Perceptions of Objective.
Educational programs fOr the occupational
Computer Literacy
Among Occupational
Therapy Students
Adelle M. Williams, Augustine O. Agho,
Margo B. Holm
Key Words: education • technology
Adelle M. Williams, PhD. is Associare Professor and Direcror,
Healrh Services Adminisrrarion, Deparrmenr of AJlied Healrh,
Slippery Rock Universiry, Slippery Rock, Pennsylvania 16057
Augusrine O. Agho, PhD. is Associare Professor and Direcror,
Division of Healrh Care Management, School of AJlied
HeaJrh Sciences, Florida A&M Universiry, Tallahassee,
Florida.
Margo B. Holm, PhD. OTRIL. FAOTA. is Professor, Universiry of
PlIger Sound, Tacoma, Washingron, and Adjllncr Assisranr
Professor of Psychiarry, School of Medicine, Universiry of
Pitrsburgh, Pitrsburgh, Pennsylvania.
This artide was accepted for publication April 13, 1995.
The American Journal ofOccupational Therapy
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therapist and the occupational therapy assistant are man-
dated to include content on technologies in their curricula.
Given the increasing use oftechnology skifls among occu-
pational therapists, especially computer technology skifls, it
seemedjudicious to ascertain the current and desired levels
ofskiff ofoccupational therapy students as weff as their
opinions about computer technology.
Method. Program directors from five baccalaureate-
level curricula distributed the Computer Opinion Survey
and the Computer Knowledge Survey to 109 junior and
senior occupational therapy students. The students were
instructed to complete and return questionnaires to their
program directors who, in turn, fOrwarded the question-
naires to the principal investigators.
Resulrs. Respondents were generally positive about
computer technoLogy, and the level ofknowledge they
desired about computer technology applications in occupa-
tional therapy was much greater than their current level
ofknowledge. Although respondents'positive attitudes were
significantly correlated with their current levels ofcom-
puter knowledge, no significant relationshlp was estab-
Lished among positive attitudes, current levels ofcomputer
Imowledge, and number ofcomputer courses completed
befOre entering an occupational therapy cunicuLum.
Conclusions. Even though the respondents were com-
puter literate (i.e., they had a general working knowledge
ofthe uses, limitations, and impact ofcomputers), no rela-
tionship was established between their previous computer
course work and their current knowledge ofthe use of
computer technoLogy in occupational therapy. The Linkage
between generic computer literacy and knowLedge ofits
relationship to the use ofcomputer technology in occupa-
tionaL therapy was not evident to this sample ofjunior
and senior students.
n its 1991 Essentials and Guidelines fOr an Accredited
I Educational Program for the occupational therapist
and the occuparional rherapy assisranr, rhe American
Occupational Therapy Association (AOTA) mandared rhar
conrenr on technologies be included in occupational thera-
pist and occupational therapy assistant curricula (AOTA,
1991a, 1991b). An AOTA position paper on occupational
therapy and assisrive rechnology defines some of the rech-
nologies lIsed by occupational therapists in terms of the
federal definition of assistive technology devices (ATDs)
and describes them as "any item, piece of equipmenr, or
producr system, wherher acquired commercially off the
shelf, modified, or customized, that is used to increase,
maintain, or improve functional capabilities of individuals
with disabiliries" (Technology-Relared Assisrance for In-
dividuals Wirh Disabiliries Acr of 1988 [Public Law
217
 100-407J as cited in AOTA, 1991c,p.l076).
Kanny, Anson, and Smith (1991) surveyed entry-
level occupational therapy curriculum directOrs and iden-
tified 11 areas of technology training included in their
curricula: augmentative communication; cognition and
memory; device interfaces; environmental access; com-
puter technology; ethical, legal, and funding issues; pros-
thetics and orthotics; roles of service providers; sensory
aids; vehicle modifications; and wheeled mobility. Given
the increased use of technology in current occupational
therapy practice (Angelo, 1992; Angelo & Smith, 1993;
Anson, 1994; Bates, Spencer, Young, & Rintala, 1993;
Bay, 1991; Buning & Hanzlik, 1993; Holm & Rogers,
1991; Lau & O'leary, 1993; Pedretti et al., 1992; Post,
1993; Rogers & Holm, 1991; Shuster, 1993; Smith,
1993; Swinth, Anson, & Deitz, 1993), it is not surprising
that 88% of the survey respondents indicated that intro-
ductory-level technology skills should be included in
entry-level occupational therapy curricula.
Although 11 areas were specified, computer technol-
ogy content constituted 25.5% of required content in
technology and 41.9% of elective content in technology
in the 59 programs that responded to the survey, the
largest percentages of both required and elective technol-
ogy content in occupational therapist curricula (Kanny et
al., 1991). In current practice, computer technology can
be used for patient evaluation and intervention as well as
to gain easy access to patient databases, develop comput-
erized patient care and discharge plans, access product
databases and rehabilitation technology suppliers, partici-
pate in distance learning, and communicate with other
professionals via the Internet (Anson, 1994; Hammel &
Smith, 1993; Powell, 1994; Smith, 1993). Technology
competencies for preservice training (e.g., occupational
therapy educational curricula) and continuing education,
including computer technology competencies, have been
developed by the AOTA Technology Special Interest
