Advanced Research Design P49210: Summative Assignment Research Proposal

Advanced Research Design P49210: Summative Assignment Research Proposal


What are Occupational Therapist’s experiences of utilising the Vona du Toit Model of Creative Ability: Creative Participation Assessment in forensic mental health settings in the U.K?



Occupational Therapy (O.T) practice is supported by the use of conceptual models of practice, which aid the implementation of occupation-based theory and the O.T process (Duncan 2011). Forensic mental health care pertains to the treatment of mentally disordered offenders in secure hospitals in the U.K (COT 2012).

The researcher’s workplace, an O.T department within a forensic hospital, is piloting the use of the Vona du Toit Model of Creative Ability (VdT MoCA) (de Witt 2014). As a Clinical Specialist O.T, the researcher is supporting the team in integrating the model with the aim of this being the primary model of O.T Practice.

The VdT MoCA (de Witt, 2014) has been in existence since the 1960’s, with its use widespread in South Africa. However, only recently has its popularity grown exponentially in the U.K within mental health services (Sherwood 2011). de Witt (2014) highlights the VdT MoCA’s efficacy in treating large numbers of patients with diverse needs, backgrounds and levels of functioning by enabling O.T’s to cluster patients according to 9 levels of occupational performance (motivation and action) and treatment needs. Van Heerden (2008:132) describes VdT MoCA (de Witt, 2014) as being useful in all realms of healthcare. It is unique in offering guidance and guidelines for assessment and treatment phases to ensure that individuals are supported in progressing through the levels of motivation and action, through provision of suitably challenging occupations, within an appropriate environmental context (de Witt 2014, Van Heerden 2008).

Although the model is not prescriptive of which specific activities meet the needs of individuals at certain levels of creative ability, it proposes that activities have certain features and O.T’s use specific handling principles to guide patients’ progress (Van Heerden 2008). For activities to be selected at the correct level for the individual, it is vital that the assessment on which this is based is accurate.

Casteleijn and De Vos (2007) explain that the Vona du Toit Model of Creative Ability: Creative Participation Assessment (VdT MoCA: CPA) (van der Reyden, no date, as cited in de Witt 2005) is the most commonly used assessment. However, as experienced by the researcher and colleagues, the implementation of the assessment is problematic due to the lack of surrounding literature and clear guidelines for implementation (van der Reyden 1989 as cited in Casteleijn and De Vos 2007). Sherwood (2011:24) reiterates the need for further research into the ‘methods and processes of assessment’ as a priority. This is the basis on which this research project is being proposed.

Research question

What are Occupational Therapist’s experiences of utilising the Vona du Toit Model of Creative Ability: Creative Participation Assessment in forensic mental health settings in the U.K?


To understand and explore the experiences of O.T’s in using the VdT MoCA:CPA in forensic mental health settings in the U.K


  • To gain insights into logistics/practicalities when implementing the assessment o To explore strategies used to integrate this tool in practice
  • To explore features of a forensic environment and how they affect its use
  • To highlight challenges relating to the implementation of the assessment
  • To provide knowledge to support implementation of this assessment/model
  • To contribute to evidence-base of the assessment/model
  • For the researcher to develop research skills by completing this study

The literature

A preliminary literature review was undertaken to review the subject area for this proposal. A comprehensive review will be completed prior to the study. CINAHL, AMED, and Web of Science were searched. Literature lists from the VdT Model of Creative Ability Foundation (UK) were used to source further literature, along with a search of references from literature obtained. Approximately 7-8 published research articles were identified on the VdT MoCA: CPA (van der Reyden, no date, cited in de Witt 2005), 3 of which are proving difficult to acquire through inter-library loans however; the author intends to contact the authors to request copies. A great deal of additional literature on the model is available but largely opinion based/anecdotal. Primary data studies of the VdT MoCA: CPA (van der Reyden, no date, cited in de Witt 2005) include:


  • Casteleijn (2014) found through Rasch analysis, that the tool gave a valid and reliable indication of individuals’ abilities and confirmed that the levels of creative ability exist
  • Samsonraj et al (2012) found it to be valid and reliable in measurement of functioning in comparison to other tools
  • Jansen and Casteleijn (2009) found it effective in measuring motivation in patients with diabetes related foot problems
  • Casteleijn and Smit (2002) found psychometric properties to be acceptable, with schizophrenia patients but highlighted need of further investigation
  • Turnbull et al (2002:17) found correlation between tool and other neurological scales with head-injured patients; ‘offering a sound and practical approach’.

