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Analysis of the Status and Extent of Marketing and Promotion Strategies in the Practice of Recreation Therapy.

The field of recreation therapy (RT) still struggles with occupational prestige and professional acknowledgment as a viable and effective treatment service. Thorn (1984) emphasized the need for a marketing strategy for the field of RT, noting the importance of identifying recreational therapists' professional image. Unfortunately, little has been done to identify and implement a comprehensive marketing strategy for the field. The purpose of this study was to examine current status and extent of RT marketing as perceived by practicing Certified Therapeutic Recreation Specialists (CTRSs) in the United States and Canada. This study was designed to understand the needs and strengths of marketing in the field that subsequently may give direction to future marketing efforts. Using the Social Marketing Theory (SMT) (Morris & Clarkson, 2009) as well as marketing literature as a framework, a 53-item electronic questionnaire was designed and emailed to 6,500 active CTRSs through the National Council on Therapeutic Recreation Certification (National Council for Therapeutic Recreation Certification). Respondents (n = 1,116) represent broad demographics in terms of geography, setting, population, and professional experiences. Results showed that overall the status of marketing by CTRSs is inconsistent and moderate at best. Particular concerns included CTRSs' lack of awareness and use of available marketing resources and techniques. Recommendations address suggestions for future research as well as local (agency) and global (organizational) initiatives to improve the status of marketing in the field of RT.

Since its inception, the field of recreation therapy/therapeutic recreation (recreation therapy) has grown in number and professional reputation; however, in many ways, it is still one of health care's "best-kept secrets." The unfamiliarity of recreation therapy (RT) services among the general public and within the health care arena is an often repeated concern among professionals in the field. The field of RT has long struggled in terms of occupational prestige and professional acknowledgment as a legitimate therapeutic service, especially when compared to related treatment services such as occupational and physical therapies (Harkins, 2010; Harkins & Bedini, 2013; Hinton, 2000; Smith, Perry, Neumayer, Potter, & Smeal, 1992). Furthermore, in addition to lower salaries offered when compared to those of related therapies (Bureau of Labor Statistics, 2016-2017), recreation therapy programs are also challenged within their own agencies for recognition, often experiencing omission from websites, marketing materials, and other marketing outlets (Bedini & Petrarca, 2013).

Over the last several decades, national professional organizations in the field (i.e., American Therapeutic Recreation Association [ATRA], National Therapeutic Recreation Society [NTRS], and the National Council for Therapeutic Recreation Certification [NCTRC]) have made efforts to market recreation therapy through the use of marketing teams, printed materials, promotional items, RT Month (and previously TR Week) celebrations, publications such as the Promoting Therapeutic Recreation: The Marketing Guide, and brochures such as Why Hire a CTRS and Why Become a CTRS. Although these efforts have served to inform and advance the visibility and understanding of RT overall, the field still lacks marketing skills and knowledge needed to consistently and effectively demonstrate RT's impact as a credible therapy.

In 1984, Thorn emphasized the importance of a marketing strategy for the RT field, noting the importance of identifying recreational therapists' professional image and proposing that the field seek to understand the "discrepancies between the desired image and the actual image" (p. 44). Thirty-two years later, however, little research exists that specifically addresses needs, barriers, and/or strategies for RT marketing (e.g., Harkins, 2010; Harkins & Bedini, 2013; Hinton, 2000; Smith et al., 1992). To address the problems of visibility, credibility, and occupational prestige, the field of RT needs to go beyond informational marketing and move toward establishing a unified, targeted, and comprehensive marketing strategy for the field. Therefore, this study was designed to gather input directly from practicing CTRSs regarding their experiences, insights, obstacles, and suggestions about marketing in an effort to begin the discussion of designing and implementing a model that may allow for a consistent, widespread marketing of RT.

