Learning Outcomes, Attitudes, and Experiences of Occupational Therapy Students in Service-Learning: A Mixed-Methods Study

Learning Outcomes, Attitudes, and Experiences of Occupational Therapy Students in Service-Learning: A Mixed-Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Learning Outcomes, Attitudes, and Experiences of Occupational Therapy Students in Service-Learning: A Mixed-Methods Study Sun-Hwa Shim, Hye-Won Cheon, Na-Kyoung Hwang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9155148/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Service-learning has emerged as an effective pedagogical strategy in health professions education, promoting academic development, civic engagement, and professional growth. However, evidence of its impact on occupational therapy (OT) students remains limited. Objective: This study aimed to investigate the learning outcomes, attitudes, and experiences of OT students who participated in a service-learning program. Methods: A mixed-methods design was employed. Pre- and post-program surveys (n=31) using the Service-Learning Outcomes Measurement Scale-Short Version were used to assess competency-based outcomes. After program completion, a survey was conducted to assess the students’ understanding of service-learning and its perceived relevance to OT education. Focus group interviews were subsequently conducted and thematically analyzed to further explore their perspectives. Results: Quantitative analyses revealed significant improvements with moderate effect sizes in knowledge application, personal and professional skills, and self-awareness. Although changes in civic orientation and engagement were non-significant, small-to-moderate effect sizes were observed. Post-program surveys indicated positive perceptions of service-learning, with students acknowledging its relevance to OT education and its role in integrating theoretical knowledge with real-world practice. Qualitative analysis identified three overarching themes: enhanced learning outcomes, personal growth and transformation, and strengthened professional identity. Conclusion: Service-learning positively contributes to academic development, personal growth, and the formation of professional identity among OT students. These findings underscore the importance of integrating service-learning into OT curricula to promote holistic student growth and professional preparedness. service-learning occupational therapy education student attitudes learning outcomes mixed-methods Figures Figure 1 Figure 2 Figure 3 Introduction In contemporary health professions education, there is growing recognition that cultivating technical competence alone is insufficient to prepare future practitioners for the complexities of modern healthcare systems. 1 Educators now emphasize the development of interpersonal skills, ethical reasoning, civic responsibility, and professional identity as essential components of comprehensive professional development. 2 , 3 To address these evolving educational needs, service-learning has emerged as an innovative and impactful pedagogical approach that integrates academic content with meaningful community engagement. 4 Service-learning is a structured educational experience in which students engage in organized service activities addressing community-identified needs, combined with guided reflection that promotes academic learning and personal growth. 5 Unlike traditional classroom learning, service-learning emphasizes experiential, student-centered education that situates learning within authentic social contexts. This approach enhances empathy, critical thinking, cultural competence, and social awareness among students across health-related disciplines. 6 , 7 In occupational therapy (OT) education, service-learning is particularly relevant because it aligns with the profession’s core principles of occupational justice, holistic care, and client-centered practice. Engaging with underserved populations in real-world settings allows OT students to deepen their understanding of the social determinants of health, develop professional communication skills, and address ethical and practical challenges that extend beyond textbook scenarios. 8 – 10 Such experiences often foster personal reflection, value clarification, and identity formation, all of which are integral to becoming competent and compassionate occupational therapists. 11 – 13 Despite the theoretical alignment and growing advocacy for service-learning in OT curricula, empirical evidence of its impact remains limited, particularly in non-Western and culturally diverse contexts. Most existing studies have relied on quantitative methods or focused primarily on academic performance and skill acquisition. 14 However, beyond quantitative research, exploring students’ subjective perspectives on how they interpret, internalize, and transform their service-learning experiences remains essential. Understanding students’ narratives of learning and growth is crucial for assessing the actual educational value of service-learning and optimizing its integration into health professions education. 15 This study addressed this gap by employing both qualitative and quantitative methods to examine the perceived learning outcomes, personal growth, and professional development of OT students who participated in a structured service-learning program. Through an in-depth analysis of student reflections alongside a quantitative evaluation of academic competencies and skill acquisition, this study aimed to elucidate how service-learning fosters professional identity formation and prepares students to navigate the interpersonal and ethical complexities of clinical practice. Focusing on Korean OT students, it offers a context-specific perspective that contributes to a broader understanding of how service-learning supports student development across diverse educational and cultural settings. Method Participants Participants were third-year OT students enrolled in the Community-Based Occupational Therapy course at Jeonju University in the Jeolla region of Korea. The course includes a structured service-learning program spanning two academic semesters. A total of 31 students participated in the study during the first semester of 2025, all without prior service-learning experience. Although service-learning activities were course requirements, only students who voluntarily consented were included in the pre- and post-surveys and focus-group interviews. Focus group participants were selected through purposive sampling based on two criteria: (a) enrollment in and completion of the service-learning course during the study period, and (b) voluntary agreement to participate in the discussions. Students who did not consent or missed major program activities were excluded to ensure that participants had direct, relevant experiences to provide meaningful insights into the program’s learning outcomes. Written informed consent was obtained from all participants prior to data collection. The study protocol was reviewed and approved by the Institutional Review Board of Jeonju University (No. jjIRB-2024-1005). Service-learning procedure The structured service-learning program was integrated into the Community-Based Occupational Therapy course over one academic semester. The program was implemented in four sequential phases: preparation, action, reflection, and evaluation and feedback. Figure 1 outlines the components and details of the service-learning approach used in this study. Outcome measures Quantitative and qualitative methods were employed to assess students’ perceptions, attitudes, and competency-based outcomes related to the service-learning course. A self-developed questionnaire assessed the students’ understanding of service-learning, its perceived relevance to OT education, and their attitudes toward community engagement. Questionnaire items were developed based on a review of relevant literature and core components of service-learning in OT education. 16,17 To ensure content validity, faculty experts reviewed the draft questionnaire, and a pilot test was conducted with a small group of students to confirm its clarity and relevance. A validated short version of the Service-Learning Outcomes Measurement Scale (S-LOMS-SV) was used to measure competency-based learning outcomes. It comprises 21 items across four domains: knowledge application, personal and professional skills, civic orientation and engagement, and self-awareness. The S-LOMS-SV has demonstrated content and construct validity and high internal consistency in a previous study 18 and was adapted to align with the core competencies emphasized in OT education. The scale was administered before and after the program to examine changes in student outcomes over time. To gain an in-depth understanding of students’ subjective experiences, semi-structured guiding questions were developed for the focus group interviews. The interview guide was developed based on a literature review of service-learning in OT education. It explored themes such as perceived learning outcomes, challenges encountered during the program, personal growth, and professional identity formation. By integrating quantitative and qualitative approaches, this study comprehensively captured the educational and experiential impacts of the service-learning program. Table 1 presents the semi-structured interview guide developed for the focus group discussions. Data analysis All quantitative data were analyzed using SPSS version 15.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means, standard deviations, and frequencies, were used to summarize the participant characteristics. Changes in outcomes measured using the S-LOMS-SV were examined using paired sample t -tests, with statistical significance set at p <.05. Perceptions and attitudes toward service-learning were analyzed using means, standard deviations, and positive response rates (%), calculated as the proportion of students who selected “agree” or “strongly agree” for each item. Qualitative data from the focus group interviews were analyzed using a constant comparative method. 19 Two researchers independently reviewed and coded transcripts, using open coding to identify initial themes. Codes were discussed until consensus was reached, after which categories were developed and axial coding was applied to identify overarching themes and subthemes. Selective coding was then used to refine the analysis and capture key learning outcomes, personal and professional growth, and perceived challenges during the service-learning program. The criteria of truth value, applicability, consistency, and neutrality proposed by Lincoln and Guba 20 were applied to ensure the trustworthiness of the qualitative data. Participants’ statements were recorded verbatim and independently analyzed by two researchers to maintain truth value. Applicability was confirmed through consultations with two OT professors experienced in qualitative research who were not involved in the study. Consistency was enhanced through regular meetings among the authors to compare analyses and discuss alternative interpretations. To ensure neutrality, the researchers adopted an “epoche” approach to minimize the influence of personal bias on data interpretation. Results Participant characteristics A total of 31 students participated in this study, comprising 13 men (41.9%) and 18 women (58.1%), with a mean age of 21.61±1.45 years. Changes in service-learning outcomes Significant improvements and moderate effect sizes were observed in the domains of knowledge application (pre: 6.13±1.97; post: 7.25±1.63; p =.011, Cohen’s d =0.56), personal and professional skills (pre: 6.38±1.85; post: 7.24±1.68; p =.047, d =0.47), and self-awareness (pre: 7.17±1.65; post: 8.16±1.62; p =.037, d =0.45). Although the improvement in civic orientation and engagement was not significant ( p =.175), the mean score increased from 7.66±1.54 to 8.21±1.38, with a small-to-moderate effect size ( d =0.40) (Table 2, Figure 2). Perceptions and attitudes toward the service-learning course Post-program survey revealed that participants generally expressed high levels of agreement regarding their perceptions of and attitudes