Australian Occupational Therapy Journal (2015) 62, 228–237

doi: 10.1111/1440-1630.12191

Research Article

Exposure to occupational therapy as a factor influencing recruitment to the profession Nicole Byrne Speech Pathology, University of Newcastle, Dangar, New South Wales, Australia

Aim: This article provides insight into the impact that exposure to an occupational therapist, in personal capacity or via a professional interaction, has on the decision to enter an occupational therapy undergraduate programme. Methods: A quantitative survey was completed by 139 occupational therapy students. The survey tool focussed on the students’ exposure to a range of allied health professions (e.g. occupational therapy, physiotherapy, psychology) and investigated how exposure to occupational therapy had influenced their decision to enter the programme. Results: The results indicated that over 70% of respondents had personal professional exposure to occupational therapy prior to making a career decision. Exposure most frequently involved occupational therapy intervention of a friend or family member. The majority of students who had professional exposure to occupational therapy (e.g. family, self, friend received occupational therapy) identified that it was the most influential factor in their career choice. Forty per cent of the occupational therapy students did not enter the programme straight from school and the influence of ‘working with an occupational therapist’ was noteworthy for mature aged students. Conclusion: Occupational therapists need to consider that every interaction they have with the community provides valuable information regarding the profession and gives insight into occupational therapy as a potential career path for other people. Additionally, the current research identifies there were differences in the impact, type and number of exposures for different student groups, and this potentially offers some insight into ways in which occupational therapy could target specific groups within the community to increase future diversity in the profession.

Nicole Byrne PhD, MAM (Health), BAppSc (Speech Pathology). Correspondence: Nicole Byrne, Speech Pathology, University of Newcastle, Callaghan Campus, Dangar 2308, NSW, Australia. Email: [email protected] Accepted for publication 6 January 2015. © 2015 Occupational Therapy Australia

KEY WORDS career choice, workforce, exposure to occupational therapy.

Introduction Research into career choice in occupational therapy has been prompted by concerns of future shortages within the field both in Australia and internationally (Craik, Gissane, Douthwaite & Philp, 2001; National Health Workforce Taskforce, 2009; Productivity Commission, 2005). In order to ensure adequate supply of professionals in the workforce, it is clear there needs to be an understanding of the factors that influence the decision to enter an allied health profession, and in particular, an occupational therapy programme. Understanding the factors that influence career choice will provide clear guidance on ways to attract sufficient students into the profession in order to meet future demands. Additionally, understanding the factors that influence different groups will assist to identify ways to target people in the community who are currently unlikely to enter occupational therapy (e.g. men, people from culturally and linguistically diverse groups, including Aboriginal people) (ACT Health Allied Health Advisor’s Office, 2008; AIHW Australian Institute of Health and Welfare, 2006; Fleming, Gilbert, McKenna & Heath, 1997).

Literature review A study conducted by Madigan (1985) considered the differences between students entering different levels of occupational therapy training (i.e. occupational therapy students vs. occupational therapy assistant students) to assist in specific recruitment strategies that would target the two different subgroups within occupational therapy. Madigan (1985) used a work values inventory and found that both occupational therapy and occupational therapy assistant students identified altruism as their highest ranking work value. It has since been well reported that occupational therapy students enter the programme influenced by their desire to help others (Byrne, 2008a; Cooperstein & Barker Schwartz, 1992;