Section (Hammel & Smith, 1993).
We reasoned, however, that to provide students with
the ATD learning experiences needed to become compe-
tent users of computer technology, occupational therapy
educators muSt first evaluate the computer literacy skills
of their students and faculty members. Computer litera-
cy, which is defined as the extent to which a person has a
general working knowledge of the uses, limitations, and
impact of computers, could soon be considered a pre-
requisite skill that occupational therapy students must
have to compete and survive in occupational therapy
curricula as well as in a society that increasingly depends
on computer technology (Montag, 1984; Hammel &
Smith, 1993).
218
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The purpose of this study was to (a) describe entry-
level occupational therapy students' opinions about com-
puter technology, (b) compare students' perceptions of
their current and desired knowledge of computer applica-
tions in occupational therapy, and (c) examine the rela-
tionship among opinions about computer technology,
current and desired knowledge of computer applications,
and the number of semesters of computer technology
courses completed (i.e., level of computer literacy).
Method
This study is part of a larger study on computer literacy
among allied health students. A random sample of nine
baccalaureate entry-level occupational therapy programs
(seven state universities and cwo private liberal arts col-
leges) was selected from a directory of accredited schools
offering these programs (Peterson Guide Publishing Com-
pany, 1993). Data were collected with cwo survey instru-
ments, which were mailed to entry-level program direc-
tors who were requested to administer the questionnaires
to their students and return the completed surveys to the
second author. Part I of the survey contained questions
regarcLng general attitudes about computers; Part II con-
tained questions about current and desired levels of
knowledge about computer applications in the field of
occupational therapy. Data were also collected about
respondents' enrollment status (junior or senior), age,
gender, race, number of required computer courses taken,
access to computers at school or home, and types of soft-
ware regularly used. A cover letter was attached to the
surveys explaining the objective of the study and solicit-
ing voluntary participation. The program directors of five
occupational therapy programs administered the ques-
tionnaires to their students and returned the completed
questionnaires to the second author, representing a 56%
return rate.
Respondents
The sample included 109 occupational therapy students;
27 (24.77%) were juniors and 82 (75.23%) seniors. The
mean age of the respondents was 24 years; 15 (13.76%)
were men and 94 (86.24%) were women. Ninety-eight
respondents (90.00%) were European-American, 8
(7.34%) African-American, 1 (.92%) Hispanic, 1 (.92%)
Asian-American, and 1 (.92%) Native American.
Eighty-four (77.06%) respondents had taken a com-
puter literacy course, with 33 (39.29%) of those respon-
dents indicating that the course was required. In response
to the question on the number of computer courses
taken, 14 (12.84%) respondents reported having taken
less than one course over a semester, 49 (44.95%) had
March 1996. Volume 50, Number 3
 one course, 18 (16.51 %) had twO courses, 3 (2.75%) had
three courses, and 2 (1.83%) had more than three cours-
es. Eighty-one (74.31 %) respondents reponed having
access to a computer and 97 (88.99%) reponed a work-
ing knowledge of commonly used word processing and
spreadsheet applications.
Instrument
Two instruments were used for data collection. The Com-
puter Opinion Survey (COS) (Mauser & Simonson,
1984) was used to assess general opinions toward comput-
er technology. The COS is a 26-item tool designed to
assess the extent to which respondents agree with state-
ments such as "I feel very negative about computers in
general" and "If I use a computer, I could get a better pic-
ture of the facts and figures." Each statement is rated with
a 6-point scale that ranges from 1 (strongly agree) to 6
(strongly disagree). The reliability and validity of the
instrument has been demonstrated in previous studies
(Mauser & Simonson, 1984; Montag, Simonson, &
Mauset, 1984; Thomas, 1985). In this study, the 26
items loaded on a single factor, and the instrument
achieved an acceptable Cronbach's index of internal con-
sistency of 0.94.
The second instrument used in this study was a
modified version of the Computer Knowledge Survey
(CKS) (Parks, Damrosch, Heller, & Romano, 1986).
The CKS is a 20-item tool designed to have respondents
self-assess their current and desired levels of computer
knowledge in three general areas: how computers func-
tion, issues of privacy and confidentiality, and computer
applications in their chosen field of study. Respondents
rate their current and desired knowledge for each item
with a 5-point scale that ranges from 1 (very low) to 5
(very high). Cronbach's index of internal consistency of
the scale was 0.95.
Results
Opinions About Computer Technology
Descriptive statistics of respondents' opinions about com-
puter technology (COS) are presented in Table 1.
Fourteen items (5, 7, 9,11,12,14, 18, and 19-25) were
stated in the negative and were therefore recoded so that
for reporting purposes, lower means would reflect posi-
tive opinions and higher means would indicate negative
opinions. Item means ranged from 1.44 to 3.42, with an
overall mean of 2.22, indicating that respondents' opin-
ions were generally positive about computer technology.

