Occupational Therapy in Mental Health

ISSN: 0164-212X (Print) 1541-3101 (Online) Journal homepage: https://www.tandfonline.com/loi/womh20

Utility of Model of Human Occupation Screening

Tool in Sweden

Lena Haglund

To cite this article: Lena Haglund (2020) Utility of Model of Human Occupation
Screening Tool in Sweden, Occupational Therapy in Mental Health, 36:3, 244-257, DOI:
10.1080/0164212X.2020.1757558

To link to this article: https://doi.org/10.1080/0164212X.2020.1757558

© 2020 The Author(s). Published with

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Published online: 12 May 2020.

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OCCUPATIONAL THERAPY IN MENTAL HEALTH
2020, VOL. 36, NO. 3, 244–257
https://doi.org/10.1080/0164212X.2020.1757558

Utility of Model of Human Occupation Screening Tool

in Sweden
Lena Haglund
Division of Occupational Therapy, Department of Social and Welfare Studies, Link€oping
University, Norrk€oping, Sweden

ABSTRACT KEYWORDS
Occupational therapists in Sweden are expected to use evi- Assessment; occupational
dence-based practice. To meet this expectation, a helpful tool participation; usefulness
could be the Model of Human Occupational Screening Tool of assessment
(MOHOST). The aim of this study was to examine the utility of
the Swedish version of MOHOST. Thirty-seven occupational
therapists were invited to take part in the examination. A
questionnaire covering transferability, feasibility and clinical
relevance was developed. The results show that MOHOST-S
seems to have suitable utility. The study supports its imple-
mentation potential and clinical relevance. It gives a broad
picture of the client’s occupational participation and it sup-
ports the treatment planning process.

Introduction
As a profession, occupational therapists (OTs) in Sweden are expected to
deliver health care which is in accordance with science and best practice.
Furthermore, occupational therapy services should be designed and imple-
mented, as far as possible, in consultation with the client (Svensk
f€
orfattningssamling, 2010). In order to fulfill these expectations, it is important
that OTs take an evidence-based approach to decision making, taking the best
available research findings and/or best practice into consideration when inter-
acting with clients. Another central basis for OT services is the Code of Ethics
for Occupational Therapists published by the Swedish Association of
Occupational Therapists (2018a). The code states, for example, that the object-
ive of the profession “is to support a person’s activity and participation in a
manner that promotes possibilities to live as full a life as possible” (page 5).
Consequently, an OT must have access to tools that support client-
centered work and must obtain both correct and sufficient information on

CONTACT Lena Haglund lena.haglund@arbetsterapeuterna.se Rådjursv€agen 49, Link€

oping 587 31, Sweden.
This article has been republished with minor changes. These changes do not impact the academic content of
the article.
ß 2020 The Author(s). Published with license by Taylor and Francis Group, LLC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives
License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction
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 OCCUPATIONAL THERAPY IN MENTAL HEALTH 245

the client’s occupational participation in order to be able to make the best

possible decision concerning the client’s needs. “Tools,” in this context,
means models of practice, theories,and assessments that help the OT to
identify the client’s needs and, if necessary, select an intervention. One
model that supports evidence-based practice, has a client-centered
approach, supports the generation of treatment goals, and gives a rationale
for intervention is the Model of Human Occupation (MOHO), developed
in part by Professor Gary Kielhofner more than 30 years ago (Taylor,
2017). Furthermore, the model focuses on engagement and participation in
occupations. It explains how a person engages in occupation as a result of
a dynamic interaction between volition, habituation, performance capacity
and environment. A wide range of MOHO-based standardized assessments
have been developed over the years to support the application of the model
(Taylor, 2017). Many of these assessments have over the years been trans-
lated into Swedish and tested for scientific standards (MOHO web, 2020).
Assessment is the initial step in a treatment planning process, and the
primary goal is to determine the client’s need for treatment. The assess-
ment procedure is crucial to the planning process since it is the introduc-
tory step and it influences all other steps, including goal setting, choice of
intervention, etc. Therefore, it is essential that the step is carried out based
on a credible and sound scientific basis.
Different data collection methods are used in various MOHO-based
assessments. There are assessments that use observation, while others use
interviews, semi-structured interviews, and also self-report methods. In
some assessments, these methods are even combined. A few assessments
focus on occupational skills such as the Assessment of Communication and
Interaction Skills (ACIS) (Forsyth et al., 1998) while others, for example,
the Model of Human Occupation Screening Tool (MOHOST) (Parkinson
et al., 2006), cover the majority of MOHO concepts.
MOHOST is the most flexible assessment related to MOHO (Parkinson
et al., 2006) and easy to administer (Taylor, 2017). Furthermore, it pays
attention to participation, it supports evidence-based practice, it is client-
centered, and it conforms to scientific standards internationally (Forsyth
et al., 2011; Maciver et al., 2016). Therefore, there is a value in translating
the MOHOST into Sweden and investigating the use of it.
The aim of this study was to examine the utility of the Swedish version
of the Model of Human Occupational Screening Tools, MOHOST.