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Craik & Wyatt-Rollason, 2002; Davis, 2008; Fleming et al., 1997; Meredith, Merson & Strong, 2007; Roney, Meredith & Strong, 2004) and regard helping others as a major component of the work (Turpin, Rodger & Hall, 2012). Dudgeon and Cunningham (1992) identified that 30% of occupational therapy students selected ‘an adult in health’, 25% a ‘medical incident’ and 10% ‘personal experience as a patient’ as an influential factor in the decision to enter occupational therapy. None of these exposure categories were specified as directly involving an occupational therapist and could in fact involve any medical professional. More recently research has identified that work in health care was the method by which students first heard about occupational therapy – reported by 24.6% (Craik & Zaccaria, 2003) and 30% of students (Craik et al., 2001). Research also suggests that career choice and the decision to enter a health programme is associated with contact with ‘a health professional in your field’ (Baldwin & Agho, 2003) and a health professional who was a family member or friend (Townsend & Mitchell, 1982) though not specified as an occupational therapist, were influential. Later studies examined exposure to the profession through therapy or knowing an occupational therapist. Studies of occupational therapy students showed that approximately three to four per cent of the students reported receiving occupational therapy intervention themselves (Craik et al., 2001; Townsend & Mitchell, 1982; Wyrick & Stern, 1987). Research to date has considered the connection between personal receipt of occupational therapy services and those received by another person, but has typically combined the two options into the one category, and this has been reported as a source of information or influence to enter the profession by between one and 12% of occupational therapy students (Cooperstein & Barker Schwartz, 1992; Craik & WyattRollason, 2002; Craik & Zaccaria, 2003; Craik et al.; Fleming et al., 1997). In an Australian study, seven per cent of occupational therapy students reported they had a parent or relative who was an occupational therapist (Fleming et al.). In overseas research, the number of students who reported to know an occupational therapist as a family member or a friend varied from 12 to 51% (Craik & Alderman,1998; Craik & Wyatt-Rollason; Craik et al.). Approximately 25% of students report an occupational therapist was an influential source of information about the profession (Cooperstein & Barker Schwartz; Wyrick & Stern). This is consistent with speech-language pathology findings that contact with the profession was a strong influencing factor on the decision to enter the profession (Byrne, 2007a,b, 2008b). Wyrick and Stern (1987) identified contact with both occupational therapists and occupational therapy students proved a successful recruitment tool, but they did not specify whether the contact was personal (e.g. friend) or professional (e.g. related to the receipt of

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intervention). Rozier, Gilkeson and Hamilton (1992) reported 22% of students had worked in an occupational therapy department and the experience had a positive influence. However, Rozier et al. also identified being acquainted with an occupational therapist, or the recipient of occupational therapy (‘self’ or ‘relative’) had not been a significant factor in career choice. Craik and Alderman (1998) reported 50% of a small sample had worked in an occupational therapy department and 35% identified it had influenced their decision. Parents, family members and friends were also highlighted as general sources of influence or information regarding occupational therapy (Dudgeon & Cunningham, 1992; Madigan, 1985; Meredith et al., 2007; Wyrick & Stern). The concept of occupational therapy as a second career has been investigated to suggest that many mature age occupational therapy students were not aware of the profession when leaving school (Craik & Alderman, 1998; Craik & Napthine, 2001), and had entered occupational therapy only after their initial degree and subsequent employment had put them in contact with an occupational therapist. American studies also showed that working in an occupational therapy department was an important source of information about occupational therapy for many prospective students (Cooperstein & Barker Schwartz, 1992; Craik & Alderman, 1998; Craik et al., 2001; Rozier et al., 1992; Townsend & Mitchell, 1982). Australian researchers (Fleming et al., 1997) did not identify working in an occupational therapy department as a key source of information, but this may reflect different utilisation of occupational therapy assistants at that time. Wheeler (2001) reported 42% of ‘non-traditional’ students had direct exposure to occupational therapy practice before entry. However, Wheeler also did not clarify what ‘non-traditional’ encompassed, although reference was made to ethnic minority students and/or those not entering directly from school in the results. The Systems Theory Framework (Patton & McMahon, 1999) has been successfully applied as an underpinning theoretical framework to speech-language pathology career choice research (Byrne, 2007a,b). The Systems Theory Framework considers, and allows theorising about the interaction between factors that are influential in career decision-making, especially relevant for speech-language pathology were the individual (e.g. interests, altruism) and social system (e.g. family, exposure to a speech-language pathologist) (Byrne). Thus, with reference to the factors already identified in the previous research for occupational therapy career choice, exposure to occupational therapy, either through therapy or knowing an occupational therapist, is an example of what is described within the Framework as ‘recursiveness’, where both interaction and influence can occur between individual factors (including interests, personality, values, e.g. helping others) and social systems (e.g. family, friends) as a part of the career © 2015 Occupational Therapy Australia

230 decision-making process. This paper will consider the application of the theoretical framework in career choice for occupational therapists. The research data presented illustrates the difficulties in making comparisons of the influences of exposure to occupational therapy, as studies utilise different categories. The current research aims to:  Clearly articulate the number and types of exposure to occupational therapy prior to entering the programme  Identify the impact these exposures may have on the decision to enter the occupational therapy programme and  Consider whether exposures are different for discrete groups.