Table 1
Mean Scores on the Computer Opinion Survey (N = 109)
!cem Starement Range M SD Rank b
1 Having a computer available to me would improve my productivity. J--6 1.66 0.98 3
2 If I have ro usc a comp"rer for some reason, ir would probablv save me some time and work. 1--6 ] .73 0.88 4
3 If I use a compurer, I could ger a bercer piCture of tne facrs and figures. 1-6 2.47 1.05 20
4 Having a compurc=r available ro me would ill1lJrove my general sarisFacrion. 1--6 2.28 III Iii
5' Having ro use a computet could make my life less enjoyable. 1-6 2.06 1.08 12
6 Having a compurer available ro me could make things easier for me. ]-6 1.88 090 5
7" I feel very negative abuut computers in genetal. 1-6 1.95 l.l7 8
8 Having a computer available ro me could make things more fun fm me. 1-6 2.61 1.25 23
9' If I had a computer at my disposal, I would try ro get rid of it. 1-6 1.44 0.79 I
]0 I luok forward to a time when computers arc more widely used. 1-6 2.51 1.19 22
I]" I doubt if .I would ever Ilse computers very much. 1-6 1.90 1.04 6
12' I avoid using computers whenever I can. I-Ii 2.12 1.27 13
13 I enjoy using computers. 1-6 231 1.15 17
14' I feel rhar there are roo mallY computers arnund now. 1--6 2.05 1.15 II
15 Computers are probably goillg to be an imporrallr parr of my life. 1-6 1.99 0.92 9
16 A eumpurer could make learning fUll. 1-6 2.04 0.92 10
17 If I were ru us~ a compurer, I cnuld ger a lOt of sarisfacrion frum ir. 1-6 2.31 1.00 17
18' If I had ro use a computer, jt would pmbahly h~ more rrouble rhan ir was worrh. 1-6 2.16 1.03 14
19' 1 am usually uncomforrable when I have ro use compurers. 1-6 299 1.48 24
20' I somerjmes get nervous JUSt thinking ahout cnmpurers. 1-6 239 1.26 19
21' I will probably never learn ro use a cam purer. 1-6 1.60 0.83 2
22' Cumputer> are tOO complicated to be of much use [(J Ille. 1--6 1.94 104 7
23' If! had rn use a computer all the time, 1 would probably be verv unhappy. 1-6 2.47 137 20
24' I somerimes feel intimidated when I have ro use a compurer. 1-6 314 1.51 25
25' I somerimes feel due compurers are ~mcHrcr rhan I am. 1-6 342 145 26
21i 1can rhink of Illan)' ways rhar I could usc a compurer. 1-6 2.20 113 15
OlNegarive sraremenrs were recoded co march (he scoring scheme of positive sr;uemenrs; rherefore, lower means indicare more posirive opinions (respondenrs
s(rongly disagreed wirh [he sraremenr), and higher scores indican.: more negarive opinions.
hRank indicares rh.e mOSt positive response 0) ro rhe mnst negative response (26).