Description of the assessment

The MOHOST (Parkinson et al., 2006) is an assessment tool designed to
measure occupational participation, regardless of diagnosis. It can be used
246 L. HAGLUND

Table 1. Model of Human Occupation Screening Tool (MOHOST).

Concept Item
Volition or motivation for occupations Appraisal of ability
Expectation of success
Interest
Choices
Habituation or pattern of occupation Routine
Adaptability
Roles
Responsibility
Communication and interaction skills Non-verbal skills
Conversation
Vocal expression
Relationships
Process skills Knowledge
Timing
Organization
Problem-solving
Motor skills Posture and mobility
Co-ordination
Strength and effort
Energy
Environment Physical space
Physical resources
Social groups
Occupational demands

for the evaluation of a wide range of clients with psychosocial and/or phys-
ical impairments. The MOHOST measures relevant MOHO concepts, and
each of the following six concepts (a–f) includes four items: (a) volition or
the motivation for occupations, (b) habituation or pattern of occupation,
(c) communication and interaction skills, (d) process skills, (e) motor skills,
and (f) environment (Table 1).
Each item in the MOHOST (Table 1), in a total of 24 items, is rated on
a four-point rating scale concerning effects on occupational participation.
An “F” indicates that the item “Facilitates” occupational participation, an A
that the item “Allows,” an “I” that it “Inhibits,” and finally an “R” indicates
that the item “Restricts” occupational participation.
The MOHOST is primarily an assessment based on observation, however, it
allows multiple data gathering methods such as observation in formal or infor-
mal settings, semi-structured interviews or discussion with the client, discus-
sion with carers and/or the multidisciplinary team, discussion with relatives,
and reading medical records. The questions linked with another MOHO-based
assessment, namely the Occupational Circumstance Assessment-Interview and
Rating Scale (OCAIRS) (Forsyth et al., 2005), are in the User’s Manual for the
MOHOST (Parkinson et al., 2006) recommended as a helpful tool for the
semi-structured interview when using the MOHOST. The time needed for
gathering information is strongly dependent on which method or methods are
used; consequently, no recommended time is stipulated.
The scientific standard for the English version of the MOHOST has been
established by several studies. For example, Rasch analyses show that the
 OCCUPATIONAL THERAPY IN MENTAL HEALTH 247

assessment can function as a valid and reliable measure of occupational

participation (Forsyth et al., 2011).
Furthermore, the positive value of using the assessment in practice has
been described by Parkinson et al. (2008) and Kramer et al. (2009) confirmed
that MOHOST can be used to measure client change after treatment.