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TABLE 1: Participant demographics (n = 134*) Age Gender Country of birth

Language spoken at home

Minimum – 17 years, Maximum – 47 years Female n = 125 (90%) Male n = 14 (10%) Australia n = 124 (93%) New Zealand n = 2 (1.5%) One student from each of the following countries: South Africa, India, Brunei, Korea, Hong Kong, England, Germany, Malaysia English n = 128 (95.5%) English + other language n = 1 (0.7%) Other language n = 5 (3.7%)

*Five participants did not respond to demographic data.

Method Ethics approval from the University of Newcastle Human Research Ethics Committee (H-954-0205) was attained. The author, who was not affiliated with the occupational therapy programme, introduced the research as part of a larger study of research into career choice of allied health and education undergraduate students enrolled in an Australian regional University. The voluntary and anonymous questionnaire was handed out to 166 occupational therapy students at the commencement of an occupational therapy lecture. Students were invited to participate in the research by completing the questionnaire. Confidentiality and anonymity of responses was ensured by providing the participants with a box at the end of the room to return the questionnaires. Alternatively, they could use the postage paid envelope that was attached to each questionnaire. Consent was implied through completion of the questionnaire. As part of a larger questionnaire the participants replied to questions about their exposure to a range of allied health professions (e.g. occupational therapy, speech-language pathology, physiotherapy, social work, psychology). They were asked to rate and rank how exposure to the profession they were studying (occupational therapy in this case) had influenced their decision to enter that undergraduate programme. Students were also asked to rate three statements using a 5-point Likert scale: (1) disagree strongly, (2) disagree, (3) neutral, (4) agree or (5) strongly agree.

Results Participant data There was a response rate of 83.7%, with 139 of the survey questionnaires returned completed. Table 1 identified students were mostly female and born in Australia. The students had an average age of 22.4 years. 18% of the students entered the programme as mature aged students, i.e. over 21 years on entry and interestingly

© 2015 Occupational Therapy Australia

six of the male participants entered the programme as mature aged students. None of the students identified as Aboriginal/Torres Strait Islander. The students were in the first (31.9%), second (37.7%), third (6%) or fourth year (24.6%) of the occupational therapy programme. For 77% of the students, the occupational therapy programme was their first programme choice. Students who identified occupational therapy was not their first programme choice, were most likely to identify physiotherapy (n = 21) as their first choice, followed by other medically related programs such as Medicine, Medical Radiation Science, Speech-Language Pathology. Nearly 60% of the students identified they had entered the occupational therapy programme immediately after the completion of high school studies. The remaining students reported they were working, doing a University bridging course, travelling or were enrolled in another University programme prior to entering occupational therapy. Students identified they worked in a range of roles prior to entering the occupational therapy programme, including physiotherapy aide, diversional therapist, dental assistant and retail. Previous University enrolment immediately prior to entering occupational therapy, largely consisted of enrolment in the Nursing (35%) or Science (35%) programme. Overseas occupational therapy workforce literature has considered factors relating to mature aged entry into occupational therapy (Craik & Alderman, 1998; Craik & Napthine, 2001; Craik & Zaccaria, 2003). The current research has the opportunity to consider factors relevant to career choice in the Australian context. Additionally, occupational therapy demographics identifies men as less likely to enter the profession (ACT Health Allied Health Advisor’s Office, 2008; AIHW Australian Institute of Health and Welfare, 2006; Fleming et al., 1997) the current research has sufficient numbers to be able to consider men as a discrete group – whereas acknowledging the numbers are small and limited conclusions possible.

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Students reported they were on average 17.7 years old when they first heard about occupational therapy, although this varied from 5 to 40 years. Overall, 37 of the students identified they had a parent who worked in the health field, this included two students who had a parent who was an occupational therapist. Some students reported both of their parents worked in health; this included a range of medical professions, including General Practitioner, nurse, pharmacist, social worker and psychologist.

Exposure to occupational therapy The students were investigated whether they had any exposure to occupational therapy prior to entering the programme. Table 2 identifies the greater majority of students did have exposure to occupational therapy (i.e. 70%). The results of both mature age and male students were also considered separately, there were 24 mature aged students (six of the males were also mature aged and are reported in both categories). Nearly 80% of the males reported prior exposure to occupational therapy. Of note, the students who were

TABLE 2: Number (and %) of students reporting any exposure to occupational therapy prior to entering the programme

Total students (n = 139) Mature aged (n = 24)* Males (n = 14)*

Previous exposure to occupational therapy

No exposure to occupational therapy

98 (70.5) 16 (66.6) 11 (78.6)