Published research literature on the VdT MoCA: CPA (van der Reyden, no date, cited in de Witt 2005) is scant and quantitative in nature. Despite UK-based mental health O.T’s (Wilson and White 2011, Harvey and Fuller 2009, Sherwood 2009) promoting the use of the model, through opinion based articles, no qualitative data studies have investigated the experiences of O.T’s when using the VdT MoCA: CPA (van der Reyden, no date, as cited in de Witt 2005) in practice in the U.K, despite this being the main assessment to support the implementation of the model.


This will be a qualitative study based upon a constructivist approach where the researcher and O.T’s involved will collaborate in order to construct meaning mutually (Holloway and Wheeler 2010). A constructivist approach means that theory is not tested but is derived and induced from the research process typically using qualitative methodology (Cresswell 2003 as cited in Mackenzie and Knipe 2006). Given the lack of existing knowledge in this area, theory generation would seem appropriate as an initial research approach.



The researcher is proposing to undertake a small-scale study using qualitative methodology in order to investigate the research question. Brikci and Green (2007), Bowling (2002) and Pope and Mays (1995) advocate the use of qualitative studies in circumstances where there is little published literature and explain how they can generate hypotheses, which can later be tested by quantitative studies. Appleton (2009) describes such studies as ‘inductive’ where new ‘insights or theory’ can be extrapolated from the data. Parahoo (2006:45) asserts that qualitative methods are also ‘interactive and flexible, and effective in revealing individuals’ ‘experiences and perceptions’, with Topping (2010) adding how meaning and understandings of actions can be gathered. A qualitative methodological approach was selected over a quantitative methodological approach due to the philosophy of qualitative research being based upon multiple truths, such truths being perception-based and varying over time and experience, and being related to given circumstances (Burns and Grove 2009). Pope and Mays (1995:44) argue how neither methodology should be considered more or less valuable, with both accessing different areas of data, and emphasise qualitative research’s role in ‘exploring complex phenomena’ and areas which quantitative research cannot.


The researcher proposes to recruit forensic O.T’s using the VdT MoCA: CPA (van der Reyden, no date, as cited in de Witt 2005) in their practice in the U.K. Sampling will be of purposive nature to recruit approximately 6-10 participants. Kuzel (1992), as cited in Holloway and Wheeler (1996), describe 6-8 as being suitable should the sample show homogeneity. To strive to achieve data saturation, the researcher will ensure the study remains focused on a narrow topic, which is directly relevant to participants, and methods used will attempt to gain relevant data (Burns and Grove 2009).

Purposive sampling is the planned sampling of individuals who have a particular feature in common (Bowling 2002) and a ‘direct reference to the research question being asked’ (Bryman 2008:375), therefore providing a ‘rich source of data’ (Procter et al 2010:149), which is pertinent to the study and answers the research question (Bryman 2008, Parahoo 2006). Purposive samples do not represent the wider-population however the study is not seeking answers to phenomenon related to the wider-population (Procter et al 2010). Polit and Beck (2014) also warn of potential bias but support its use in order to sample specialists within fields.


The researcher will contact the VdT Model of Creative Ability (UK) Foundation to forward an email invitation and information sheet (Appendix A) to all forensic O.T U.K members. The study will be advertised within OT News to recruit additional participants. The researcher will aim to gain participants from a range of forensic units in order to ensure transferability (Shenton 2004), which is a benefit of purposive sampling, where the breadth of participants can be considered (Procter et al 2010). Homogeneity and heterogeneity of the sample will be deliberated so the sample has similarities, in this case familiarity with the tool and regular use of it, but also differences in order to allow appraisal (Bryman 2008). Therefore, O.T’s recruited should have experience of using this tool routinely however, there will be no jurisdiction over other characteristics (including workplace level of security, department size, or post-graduate experience).

Once potential participants have made contact, they will be sent a participant consent form (Appendix B). Following receipt of the completed participant consent form, participants will be offered to arrange a semi-structured telephone interview.

Data collection

The researcher proposes to collect data through semi-structured telephone interviews. Bowling (2002:230) states that ‘interviews involve the collection of data through talking to respondents (interviewees) and recording their responses’. Interviews are one of the most popular data collection methods within qualitative research and can vary in structure depending on the type of data the researcher is wishing to elicit (DiCicco-Bloom and Crabtree 2006).