toward the service-learning course (Table 3). Among the perception-related items, the highest positive response rates (100%) were observed for “Class content was linked to actual service activities” and “I felt a sense of responsibility as a community member.” Similarly, items such as “The content of the course is related to my major” and “Classroom learning was connected with field experience” also demonstrated high positive response rates (95.9%). Regarding attitudes toward service-learning, students strongly agreed that the program effectively connected academic learning with real-world experiences (positive response: 95.9%) and enhanced their interpersonal skills as future professionals (95.8%). However, the item “My ability to collaborate has improved” received a relatively lower positive response rate (66.7%). Qualitative findings Thematic analysis of the focus group interviews identified three primary categories: (1) perceived learning outcomes from service-learning, (2) perceived personal growth and transformation, and (3) influence on professional outlook and career identity (Figure 3). Perceived Learning Outcomes from Service-Learning Participants described applying academic knowledge in real-world contexts and developing practical clinical skills. The “application of academic knowledge” theme involved the transfer of classroom learning to field experiences and a deeper understanding of OT. For example, one participant stated, “It was meaningful to apply what I had learned in class directly to clients.” The “development of practical skills” theme encompassed acquiring clinical competencies, implementing intervention plans, and learning client interaction. Students also reported experiences related to “client-centered approaches” such as tailoring interventions to clients’ needs and recognizing the therapeutic value of meaningful activities. Additional themes included “emotional engagement,” which involves building rapport with clients; “adaptive problem-solving,” characterized by managing unexpected situations; and “teamwork and program design,” reflecting collaborative goal setting and planning with peers (Table 4). Perceived Personal Growth and Transformation Participants described various dimensions of personal development during the program. The theme “growth in flexibility and adaptability” captured students’ increased ability to respond to changing circumstances. One student remarked, “I used to panic when things deviated from plans, but I became more flexible.” The “enhanced collaboration and communication” theme reflected experiences of working together to plan and implement interventions. Students also highlighted “development of professional attitudes,” including greater respect and empathy for clients, and recognizing the importance of client autonomy. Themes related to “value clarification and ethical sensitivity” comprised increased awareness of social justice issues and evolving perceptions toward people with disabilities. Additionally, participants described “increased self-efficacy” and “empathy and human understanding,” reporting improvements in confidence and the ability to understand clients within their broader life contexts (Table 5). Influence on Professional Outlook and Career Identity Students discussed how service-learning shaped their perspectives on future professional roles. The “clarification of OT roles in the community” theme reflected an enhanced understanding of OT functions and scope in community settings. The “strengthening of career commitment” theme involved affirming OT as a career choice and an increased awareness of its societal impact. Under “future applications of learned skills,” participants expressed intentions to incorporate their experiences into clinical practice, particularly in program development and intervention planning. Additional themes included “development of professional vision,” reflecting students’ ability to envision themselves as competent practitioners, and “recognition of social responsibility,” highlighting their awareness of a therapist’s role in promoting client well-being through therapeutic programs (Table 6). Discussion This study examined the impact of a service-learning course on OT students’ learning outcomes, personal development, and professional identity. Integrated analysis of both quantitative and qualitative data revealed that service-learning experiences significantly enhance students’ academic progress, personal growth, and the development of professional competencies. Enhancement of academic and practical competencies The quantitative results demonstrated significant improvements in knowledge application, personal and professional skills, and self-awareness, with moderate effect sizes (Cohen’s d = 0.45–0.56), indicating significant contributions to participants’ learning outcomes. These findings align with prior research, suggesting that service-learning enhances students’ ability to translate theoretical knowledge into practice. 21 – 23 Improvements in self-awareness and professional skills align with the findings of Bogo, 24 who emphasized the importance of reflective practice in professional identity formation among healthcare students. Qualitative findings corroborated the quantitative results, highlighting the development of clinical competencies, such as assessment and intervention planning, and client-centered care, which are considered core components of OT education and practice. 25 Furthermore, students’ reflections indicated that the course effectively integrated academic knowledge with real-world engagement, exemplifying the principles of experiential and transformative learning. 21 , 26 This alignment between classroom instruction and community-based practice reinforces the pedagogical value of service-learning in preparing OT students for diverse and dynamic clinical environments. 27 , 28 Development of personal and interpersonal skills The service-learning program significantly fostered students’ personal and interpersonal development, particularly in flexibility, empathy, collaboration, and ethical sensitivity. The participants reported an enhanced ability to adapt to unexpected situations, greater respect for clients’ lived experiences, and an increased awareness of social justice issues. These findings align with existing literature indicating that service-learning enhances civic responsibility, empathy, interpersonal communication, and ethical reasoning. 15 , 29 Additionally, students’ reflections indicated growth in perspective-taking and recognition of systemic inequities, which are essential humanistic competencies in OT practice. 30 – 32 These insights demonstrate how experiential learning settings can promote critical engagement with social contexts and professional values. Although the quantitative measures of civic orientation and engagement did not reach statistical significance, the observed small-to-moderate effect size (Cohen’s d = 0.40) suggests that the program significantly influenced students’ attitudes. This finding is consistent with previous studies suggesting that service-learning can foster attitudinal and value-based development even when measurable changes are modest. 21 These results indicate that the program facilitated the development of professional identity rooted in humanistic values and social awareness, which are increasingly recognized as essential for effective, client-centered OT practice. Influence on career identity and professional vision The service-learning experience significantly enhanced the students’ professional identity formation and vision for their future careers. Students reported gaining insight into the broader role of occupational therapists in community settings and reaffirmed their commitment to the profession. These findings align with scoping reviews and mixed-method studies, highlighting that practice-based pedagogies, such as service-learning, are critical for developing professional identity and intelligence in OT students. 33 Furthermore, reflections on applying acquired skills and envisioning themselves as competent practitioners suggest that the program contributed to immediate skill acquisition and long-term professional growth. This finding aligns with prior research showing that immersive learning experiences promote identity formation and readiness for professional roles. 34 Educational and curricular implications The findings of this study strongly support integrating structured service-learning into the OT curriculum. By bridging academic content with community-based practice, service-learning enhances students’ clinical reasoning, ethical awareness, and social responsibility, which are core competencies in client-centered OT. 31,33 High levels of student agreement on the course’s relevance and its connection to field experience underscore the educational value of such programs. These findings align with recent literature showing that service-learning fosters professional identity formation, civic awareness, and reflective thinking among OT students. 12 , 35 Given the growing emphasis on experiential learning and occupational justice in health profession education, incorporating service-learning as a pedagogical strategy may better prepare students for the complex demands of community-based practice. 31 , 36 Limitations and future directions Despite the encouraging outcomes, this study has a few limitations. First, the sample size was relatively small and drawn exclusively from a single institution, limiting the generalizability of the findings to broader populations or other educational contexts. Future research should involve larger, more diverse samples across multiple institutions to enhance external validity. Second, the reliance on self-report instruments and the voluntary nature of participation may have introduced response bias, including social desirability and selection bias. Future studies should consider incorporating mixed-method approaches, including observational assessments, peer evaluations, and instructor-rated performance measures, to triangulate the data and improve objectivity. Third, this study assessed only short-term outcomes. Therefore, longitudinal research is needed to examine the lasting effects of service-learning on students’ professional competencies, civic engagement, and workforce integration after graduation. Finally, although positive outcomes were observed across several domains, collaboration and civic engagement showed relatively modest improvements. To strengthen these specific domains, further investigations should explore pedagogical strategies or curricular enhancements, such as interprofessional education modules, structured reflection, and mentorship opportunities. Conclusion This study provides evidence of the educational value of service-learning within OT programs. By integrating academic content with real-world community engagement, service-learning fosters cognitive development, personal growth, and professional identity formation. Participants reported enhanced understanding of course materials, increased empathy, improved communication skills, and a clearer vision of their roles as future occupational therapists. These findings highlight the potential of service-learning as a transformative pedagogical tool aligned with the holistic and client-centered values of OT. Therefore, integrating service-learning into health professions education may serve as an effective strategy to prepare socially responsive and competent practitioners capable of addressing the complex needs of diverse populations. Declarations Data Sharing Statement All data generated or analyzed during this study are included within this article. Further inquiries can be directed to the corresponding author. Ethics Approval and Consent to Participate This study was approved by the Ethics Committee of Jeonju University and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study. Author Contributions All authors contributed to data analysis, drafting or revising the manuscript, gave final approval of the version to be published, agreed to the submitted journal, and take responsibility for all aspects of the work. Funding The authors declare that no funding was received for this research. Disclosure The authors declare no conflicts of interest in this work. References Benner P. Educating nurses: a call for radical transformation-how far have we come?. J Nurs Educ. 2012;51(4):183-184. https://doi.org/10.3928/01484834-20120402-01 Fitzgerald HE, Bruns K, Sonka ST, Furco A, Swanson L. The centrality of engagement in higher education: reflections and future directions. J Higher Educ Outreach Engagem. 