The Amerimn journal o/Ormpatlona! Therapy 219

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 The rotal possible score on the COS was 156, and after
recoding, respondents' scores ranged from 28 ro 122,
with a mean of 57.60. The 10 items with the lowest
means (strongest agreement with the statements) indicat-
ed that respondents agreed that computers are valued,
easy to learn, could improve productivity, and could
probably save time and work.
Computer KnowLedge: Current and Desired LeveLs of
KnowLedge
Results of the comparison between current and desired
levels of computer knowledge (CKS) are presented in
Table 2. Because of mulriple t-test comparisons, a Bon-
ferroni correction was used (Shott, 1990). Therefore, an
unadjusted p value of .0025 was required for an alpha
level of p < .05 (i.e., .05/20 comparisons = .0025).
Significant differences were established between respon-
dents' perceived current knowledge and their desired
knowledge of computers for all 20 items of the CKS. In
each instance, respondents' desired levels of computer
knowledge were significantly higher than their current
level of computer knowledge. Out of a possible total of
100 points, the respondents' mean total score was 50.70
for perceived current knowledge and 83.32 for desired
level of knowledge.
ReLationship Between Current KnowLedge and Computer
Literacy
We hypothesized that (a) greater levels of computer
knowledge would be highly correlated with the number
of computer courses completed; (b) positive opinions
toward computer technology would be highly correlated
with the number of computer courses taken; and (c) pos-
itive opinions toward computers would be highly corre-
lated with current levels of computer knowledge. Pearson
product-moment correlations did not support two of the
three hypotheses. Greater current levels of computer
knowledge were not found to be highly correlated with
the number of computer courses taken (r = -.02, not sig-
nificant) nor were positive opinions (lower mean scores)
toward computer technology strongly correlated with the
number of computer courses taken (r = -.04, not signifi-
cant). Positive opinions toward computer technology,
however, were moderately correlated with current levels
of computer knowledge (1' = -.36, P < .001).
Discussion
This study investigated occupational therapy students'
attitudes toward computers and their evaluation of po-
tential gaps between their current and desired levels of
computer knowledge. Relationships among computer lit-

Table 2
Mean Scores on the Computer KnOWledge Survey (N = 109)
Currenr Desired
Knowledge Knowledgeb
Irem Compurer Knowledge Are~ Iv! SD Iv! SD I Valuec

1 Howa compurer funcrions 2.98 0.93 4.32 1.00 ] 2.53'

2 The issues of confidenrialiry in com purer informarion rnanagemenr 2.05 1.38 3.57 1.16 10.85*
3 YOllr expccred role in yOlll field 2.25 1.40 3.97 1.18 ll..? 1*
4 Com purer appJicarions in youI' field 2.56 1.17 4.46 0.81 15.39*
5 Howa cornpurer can assisr yOll in providing parienr care 2.52 1.11 4.61 0.79 17.35*
6 How comp"rers al'e used by managers 2.42 1.36 4.09 0.97 1 J .50-
7 How compurers are used ro perform sr~risrical analyses 2.37 1.30 3.67 1.28 8.82*
8 The impacr of compllrer rechnology on rrearmenr ourcomes 2.14 1.35 4.30 0.88 14.65'
9 The imp~cr of compurer rechnology on cosr of healrh c~re 2.03 1.26 4.23 1.05 16.12*
10 How ro wrire a compurer program 1.81 1.07 3.45 1.54 11.01'
II How ro use a compurer 3.27 0.94 4.72 0.83 13.25*
12 How ro use a comp"rel' as a word processor 3.85 1.10 4.82 0.79 8.89*
13 The porenrial problems in compllrerized sysrems 2.16 1.28 3.81 1.2] 12.76*
14 The componenrs of a com purer sysrem 2 . 3 3 ] .21 3.82 1.46 I] .33-
15 The porenrials of comp"rers 2.77 1.27 4.30 0.95 11.44'
16 The limirarions of compurel's 2.50 \.22 4.08 1.08 11.74-
17 The av~iJ~biliry of rypes of compurers on rhe marker 2.42 1.45 3.92 1.09 9.95'
18 How ro lise cnrnpurers ro manage dara 2.25 1.20 3.98 1.20 11.01'
19 How (0 use compurel's in your school library for lilel'~rure search 3.52 1.00 4.67 083 9.85"
20 How camp"rers are llsed by arhers in your field 2.47 1.28 4.47 0.74 15.23'