Semi-structured interviews involve the discussion of a pre-arranged subject by use of open-ended questions, along with flexibility to allow the interviewer to use additional questions to explore issues highlighted by participants, which were not anticipated (Tod 2010, DiCicco-Bloom and Crabtree 2006). Tod (2010) emphasises semi-structured interviews as having a unique ability to generate rich and detailed data with DiCicco-Bloom and Crabtree (2006) describing them as effective as a sole method of data collection. Conversely, Tod (2010) highlights structured interviews as typically garnering quantitative data. Polit and Beck (2014:290) state unstructured interviews should be used when there are no ‘preconceived views’ and aim is to strictly explore ‘perceptions and experiences’, however Parahoo (2006) argues that ‘unstructured’ is a redundant term as some form of questioning is always used within interviews. In considering alternative methods, some warn researchers not to view focus groups as a quicker method of data collection, highlighting the need for researchers to be additionally skilled in analysis of group dynamics (Polit and Beck 2014, DiCicco-Bloom and Crabtree 2006).

Telephone interviews are popular in qualitative research due to cost and time efficiency, meaning the researcher does not need to travel to meet interviewees face-to-face, and has easy accessibility to participants (i.e. those working in secure environments or widespread geographical locations) (Polit and Beck 2014, Opdenakker 2006, Carr and Worth 2001). Opdenakker (2006) acknowledges the lack of non-verbal cues during telephone interviews, although argues that this is less important where the interviewee is considered an expert on a subject, rather than the interviewee describing their attitudes or sensitive information, emphasising that speech and tone are importantly still present. Sturges and Hanrahan’s (2004) study found telephone interviews yielded the same quantity, quality and depth of data in comparison to face-to-face interviews with interviewees highlighting convenience, anonymity, flexibility and experiencing less anxiety as beneficial. They also advocate that probing participants is still possible despite the absence of non-verbal cues, as verbal cues will still signal such opportunities to the researcher. Mealer and Jones (2014) argue that the lack of non-verbal communication improves the typical power imbalance between researcher and interviewee and furthermore argue how silences in conversation can be used effectively to allow the interview to think and consider answers.

The telephone interviews will be audio-recorded, with the researcher also taking notes to ensure that all questions are answered and that data is not lost in the event of a technical failure (Burke and Miller 2001). Sturges and Hanrahan (2004) highlight how note taking is less distracting for interviewees during telephone interviews but highlight the lack of control the researcher has over the environment in which the interviewee is located at the time.

Participants will be offered to negotiate a convenient time for the interview and the importance of a quiet environment will be explained (Easton et al 2000). Burke and Miller (2001) advocate for interview questions to be provided in advance to maximise depth of information gained however as explained by Pope et al (2008) questions may be refined during the data collection process. Some general questions will be provided prior to the interviews. Interviews will be up to an hour in duration but ultimately dependent upon the interviewee (Field and Morse 1985 as cited in Holloway and Wheeler 1996). The researcher will gain verbal consent at the start of the interview and advise of audio recording. Prior to the interviews, the researcher will pilot the interview questions, a selection of open-ended and closed questions, and equipment in order to ensure clarity, flow of interview and prevention of technical issues (Burke and Miller 2001).

The researcher will follow guidance from DiCicco-Bloom and Crabtree (2006:316) in carrying out the interviews. They describe the various phases of interviewing and emphasise the need for rapport building, with ‘broad, open-ended questions’ to reduce apprehension. The researcher will use interviewee’s words in order to seek elaboration in a non-leading and non-threatening way, and to encourage them to share further experiences in their own words. Once the co-operation phase has been reached, the researcher may feel more able to ask more probing questions or seek clarification. To signal the conclusion of the interview, interviewees will be asked whether there is anything else they would like to contribute (Burke and Miller 2001). Interviewees will be informed that their interview will be transcribed verbatim immediately and will be sent to them to clarify that the transcript reflects the interview.


Data analysis

Burke and Miller (2001) offer novice researchers practical strategies to aid data analysis such as the allocation of numeric codes to each participant, to protect confidentiality, which is added to interview questions, notes, audio-recordings and transcripts. They also advise researchers to read interview notes post-interview to ensure comprehensively detailed.

Each interview will be transcribed by the researcher as soon after the interview as possible, with the recording being destroyed after full analysis has occurred (DiCicco-Bloom and Crabtree 2006). The raw transcript will be sent to the interviewee to ensure data is accurate and reflective of their views (Carr and Worth 2001) and to check if words and punctuation, as incorrect use may alter meanings (DiCicco-Bloom and Crabtree 2006, Easton et al 2000). Easton et al (2000) support the researcher transcribing the interviews, and using italics to highlight words of importance, as indicated by tone and pitch, to aid analysis. Pope et al (2008) also encourage silences, exhalations and amusement to be included within transcripts.