2016;20(1):245-253. Tijsma G, Hilverda F, Scheffelaar A, et al. Becoming productive 21st century citizens: a systematic review uncovering design principles for integrating community service learning into higher education courses. Educ Res. 2020;62(4):390-413. https://doi.org/10.1080/00131881.2020.1836987 Stewart T, Wubbena Z. An overview of infusing service-learning in medical education. Int J Med Educ. 2014;5:147-156. https://doi.org/10.5116/ijme.53ae.c907 Bringle RG, Hatcher JA. A service-learning curriculum for faculty. Mich J Community Serv Learn. 1995;2(1):112-122. Schmidt NA, Brown JM. Service Learning in Undergraduate Nursing Education: Strategies to Facilitate Meaningful Reflection. J Prof Nurs. 2016;32(2):100-106. https://doi.org/10.1016/j.profnurs.2015.06.006 Chen HC, McAdams-Jones D, Tay DL, Packer JM. The impact of service–learning on students’ cultural competence. Teach Learn Nurs. 2012;7(2):67-73. https://doi.org/10.1016/j.teln.2011.11.002 Hansen AM, Muñoz J, Crist PA, et al. Service learning: meaningful, community-centered professional skill development for occupational therapy students. Occup Ther Health Care. 2007;21(1-2):25-49. https://doi.org/10.1080/J003v21n01_03 Maloney SM, Myers C, Bazyk J. The influence of a community‑based service‑learning experience on the development of occupational therapy students’ feelings of civic responsibility. Occup Ther Ment Health. 2014;30(2):144‑161. https://doi.org/10.1080/0164212X.2014.910160 Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client Centeredness and Health Reform: Key Issues for Occupational Therapy. Am J Occup Ther. 2015;69(5):6905090010p1-6905090010p8. https://doi.org/10.5014/ajot.2015.695001 Lahav O, Daniely N, Yalon-Chamovitz S. Interpersonal social responsibility model of service learning: A longitudinal study. Scand J Occup Ther. 2018;25(1):61-69. https://doi.org/10.1080/11038128.2017.1335775 Tal-Saban M, Zaguri-Vittenberg S, Weintraub N. Enhancing professional identity of first-year occupational therapy students with the community-academia student tutoring program. Br J Occup Ther. 2024;87(2):106-113. https://doi.org/10.1177/03080226231198341 Bazyk S, Glorioso M, Gordon R, Haines J, Percaciante M. Service learning: the process of doing and becoming an occupational therapist. Occup Ther Health Care. 2010;24(2):171-187. https://doi.org/10.3109/07380571003681194 Wang Y, Chung LH, Cheng CY, et al. Predictors of academic and fieldwork performance in occupational therapy students: A systematic review. Occup Ther Int. 2023;2023:7281505. https://doi.org/10.1155/2023/7281505. Jacoby B. Service-learning essentials: Questions, answers, and lessons learned. San Francisco: Jossey-Bass; 2015. Andonian L. Occupational therapy students’ self‑efficacy, experience of supervision, and perception of meaningfulness of Level II fieldwork. Open J Occup Ther. 2017;5(2):Article 7. https://doi.org/10.15453/2168‑6408.1220. Mattila A, DeIuliis ED, Cook AB. Increasing self‑efficacy through role emerging placements: Implications for occupational therapy experiential learning. J Occup Ther Educ. 2018;2(3). https://doi.org/10.26681/jote.2018.020303 Lau KH, Lam L, Snell RS, Ma CH‑K. The development of the Service‑Learning Outcomes Measurement Scale—Short Version (S‑LOMS‑SV) and its preliminary validation. Int J Res Serv‑Learn Community Engagem. 2024;12(1). https://doi.org/10.37333/001c.125347. Glaser BG, Strauss AL. The constant comparative method of qualitative analysis. Soc Probl. 1965;12(4):436‑445. Lincoln YS, Guba EG. Naturalistic Inquiry. Thousand Oaks (CA): SAGE; 1985. Eyler J, Giles DE. Where's the learning in service-learning? San Francisco: Jossey-Bass; 1999. Hunt R. Service-learning: an eye-opening experience that provokes emotion and challenges stereotypes. J Nurs Educ. 2007;46(6):277-281. https://doi.org/10.3928/01484834-20070601-07 Coker JS, Heiser E, Taylor L, Book C. Impacts of experiential learning depth and breadth on student outcomes. J Exper Educ. 2017;40(1):5‑23. https://doi.org/10.1177/1053825916678265 Bogo M. Achieving competence in social work through field education. Toronto: University of Toronto Press; 2010. Thomas Y, Penman M. WFOT standard for 1000 hours of practice placement: Informed by tradition or evidence? Br J Occup Ther. 2018;82(1):3‑4. https://doi.org/10.1177/0308022618788785. Mezirow J. Transformative Learning: Theory to Practice. New Dir Adult Cont Educ. 1997;(74):5‑12. https://doi.org/10.1002/ace.7401 Anderson KL, Pierce ME, McNamara KM. NUMB3Rs revisited: Long-term impacts of reimagining service learning. J Exper Educ. 2022;45(1):51‑67. https://doi.org/10.1177/1053825920973692 Jones D, McAllister L, Lyle D. Interprofessional academic service-learning in rural Australia: Exploring the impact on allied health student knowledge, skills, and practice. A qualitative study. Int J Pract-Based Learn Health Soc Care. 2015;3(2):1‑16. https://doi.org/10.18552/ijpblhsc.v3i2.217 Simons L, Cleary B. The influence of service learning on students’ personal and social development. Coll Teach. 2006;54(4):307‑319. https://doi.org/10.3200/CTCH.54.4.307‑319 Hansen AM. Bridging theory and practice: occupational justice and service learning. Work. 2013;45(1):41-58. https://doi.org/10.3233/WOR-131597 Wisniewski PA. Community–Based Learning: Transformative Change in OT Students’ Awareness of Occupational Justice & Community Health. Am J Occup Ther. 2024;78(Suppl 2):7811500064p1. https://doi.org/10.5014/ajot.2024.78S2‑PO64 Lim SM, Tan BL, Lim HB, Goh ZAG. Engaging persons with disabilities as community teachers for experiential learning in occupational therapy education. Hong Kong J Occup Ther. 2018;31(1):36‑45. https://doi.org/10.1177/1569186118783877 Souto‑Gómez A‑I, Talavera‑Valverde M‑Á, Márquez‑Álvarez L‑J, García‑de‑la‑Torre M‑d‑P. Analysis of Occupational Therapy Students’ Pedagogical Practices for the Forging of Professional Identity and Development of Professional Intelligence: A Scoping Review. J Intell. 2023;11(3):48. https://doi.org/10.3390/jintelligence11030048 Gray H, Colthorpe K, Ernst H, Ainscough L. Professional identity of undergraduate occupational therapy students. J Occup Ther Educ. 2020;4(1). https://doi.org/10.26681/jote.2020.040102 Potvin MC, Morales AN, West EK, Kalimi M, Coviello JM. Occupational therapy students' perceptions of their experience in a role-emerging Level II fieldwork within higher education student services. BMC Med Educ. 2024;24(1):384. https://doi.org/10.1186/s12909-024-05303-7 Valdes K, Rider J, Leach C, Manalang KC. The impact of service‑learning on occupational therapy doctoral students. J Serv‑Learn High Educ. 2023;17:3‑15. Tables Table 1. Areas and questions for group interviews Learning Outcomes 1. What achievements did you gain from the community service experience? 2. Can you describe a session that went particularly well? 3. Were there any confusing or challenging moments during the program? 4. How was your interaction with the clients? Personal Change and Growth 1. Did you make any decisions or modify sessions during the program? How did you feel, and what were your thoughts? 2. Please describe your experiences collaborating and discussing with team members to plan and implement the program. 3. How did the community service experience influence your goals, values, attitudes, or beliefs? Professional Change and Growth 1. How will this community service experience affect your future professional practice? Table 2. Pre-post changes in service-learning outcomes (S-LOMS-SV). Domain Pre (M±SD) Post (M±SD) t df p Cohen’s d Knowledge application 6.13±1.97 7.25±1.63 -2.758 23 .011 0.56 Personal & professional skills 6.38±1.85 7.24±1.68 -2.081 23 .047 0.47 Civic orientation & engagement 7.66 ±1.54 8.21±1.38 -1.398 23 .175 0.40 Self-awareness 7.17±1.65 8.16±1.62 -2.210 23 .037 0.45 Table 3. Perceptions and attitudes toward service-learning (post) Perception of the service-learning course M±SD Positive response rate (%) The course content is related to my major. 4.63±0.57 95.9 Class content was linked to actual service activities. 4.58±0.50 100 It made me reflect on community issues. 4.54±0.65 91.7 Activities helped me understand the course objectives. 4.42±0.58 95.8 The course improved my ability to solve real-world problems. 4.58±0.65 91.7 Classroom learning was connected with field experience. 4.63±0.57 95.9 I felt a sense of responsibility as a community member. 4.61±0.49 100 I considered the roles and values of community. 4.46±0.58 95.8 Attitudes Toward Service Learning M±SD Positive response rate (%) I became more aware of the surrounding social issues. 4.38±0.71 87.5 Service-learning connects academic learning with real-world experience. 4.50±0.59 95.9 My ability to collaborate has improved. 4.17±0.91 66.7 I became more open to diverse opinions. 4.38±0.64 91.6 Service learning is necessary in university education. 4.25±0.67 87.5 I think it can be applied to other courses in the future. 4.58±0.50 100 It helped me develop interpersonal skills needed as a professional. 4.46±0.58 95.8 Table 4. Perceived learning outcomes of the service-learning experience Theme Subtheme Representative Quotes 1. Application of Academic Knowledge - Applying textbook knowledge in real-world settings “It was meaningful to apply what I had learned in class directly to clients.” (Student 5) - Better understanding of occupational therapy “I achieved a deeper understanding of my major and gained practical capabilities.” (Student 6) 2. Development of Practical Skills - Acquiring clinical competencies and field skills “I was able to experience actual clinical skills and how to interact with real clients.” (Student 1) - Planning and executing interventions “I acquired skills in planning and implementing programs, and adjusting interventions based on post-evaluation.” (Student 10) 3. Client-Centered Approach - Adapting activities to client needs and functional levels “I learned how to grade activities according to clients’ abilities.” (Student 4) - Understanding the therapeutic effects of meaningful activities “I recognized the effects of handcraft activities for clients with impaired hand function.” (Student 4) 4. Emotional Engagement - Building rapport and mutual sharing “We shared our life stories, and by the end, we had formed a close relationship.” (Student 3) - Enhancing empathy and communication “It helped me develop communication skills with clients.” (Student 6) 5. Adaptive Problem-Solving - Managing unexpected or challenging situations “When a client cried and left, I felt confused and did not know how to respond.” (Student 2) - Flexibility and responsiveness in real-time settings “I had to quickly change the activity depending on each client’s interest and ability.” (Student 10) 6. Program Design and Teamwork - Collaborating on intervention goals and methods “We actively shared opinions in selecting activities tailored to the clients.” (Student 1) - Enhancing intervention planning skills “I developed the ability to determine which program suits which client best and recognized the importance of feedback.” (Student 7) Table 5. Perceived personal growth and transformation through service-learning Theme Subtheme Representative Quotes 1. Growth in Flexibility and Adaptability - Real-time decision-making and session adjustment “When the activity ended early, we improvised and implemented another activity.” (Student 3) - Becoming less rigid and more solution-oriented “I used to panic when things deviated from plan, but I became more flexible.” (Student 1) 2. Enhanced Collaboration and Communication - Active discussion and shared decision-making among team members “We constantly exchanged ideas and improved the program through group discussion.” (Student 9) - Negotiating program content and responsibilities “Each session was planned collaboratively, and everyone