Clinical Utility of an Occupational Therapist-Led Smart Home Modification Program: A Mixed-Methods Evaluation

Importance For smart home modification (SHM) to translate into routine practice, clinicians need evidence that occupational therapist (OT)-led workflows are clinically useful, feasible, and scalable in community settings. Objective To evaluate the clinical utility of an OT-led SHM program and to identify implementation barriers and strategies that support adoption and sustainment in community practice. Design Sequential explanatory mixed-methods study. Setting Community-based practice settings. Participants Ten licensed OTs who implemented the SHM program in community services. Therapists’ implementation experience included delivering the program to 40 community-dwelling adults with physical disabilities (effectiveness outcomes reported separately). Outcomes and Measures OTs rated the clinical utility of 31 program recommendations using a structured evaluation form across appropriateness, applicability, and effectiveness (9-point scale) and documented whether each recommendation was applied. Semistructured interviews were conducted to explain rating patterns and to explore implementation barriers and improvement needs. Interview data were analyzed using thematic analysis by two coders with consensus procedures and an audit trail. Mixed-methods integration mapped themes to recommendation-level ratings. Results Overall, OTs rated the recommendations as highly clinically useful across domains. Applicability was comparatively lower for budget planning and for developing/implementing automation scenarios. Interviews indicated that cost constraints and technical complexity reduced feasibility, whereas OT-led goal prioritization, partial automation, simplification of operational steps, context-based training, and caregiver-inclusive education supported adoption. Revisits were most commonly linked to predictable maintenance events (e.g., unplugged power, device resets, battery depletion), underscoring the need for platform-based self-management resources and a triage pathway separating clinical OT tasks from technical support. Conclusions and Relevance OT-led SHM shows strong clinical utility in community practice when delivered through occupation-centered assessment, tailored training, and iterative refinement. Scalable implementation may be strengthened by feasible automation strategies, caregiver-inclusive education, and structured support pathways that reduce preventable follow-up. Article Contribution This study provides clinically grounded evidence for the utility of a manualized, OT-led SHM workflow and offers implementation strategies (partial automation, caregiver-inclusive training, platform-based self-management with triage) to support sustainable community delivery.