41 (29.5) 8 (33.3) 3 (21.4)

*Six students fell into both male and mature aged category.

born overseas were less likely to have had exposure to occupational therapy (60%). The exposure to occupational therapy was further defined as personal or professional exposure. Personal exposure to occupational therapy comprised of personally knowing an occupational therapist prior to entering the occupational therapy programme. This personal contact or exposure was identified as having a parent who was an occupational therapist or a family member or friend who was an occupational therapist or occupational therapy student. The results (Table 3) suggest that it was more likely that students had personal exposure to occupational therapy through having a friend who was an occupational therapist or an occupational therapy student (i.e. ‘friend an occupational therapy (student)’ 47.5%) rather than a ‘family member’ (3.6%) or a ‘parent’ (1.4%) who was an occupational therapist. Professional exposure to occupational therapy was comprised of exposure related to therapeutic contact or involvement by an occupational therapist – this referred to either the students themselves receiving occupational therapy or a family member or friend receiving occupational therapy prior to entering the programme. Students were more likely to identify professional exposure to occupational therapy through a ‘friend received occupational therapy’ (reported by 33.8%) or ‘family member received occupational therapy’ (25.2%), rather than themselves being the recipient of occupational therapy which was reported by eight students (5.8%). However, both the mature aged and male students did have a proportionally higher report of ‘I received occupational therapy’ (12.5% and 14.3%) than the whole cohort, but given the number in the sub sample it is not possible to draw conclusion from this. Male participants were similar to the whole group in the reporting having a ‘friend an occupational therapy’ but were unlikely to report a ‘friend received occupational therapy’. From the responses, it became apparent that the spread of number of exposures varied. Table 4 shows 71 (51.1%) of the 139 students identified they had had some type of personal exposure to occupational therapy, that is they

TABLE 3: Number (and %) and type of personal and professional exposures to occupational therapy

Exposure

Type

Number (%) of total occupational therapy students (n = 139)

Personal exposure

Parent an occupational therapist Family member an occupational therapist (student) Friend an occupational therapist (student) I received occupational therapy Family member received occupational therapy Friend received occupational therapy

2 5 66 8 35 47

Professional exposure

(1.4) (3.6) (47.5) (5.8) (25.2) (33.8)

Number (%) of mature age* students (n = 24)

Number (%) of male* students (n = 14)

– 1 12 3 5 10

– – 7 2 3 1

(4.2) (50) (12.5) (20.8) (41.7)

(50) (14.3) (21.4) (7.1)

*Six students fell into both male and mature aged category. © 2015 Occupational Therapy Australia

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students were more likely to report multiple (between two and four) exposures to occupational therapy (i.e. 45.9%), than was reported by the total cohort (31.7%) (Table 4). Students were asked to both rate and rank the top factor influencing their decision to enter the occupational therapy programme; these factors made specific reference to the impact that prior personal and professional exposure to occupational therapy had on the decision to enter the programme. It is shown in Table 5 students were most likely to identify ‘parents/family’ as most influential in their decision to enter occupational therapy; this was selected by 44.7% of the total students. This high number may partially reflect the large number of students who reported to either have a parent or family member who was an occupational therapist (n = 7) or a parent working in the health field (n = 37). The influence of a parent/family member who was an occupational therapist would provide multiple exposures to occupational therapy over an extended period of time and this would also be consistent with some students’ reports they were first aware of the profession at 5 years of age. There may also be a similar influence regarding working generically in the health field.

had a parent, a family member or a friend who was an occupational therapist or occupational therapy student and 66 (47.5%) identified some type of professional exposure to occupational therapy prior to entering the programme. The results also show that while most of the students had one exposure to occupational therapy, some students had multiple exposures. Multiple exposures were more likely to be ‘professional exposure’, with 20 students reporting two types of professional exposures (e.g. self and/or family and/or a friend had received occupational therapy) prior to entering the occupational therapy programme, whereas only three students reported two personal exposures to occupational therapy. Overall the mature aged students (46%) were more likely than the overall group (32%) to report multiple exposures to occupational therapy. Overall, the students were most likely to report they had one exposure to occupational therapy prior to entering the programme this was reported by 38.8% of the overall group and could have been either a personal (48.9%) or a professional (31.7%) exposure. Similarly nearly a third reported they had multiple exposures to occupational therapy prior to entering the programme. The males were more likely to report one exposure to occupational therapy (64.3%), whereas the mature aged