Translation process of the assessment

The User’s Manual for the MOHOST (Parkinson et al., 2006) was trans-
lated into Swedish by the author in 2014. Some chapters were translated,
and some were summarized. The chapter Expanded Criteria was translated
entirely. No cases were translated from the Manual. The translated version
of the MOHOST was examined by three experienced OTs. One had a
Ph.D., and had translated three MOHO assessments previously; one had an
MSc in occupational therapy and a specialist certification, had worked in
mental health for many years and used MOHO in practice; and the third
had a licentiate degree in occupational therapy, had used MOHO in prac-
tice and had worked in mental health for many years.
The comments from the three experienced OTs were mainly related to
Swedish linguistic expressions caused by incomplete translation work. This
resulted in an experimental Swedish version of the MOHOST and a back
translation into the source language was completed by a professional transla-
tor. This translator had experience in translating occupational therapy papers
and articles. A consensus discussion between the author and the translator
was then conducted, in order to compare the original version with the back
translation. Any small discrepancies were caused by the wording and sen-
tence structure. It was concluded that the meaning of the content was the
same when comparing the original and the back translation. After that, an
initial version of the MOHOST-S was completed, and it was used by 12 OTs
who assessed at least four clients each. During this process, the OTs were
asked to keep notes if they encountered any problems using the manual.
There were very few comments from them, and the comments mainly con-
cerned linguistic expressions and spelling mistakes which were considered in
the completion of the final Swedish version (Haglund, 2014a), which is for
sale from the Swedish Association of Occupational Therapists.

Material and method

The questionnaire
A questionnaire containing questions related to the utility of the
MOHOST-S was developed. According to Polit and Beck (2004, 2008) the
utility of innovation, for example, testing a new assessment in practice, can
248 L. HAGLUND

be evaluated by studying its implementation potential, clinical relevance,

and scientific merit.
The questionnaire included 19 questions and used a variety of response
options: yes/no options, numerical response scales, and short written
answers. The first three questions collected demographic information.
Question number four identified OTs who did not meet people for assess-
ment in their daily work. If they did not work with assessments, they did
not respond to any further questions in the questionnaire. They concluded
their participation in the study after question number four.
The implementation potential comprises the transferability, feasibility,
and cost and benefits of the assessment. Transferability implies the fit of
innovation in a specific setting. Questions focusing on transferability in this
study are, for example: How often is the MOHOST-S used? Time required
for using MOHOST-S? Used method for gathering data? Feasibility con-
cerns the practical part of the implementation of the innovation in practice,
and it is consistent with OT functions. Feasibility also refers to the neces-
sary skills for using innovation. Examples of questions focusing on feasibil-
ity in the questionnaire are: Compared to other assessments you are using,
what benefits and disadvantages do you see with the MOHOST-S? Do you
think there is anything that should be changed in the manual? The cost
and benefits of the innovation in practice, the last aspect of implementation
potential, were not investigated in the present study.
The clinical relevance concerns aspects regarding the assessment’s poten-
tial to give support in solving problems and decision-making in practice.
To what degree does the innovation support practitioners in their daily
work? Examples of questions related to clinical relevance are: Has the
assessment supported you in your problem-solving process regarding
the clients’ need for intervention? Has your style of communication with
the client been affected? Do you think you will use MOHOST-S in the
future? Would you recommend that colleagues use the MOHOST-S?
Scientific merit is focused on validity, reliability, and generalizability of
the innovation. International studies support this aspect of the MOHOST.
The present study, however, does not focus on this aspect of the utility of
the Swedish version of the MOHOST.

Data analysis
Data collected from the yes/no options and numerical response scales
in the questionnaire were analyzed using descriptive statistics. The short-
written answers were mainly in short phrases. Answers for each of the
questions were compiled, and answers with the same intention were clus-
tered together.
 OCCUPATIONAL THERAPY IN MENTAL HEALTH 249

Participants
In the present study, 65 persons who had had the opportunity to use the
MOHOST-S for at least six months received the questionnaire by email.
Twenty of those persons were OTs who had attended a two-day course with
the purpose of learning how to use the MOHOST-S. These were group A. On
the first day of the course, MOHO was the main theme, and on the second
day, the participants learned about the MOHOST-S. For example, two films
were used which were rated individually by the participants and then discussed
in class.
The remaining 45 persons, group B, had purchased the assessment more
than six months earlier. They had ordered the assessment by sending an
email to the Swedish Association of Occupational Therapists.
An email was sent to each person (n ¼ 65) separately, explaining the aim
of the study and requesting participation. The study questionnaire was
attached. It could be downloaded to the responder’s computer and the
answers could be filled in. If they wanted, they could reply to the author
and attach the completed questionnaire or they could print the completed
questionnaire and send it to the author by post, or print the original ques-
tionnaire, answer the questionnaire in pencil and send it by post to the
author. A reminder was sent once. No questionnaire was sent back by post.
All were attached to an email reply.