contributed with ideas.” (Student 5) 3. Development of Professional Attitudes - Embracing respect and empathy for clients “I learned to approach people with disabilities without hesitation.” (Student 4) - Understanding the importance of client participation and autonomy “I realized that supporting client participation is more important than providing help unconditionally.” (Student 5) 4. Value Clarification and Ethical Sensitivity - Increased awareness of social justice and diversity “It made me reflect on how to understand and support the socially vulnerable.” (Student 6) - Shifting perspectives toward people with disabilities “I began to view people with disabilities not as different, but as individuals just like us.” (Student 9) 5. Increased Self-Efficacy and Confidence - Gained confidence in clinical and leadership skills “I developed confidence and courage to lead a program.” (Student 2) - Identifying personal strengths and areas for improvement “I became aware of areas for improvement and strategies for managing unexpected challenges.” (Student 3) 6. Empathy and Human Understanding - Recognizing the client’s life context “To improve clients’ quality of life, therapeutic skill alone is not enough—understanding people is essential.” (Student 6) - The importance of rapport and client-centered interaction “I realized the importance of rapport in enabling meaningful participation.” (Student 8) Table 6. The influence of service-learning on occupational therapy students’ professional outlook and career identities Theme Subtheme Representative Quotes 1. Clarification of OT Roles in the Community - Understanding the scope and function of community-based OT “I learned what occupational therapists actually do in the community setting.” (Student 1) - Increased interest in community-based practice “Among various OT fields, I became more interested in the community area.” (Student 5) 2. Strengthening of Career Commitment - Confirmation of OT as a future profession “This experience helped me build confidence and confirmed my desire to become an occupational therapist.” (Student 6) - Awareness of the profession’s social impact “It prompted me to reflect on the significance and importance of being an occupational therapist.” (Student 10) 3. Future Application of Learned Skills - Applying service-learning experience to future clinical practice “These experiences will help me in designing and delivering future clinical programs.” (Student 3) - Enhancing ability to design and evaluate interventions “Through post-program evaluation, I realized how our intervention improved hand function, which made me appreciate the value of OT.” (Student 4) 4. Development of Professional Vision - Envisioning oneself as a capable and strategic occupational therapist “I want to become a therapist who is friendly but also takes the lead with well-planned programs.” (Student 2) - Self-reflection on potential strengths and specialization “It prompted me to consider which area of OT would best suit me in the future.” (Student 10) 5. Recognition of Social Responsibility - Helping clients live better lives through therapeutic programs “As aging progresses, we can offer more diverse, targeted interventions to support better living for people with disabilities.” (Student 2) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviews received at journal 23 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 27 Mar, 2026 Editor assigned by journal 19 Mar, 2026 Submission checks completed at journal 19 Mar, 2026 First submitted to journal 18 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9155148","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":628454555,"identity":"df02623e-d286-46e8-a295-96c19711c2d0","order_by":0,"name":"Sun-Hwa Shim","email":"","orcid":"","institution":"Jeonju University","correspondingAuthor":false,"prefix":"","firstName":"Sun-Hwa","middleName":"","lastName":"Shim","suffix":""},{"id":628454559,"identity":"969759cf-3554-4812-aee0-d4feb1fddff3","order_by":1,"name":"Hye-Won Cheon","email":"","orcid":"","institution":"Howon University","correspondingAuthor":false,"prefix":"","firstName":"Hye-Won","middleName":"","lastName":"Cheon","suffix":""},{"id":628454561,"identity":"eba481ba-4311-4b31-9119-98616074507f","order_by":2,"name":"Na-Kyoung Hwang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBADHgYG5gMHPgBZbOzE6TAAamFLPDgDpIWZSC0gi4wP84DYhLTwsx9+Jl1Q80eGX7ot4bDNr23yfMwMjB8+5uDWItmTZiY945gBj+ScwwcO5/bdNmxjZmCWnLkNj4tu8LBJ87AZ8BjcSEs4nNtzmxGohY2Zl6CWfyAtOQaHLXtu2xOnhbcNqoXhx+1EglqAfjG2ntlnzCM5Iy3hYG/D7eQ2ZsZmvH4BhtjD2wXf5Oz5JZIPf/jx57bt/Pbmgx8+4tECAoiIYGwDkw341aNoYfhDUPEoGAWjYBSMQAAAYhlLpRRWB/gAAAAASUVORK5CYII=","orcid":"","institution":"Seoul Metropolitan Bukbu Hospital","correspondingAuthor":true,"prefix":"","firstName":"Na-Kyoung","middleName":"","lastName":"Hwang","suffix":""}],"badges":[],"createdAt":"2026-03-18 06:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9155148/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9155148/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108125893,"identity":"2e540d72-a007-43f1-be6c-97837fa0ead3","added_by":"auto","created_at":"2026-04-29 15:21:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74512,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eService-learning procedure\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Binder11.png","url":"https://assets-eu.researchsquare.com/files/rs-9155148/v1/8a7b6302155718e3c5b58565.png"},{"id":108182707,"identity":"8aa421e2-521a-49cc-90b7-e26d606485b9","added_by":"auto","created_at":"2026-04-30 08:59:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16304,"visible":true,"origin":"","legend":"\u003cp\u003ePre-Post Comparison of S-LOMS-SV Domain Scores\u003c/p\u003e","description":"","filename":"Binder12.png","url":"https://assets-eu.researchsquare.com/files/rs-9155148/v1/de246bbbdd08151cde46f105.png"},{"id":108125895,"identity":"010fa847-e72f-4fee-bde3-cc49f49966bb","added_by":"auto","created_at":"2026-04-29 15:21:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":164501,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerceived learning outcomes from service-learning\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Binder13.png","url":"https://assets-eu.researchsquare.com/files/rs-9155148/v1/1ca9d4d2ac834f227f1f3325.png"},{"id":108183508,"identity":"a7246bab-9435-47d7-97a0-0825af3bea62","added_by":"auto","created_at":"2026-04-30 09:01:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":672535,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9155148/v1/19484e7c-c029-49b8-b3b8-0bc50e5b2a6a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Learning Outcomes, Attitudes, and Experiences of Occupational Therapy Students in Service-Learning: A Mixed-Methods Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn contemporary health professions education, there is growing recognition that cultivating technical competence alone is insufficient to prepare future practitioners for the complexities of modern healthcare systems.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Educators now emphasize the development of interpersonal skills, ethical reasoning, civic responsibility, and professional identity as essential components of comprehensive professional development.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e To address these evolving educational needs, service-learning has emerged as an innovative and impactful pedagogical approach that integrates academic content with meaningful community engagement.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eService-learning is a structured educational experience in which students engage in organized service activities addressing community-identified needs, combined with guided reflection that promotes academic learning and personal growth.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Unlike traditional classroom learning, service-learning emphasizes experiential, student-centered education that situates learning within authentic social contexts. This approach enhances empathy, critical thinking, cultural competence, and social awareness among students across health-related disciplines.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn occupational therapy (OT) education, service-learning is particularly relevant because it aligns with the profession\u0026rsquo;s core principles of occupational justice, holistic care, and client-centered practice. Engaging with underserved populations in real-world settings allows OT students to deepen their understanding of the social determinants of health, develop professional communication skills, and address ethical and practical challenges that extend beyond textbook scenarios.\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Such experiences often foster personal reflection, value clarification, and identity formation, all of which are integral to becoming competent and compassionate occupational therapists.\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the theoretical alignment and growing advocacy for service-learning in OT curricula, empirical evidence of its impact remains limited, particularly in non-Western and culturally diverse contexts. Most existing studies have relied on quantitative methods or focused primarily on academic performance and skill acquisition.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, beyond quantitative research, exploring students\u0026rsquo; subjective perspectives on how they interpret, internalize, and transform their service-learning experiences remains essential. Understanding students\u0026rsquo; narratives of learning and growth is crucial for assessing the actual educational value of service-learning and optimizing its integration into health professions education.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e This study addressed this gap by employing both qualitative and quantitative methods to examine the perceived learning outcomes, personal growth, and professional development of OT students who participated in a structured service-learning program. Through an in-depth analysis of student reflections alongside a quantitative evaluation of academic competencies and skill acquisition, this study aimed to elucidate how service-learning fosters professional identity formation and prepares students to navigate the interpersonal and ethical complexities of clinical practice. Focusing on Korean OT students, it offers a context-specific perspective that contributes to a broader understanding of how service-learning supports student development across diverse educational and cultural settings.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were third-year OT students enrolled in the \u003cem\u003eCommunity-Based Occupational Therapy\u003c/em\u003e course at Jeonju University in the Jeolla region of Korea. The course includes a structured service-learning program spanning two academic semesters. A total of 31 students participated in the study during the first semester of 2025, all without prior service-learning experience. Although service-learning activities were course requirements, only students who voluntarily consented were included in the pre- and post-surveys and focus-group interviews. Focus group participants were selected through purposive sampling based on two criteria: (a) enrollment in and completion of the service-learning course during the study period, and (b) voluntary agreement to participate in the discussions. Students who did not consent or missed major program activities were excluded to ensure that participants had direct, relevant experiences to provide meaningful insights into the program’s learning outcomes. Written informed consent was obtained from all participants prior to data collection. The study protocol was reviewed and approved by the Institutional Review Board of Jeonju University (No. jjIRB-2024-1005).