaired single tailed t-test was used to compare the mean scores between the MOT and OTD student responses for each scale and subscale. Two hundred and twenty-six students filled out the questionnaire. Both the OTD and MOT students had a favorable perception …


A Personal Perspective On Daily Occupations To Counteract Cancer Related Fatigue: A Case Study, Sheila M. Longpre', Katie M. Polo, Mary F. Baxter Jan 2020

A Personal Perspective On Daily Occupations To Counteract Cancer Related Fatigue: A Case Study, Sheila M. Longpre', Katie M. Polo, Mary F. Baxter

The Open Journal of Occupational Therapy

Background: This case study aimed to identify and describe meaningful physical occupations used by a cancer survivor to increase or maintain levels of participation during active chemotherapy and subsequent cancer related fatigue.

Method: A case study approach was used to develop an in-depth description and analysis based on one participant’s experience with breast cancer and associated treatments. A semi-structured interview was conducted. The data were analyzed through description of the case, categories, and themes. It also included categorical aggregation in efforts to seek a collection of instances from the data to explore any issue-relevant meanings.

Results: Following …


Defining Mobile Tech Posture: Prevalence And Position Among Millennials, Nathan Short, Michelle Mays, Alex Cool, Ariana Delay, Ali Lannom, Laryn O'Donnell, Ruth Stuber Jan 2020

Defining Mobile Tech Posture: Prevalence And Position Among Millennials, Nathan Short, Michelle Mays, Alex Cool, Ariana Delay, Ali Lannom, Laryn O'Donnell, Ruth Stuber

The Open Journal of Occupational Therapy

Background: Mobile technologies have revolutionized daily life, significantly impacting ADLs and IADLs, as well as use of the hand and upper extremity. The primary objectives of this study are to (a) provide a formal goniometric description of mobile tech posture and (b) examine the prevalence of this sub-optimal posture among a group of graduate students.

Method: This study used a cross-sectional study design. Comprehensive goniometric measurements of the neck and upper extremity were taken with participants (N = 46) using their mobile devices while texting or using the Internet. Handheld usage data from the iPhone Screen Time …


Mapping Occupational Therapy Practice With Postsecondary Students: A Scoping Review, Karen M. Keptner, Karen Mccarthy Jan 2020

Mapping Occupational Therapy Practice With Postsecondary Students: A Scoping Review, Karen M. Keptner, Karen Mccarthy

The Open Journal of Occupational Therapy

Background: Legislation supports a role for occupational therapy in postsecondary settings, but this area is not a common practice area and the practice area is not well understood. This scoping review maps current literature of occupational therapists working with students in postsecondary settings in order to inform future research and practice.

Method: After identifying included articles, a narrative description of the quantitative studies along with a concept map were completed. A qualitative thematic analysis of the articles was also conducted.

Results: Twenty-five articles met the inclusion criteria. Quantitative results describe occupational therapy services as both a direct …


Sensory Processing Patterns And Internalizing Behaviors In The Pediatric And Young Adult General Population: A Scoping Review, Kasey Kotsiris, Jennifer Westrick, Lauren Little Jan 2020

Sensory Processing Patterns And Internalizing Behaviors In The Pediatric And Young Adult General Population: A Scoping Review, Kasey Kotsiris, Jennifer Westrick, Lauren Little

The Open Journal of Occupational Therapy

Background: While research has largely focused on the relationship between sensory processing patterns and internalizing behaviors (e.g., anxiety, depression) in children with autism spectrum disorder or attention deficit hyperactivity disorder, this relationship is not fully understood among the general population or across development.

Method: This scoping review addressed the following research question: How are sensory processing patterns associated with internalizing behaviors (e.g., anxiety, depression) among children with various conditions as well as typically developing children from birth to 22 years of age?

Results: Since 2005, n = 97 peer-reviewed articles have addressed this topic and were included …


Scoping Review Of Interventions To Promote Social Participation In Adolescents And Young Adults With Neurodisability, Conall O'Rourke, Mark Linden, Gary Bedell Jan 2020

Scoping Review Of Interventions To Promote Social Participation In Adolescents And Young Adults With Neurodisability, Conall O'Rourke, Mark Linden, Gary Bedell

The Open Journal of Occupational Therapy

Background: Social participation, described as taking part in, being involvement and engaged with, and doing or being with others, is an important health outcome. Adolescents and young adults with neurodisability are often restricted in their social participation, particularly if they experience social and executive functioning challenges. A scoping review was conducted to examine interventions aimed at improving social participation in adolescents and young adults with neurodisability characterized by these challenges.