Results
Participants
Seventeen (85%) of the 20 OTs in group A, and 30 (67%) of the 45 persons
who purchased the MOHOST-S, group B, responded to the questionnaire.
All those who had purchased the MOHOST-S and replied had an occupa-
tional therapy education. In total, 47 OTs responded to the questionnaire
(72%). Fourteen of the 17 OTs in group A answered that they had used the
assessment, as did 23 of the 30 who had purchased the MOHOST-S, group
B. Consequently, the investigated group consisted of 37 OTs (Figure 1).

Description of participants
All except six of the OTs had a Bachelor of Science in Occupational
Therapy; eight also had a Master’s degree in occupational therapy; two had
a Council certification as a specialist in occupational therapy. The number
of years of experience as an OT ranged from less than one year up to
36 years, while the mean number of years was 12 (Table 2).
How much knowledge the OTs had about the MOHO was assessed by
themselves on a three-point rating scale running from “1 ¼ I have little
250 L. HAGLUND

Group A Group B

MOHOST-S course Purchased MOHOST-S

n = 20 n = 45

Responded to the Responded to the

quesonnaire quesonnaire
n = 17 n = 30

Conducted Did not conduct Conducted Did not conduct

assessments assessments assessments assessments
n = 14 n=3 n = 23 n=7

Figure 1. Selection of participants.

Table 2. Descriptions of participants (n ¼ 37).

Group A (n ¼ 14) Group B (n ¼ 23) Totals
Education
Diploma Degree 2 (14%) 4 (17%) 6 (16%)
Bachelor’s Degree 12 (86%) 19 (83%) 31 (84%)
Master’s Degree 4 (28%) 4 (17%) 8 (22%)
Council certification 2 (9%) 2 (6%)
Years of experience
0–5 years 4 (28%) 5 (22%) 9 (24%)
6–10 years 2 (14%) 5 (22%) 7 (19%)
11–15 years 3 (22%) 8 (35%) 11 (30%)
16–20 years 4 (28%) 2 (9%) 6 (16%)
>21 years 1 (7%) 3 (13%) 4 (11%)
Level of knowledge of MOHO
Little knowledge 1 (7%) 4 (17%) 5 (14%)
Reasonable knowledge 4 (28%) 10 (43%) 14 (38%)
Good understanding 9 (64%) 9 (39%) 18 (48%)

knowledge of the MOHO” to “3 ¼ I have a good understanding of the

MOHO and use the model now and then in my work.” Group A, the
group who had completed the course, rated their knowledge higher than
group B. One occupational therapist reported that she had little knowledge,
while almost two-thirds stated that they had a good understanding of
MOHO (rated 3) compared to just over one-third in group B (Table 2).
Thirty-two of the OTs indicated that they used other MOHO-based
assessments available in Swedish. On a supplementary question about
 OCCUPATIONAL THERAPY IN MENTAL HEALTH 251

Table 3. Use of other MOHO-based assessments (n ¼ 32).

Assessment Totals Group A (n ¼ 14) Group B (n ¼ 23)
OCAIRS-S 18 6 (43%) 12 (52%)
WRI-S 13 5 (39%) 8 (35%)
DOA 10 5 (39%) 5 (22%)
OSA-S 6 2 (14%) 4 (17%)
ACIS-S 4 2 (14%) 2 (9%)
AMPS 1 1 (4%)
Totals 52

which other assessment they had used, they could name several.
Occupational Circumstance Assessment-Interview and Rating Scale
(OCAIRS-S) (Haglund, 2014b) was listed 18 times, followed by the Worker
Role Interview (WRI-S) (Ekbladh & Haglund, 2012), Dialogue about
Working Ability (DWA) (Norrby & Lindahl, 2017), Occupational Self-
Assessment (OSA-S) (Sj€ oberg, 2012), Assessment of Communication and
Interaction Skills (ACIS-S) (Haglund & Kjellberg, 2012), and Assessment of
Motor and Process skills (AMPS) (Fisher & Bray Jones, 2010). Six OTs
mentioned three assessments, eight mentioned two, and finally, 18 men-
tioned one assessment (Table 3).