TABLE 4: Number (and %) of students reporting multiple personal or professional exposures to occupational therapy Exposure

0 Exposure

1 Exposures

2 Exposures

3 Exposures

4 Exposures

Personal exposure (n = 139) Professional exposure (n = 139) Total personal and professional exposures (n = 139) Mature aged (n = 24)* Males (n = 14)*

68 73 41 8 3

68 44 54 5 9

3 20 24 7 2

– 2 (1.4) 19 (13.7) 4 (16.7) –

– – 1 (0.7) – –

(48.9) (52.5) (29.5) (33.3) (21.4)

(48.9) (31.7) (38.8) (20.8) (64.3)

(2.2) (14.4) (17.3) (29.2) (14.3)

*Six students fell into both male and mature aged category. TABLE 5: Students, with prior exposure to occupational therapy, ranked the most influential factor for entering the occupational therapy programme

The most influential factor

Number (%) total students (n = 94)*

Number (%) mature age (n = 14)

Number (%) males (n = 9)

Parents/family Friend an occupational therapist (student) Working with an occupational therapist Family member used occupational therapy services I used occupational therapy services Family member an occupational therapist Family member works with an occupational therapist

42 17 12 8 6 5 4

4 3 4 1 2 – –

4 1 1 2 1 – –

(44.7) (18.1) (12.8) (8.5) (6.4) (5.3) (4.3)

(28.6) (21.4) (28.6) (7.1) (14.3)

(44.4) (11.1) (11.1) (22.2) (11.1)

*Four students who had exposure to occupational therapy did not rank the most influential factor in entering the occupational therapy programme. © 2015 Occupational Therapy Australia

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TABLE 6: Mean student rating* related to their career choice of occupational therapy

Happy with my choice of programme (occupational therapy) Knew a lot about occupational therapy Confident I will perform well as an occupational therapist

Overall (n = 139)

Exposure to occupational therapy (n = 98)

No exposure to occupational therapy (n = 41)

4.32 3.03 4.05

4.33 3.04 4.03

4.29 3.02 4.10

*5-point Likert scale: (1) disagree strongly, (2) disagree, (3) neutral, (4) agree or (5) strongly agree.

A ‘friend an occupational therapy (student)’ was identified overall by 17 students (18.1%) as the most influential factor; however, it was less influential for the male participants in the sample (11.1%). Similarly, in Table 5, six students reported ‘I used occupational therapy services’ as the most influential factor in the decision to enter occupational therapy, which corresponds with eight students reporting that they had themselves received occupational therapy in Table 3. Five students identified that ‘family member an occupational therapist’ was the most influential factor in their decision to enter occupational therapy, this corresponds with Table 3, where five students identified they had a family member who was an occupational therapist. However, neither males nor mature aged students identified that a ‘family member an occupational therapist’ was influential. For the mature aged students ‘parents/family’ and ‘working with an occupational therapist’ were equally influential factors. For the male participants, ‘parents/family’ were clearly the most influential factor in the decision to enter the occupational therapy programme, followed by ‘family member used occupational therapy’. Additionally, nearly 40% of the males identified they had a parent who worked in the health field (e.g. nurse, social worker, mental health worker). Students were also asked to rate the following statements: (i) I am happy with my choice of programme, (ii) I knew a lot about my programme before entering (iii) I am confident I will perform well as an occupational therapist (see Table 6). Regardless of whether students had exposure to occupational therapy they were likely to Agree (4) with the statement that they were happy with their career choice in occupational therapy and were confident that they would perform well as an occupational therapist. Student responses were Neutral (3) to the statement regarding their knowledge about occupational therapy prior to entering the programme, again regardless of exposure.

Discussion This study has built on previous research into career choice in occupational therapy, it has provided conclusive evidence regarding the role that exposure to