Method: The scoping review included peer-reviewed empirical studies published from 1990 to 2016 that employed psychosocial interventions to improve social participation in young people 13 to 24 years …


Schizophrenia Spectrum Disorders: Linking Motor And Process Skills, Sensory Patterns, And Psychiatric Symptoms, Lola Halperin, Janet Falk-Kessler Jan 2020

Schizophrenia Spectrum Disorders: Linking Motor And Process Skills, Sensory Patterns, And Psychiatric Symptoms, Lola Halperin, Janet Falk-Kessler

The Open Journal of Occupational Therapy

Background: Consistent evidence suggests sensory abnormalities and skill deficits in people with Schizophrenia Spectrum Disorder (SSD). Further exploration of their sensory patterns and performance skills is warranted to promote community participation among these individuals.

Method: This study examined sensory patterns and motor and process skills in relationship to psychiatric symptoms in adult patients with SSD. Participants were evaluated using the Adolescent/Adult Sensory Profile, the Assessment of Motor and Process Skills, and the Brief Psychiatric Rating Scale.

Results: Of the 18 participants, the majority showed sensory differences, deficits in motor and process skills, and the presence of moderate …


State Of The Journal: 400,000 And Growing, Diane Powers Dirette Jan 2020

State Of The Journal: 400,000 And Growing, Diane Powers Dirette

The Open Journal of Occupational Therapy

No abstract provided.


Facilitating The Creative Process Through Collaboration, Jennifer K. Fortuna Oct 2019

Facilitating The Creative Process Through Collaboration, Jennifer K. Fortuna

The Open Journal of Occupational Therapy

Miles Parker Scharfenberg, an artist based in Richland, Michigan, provided the cover art for the Fall 2019 edition of The Open Journal of Occupational Therapy (OJOT). “Late Night Fireworks” is a 30” x 40” painting made from acrylic on canvas. Born 15 weeks premature, Miles’ multiple health impairments have made it difficult to engage in meaningful occupations, such as painting. With support from his mother, Carol; occupational therapy students; and members of the community; Miles creates colorful abstract expressionist paintings. Collaboration is part of his creative process. In this fifth anniversary issue of OJOT, Occupation and the Artist is following …


Perceptions And Outcomes Of Occupational Therapy Students Participating In Community Engaged Learning: A Mixed-Methods Approach, Amy Mattila Oct 2019

Perceptions And Outcomes Of Occupational Therapy Students Participating In Community Engaged Learning: A Mixed-Methods Approach, Amy Mattila

The Open Journal of Occupational Therapy

Today’s health care system requires therapists to acquire a level of confidence, flexibility, and personal growth that enables them to treat a diverse and complex clientele. Occupational therapy programs need to ensure that clinical placements can best prepare students for these demands. Community engaged learning (CEL) offers a distinctive opportunity both to meet the curricular requirements of fieldwork and to afford students the chance to develop unique sets of skills. The purpose of this mixed-methods study was to examine the experiences of graduate occupational therapy students participating in CEL fieldwork placements. The study explored the students’ self-efficacy before and after …


Occupational Therapy’S Work And Industry Area Of Practice: Content In Entry-Level Professional Occupational Therapy Curricula: A Survey, Thomas F. Fisher Oct 2019

Occupational Therapy’S Work And Industry Area Of Practice: Content In Entry-Level Professional Occupational Therapy Curricula: A Survey, Thomas F. Fisher

The Open Journal of Occupational Therapy

The Occupational Therapy Practice Framework: Domain and Process identifies work as an area of occupation that has long been recognized by the profession as an area of practice. This study identified how entry-level professional occupational therapy programs meet educational standards required by the Accreditation Council for Occupational Therapy Education for educational programs. Standards identified were those that relate to the area of work and industry practice. One hundred and sixty-seven program directors were invited to participate in a survey directed at work and industry occupational therapy practice. Items on the survey related to content taught in their entry-level occupational therapy …


Evaluation And Treatment Of Musicians From A Holistic Perspective, Annie Ting, Janice Rocker Oct 2019

Evaluation And Treatment Of Musicians From A Holistic Perspective, Annie Ting, Janice Rocker