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eService-learning procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe structured service-learning program was integrated into the \u003cem\u003eCommunity-Based Occupational Therapy\u003c/em\u003e course over one academic semester. The program was implemented in four sequential phases: preparation, action, reflection, and evaluation and feedback. Figure 1 outlines the components and details of the service-learning approach used in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative and qualitative methods were employed to assess students’ perceptions, attitudes, and competency-based outcomes related to the service-learning course. A self-developed questionnaire assessed the students’ understanding of service-learning, its perceived relevance to OT education, and their attitudes toward community engagement. Questionnaire items were developed based on a review of relevant literature and core components of service-learning in OT education.\u003csup\u003e16,17\u003c/sup\u003e To ensure content validity, faculty experts reviewed the draft questionnaire, and a pilot test was conducted with a small group of students to confirm its clarity and relevance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA validated short version of the Service-Learning Outcomes Measurement Scale (S-LOMS-SV) was used to measure competency-based learning outcomes. It comprises 21 items across four domains: knowledge application, personal and professional skills, civic orientation and engagement, and self-awareness. The S-LOMS-SV has demonstrated content and construct validity and high internal consistency in a previous study\u003csup\u003e18\u003c/sup\u003e and was adapted to align with the core competencies emphasized in OT education. The scale was administered before and after the program to examine changes in student outcomes over time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo gain an in-depth understanding of students’ subjective experiences, semi-structured guiding questions were developed for the focus group interviews. The interview guide was developed based on a literature review of service-learning in OT education. It explored themes such as perceived learning outcomes, challenges encountered during the program, personal growth, and professional identity formation. By integrating quantitative and qualitative approaches, this study comprehensively captured the educational and experiential impacts of the service-learning program. Table 1 presents the semi-structured interview guide developed for the focus group discussions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll quantitative data were analyzed using SPSS version 15.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means, standard deviations, and frequencies, were used to summarize the participant characteristics. Changes in outcomes measured using the S-LOMS-SV were examined using paired sample \u003cem\u003et\u003c/em\u003e-tests, with statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026lt;.05. Perceptions and attitudes toward service-learning were analyzed using means, standard deviations, and positive response rates (%), calculated as the proportion of students who selected “agree” or “strongly agree” for each item.\u003c/p\u003e\n\u003cp\u003eQualitative data from the focus group interviews were analyzed using a constant comparative method.\u003csup\u003e19\u003c/sup\u003e Two researchers independently reviewed and coded transcripts, using open coding to identify initial themes. Codes were discussed until consensus was reached, after which categories were developed and axial coding was applied to identify overarching themes and subthemes. Selective coding was then used to refine the analysis and capture key learning outcomes, personal and professional growth, and perceived challenges during the service-learning program. The criteria of truth value, applicability, consistency, and neutrality proposed by Lincoln and Guba\u003csup\u003e20\u003c/sup\u003e were applied to ensure the trustworthiness of the qualitative data. Participants’ statements were recorded verbatim and independently analyzed by two researchers to maintain truth value. Applicability was confirmed through consultations with two OT professors experienced in qualitative research who were not involved in the study. Consistency was enhanced through regular meetings among the authors to compare analyses and discuss alternative interpretations. To ensure neutrality, the researchers adopted an “epoche” approach to minimize the influence of personal bias on data interpretation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 31 students participated in this study, comprising 13 men (41.9%) and 18 women (58.1%), with a mean age of 21.61±1.45 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanges in service-learning outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant improvements and moderate effect sizes were observed in the domains of knowledge application (pre: 6.13±1.97; post: 7.25±1.63; \u003cem\u003ep\u003c/em\u003e=.011, Cohen’s \u003cem\u003ed\u003c/em\u003e=0.56), personal and professional skills (pre: 6.38±1.85; post: 7.24±1.68; \u003cem\u003ep\u003c/em\u003e=.047, \u003cem\u003ed\u003c/em\u003e=0.47), and self-awareness (pre: 7.17±1.65; post: 8.16±1.62; \u003cem\u003ep\u003c/em\u003e=.037, \u003cem\u003ed\u003c/em\u003e=0.45). Although the improvement in civic orientation and engagement was not significant (\u003cem\u003ep\u003c/em\u003e=.175), the mean score increased from 7.66±1.54 to 8.21±1.38, with a small-to-moderate effect size (\u003cem\u003ed\u003c/em\u003e=0.40) (Table 2, Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceptions and attitudes toward the service-learning course\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-program survey revealed that participants generally expressed high levels of agreement regarding their perceptions of and attitudes toward the service-learning course (Table 3). Among the perception-related items, the highest positive response rates (100%) were observed for “Class content was linked to actual service activities” and “I felt a sense of responsibility as a community member.” Similarly, items such as “The content of the course is related to my major” and “Classroom learning was connected with field experience” also demonstrated high positive response rates (95.9%). Regarding attitudes toward service-learning, students strongly agreed that the program effectively connected academic learning with real-world experiences (positive response: 95.9%) and enhanced their interpersonal skills as future professionals (95.8%). However, the item “My ability to collaborate has improved” received a relatively lower positive response rate (66.7%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis of the focus group interviews identified three primary categories: (1) perceived learning outcomes from service-learning, (2) perceived personal growth and transformation, and (3) influence on professional outlook and career identity (Figure 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived Learning Outcomes from Service-Learning\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described applying academic knowledge in real-world contexts and developing practical clinical skills. The “application of academic knowledge” theme involved the transfer of classroom learning to field experiences and a deeper understanding of OT. For example, one participant stated, \u003cem\u003e“It was meaningful to apply what I had learned in class directly to clients.”\u003c/em\u003e The “development of practical skills” theme encompassed acquiring clinical competencies, implementing intervention plans, and learning client interaction. Students also reported experiences related to “client-centered approaches” such as tailoring interventions to clients’ needs and recognizing the therapeutic value of meaningful activities. Additional themes included “emotional engagement,” which involves building rapport with clients; “adaptive problem-solving,” characterized by managing unexpected situations; and “teamwork and program design,” reflecting collaborative goal setting and planning with peers (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived Personal Growth and Transformation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described various dimensions of personal development during the program. The theme “growth in flexibility and adaptability” captured students’ increased ability to respond to changing circumstances. One student remarked, \u003cem\u003e“I used to panic when things deviated from plans, but I became more flexible.”\u003c/em\u003e The “enhanced collaboration and communication” theme reflected experiences of working together to plan and implement interventions. Students also highlighted “development of professional attitudes,” including greater respect and empathy for clients, and recognizing the importance of client autonomy. Themes related to “value clarification and ethical sensitivity” comprised increased awareness of social justice issues and evolving perceptions toward people with disabilities. Additionally, participants described “increased self-efficacy” and “empathy and human understanding,” reporting improvements in confidence and the ability to understand clients within their broader life contexts (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInfluence on Professional Outlook and Career Identity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents discussed how service-learning shaped their perspectives on future professional roles. The “clarification of OT roles in the community” theme reflected an enhanced understanding of OT functions and scope in community settings. The “strengthening of career commitment” theme involved affirming OT as a career choice and an increased awareness of its societal impact. Under “future applications of learned skills,” participants expressed intentions to incorporate their experiences into clinical practice, particularly in program development and intervention planning. Additional themes included “development of professional vision,” reflecting students’ ability to envision themselves as competent practitioners, and “recognition of social responsibility,” highlighting their awareness of a therapist’s role in promoting client well-being through therapeutic programs (Table 6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the impact of a service-learning course on OT students\u0026rsquo; learning outcomes, personal development, and professional identity. Integrated analysis of both quantitative and qualitative data revealed that service-learning experiences significantly enhance students\u0026rsquo; academic progress, personal growth, and the development of professional competencies.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEnhancement of academic and practical competencies\u003c/h2\u003e \u003cp\u003eThe quantitative results demonstrated significant improvements in knowledge application, personal and professional skills, and self-awareness, with moderate effect sizes (Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.45\u0026ndash;0.56), indicating significant contributions to participants\u0026rsquo; learning outcomes. These findings align with prior research, suggesting that service-learning enhances students\u0026rsquo; ability to translate theoretical knowledge into practice.\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Improvements in self-awareness and professional skills align with the findings of Bogo,\u003csup\u003e24\u003c/sup\u003e who emphasized the importance of reflective practice in professional identity formation among healthcare students. Qualitative findings corroborated the quantitative results, highlighting the development of clinical competencies, such as assessment and intervention planning, and client-centered care, which are considered core components of OT education and practice.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Furthermore, students\u0026rsquo; reflections indicated that the course effectively integrated academic knowledge with real-world engagement, exemplifying the principles of experiential and transformative learning.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e This alignment between classroom instruction and community-based practice reinforces the pedagogical value of service-learning in preparing OT students for diverse and dynamic clinical environments.