occupational therapy has on the decision to enter the occupational therapy programme. The breadth of the Systems Theory Framework (Patton & McMahon, 1999) acknowledges both diversity in experiences and individual differences. These were evident through students’ reports of different numbers and types of exposure to occupational therapy and the presence of a range of different factors as influential for career choice. The number of male participants in the sample was consistent with international research (Craik & Zaccaria, 2003; Craik et al., 2001), although slightly higher than currently registered as occupational therapists in Australia (8.26%) (Occupational Therapy Board Australia, 2013). Although there were few students born overseas or who spoke a language other than English at home, this was also consistent with the previous demographics of occupational therapy research in Australia (Fleming et al., 1997), which may be less ethnically diverse than occupational therapy professionals elsewhere (Craik & Zaccaria). However, it remains unclear, like in speechlanguage pathology (Byrne, 2010), why certain groups of people are less likely to enter occupational therapy, such as men and people from Indigenous and minority backgrounds. Low numbers of Indigenous staff working across the health professions has been reported (Hindmarsh, 2003; O’Kane & Curry, 2003). Researchers believe that one way to address the current health discrepancies between Indigenous and non-Indigenous people is through increased numbers of trained Indigenous health-care workers (Murray & Wronski, 2006). The low diversity in occupational therapy, poses challenges for the profession in order to be able to meet the diverse needs of the population. Byrne (2008a) identified male allied health students were more likely to acknowledge they wanted to help ‘society’ as opposed to ‘individuals’ and that this concept of promoting the allied health profession as contributing to the wider community and society could be utilised to attract a greater number of men to allied health professions. In this sample, 58% of the students reported they had entered the programme from high school. Compared to other Australian research these results were marginally higher than Fleming et al. (1997) who reported 47% had entered occupational therapy straight after high school. © 2015 Occupational Therapy Australia

234 However, the proportion of mature aged students in UK studies was noticeably higher, and this may reflect differences in the occupational therapy programs admissions procedures and diversity of routes into entry level programs. In UK, Craik and Zaccaria (2003) identified 27–34% of the students were under 21 years of age at entry. This study identified some students (23%) reported occupational therapy was not their first programme choice, this was substantially lower than the 70% reported by Baldwin and Agho (2003) and yet higher than a previous Australian study by Fleming et al. (1997), where 14% selected occupational therapy after being unsuccessful in entering another programme.

Personal exposure The report of a close relative (i.e. parent or family member) as an occupational therapist by 6% was consistent with previous reports (7%) (Fleming et al., 1997). However, the salience of that exposure is now apparent, five students identified they had a ‘family member an occupational therapist/student’ and this was recognised as the most influential factor in career choice for those five students. The role of a friend who was an occupational therapist (or occupational therapy student) has not been consistently explored in the literature. These results strongly suggest a peer is a valuable source of information regarding the occupational therapy program. Nearly half of the students in reported having a friend who was an occupational therapist or occupational therapy student, which was three times that reported in UK research (Craik & Zaccaria, 2003). The influence of a friend was reported as greater for female and mature age students than for male participants. The current study supports the findings of Craik and Zaccaria (2003) who identified over a two year period that increased numbers of students reported occupational therapist contact was influential on programme entry. Craik and Zaccaria also identified the significance of professional exposures on subsequent career plans at the end of the occupational therapy programme. Australian researchers McKenna, Scholtes, Fleming and Gilbert (2001) showed 87% of occupational therapy students reported a particular clinician as having the greatest impact on their future career plans. ‘Working with an occupational therapist’ was the third most influential factor for the overall cohort. It was the second most influential factor for the mature aged students, which is consistent with some of the mature aged students reporting they had been working in the health related profession prior to entering the programme.

Professional exposure Similar to previous occupational therapy research, current participants were more likely to report that a friend © 2015 Occupational Therapy Australia

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or a family member had received occupational therapy than themselves. However, 6% of the participants (n = 8) had received occupational therapy themselves before entering the programme, which is nearly double the 3.7% previously reported (Rozier et al., 1992). This finding is consistent with speech-language pathology (SLP) studies by Byrne (2008b) who found 6.3% of SLP students had received intervention prior to entering the SLP programme (Byrne). Additionally, these results identified the impact and relevance of that exposure; 75% of students who had professional exposure to occupational therapy through being the recipient of occupational therapy identified that it was the most influential factor in their choice of occupational therapy as a career. The identification of wanting a physical ‘hands on’ career in reference to selection of occupational therapy as a career (Byrne, 2010) may highlight the importance of the exposure of therapy and the benefits of observing therapy in action (i.e. ‘first hand’ experience). The current research identifies a greater number of professional exposures to occupational therapy and a higher relative importance of receiving intervention than previous research-which may be a reflection of increased utilisation and knowledge regarding occupational therapy in the general public than the earlier studies. Students’ report that a ‘family member received occupational therapy’ (25.2%) was considerably higher than had been previously reported elsewhere. In Rozier et al. (1992) 9.6% of students reported a family member had received occupational therapy. The impact of a family member having received occupational therapy was identified as the most influential factor in career choice in eight students; this was specifically relevant for female and non-mature aged students. The strength of the impact of a family member receiving therapy was described in a keynote address by Matthew Molineux who described his younger sister’s utilisation of occupational therapy. Molineux (2011) described the impact of his parents’ being impressed with the services provided by the occupational therapist and being able to see the clear benefit that regular intervention had on his sister, as the key factors that resulted in him considering occupational therapy as a career. These results clearly articulate the role of personal or professional exposure to occupational therapy has on future career choice and highlights how these contacts can be used to promote the profession to groups who currently are not likely to enter the profession (e.g. people from culturally and linguistically diverse and Aboriginal backgrounds, men). The results suggest that the presence of previous exposure to occupational therapy was not related to whether the students were happy with their programme choice, knew a lot about occupational therapy before entering or were confident they would perform well as an occupational therapist. These statements may have been influenced by a range of other factors, including number of years of the occupational therapy programme completed