James (2013) and DiCicco-Bloom and Crabtree (2006) urge researchers to execute caution when considering computer software to analyse data. DiCicco-Bloom and Crabtree (2006:318) reinforce the ‘excellence of qualitative research’ being underpinned by researchers’ ‘experience, discipline and expertise’. The researcher intends to analyse the data personally through thematic analysis, which is defined as ‘a method for identifying, analysing and reporting patterns (themes) within data [to] organise and describe the data set’…..’and interpret various aspects of the research topic’ (Boyzatis 1998 cited in Braun and Clarke (2006).

Braun and Clarke (2006:87) offer a clear guide using 6 phases to assist novice researchers in using thematic analysis in short they are: ‘familiarising yourself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report’ (Appendix C). James (2013) and Braun and Clarke (2008) reinforce the importance of researcher’s immersion in the data in order to progress beyond the eliciting of themes and codes, and to use analytical imagination to look ‘beyond the data’ (Mason 2002 as cited in James 2013). James (2013) also highlights Hammersley’s (2010) view of the difference between data and evidence with evidence arising from the analytic process of comparing and contrasting the full data set. Braun and Clarke (2008) warn of the dangers of using this form of analysis; risk of not analysing the data fully/weak analysis, risk of focusing on questions used as ‘themes’, and lack of data and evidence correlation. Braun and Clarke’s (2006:96) 15-point checklist will be used to ensure effective analysis (Appendix C). Braun and Clarke (2006) recommend this mode of analysis due to its flexibility and explain how rigorous application can ensure that research questions are answered.


Criteria used to assess the quality of qualitative research remain a contentious issue, meaning various languages are used in this regard (Polit and Beck 2014, Rolfe 2006, Mays and Pope 2000). However, Polit and Beck (2014:322) highlight Lincoln and Guba’s (1985) trustworthiness criteria as the ‘gold standard’. To ensure that this study is conducted as rigourously as possible with evidence obtained being of as high quality as possible, strategies recommended by Lincoln and Guba (1985) cited in Polit and Beck (2014) will be implemented.

To maintain credibility, the researcher will urge participants to be open and honest at the start of the interview and within the invitation (See Appendix A), emphasising the explorative nature of this study with no single answer being right nor wrong (Shenton 2004, Krefting 1991). The researcher will also maintain a reflexive journal to provide a clear audit trail of the entire research process and show decision-making, along with a demonstration of the researcher’s sensitivity to their preconceptions and personal experience and, inexperience in research itself (Tracy 2010, Ortlipp 2010, Rolfe 2006, Shenton 2004, Mays and Pope 2000). This will also aid confirmability, where findings can be demonstrated as coming from participants as opposed to from the researcher. Participants will also be asked to proofread their transcripts, known as member checking (Shenton 2004), to ensure that both their views are accurately captured and that punctuation and language used correctly portrays their experiences. Polit and Beck (2014) highlight this strategy as controversial, due to risk of participants altering the views they expressed but do agree that it serves to ensure credibility.

To ensure transferability, the researcher will aim for participants to come from as wide a range as possible of forensic settings to ensure the findings are transferable at least across forensic OT Practice. To augment this, the researcher will attempt to achieve data saturation and will ensure that rich descriptions of settings are available to allow readers to ascertain whether transferable to their practice (Polit and Beck 2014, Shenton 2004). Shenton (2004) highlights how the onus is on the researcher to ensure readers can easily draw such inferences. Thick descriptions are therefore especially valuable and will be used to describe the settings involved, participants and experiences elicited. Thick descriptions will be used in the findings in the form of verbatim extracts to demonstrate authenticity of the findings (Polit and Beck 2014, Shenton 2004).

Achievement of authenticity and dependability will be supported by the strategies described above however, additionally, the researcher will aim to ensure clarity of the research process to allow replication of the study and, through thorough analysis, will aim to holistically portray all experiences described by participants, including negative cases (Polit and Beck 2014, Bryman 2008, Shenton 2004, Mays and Pope 2000). Full detailed records will also be kept throughout the process (Bryman 2008).


Model of Human Occupation (MoHO) (Kielhofner 2008) dominates Forensic O.T practice with its use recommended by the COT (2012) practice guidelines for secure mental health. However, research underpinning its use in secure mental health is limited (O’Connell and Farnworth 2007). With the VdT MoCA (de Witt 2014) being widely piloted within various mental health settings across the U.K, due to its uniquely structured guide for treatment provision (Van Heerden 2008), it appears imperative that the evidence-base of this model and its associated assessments is broadened.