Implementation potential
Transferability
The MOHOST-S was used at least once a week by 8 (22%) OTs, once a
month by 22 (59%) and rarely by 7 (19%) OTs. The difference between
group A and B were marginal (once a week: group A 23%, group B 20%;
once a month: group A 61%, group B 59%; and rarely: group A 18%, group
B 21% respectively).
In a question regarding how information was gathered, the OTs were
asked to rank their principally used method from 1 to 3, where 1 repre-
sented most used. “Semi-structured interview,” followed by “Observation”
was most often used. Discussions with team members/carers or relatives
were not used at all. Ten OTs only ranked two alternative methods used
(Table 4).
The time required for assessment was reported as a “Reasonable amount
of time” by 25 OTs (68%) (group A, 57%; B, 73%). Twelve stated that it
took a “Long time.” No OTs rated the third finally alternative answer
“excessively long time” to the question of time required for assessment.

Feasibility
On the question of what benefits and disadvantages the OTs saw with the
MOHOST-S compared to other assessments they used, 15 OTs did not
write any comments at all. Eighteen wrote one comment, mentioning 14
252 L. HAGLUND

Table 4. Data gathering methods.

Rank 1 Rank 2 Rank 3
Group A Group B Group A Group B Group A Group B
Method (n ¼ 14) (n ¼ 23) (n ¼ 14) (n ¼ 23) (n ¼ 14) (n ¼ 23) Totals
Semi-structured interview (OCAIRS-S) 7 12 5 9 4 4 41 (40%)
Observation 3 7 5 8 4 10 37 (37%)
Discussions with client 3 4 3 4 2 2 18 (18%)
Reading medical record 1 1 2 1 5 (5%)
Totals 14 23 14 23 11 16 101 (100%)

benefits and four disadvantages; two made two comments and noted three
benefits and one disadvantage, and two OTs made four comments and
noted five benefits and three disadvantages. In total, there were 30 com-
ments, 22 benefits (group A, n ¼ 11; B, n ¼ 11) and eight disadvantages
(group A, n ¼ 2; B ¼ 6). The most commonly occurring response concern-
ing benefits was “Gave a wide picture of the client” (n ¼ 11), “Allows mul-
tiple data gathering methods” (n ¼ 5), and “Supports documentation”
(n ¼ 3). Other benefit comments were: “Easy to apply” (n ¼ 2), and one
wrote, “Supports reporting back results to client.” Regarding disadvantages,
the most frequent responses were “Difficult to get into” (n ¼ 5, all belong-
ing to group B) and the other responses were “Requires too much insight
into the client’s situation” (n ¼ 2) and “Takes time to perform” (n ¼ 1).
Six OTs gave feedback that there was a need to develop the manual fur-
ther with more detailed descriptions. One OT from group A and three
from group B stated that the concept “Volition” needed to be investigated
further. And, two OTs from group B pointed out that the item
“Adaptability” which is a part of the concept Habituation (Table 1) needs
to be described more accurately in the Swedish version of MOHOST.

Clinical relevance
The results for clinical relevance are shown in Table 5. All except four of
the OTs stated that using the MOHOST-S had influenced their communi-
cation with the client. The use of the MOHOST-S was also supportive in
the problem-solving process when determining the client’s need
for treatment.
Thirty-two (86%) of the OTs found that the MOHOST-S had a positive
impact on their ability to report to other team members about the clients’
occupational participation. Communication with authorities outside the
healthcare system regarding the client’s situation was also facilitated.
All OTs reported that data from the MOHOST-S was helpful when writ-
ing notes in the clients’ medical records or when write reports to other
authorities.
 OCCUPATIONAL THERAPY IN MENTAL HEALTH 253

Table 5. Clinical relevance (n ¼ 37).