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and completion of clinical placements. This also acknowledges the likely role of other information sources about occupational therapy (e.g. websites, professional association). In this research a large number of students identified their ‘parents/family’ were influential in career choice. Recent allied health research in this area has been mixed, a study across a range of allied health and nonhealth students developing a predictive scale suggested parents were not influential in career choice (Barfield, Folio, Lam & Zhang, 2011). While research into attachment styles identified no difference between commerce and occupational therapy students in regard to parental influence, but found parental influence was important for occupational therapy students with a ‘preoccupied’ attachment style (Meredith et al., 2007). In the current study, 45% of students reported that parents/family were the most influential factor in career choice. These results identified a weaker presence of parental influence, when compared to other studies, as Roney et al. (2004) conversely reported 45% of their cohort identified parental influence was ‘not at all or not very important’. Previous research with occupational therapy students had not reported upon parental work in the health fields. It is anticipated that parental exposure to occupational therapy in the workplace is a possible source of knowledge regarding the profession. For this sample, 37 students reported to have a parent who worked in a health field, so it can be expected that the influence of a parent/family may have also extended to the parents’ knowledge of health and medical services and the role of the occupational therapist based on their working knowledge. The students who had exposure to occupational therapy personally or professionally prior to entering the programme were still likely to identify their ‘parents/family’ as influential. Interestingly, the male participants who participated in the study were more likely to be mature aged, yet clearly identified the influence of ‘parents/family’ as the most influential factor on their career choice. Consideration must be given to whether this relates to engaging support for moving into a woman-dominated ‘pink collar’ profession, or whether it related to the high number of males reporting their parents worked in the health field. These results suggest that occupational therapists’ contact with other professionals may provide impetus for those professionals to suggest occupational therapy as a career to their child, and this appears to especially the case for male children. Further research would benefit from separating categories ‘parents’ and ‘family’ to more specifically consider the potential comparative influence of ‘parents’ vs. other ‘family members’, including a partner/spouse or children, which may be especially pertinent for mature age students. Forty per cent of the students identified they did not enter the programme straight after high school and 18% were mature aged students. This suggests that the stu-

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dents had a range of opportunities to mix with people and other students, who may have been a source of information regarding occupational therapy. Wheeler (2001) identified 42% of ‘non-traditional’ occupational therapy students had direct contact with the profession prior to entry and also reported a lower incidence of considering leaving the programme. Similarly, nearly two-thirds of Craik and Napthine’s (2001) mature aged students identified their former employment had involved contact with an occupational therapist. Further support was found in this study where ‘working with an occupational therapist’ was the second highest influencing factor for mature aged students (28.6%), compared to the whole cohort (12.8%). Craik and Zaccaria (2003) reported nearly 67% worked in the health-care setting which was consistent with this sample. Craik and Napthine (2001) considered the choice of occupational therapy as second degree and found that 66% of the students had not been aware of occupational therapy when entering their first degree and identified more than half of those students entered a health/science degree initially. The current research found similar results, where 70% of students who were enrolled in another programme immediately prior to entering occupational therapy identified they were enrolled in a nursing or science programme. Given the small sample size it is possible to draw only preliminary findings that the male students had different exposures to occupational therapy prior to entering the programme than the total group. Male participants were more likely to have had exposure to occupational therapy than the whole group. They were more likely to have received therapy themselves and found the influence of a family member receiving therapy as highly influential.