With an accurate assessment being essential for O.T’s to prescribe appropriate interventions, it is crucial that the utilisation of this assessment is explored further. So far, quantitative studies surrounding the VdT MoCA:CPA (van der Reyden, no date, as cited in de Witt 2005) confirm it as effective in measuring levels of motivation and functioning with patients of various diagnoses. However, no qualitative study has yet explored the experiences of O.T’s in utilising the VdT MoCA: CPA (van der Reyden, no date, as cited in de Witt 2005) in forensic mental health settings in the U.K, despite this being a field which is progressively implementing the VdT MoCA (de Witt 2014) over MoHO (Kielhofner 2008).

In order to justify this transition, studies such as this are vital. This study is intending to highlight the logistics and practicalities that are considered by O.T’s when using the assessment and the unique challenges offered by a forensic environment. It is hoped that the study will elicit knowledge, which can be used to support implementation of this model and assessment, potentially increasing its use, and supporting its use in forensic mental health in the U.K.

It is hoped that the results of this study will make a useful contribution to the evidence-base of both the VdT MoCA: CPA (van der Reyden, no date, cited in de Witt 2005) and also the VdT MoCA (de Witt 2014). The researcher hopes to disseminate findings through a presentation at future International VdT Model of Creative Ability Conferences, and potential publication in a peer-reviewed journal, such as the British Journal of Occupational Therapy.


This study is exploratory in nature and is seeking to understand experiences of O.T’s in using the VdT MoCA: CPA (van der Reyden, no date, as cited in de Witt 2005) in forensic mental health environments. Therefore, the findings will not be generalisable across all realms of health care. It is hoped that this study will be able to communicate useful information to forensic O.T’s in the U.K utilising the VdT MoCA:CPA (van der Reyden, no date, as cited in de Witt 2005) and VdT MoCA (de Witt 2014). However, due to unique environmental impacts of a forensic environment, it is unlikely that all of the findings will be directly transferable across U.K mental health services. Due to the timescale and researcher being a novice, the study will be a small-scale simple qualitative study and may not achieve data saturation.

Due to time and financial constraints, face-to-face interviews have been deemed unrealistic, meaning that telephone interviews have been selected in order to maximise the breadth of sample without concern for geographical location.

The researcher is a novice having only completed 1 qualitative research study towards their BSc (Hons) in Occupational Therapy in 2002. An MSc supervisor will support the researcher during this study.


This study will be completed over a 12-month period. An average of 8-12 hours per week will be dedicated to this, with the researcher’s employer currently providing 1 study day per week. To work towards a timescale of 1 year, a gantt chart will be used to plan and track progress:


Ethical Issues

Ethical approval will be sought from the appropriate committees, with local Research and Development committees also consulted (COT 2014). COT (no date) recommends that O.T’s adhere to the UK Research Integrity Office (UKRIO) Code of Practice for Research (UKRIO 2009), which the researcher will abide by.

Beauchamp and Childress (1994 cited by Open University, no date) suggest four principles for maintaining ethical practice: autonomy, beneficence, non-maleficence, and justice, which will be applied by the researcher. Autonomy of participants will be maintained by providing sufficient information in the participant invitation and information sheet (Appendix A), along with the intended purpose, such that participants are able to make an informed decision about whether they participate. It is highlighted that they are allowed to withdraw at any stage (Orb et al 2000).

Beneficence relates to the researcher respecting the best interests of participants, with non-maleficence relating to the prevention of harm (Beauchamp and Childress 1994 cited by Open University, no date). The researcher will ensure any information regarding participants is anonymised and stored securely. In addition, verbatim extracts from transcripts will not allow any individual to be identifiable, therefore respecting each individual’s confidentiality (Orb et al 2000). Dissemination of findings will also be made explicit at the point of recruitment (DiCicco-Bloom and Crabtree 2006). Anonymity will be maintained further via use of telephone interviews (Whiting 2008, Carr and Worth 2001) however the researcher must act in a respectful manner at all times (DiCicco-Bloom and Crabtree 2006) and convey ‘compassion and empathy’ as appropriate (Mealer and Jones 2014:37).

Justice pertains to the researcher treating all participants and their contributions equally even those expressing alternative views to others (Orb et al 2000). Guillemin and Guillam (2004) helpfully remind researchers of the need to act ethically throughout the research process and not to have plans just to appease ethics committees. They also highlight the importance of reflexivity and encourage researchers to constantly reflect on their role and behaviour towards participants to ensure they react in an ethical manner throughout the research journey.




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