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment of personal and interpersonal skills\u003c/h2\u003e \u003cp\u003e The service-learning program significantly fostered students\u0026rsquo; personal and interpersonal development, particularly in flexibility, empathy, collaboration, and ethical sensitivity. The participants reported an enhanced ability to adapt to unexpected situations, greater respect for clients\u0026rsquo; lived experiences, and an increased awareness of social justice issues. These findings align with existing literature indicating that service-learning enhances civic responsibility, empathy, interpersonal communication, and ethical reasoning.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Additionally, students\u0026rsquo; reflections indicated growth in perspective-taking and recognition of systemic inequities, which are essential humanistic competencies in OT practice.\u003csup\u003e\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e These insights demonstrate how experiential learning settings can promote critical engagement with social contexts and professional values. Although the quantitative measures of civic orientation and engagement did not reach statistical significance, the observed small-to-moderate effect size (Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.40) suggests that the program significantly influenced students\u0026rsquo; attitudes. This finding is consistent with previous studies suggesting that service-learning can foster attitudinal and value-based development even when measurable changes are modest.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e These results indicate that the program facilitated the development of professional identity rooted in humanistic values and social awareness, which are increasingly recognized as essential for effective, client-centered OT practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eInfluence on career identity and professional vision\u003c/h2\u003e \u003cp\u003eThe service-learning experience significantly enhanced the students\u0026rsquo; professional identity formation and vision for their future careers. Students reported gaining insight into the broader role of occupational therapists in community settings and reaffirmed their commitment to the profession. These findings align with scoping reviews and mixed-method studies, highlighting that practice-based pedagogies, such as service-learning, are critical for developing professional identity and intelligence in OT students.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Furthermore, reflections on applying acquired skills and envisioning themselves as competent practitioners suggest that the program contributed to immediate skill acquisition and long-term professional growth. This finding aligns with prior research showing that immersive learning experiences promote identity formation and readiness for professional roles.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eEducational and curricular implications\u003c/h2\u003e \u003cp\u003eThe findings of this study strongly support integrating structured service-learning into the OT curriculum. By bridging academic content with community-based practice, service-learning enhances students\u0026rsquo; clinical reasoning, ethical awareness, and social responsibility, which are core competencies in client-centered OT.\u003csup\u003e31,33\u003c/sup\u003e High levels of student agreement on the course\u0026rsquo;s relevance and its connection to field experience underscore the educational value of such programs. These findings align with recent literature showing that service-learning fosters professional identity formation, civic awareness, and reflective thinking among OT students.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Given the growing emphasis on experiential learning and occupational justice in health profession education, incorporating service-learning as a pedagogical strategy may better prepare students for the complex demands of community-based practice.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future directions\u003c/h2\u003e \u003cp\u003eDespite the encouraging outcomes, this study has a few limitations. First, the sample size was relatively small and drawn exclusively from a single institution, limiting the generalizability of the findings to broader populations or other educational contexts. Future research should involve larger, more diverse samples across multiple institutions to enhance external validity. Second, the reliance on self-report instruments and the voluntary nature of participation may have introduced response bias, including social desirability and selection bias. Future studies should consider incorporating mixed-method approaches, including observational assessments, peer evaluations, and instructor-rated performance measures, to triangulate the data and improve objectivity. Third, this study assessed only short-term outcomes. Therefore, longitudinal research is needed to examine the lasting effects of service-learning on students\u0026rsquo; professional competencies, civic engagement, and workforce integration after graduation. Finally, although positive outcomes were observed across several domains, collaboration and civic engagement showed relatively modest improvements. To strengthen these specific domains, further investigations should explore pedagogical strategies or curricular enhancements, such as interprofessional education modules, structured reflection, and mentorship opportunities.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides evidence of the educational value of service-learning within OT programs. By integrating academic content with real-world community engagement, service-learning fosters cognitive development, personal growth, and professional identity formation. Participants reported enhanced understanding of course materials, increased empathy, improved communication skills, and a clearer vision of their roles as future occupational therapists. These findings highlight the potential of service-learning as a transformative pedagogical tool aligned with the holistic and client-centered values of OT. Therefore, integrating service-learning into health professions education may serve as an effective strategy to prepare socially responsive and competent practitioners capable of addressing the complex needs of diverse populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Sharing Statement\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;All data generated or analyzed during this study are included within this article. Further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study was approved by the Ethics Committee of Jeonju University and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to data analysis, drafting or revising the manuscript, gave final approval of the version to be published, agreed to the submitted journal, and take responsibility for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funding was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest in this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBenner P. Educating nurses: a call for radical transformation-how far have we come?. J Nurs Educ. 2012;51(4):183-184. https://doi.org/10.3928/01484834-20120402-01\u003c/li\u003e\n\u003cli\u003eFitzgerald HE, Bruns K, Sonka ST, Furco A, Swanson L. The centrality of engagement in higher education: reflections and future directions. \u003cem\u003eJ Higher Educ Outreach Engagem.\u003c/em\u003e 2016;20(1):245-253.\u003c/li\u003e\n\u003cli\u003eTijsma G, Hilverda F, Scheffelaar A, et al. Becoming productive 21st century citizens: a systematic review uncovering design principles for integrating community service learning into higher education courses. \u003cem\u003eEduc Res.\u003c/em\u003e 2020;62(4):390-413. https://doi.org/10.1080/00131881.2020.1836987\u003c/li\u003e\n\u003cli\u003eStewart T, Wubbena Z. An overview of infusing service-learning in medical education. Int J Med Educ. 2014;5:147-156. https://doi.org/10.5116/ijme.53ae.c907\u003c/li\u003e\n\u003cli\u003eBringle RG, Hatcher JA. A service-learning curriculum for faculty. \u003cem\u003eMich J Community Serv Learn.\u003c/em\u003e 1995;2(1):112-122. \u003c/li\u003e\n\u003cli\u003eSchmidt NA, Brown JM. Service Learning in Undergraduate Nursing Education: Strategies to Facilitate Meaningful Reflection. \u003cem\u003eJ Prof Nurs.\u003c/em\u003e 2016;32(2):100-106. https://doi.org/10.1016/j.profnurs.2015.06.006\u003c/li\u003e\n\u003cli\u003eChen HC, McAdams-Jones D, Tay DL, Packer JM. The impact of service\u0026ndash;learning on students\u0026rsquo; cultural competence. \u003cem\u003eTeach Learn Nurs.\u003c/em\u003e 2012;7(2):67-73. https://doi.org/10.1016/j.teln.2011.11.002\u003c/li\u003e\n\u003cli\u003eHansen AM, Mu\u0026ntilde;oz J, Crist PA, et al. Service learning: meaningful, community-centered professional skill development for occupational therapy students. Occup Ther Health Care. 2007;21(1-2):25-49. https://doi.org/10.1080/J003v21n01_03\u003c/li\u003e\n\u003cli\u003eMaloney SM, Myers C, Bazyk J. The influence of a community‑based service‑learning experience on the development of occupational therapy students\u0026rsquo; feelings of civic responsibility. \u003cem\u003eOccup Ther Ment Health.\u003c/em\u003e 2014;30(2):144‑161. https://doi.org/10.1080/0164212X.2014.910160\u003c/li\u003e\n\u003cli\u003eMroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client Centeredness and Health Reform: Key Issues for Occupational Therapy. Am J Occup Ther. 2015;69(5):6905090010p1-6905090010p8. https://doi.org/10.5014/ajot.2015.695001\u003c/li\u003e\n\u003cli\u003eLahav O, Daniely N, Yalon-Chamovitz S. Interpersonal social responsibility model of service learning: A longitudinal study. Scand J Occup Ther. 2018;25(1):61-69. https://doi.org/10.1080/11038128.2017.1335775\u003c/li\u003e\n\u003cli\u003eTal-Saban M, Zaguri-Vittenberg S, Weintraub N. Enhancing professional identity of first-year occupational therapy students with the community-academia student tutoring program. Br J Occup Ther. 2024;87(2):106-113. https://doi.org/10.1177/03080226231198341\u003c/li\u003e\n\u003cli\u003eBazyk S, Glorioso M, Gordon R, Haines J, Percaciante M. Service learning: the process of doing and becoming an occupational therapist. Occup Ther Health Care. 2010;24(2):171-187. https://doi.org/10.3109/07380571003681194\u003c/li\u003e\n\u003cli\u003eWang Y, Chung LH, Cheng CY, et al. Predictors of academic and fieldwork performance in occupational therapy students: A systematic review. \u003cem\u003eOccup Ther Int.\u003c/em\u003e 2023;2023:7281505. https://doi.org/10.1155/2023/7281505.\u003c/li\u003e\n\u003cli\u003eJacoby B. \u003cem\u003eService-learning essentials: Questions, answers, and lessons learned.\u003c/em\u003e San Francisco: Jossey-Bass; 2015.\u003c/li\u003e\n\u003cli\u003eAndonian L. Occupational therapy students\u0026rsquo; self‑efficacy, experience of supervision, and perception of meaningfulness of Level II fieldwork. \u003cem\u003eOpen J Occup Ther.\u003c/em\u003e 2017;5(2):Article 7. https://doi.org/10.15453/2168‑6408.1220. \u003c/li\u003e\n\u003cli\u003eMattila A, DeIuliis ED, Cook AB. Increasing self‑efficacy through role emerging placements: Implications for occupational therapy experiential learning. \u003cem\u003eJ Occup Ther Educ.\u003c/em\u003e 2018;2(3). https://doi.org/10.26681/jote.2018.020303 \u003c/li\u003e\n\u003cli\u003eLau KH, Lam L, Snell RS, Ma CH‑K. The development of the Service‑Learning Outcomes Measurement Scale\u0026mdash;Short Version (S‑LOMS‑SV) and its preliminary validation. \u003cem\u003eInt J Res Serv‑Learn Community Engagem.\u003c/em\u003e 2024;12(1). https://doi.org/10.37333/001c.125347.\u003c/li\u003e\n\u003cli\u003eGlaser BG, Strauss AL. The constant comparative method of qualitative analysis. \u003cem\u003eSoc Probl.\u003c/em\u003e 1965;12(4):436‑445.\u003c/li\u003e\n\u003cli\u003eLincoln YS, Guba EG. \u003cem\u003eNaturalistic Inquiry.\u003c/em\u003e Thousand Oaks (CA): SAGE; 1985.\u003c/li\u003e\n\u003cli\u003eEyler J, Giles DE. \u003cem\u003eWhere\u0026apos;s the learning in service-learning?\u003c/em\u003e San Francisco: Jossey-Bass; 1999.