Limitations The following limitations of the research are identified: there was a delay from the collection of the data to publication and the research was conducted at a regional University with an Undergraduate programme and this may potentially impact on generalizability of the results. Future research would also benefit from more specific consideration of the different factors related to entering the occupational therapy programme as a first vs. second career option. Additionally, separating out the influencing factors of parents/family, into separate categories of ‘parents’ and ‘family (spouse, children, other relatives)’ may provide more specificity especially relevant to mature aged students. Further specification on the relationship of knowing an occupational therapist as a ‘close/personal friend’ vs. an ‘acquaintance’ or ‘colleague’ may be beneficial. Third year occupational therapy students were not well represented in this cohort as they were largely off-campus on clinical placements. Future use of an online or electronic survey would allow students across all years and regardless of attendance at lectures to participate equally. © 2015 Occupational Therapy Australia

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Conclusion This research supports the notion that there are a number of factors that influence career choice as per the Systems Theory Framework (Patton & McMahon, 1999). Research has identified that exposure to an allied health professional may be one factor in career choice (Byrne, 2008b), it is accepted that this interaction occurs along with other factors (Byrne, 2007b). Systems Theory Framework has been successfully used to explain the factors related to career choice in speech-language pathology (Byrne, 2007a,b). Career choice is influenced by the individual (e.g. interest in helping others), as well as, their environments (including people e.g. knowing an occupational therapist and situations e.g. receiving occupational therapy). Students identified a range of factors (e.g. personal and professional exposure, parents/family) as influential factor in their decision to enter occupational therapy, and this supports the concept that different factors will influence people differently, there was clear evidence of the significant role that exposure to occupational therapy had in that choice. Byrne identified the influences of other people (e.g. relatives, career advisors) and situations (e.g. exposure to the allied health profession) probably combine. Patton and McMahon acknowledge that individuals will identify different influences depending on their own situations, and Systems Theory Framework allows for equal importance to be given to all influencing factors. This is supported by the research here which identified the impact of parents/family and exposure to occupational therapy as key factors in the selection of occupational therapy as a career. The fact that not all students identify the same factors supports that individual student experiences differ and that there may be a number of paths to the same career choice. The information gained in this research does reinforce that practising occupational therapists and occupational therapy students are a highly effective source of information regarding the profession, providing information about occupational therapy and modelling occupational therapy practice and are influential in career decision-making. Professionals need to be cognizant of their ability to influence future professionals as a known successful technique to attract future students to occupational therapy programs (e.g. providing details about work undertaken, describing different caseloads). The students were also more likely to report multiple professional exposures to occupational therapy – which supports the key role of the direct interface with the occupational therapist as the potential student receives or observes therapy for a family member (or are involved in their care). Consideration must be given to the strong advocacy that other health professionals can be for the occupational therapy profession, as parents, these health professionals may encourage their child to enter occupational therapy based on their © 2015 Occupational Therapy Australia

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understanding of what the profession entails. Consequently, every occupational therapy clinical consultation with another health professional is an opportunity to actively advocate for the occupational therapy profession and expand understanding of the depth, breadth and complexity of the work undertaken by an occupational therapist and in doing so raise the profile as a highly desirable, challenging and rewarding potential career option. Frontline occupational therapy clinical services would benefit from reviewing the demographics of their caseload/client groups. Given the multicultural nature of Australia, clients accessing services should be reflective of the general population. Failure of specific groups to access occupational therapy services identifies gaps in the potential opportunity to influence certain communities, which is especially relevant given the key benefit that exposure to occupational therapy has on choice of occupational therapy as a career. Additionally, consideration by the occupational therapy professional association at a high level in relation to be the potential ability to actively market or target specific individuals or groups in order to make the profession more reflective of the wider community. Consideration could be given to review undergraduate programs’ ability to engage student who are from culturally and linguistically diverse groups or are Aboriginal/Torres Strait Islander backgrounds and identify the presence or absence of support mechanisms either within the programme or across health programs (e.g. other allied health) to assist students to complete the programme. There may be clear benefits to linking minority students with mentors in the workplace and positive actions to recruit Aboriginal staff in various health services (e.g. NSW Health Aboriginal cadetships). Further descriptions of exposure to occupational therapy and understanding the factors which further contribute to the actual influence (e.g. types of intervention, service delivery model) will enable more specific and targeted promotion.

Acknowledgement The author thanks the students who participated in the research study.

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