Background and Need

Although the field of RT is considered young when compared to nursing, occupational therapy (OT), physical therapy (PT), and speech and language pathology (SLP), it can be said that RT lags behind them in terms of public awareness and occupational prestige. For example, occupational prestige is founded on "high pay, high social value with the greatest training" (Rosoff & Leone, 1991, p. 322). According to the Bureau of Labor's Occupational Outlook Handbook ([BLS] 2016-2017), the field of RT holds fewer jobs, has lower educational requirements (BS degree) to practice, and on average, offers lower salaries than PT, OT, and SLP. In addition, it can be said that RT has lower social value since it is absent from many General Social Surveys that collect national data evaluating occupational prestige (Hinton, 2010). Occupational prestige is also an issue from within our own ranks. For example, internally, of the 18,600 RT practitioners identified as practicing in the field (BLS, 2014), just under 2200 (11.5%) are members of the national professional organization, ATRA. Other disciplines like OT report that 50,000 (43.5%) of their 114,600 practicing therapists are members of their national organization (AOTA, 2016).

Another obstacle to public recognition and prestige of RT is a lack of understanding by health care administrators. Harkins and Bedini (2013) reported a study of over 400 health care administrators in North Carolina, where results revealed that the majority of respondents from various settings (i.e., hospital, long-term care, behavioral health) were generally unfamiliar with RT services. For example, many administrators did not know that to practice in RT, one is required have specific training/education (56%). Nor did they know that RT was medically prescribed (43%), with 30% thinking that RT did not function as part of an interdisciplinary team. Perceptions also included that RT was "fun activities during downtime" for clients (60%), not really beneficial (55%), not permitted due to budget (70%), and not needed (40%) in their agency. In fact, a large majority of administrators perceived overlap between RT and activity professionals (79%), and 45% of the respondents also saw overlap with OT services. In addition, over 85% of the administrators reported awareness of physician referrals for PT, whereas only 19% noted physician referrals for RT.

The current study was designed based on tenets of the Social Marketing Theory (SMT) (Morris & Clarkson, 2009), as well as from marketing literature in six other disciplines (i.e., business, nursing, PT, OT, public health, higher education). The SMT offers six guiding principles: (a) goals for the target market behavior, (b) insight into customer decision processes, (c) segmentation and targeting, (d) competition, (e) exchange, and (f) marketing and intervention mix. Applying these principles to the potential target markets for our field (i.e., health care administrators, physicians, related therapies, community advocates, potential clients/families) provides a strong foundation for marketing initiatives. These "markets," while different from each other, all hold the ability to "choose" RT as a service, either through prescription, hire, or request and thus, should be considered in a comprehensive plan.

The first two principles of the SMT address the importance of changing knowledge and attitudes of our target markets in order to achieve actual behavioral changes (Morris & Clarkson, 2009, p. 137). These changes are dependent on insight of consumers to make these changes happen. Thus, it is essential to understand the motivation underlying customer choices. To this end, RT practitioners need to explore what influences and restricts potential consumers (i.e., administrators, physicians, therapists, clients) and then design methods that can affect their knowledge and attitudes to create desired behaviors (i.e., choosing our services, hiring RTs onto staff, and actively promoting RT services).

Within each of the major target markets in RT (i.e., health care administrators, physicians, therapists, consumers), there are sub-markets (segments) that should also be identified (e.g., different disability groups, settings, systems). The third principle of segmentation emphasizes the importance to matching strategies with different needs and perspectives of each of these sub-groups. Next, SMT addresses getting a field's competition (e.g., who or what stands in the way of getting the target markets) to value the commodity. As noted earlier, RT struggles to articulate an identity that separates RT from AP as well as other related therapists (i.e., OTs, PTs, SLPs). Establishing RT's value, as well as its unique contribution to achieving client outcomes, should underlie these efforts.

Successful marketing is dependent on an attractive exchange between parties. For RT, the benefit of a service to our consumer (e.g., administrator, physician, therapist, client) must exceed costs (real and perceived) for the exchange to be worthwhile. According to Morris and Clarkson (2009), cost can be more than financial, including "... emotional, social, loss of preferred behaviors, or time cost of learning new practices" (pp. 137-138). From this perspective, a challenge before the field of RT is to demonstrate how RT, conducted by a CTRS, provides therapeutic benefits that offset these and other costs.