Yes No
Group A Group B Group A Group B
Questions (n ¼ 14) (n ¼ 23 (n ¼ 14) (n ¼ 23) Totals
Influence communication with client 13 (93%) 20 (87%) 1 (7%) 3 (13%) 37
Determine client’s need for treatment 13 (93%) 21 (91%) 1 (7%) 2 (9%) 37
Influence communication with team 12 (86%) 20 (87%) 2 (14%) 3 (13%) 37
Influence communication with other authorities 12 (86%) 20 (87%) 2 (14%) 3 (13%) 37
Influence recording 14 23 37
Use MOHOST in the future 14 19 (83%) 4 (17%) 37
Recommend to colleagues 14 22 (96%) 1 (4%) 37

Most of the OTs (89%) stated that they would continue to use the
MOHOST-S in practice. The four OTs who responded “No” belonged to
group B. Three of them, however, would recommend that colleagues used
the assessment, one would not so recommend. In total, 36 OTs would rec-
ommend the use of the assessment.

Discussion
The main finding is that the Swedish version of the MOHOST is usable in
practice. The results show that MOHOST-S is an appropriate and valuable
assessment to incorporate into OT practice. It seems to help OTs to work
in accordance with the Svensk f€ orfattningssamling (2010). And, the findings
contribute to the evidence-based practice in occupational therapy in
Sweden; to base the decision to select an assessment on evidentiary studies
and evidence, in this case, utility, helps OTs to be evidence-based
practitioners.
The aim was not to investigate the difference between OTs who had
learned the MOHOST-S by studying the manual by themselves compared
to those who had attended a course regarding how to use MOHOST-S.
Still, since the results gave the opportunity to present the two groups separ-
ately, it was decided to investigate this. The groups, however, were very
similar to each other. One inference could be that the manual included suf-
ficient information for using the MOHOST-S in practice, and it is not
necessary to participate in a course. The main difference was regarding
knowledge of MOHO. Group A said that they had more knowledge than
group B, and that was to be expected. Group A had learned about the
model for one day during the course. It seems, however, that at least some
knowledge of MOHO is enough to find the MOHOST-S suitable
for practice.
OCAIRS-S (Haglund, 2014b) is available in Swedish. It may have con-
tributed to the result that the semi-structured interview was the most used
method for data gathering followed by observation. There were few, how-
ever, who stated that they used other possible methods, and some methods
254 L. HAGLUND

were not mentioned at all. At the same time, the OTs stated that a good
advantage of the MOHOST-S is that it gave a broad picture of the clients’
situation compared to other assessments because it provided the opportun-
ity to use several methods for data gathering. However, is a semi-structured
interview and observation enough to get a relatively good picture? Why do
OTs not choose to use any other methods? Other researchers (Parkinson
et al., 2006, 2008) have indicated that one of the benefits of the MOHOST-
S is that it permits multiple data gathering methods.
The results show that more than a third of the OTs responded that they
found the time required for the assessment reasonable, and this is also
reported by Hawes and Houlder (2010).
Five OTs indicated that it was difficult to understand the manual. All
belonged to group B. Explanations may be that they had too little know-
ledge of MOHO, that they were not familiar with MOHO-based assess-
ments or that they had tested the MOHOST-S too few times. It might have
been of interest to investigate this group more thoroughly; however, only a
few had this difficulty.
MOHOST-S seems to be clinically relevant (Table 5). It supports OTs in
communicating with clients and determining clients’ needs for treatment
and facilitates communication both within and outside the health care sys-
tem. This result is in line with other studies (Hawes & Houlder, 2010;
Parkinson et al., 2008; Taylor et al., 2013). Furthermore, most of these OTs
would use the MOHOST-S in the future and would recommend it
to colleagues.
Finally, a reason for the support of utility, especially clinical relevance, of
the MOHOST-S may be that it has been linked to the International
Classification of Functioning, Disability and Health (ICF) (World Health
Organization, 2001). Each item in the MOHOST-S has been related to
domains and categories in ICF in a linking project as delineated by two
occupational therapists in Sweden, familiar with the assessment, the
MOHO, and ICF. The linking of the assessment makes it possible, for
example, to integrate the rating of the assessment to an ICF structured
documentation system and to enhance communication between professions
in a multidisciplinary team that is using the ICF as a shared framework
(Taylor, 2017).

