You have to get into their world: Exploring parents' experience of missed therapy appointments

Marcia Underwood
23 November 2018


Underwood, M. S. (2018). You have to get into their world: Exploring parents' experience of missed therapy appointments. (A dissertation submitted in partial fulfilment of the degree Master of Occupational Therapy at Otago Polytechnic, Dunedin, New Zealand.) [PDF 27MB]


This thesis explores the experience of families who have missed therapy appointments, focussing on identifying factors that either facilitate, or create barriers to, participation in these appointments.  The study centres on four interviews with parents of children who are clients of a paediatric therapy team.  This is the Child Health Centre team based in Whangarei, the only city in Northland, New Zealand’s northern-most province.  The multi-disciplinary team is one service provided by the Northland District Health Board (DHB), which is the sole government-funded secondary health organisation in the region. 

Previous research suggests that non-attendance is a widespread issue for health services and that the reasons clients miss appointments, are complex.  The experiences of families keeping or missing paediatric therapy appointments has not been a big focus in the literature and little information has been located for this population compared with the literature for missed adult, medical or nursing appointments.  In addition, the majority of the research is from international studies. 

This study employs a qualitative descriptive methodology.  Four themes were developed from the data: Connection, Empathy, Empowerment and the Therapist as the face of the organisation.  Discussion around these themes highlights the necessity of effective therapeutic relationships with children and with their parents, as they collectively inhabit the role of client.  The social context in which this engagement occurs incorporates both the health organisation’s, and the families’, values.  Therapists awareness of these values is important.  Occupational therapy theory and ethics can be used to guide therapists responses to the dilemma of missed appointments.  Implications for practice include therapists contributing to the development of service policy and communication systems, which would place the family as central to service delivery.  This involves the acquisition of skills in family-centred practice models such as Occupational Performance Coaching.  For paediatric therapists this may be challenging as it requires a transition away from expert models of practice. 

When parenting a child who has been referred to the Child Health Centre, the experience of keeping or missing therapy appointments is part of this journey.  Therapists play a critical role in supporting the parenting journey by creating a family-centred therapeutic environment to facilitate families’ participation in therapy appointments.

Key words: Parents' perspectives; Therapy for children; New Zealand Māori; Qualitative descriptive; Therapeutic relationship.

Marcia Underwood's thesis was supervised by Linda Robertson.


This thesis is available under a Creative Commons Attribution-NonCommercial-NoDerivatives licence CC BY-NC-ND 4.0 International.

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