\u003c/li\u003e\n\u003cli\u003eHunt R. Service-learning: an eye-opening experience that provokes emotion and challenges stereotypes. J Nurs Educ. 2007;46(6):277-281. https://doi.org/10.3928/01484834-20070601-07\u003c/li\u003e\n\u003cli\u003eCoker JS, Heiser E, Taylor L, Book C. Impacts of experiential learning depth and breadth on student outcomes. \u003cem\u003eJ Exper Educ.\u003c/em\u003e 2017;40(1):5‑23. https://doi.org/10.1177/1053825916678265\u003c/li\u003e\n\u003cli\u003eBogo M. \u003cem\u003eAchieving competence in social work through field education.\u003c/em\u003e Toronto: University of Toronto Press; 2010.\u003c/li\u003e\n\u003cli\u003eThomas Y, Penman M. WFOT standard for 1000 hours of practice placement: Informed by tradition or evidence? \u003cem\u003eBr J Occup Ther.\u003c/em\u003e 2018;82(1):3‑4. https://doi.org/10.1177/0308022618788785.\u003c/li\u003e\n\u003cli\u003eMezirow J. Transformative Learning: Theory to Practice. \u003cem\u003eNew Dir Adult Cont Educ.\u003c/em\u003e 1997;(74):5‑12. https://doi.org/10.1002/ace.7401\u003c/li\u003e\n\u003cli\u003eAnderson KL, Pierce ME, McNamara KM. NUMB3Rs revisited: Long-term impacts of reimagining service learning. J Exper Educ. 2022;45(1):51‑67. https://doi.org/10.1177/1053825920973692\u003c/li\u003e\n\u003cli\u003eJones D, McAllister L, Lyle D. Interprofessional academic service-learning in rural Australia: Exploring the impact on allied health student knowledge, skills, and practice. A qualitative study. Int J Pract-Based Learn Health Soc Care. 2015;3(2):1‑16. https://doi.org/10.18552/ijpblhsc.v3i2.217\u003c/li\u003e\n\u003cli\u003eSimons L, Cleary B. The influence of service learning on students\u0026rsquo; personal and social development. \u003cem\u003eColl Teach.\u003c/em\u003e 2006;54(4):307‑319. https://doi.org/10.3200/CTCH.54.4.307‑319\u003c/li\u003e\n\u003cli\u003eHansen AM. Bridging theory and practice: occupational justice and service learning. Work. 2013;45(1):41-58. https://doi.org/10.3233/WOR-131597\u003c/li\u003e\n\u003cli\u003eWisniewski PA. Community\u0026ndash;Based Learning: Transformative Change in OT Students\u0026rsquo; Awareness of Occupational Justice \u0026amp; Community Health. \u003cem\u003eAm J Occup Ther.\u003c/em\u003e 2024;78(Suppl 2):7811500064p1. https://doi.org/10.5014/ajot.2024.78S2‑PO64\u003c/li\u003e\n\u003cli\u003eLim SM, Tan BL, Lim HB, Goh ZAG. Engaging persons with disabilities as community teachers for experiential learning in occupational therapy education. \u003cem\u003eHong Kong J Occup Ther.\u003c/em\u003e 2018;31(1):36‑45. https://doi.org/10.1177/1569186118783877\u003c/li\u003e\n\u003cli\u003eSouto‑G\u0026oacute;mez A‑I, Talavera‑Valverde M‑\u0026Aacute;, M\u0026aacute;rquez‑\u0026Aacute;lvarez L‑J, Garc\u0026iacute;a‑de‑la‑Torre M‑d‑P. Analysis of Occupational Therapy Students\u0026rsquo; Pedagogical Practices for the Forging of Professional Identity and Development of Professional Intelligence: A Scoping Review. \u003cem\u003eJ Intell.\u003c/em\u003e 2023;11(3):48. https://doi.org/10.3390/jintelligence11030048\u003c/li\u003e\n\u003cli\u003eGray H, Colthorpe K, Ernst H, Ainscough L. Professional identity of undergraduate occupational therapy students. \u003cem\u003eJ Occup Ther Educ.\u003c/em\u003e 2020;4(1). https://doi.org/10.26681/jote.2020.040102\u003c/li\u003e\n\u003cli\u003ePotvin MC, Morales AN, West EK, Kalimi M, Coviello JM. Occupational therapy students\u0026apos; perceptions of their experience in a role-emerging Level II fieldwork within higher education student services. BMC Med Educ. 2024;24(1):384. https://doi.org/10.1186/s12909-024-05303-7\u003c/li\u003e\n\u003cli\u003eValdes K, Rider J, Leach C, Manalang KC. The impact of service‑learning on occupational therapy doctoral students. \u003cem\u003eJ Serv‑Learn High Educ.\u003c/em\u003e 2023;17:3‑15.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Areas and questions for group interviews\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 602px;\"\u003e\n \u003cp\u003eLearning Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 602px;\"\u003e\n \u003cp\u003e1. What achievements did you gain from the community service experience?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2. Can you describe a session that went particularly well?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3. Were there any confusing or challenging moments during the program?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4. How was your interaction with the clients?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 602px;\"\u003e\n \u003cp\u003ePersonal Change and Growth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 602px;\"\u003e\n \u003cp\u003e1. Did you make any decisions or modify sessions during the program? How did you feel, and what were your thoughts?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2. Please describe your experiences collaborating and discussing with team members to plan and implement the program.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3. How did the community service experience influence your goals, values, attitudes, or beliefs?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 602px;\"\u003e\n \u003cp\u003eProfessional Change and Growth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 602px;\"\u003e\n \u003cp\u003e1. How will this community service experience affect your future professional practice?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2. Pre-post changes in service-learning outcomes (S-LOMS-SV).\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eDomain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003cp\u003e(M\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003cp\u003e(M\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s\u003cem\u003e\u0026nbsp;d\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eKnowledge application\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e6.13\u0026plusmn;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e7.25\u0026plusmn;1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePersonal \u0026amp; professional skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e6.38\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e7.24\u0026plusmn;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCivic orientation \u0026amp; engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e7.66 \u0026plusmn;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e8.21\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSelf-awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e7.17\u0026plusmn;1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e8.16\u0026plusmn;1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 3. Perceptions and attitudes toward service-learning (post)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003ePerception of the service-learning course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003ePositive response rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eThe course content is related to my major.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.63\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e95.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eClass content was linked to actual service activities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eIt made me reflect on community issues.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.54\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eActivities helped me understand the course objectives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.42\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e95.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eThe course improved my ability to solve real-world problems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eClassroom learning was connected with field experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.63\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e95.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eI felt a sense of responsibility as a community member.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.61\u0026plusmn;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eI considered the roles and values of community.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.46\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e95.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 371px;\"\u003e\n \u003cp\u003eAttitudes Toward Service Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003ePositive response rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eI became more aware of the surrounding social issues.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.38\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eService-learning connects academic learning with real-world experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e95.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eMy ability to collaborate has improved.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eI became more open to diverse opinions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.38\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e91.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eService learning is necessary in university education.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.25\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eI think it can be applied to other courses in the future.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 371px;\"\u003e\n \u003cp\u003eIt helped me develop interpersonal skills needed as a professional.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e4.46\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e95.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;Table 4. Perceived learning outcomes of the service-learning experience\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eSubtheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003eRepresentative Quotes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e1. Application of Academic Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Applying textbook knowledge in real-world settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;It was meaningful to apply what I had learned in class directly to clients.\u0026rdquo; (Student 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Better understanding of occupational therapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I achieved a deeper understanding of my major and gained practical capabilities.\u0026rdquo; (Student 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e2. Development of Practical Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Acquiring clinical competencies and field skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I was able to experience actual clinical skills and how to interact with real clients.\u0026rdquo; (Student 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Planning and executing interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I acquired skills in planning and implementing programs, and adjusting interventions based on post-evaluation.\u0026rdquo; (Student 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e3. Client-Centered Approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Adapting activities to client needs and functional levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I learned how to grade activities according to clients\u0026rsquo; abilities.\u0026rdquo; (Student 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Understanding the therapeutic effects of meaningful activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I recognized the effects of handcraft activities for clients with impaired hand function.\u0026rdquo; (Student 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e4. Emotional Engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Building rapport and mutual sharing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;We shared our life stories, and by the end, we had formed a close relationship.\u0026rdquo; (Student 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Enhancing empathy and communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;It helped me develop communication skills with clients.