Methodological weaknesses
The results in this study are based on participants who had chosen to use
the MOHOST-S. They had chosen to take part in a course or to purchase
it and had also chosen to reply to the questionnaire. A central bias may be
that they were a selected group: for example, they did not want to criticize
 OCCUPATIONAL THERAPY IN MENTAL HEALTH 255

their own choices. They may have belonged to a cohort that previously had
decided to base their practice on MOHO and MOHO-based assessments.
Only five OTs had not used other MOHO-based assessments. Or perhaps
they belong to the group of practitioners who are fond of testing innova-
tions in general (Pink, 2009)?
It might also have been of interest to investigate the cohort which did
not respond at all (n ¼ 18) to the questionnaire. Was the lack of
response because their experience was that the MOHOST-S was not use-
ful or appropriate? Furthermore, what was the reason that ten occupa-
tional therapists who had had the opportunity to use the MOHOST-S
for 6 months did not respond? Would their experience and opinion of
the MOHOST-S affect the results of the present study in any direction?
In addition, another shortcoming of the present study may be the test-
ing period. Was 6 months a reasonable amount of time for investigating
the utility of MOHOST-S? Most of the OTs used the MOHOST-S once
a month; are the results based on too few applications? Would a follow-
up after 1 year have resulted in a greater response rate and another pic-
ture of the utility of MOHOST-S? It may be assumed, however, that the
results are based on a reliable number of performed assessments. Thirty
of the OTs had used the MOHOST-S several times, at least once
a month.
It could also have been of interest to have knowledge regarding the OTs’
main area of practice. Are the results applicable in all areas or is the
MOHOST-S more applicable in certain areas? With reference to instruc-
tions in the Manual (Parkinson et al., 2006) the assessment can be used in
both psychosocial and/or physical areas. Did the investigated group repre-
sent these areas and the main areas of practice for OTs in Sweden; munici-
pal elderly care (26%) and county hospitals (12%) (The Swedish
Association of Occupational Therapists, 2018b)? In relation to this, it can
be asked if the study had highlighted different practice areas and different
groups of clients would it have resulted in extended use of multiple data
gathering methods than this study show?
Regarding the utility of innovation, it can be questioned whether trans-
ferability, feasibility, and clinical relevance are suitable to investigate before
the scientific merit is established, as Burke and Gitlin (2012) stated, “The
process of developing, testing, and implementing research-based interven-
tions is complex, costly, and time consuming” (page 85). Therefore, it can
be argued that the development must be relevant to practice, the practi-
tioners must find the development usable if they are to get involved. From
this perspective, an implication may be that questions related to the investi-
gated aspects (transferability, feasibility, and clinical relevance) represented
a relevant beginning.
256 L. HAGLUND

Future research, however, should explore whether the MOHOST-S has

scientific merit, and the cost and benefit aspects must also be taken into
consideration. Additionally, future research should explore the clients’ per-
spectives on the MOHOST-S. The assessment must reflect a meaningful
view of occupational participation based on clients’ experiences.
Conclusion: As regards transferability, feasibility and clinical relevance,
this first study conducted on the Swedish version of the MOHOST sup-
ports its use by OTs to gain relevant information on occupational partici-
pation, and therefore it can be a valuable tool when making decisions
regarding the client’s need for intervention. It helps the OTs to put evi-
dence-based theory into practice since the assessment is based on MOHO,
an evidence-based conceptual practice model (Taylor, 2017).

Acknowledgments
The author would like to acknowledge all the OT’s who participated in the study.

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