The Open Journal of Occupational Therapy

Throughout the past 3 decades, treatment of injured musicians in a health care setting has been reported; however, the quality of care from a musician’s standpoint is poor. As musicians are speaking up more about their pain, the profession of occupational therapy has the capacity to make an impact on the way musicians are treated from a rehabilitative perspective. Musicians often do not trust medical practitioners who follow the traditional medical model because their symptoms and concerns are not addressed. Occupational therapists, especially those working in the realm of hand rehabilitation, are well equipped to treat injured musicians using our …


Effect Of Verbal Directions On Grip Strength Evaluated Using The Handheld Dynamometer, Laura Walsh, Marie-Christine Potvin Oct 2019

Effect Of Verbal Directions On Grip Strength Evaluated Using The Handheld Dynamometer, Laura Walsh, Marie-Christine Potvin

The Open Journal of Occupational Therapy

Background: Grip strength measurement using the handheld dynamometer is a key aspect of the evaluation of an upper extremity injury. The handheld dynamometer manufacturer has established research-based guidelines outlining body positioning during grip strength measurement. However, verbal direction guidelines, while provided, have not yet been shown to be most effective through research. This study seeks to determine whether the use of one of two types of verbal directions, with and without encouragements, resulted in greater grip strength as measured by the handheld dynamometer.

Method: The grip strength of healthy females (n = 60) was compared using two sets of prerecorded …


Use Of Standardized Assessments And Online Resources In Stroke Rehabilitation, Susan H. Lin, Pamela R. Bosch, Veronica T. Rowe, Susan E. Fasoli, Jeanne Langan Oct 2019

Use Of Standardized Assessments And Online Resources In Stroke Rehabilitation, Susan H. Lin, Pamela R. Bosch, Veronica T. Rowe, Susan E. Fasoli, Jeanne Langan

The Open Journal of Occupational Therapy

Background: The extent to which movement-related standardized assessments and online resources are used in stroke rehabilitation is unclear in the United States.

Method: The researchers used a cross-sectional descriptive survey that examined (a) therapists use of movement-related standardized assessments, (b) factors influencing learning of new assessments, and (c) use of frequency of online resources by occupational therapists and physical therapists in the United States.

Results: Of 151 respondents (46.4% occupational therapists, 53.6% physical therapists), the most frequently used movement-related assessments by occupational and physical therapists were the Berg and Fugl-Meyer Assessment, respectively. More physical therapists use motor-related …


Health Management: Occupational Therapy’S Key Role In Educating Clients About Reliable Online Health Information, Amy Armstrong-Heimsoth, Melissa L. Johnson, Meredith Carpenter, Tincey Thomas, Ashley Sinnappan Oct 2019

Health Management: Occupational Therapy’S Key Role In Educating Clients About Reliable Online Health Information, Amy Armstrong-Heimsoth, Melissa L. Johnson, Meredith Carpenter, Tincey Thomas, Ashley Sinnappan

The Open Journal of Occupational Therapy

Background: Only 12% of Americans possess proficient health literacy skills. Among those with the lowest health literacy are individuals with chronic health conditions. Occupational therapists are well prepared to assist these clients with health literacy, given our roles in teaching new health management skills and health promotion.

Methods: An educational course was designed and taught to over 100 individuals and caregivers with chronic health conditions to assist in finding and determining trustworthy health information online. An author designed pre postsurvey was used to evaluate effectiveness.

Results: There was a significant pre-post change in four categories: finding quality …


Productivity Standards And The Impact On Quality Of Care: A National Survey Of Inpatient Rehabilitation Professionals, Leslie E. Bennett, Vanessa D. Jewell, Linda Scheirton, Molly Mccarthy, Brittney C. Muir Oct 2019

Productivity Standards And The Impact On Quality Of Care: A National Survey Of Inpatient Rehabilitation Professionals, Leslie E. Bennett, Vanessa D. Jewell, Linda Scheirton, Molly Mccarthy, Brittney C. Muir

The Open Journal of Occupational Therapy

Background: Skyrocketing health care costs have resulted in significant changes to reimbursement rates in health care. The result has increased pressure to be as efficient as possible while maintaining high-quality care. The purpose of this exploratory study was to examine health care professionals’ perceptions on whether and how productivity pressures have impacted the quality of care in therapy practice.

Method: A survey was disseminated nationally to inpatient rehabilitation facilities.

Results: Two hundred and fifty-seven surveys were opened. Of these completed surveys, 154 participants completed the closed-ended questions and 109 participants completed the open-ended questions. Outcomes indicated that …