\u0026rdquo; (Student 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e5. Adaptive Problem-Solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Managing unexpected or challenging situations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;When a client cried and left, I felt confused and did not know how to respond.\u0026rdquo; (Student 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Flexibility and responsiveness in real-time settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I had to quickly change the activity depending on each client\u0026rsquo;s interest and ability.\u0026rdquo; (Student 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e6. Program Design and Teamwork\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Collaborating on intervention goals and methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;We actively shared opinions in selecting activities tailored to the clients.\u0026rdquo; (Student 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e- Enhancing intervention planning skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 300px;\"\u003e\n \u003cp\u003e\u0026ldquo;I developed the ability to determine which program suits which client best and recognized the importance of feedback.\u0026rdquo; (Student 7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5. Perceived personal growth and transformation through service-learning\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eSubtheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003eRepresentative Quotes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e1. Growth in Flexibility and Adaptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Real-time decision-making and session adjustment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;When the activity ended early, we improvised and implemented another activity.\u0026rdquo; (Student 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Becoming less rigid and more solution-oriented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I used to panic when things deviated from plan, but I became more flexible.\u0026rdquo; (Student 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e2. Enhanced Collaboration and Communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Active discussion and shared decision-making among team members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;We constantly exchanged ideas and improved the program through group discussion.\u0026rdquo; (Student 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Negotiating program content and responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;Each session was planned collaboratively, and everyone contributed with ideas.\u0026rdquo; (Student 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e3. Development of Professional Attitudes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Embracing respect and empathy for clients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I learned to approach people with disabilities without hesitation.\u0026rdquo; (Student 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Understanding the importance of client participation and autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I realized that supporting client participation is more important than providing help unconditionally.\u0026rdquo; (Student 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e4. Value Clarification and Ethical Sensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Increased awareness of social justice and diversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;It made me reflect on how to understand and support the socially vulnerable.\u0026rdquo; (Student 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Shifting perspectives toward people with disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I began to view people with disabilities not as different, but as individuals just like us.\u0026rdquo; (Student 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e5. Increased Self-Efficacy and Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Gained confidence in clinical and leadership skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I developed confidence and courage to lead a program.\u0026rdquo; (Student 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Identifying personal strengths and areas for improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I became aware of areas for improvement and strategies for managing unexpected challenges.\u0026rdquo; (Student 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e6. Empathy and Human Understanding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- Recognizing the client\u0026rsquo;s life context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;To improve clients\u0026rsquo; quality of life, therapeutic skill alone is not enough\u0026mdash;understanding people is essential.\u0026rdquo; (Student 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e- The importance of rapport and client-centered interaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026ldquo;I realized the importance of rapport in enabling meaningful participation.\u0026rdquo; (Student 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6. The influence of service-learning on occupational therapy students\u0026rsquo; professional outlook and career identities\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eSubtheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eRepresentative Quotes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e1. Clarification of OT Roles in the Community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Understanding the scope and function of community-based OT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;I learned what occupational therapists actually do in the community setting.\u0026rdquo; (Student 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Increased interest in community-based practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;Among various OT fields, I became more interested in the community area.\u0026rdquo; (Student 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e2. Strengthening of Career Commitment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Confirmation of OT as a future profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;This experience helped me build confidence and confirmed my desire to become an occupational therapist.\u0026rdquo; (Student 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Awareness of the profession\u0026rsquo;s social impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;It prompted me to reflect on the significance and importance of being an occupational therapist.\u0026rdquo; (Student 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e3. Future Application of Learned Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Applying service-learning experience to future clinical practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;These experiences will help me in designing and delivering future clinical programs.\u0026rdquo; (Student 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Enhancing ability to design and evaluate interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;Through post-program evaluation, I realized how our intervention improved hand function, which made me appreciate the value of OT.\u0026rdquo; (Student 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e4. Development of Professional Vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Envisioning oneself as a capable and strategic occupational therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;I want to become a therapist who is friendly but also takes the lead with well-planned programs.\u0026rdquo; (Student 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Self-reflection on potential strengths and specialization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;It prompted me to consider which area of OT would best suit me in the future.\u0026rdquo; (Student 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e5. Recognition of Social Responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e- Helping clients live better lives through therapeutic programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026ldquo;As aging progresses, we can offer more diverse, targeted interventions to support better living for people with disabilities.\u0026rdquo; (Student 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"service-learning, occupational therapy education, student attitudes, learning outcomes, mixed-methods","lastPublishedDoi":"10.21203/rs.3.rs-9155148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9155148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eService-learning has emerged as an effective pedagogical strategy in health professions education, promoting academic development, civic engagement, and professional growth. However, evidence of its impact on occupational therapy (OT) students remains limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to investigate the learning outcomes, attitudes, and experiences of OT students who participated in a service-learning program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA mixed-methods design was employed. Pre- and post-program surveys (n=31) using the Service-Learning Outcomes Measurement Scale-Short Version were used to assess competency-based outcomes. After program completion, a survey was conducted to assess the students’ understanding of service-learning and its perceived relevance to OT education. Focus group interviews were subsequently conducted and thematically analyzed to further explore their perspectives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eQuantitative analyses revealed significant improvements with moderate effect sizes in knowledge application, personal and professional skills, and self-awareness. Although changes in civic orientation and engagement were non-significant, small-to-moderate effect sizes were observed. Post-program surveys indicated positive perceptions of service-learning, with students acknowledging its relevance to OT education and its role in integrating theoretical knowledge with real-world practice. Qualitative analysis identified three overarching themes: enhanced learning outcomes, personal growth and transformation, and strengthened professional identity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eService-learning positively contributes to academic development, personal growth, and the formation of professional identity among OT students. These findings underscore the importance of integrating service-learning into OT curricula to promote holistic student growth and professional preparedness.\u003c/p\u003e","manuscriptTitle":"Learning Outcomes, Attitudes, and Experiences of Occupational Therapy Students in Service-Learning: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 15:21:09","doi":"10.21203/rs.3.rs-9155148/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-13T22:27:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28972687466649593000817814269526305467","date":"2026-05-04T21:33:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T06:40:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77077510563205454513164639810341658912","date":"2026-04-21T12:38:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T12:02:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T06:25:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-19T06:09:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-19T06:08:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-18T05:56:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32bb7d14-88f1-4534-ac6c-d9891d429464","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-13T22:27:18+00:00","index":71,"fulltext":""},{"type":"reviewerAgreed","content":"28972687466649593000817814269526305467","date":"2026-05-04T21:33:52+00:00","index":68,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T15:21:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 15:21:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9155148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9155148","identity":"rs-9155148","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}