Nole. For all means. lower means indicare lower levels of knowledge, and higher me~ns indic~re highel' levels of knowledge.
'ToraJ Iv! = 50.70, roral SD = 17.10
hT oral Iv! = 83.32, roral SD = 14.02
'I value of rhe difference berween rhe rwa ror;li means= -21.99, p < .01
P< .05 wirh Bonferroni correcrion

220 lv/arch 1996, Volume 50, Number 3

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 eracy, perceived current levels of computer knowledge,
and attitudes toward computers were also investigated.
The results suggest that the occupational therapy students
surveyed were generally enthusiastic abour com purer
technology and were aware of the positive impact com-
puters can have on their professional lives. Considering
the average age of the students surveyed, this result is not
surprising because students graduating from high school
within the past 10 years have had more exposure to com-
puters in high school and even grade school.
Consistent with the findings obtained in studies of
nursing students (Delaney, 1989; Feeg, 1984; Felton &
Brown, 1985; Litwack, Linc, & Bower, 1985; Parks et
al., 1986; Thomas, 1985), these occupational therapy
students perceived themselves as having Jow levels of
knowledge of computer applications in their field. They
also expressed a strong desire to increase their computer
knowledge. According to our findings, gaps between cur-
rent and desired knowledge of computer applications in
occupational therapy for which computer literacy insrruc-
tion would be most appropriate include (a) computer
applications in patient care, (b) impact of computer tech-
nology on health care costs and treatment outcomes, (c)
potentials and limitations of computer technology, (d)
uses of computers, and (e) basic components of a com-
puter. These results are consistent with technology con-
tent identified in the foundation computer technology
preservice (education program) competencies developed
by the AOTA Technology Special Interest Section (Ham-
mel & Smith, 1993).
The results of this study, however, suggest that taking
computer courses before entering an occupational therapy
curriculum is not significandy related to increased com-
puter knowledge relevant to occupational therapy. What
is unknown, however, is the type of content included in
the computer courses the respondents had tal(en. Another
limitation of the study is the ability to generalize to the
type of institutions the respondents were enrolled in, or
the total number of students who received the surveys
versus those who completed them (actual response rate).
After removing the surveys from the envelopes and enter-
ing the data (which were not coded by institution to pro-
tect the anonymity of the respondents), the research
assistant destroyed the envelopes, precluding specifIC
identification of the five responding curricula. Hence, we
are unable to make any statements about the type of
institutions the respondents attended, which limits gener-
alizability of the results. For the 109 respondents to the
COS and CKS, however, there was a moderately suong
and significant relationship between their current level of
computer knowledge and the positive nature of their atti-
The American journal ofOccupational Therapy
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tudes toward computer technology. Even though the re-
spondents were literate in commonly used word processing
and spreadsheet applications, they did not acknowledge a
significant relationship between their previous computer
course work and their current knowledge of the use of
computer technology in the occupational therapy profes-
sion. Somehow, the linkage between generic computer
literacy and the use of computer technology in occupa-
tional therapy was not apparent to this sample of junior
and senior students.
Measures that may facilitate the linkage between
generic computer literacy and knowledge of the uses of
computer technology in occupational therapy include
the adoption of common computer literacy competen-
cies as prerequisites for admission to occupational thera-
py educational programs. For example, if literacy in word
processing, data management, and graphics programs
were prerequisites for admission, basic concepts would
not have to be taught before occupational therapy appli-
cations of computer technology are introduced. Students'
perceived knowledge of computer applications in occu-
pational therapy (see Table 2, CKS item 4) might be
greater with increased availability of computer technolo-
gy, presentation of computer applications throughout the
professional curriculum, use of computer technology
during clinical rotations, and increased faculty member
proficiency in computer technology applications neces-
sary for the current practice of occupational therapy
(Hammel & Smith, 1993; Kanny et al., 1991).
Summary
Occupational therapy students from five baccalaureate
programs were surveyed about their opinions toward
computer technology and their perceptions of current
and desired levels of knowledge about com puter technol-
ogy applications in the field of occupational therapy. The
respondents were generally positive about computer
technology, and the level of knowledge they desired
about computer technology applications in occupational
therapy was signiflcandy greater than their current level
of knowledge. Although respondents' positive attitudes
toward computer technology were signiflcan tly correlated
with their current levels of computer knowledge, no sig-
nificant relationships were established between positive
attitudes toward computer technology and number of
computer courses completed before entering an occupa-
tional therapy curriculum or between current levels of
computer knowledge and number of courses taken ....
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