The final principle of the SMT is the marketing and intervention mix, commonly known as the four "Ps" (product, price, place, promotion). As Jacobs (2012) suggested, RT professionals must be careful to avoid assumptions that our beliefs are known or shared by a particular audience. Thoughtfully analyzing and assessing our target markets will lead to accurate and effective marketing efforts for the field.


The purpose of this study was to examine the current status and extent of RT marketing across the United States and Canada. In addition, this study sought to identify specific needs and barriers that prevent successful marketing of RT programs and services, as well as successful strategies used by CTRSs to implement effective RT marketing.



A 53-item electronic Qualtrics questionnaire was designed to solicit information on the status and extent of effective marketing strategies and techniques used to promote RT programs and departments. Questions were developed based on professional marketing literature and input from RT practitioners. The questionnaire was formatted using three conceptual categories of marketing (Bedini & Kelly, 2013). The intra-departmental questions (5 items) inquired about activities conducted within the RT department to prepare staff and interns to market RT. Questions regarding inter-departmental marketing (13 items) asked about activities RT department conduct to market themselves within their agency to administration, physicians, and therapists, and clients/families as well as within the community. Questions about extra-departmental efforts (22 items) addressed the establishment of systems for continuous marketing of RT, such as branding, points of contact, media, and signage. Cronbach reliability coefficients for each of the three areas were intra-departmental ([alpha] = .78), inter-departmental ([alpha] = .89), and extra-departmental (a = .92).

Four open-ended questions were designed to solicit responses about marketing needs, marketing strengths, strategies used to market RT, and general comments and concerns about marketing in RT overall. In addition, four questions asked about the existence and use of an RT marketing plan. Finally, demographic questions (5 items) were designed using the categories of the NCTRC 2014 Job Analysis Report on current position in RT department/program, primary employment sector, client population, primary age group, and years working as a CTRS.

Sample and Procedures

An anonymous and confidential Qualtrics online questionnaire (IRB approved) was emailed to 6,500 active CTRSs through the National Council on Therapeutic Recreation Certification (NCTRC). The sample was delimited to include only full-time practicing CTRSs. Thus, part-time CTRSs, CTRAs, RT educators, and CTRSs who were not currently practicing in the field were excluded. An email describing the purpose of the study and all IRB conditions and protections along with a link to the online questionnaire was sent electronically using mailing "labels" provided by NCTRC. One week after the initial email, NCTRC sent a reminder email with the survey link to all potential participants asking those who had not participated to complete the survey. The survey was closed one week from that date.


All data received from the Qualtrics questionnaires were downloaded into the SPSS v. 22 statistical analysis program. Statistical analysis comprised descriptive analysis using frequencies and percentages and discriminatory analyses such as independent t-ests and analyses of variance (ANOVA). Content analysis was employed to determine patterns and themes from the open-ended questions.



Responses were received from 1,373 CTRSs (response rate of 21.1%). Subsequently incomplete surveys were removed, yielding a usable sample of 1,116 respondents. Respondents represented 48 states, the District of Columbia, and six Canadian provinces.

Demographically, the majority of respondents identified as therapists (48%) with administrators, supervisors, and recreation therapy leader/programmers distributed afterward. The largest employment sector was hospital (37.4%), followed by skilled nursing facilities/long-term care. The most common populations groups with whom the respondents worked were behavioral health (38%), geriatrics/long-term care (24.2%), physical medicine and physical disability (17.9%), and developmental/intellectual disabilities (7%). The majority of respondents (74%) worked with adults and/or older adults. The number of years practiced as CTRSs was distributed equally across all categories. The largest categories of respondents were those who practiced as a CTRS for more than 25 years (24.7%) and those practiced for 5 or fewer years (20%) (see Table 1).

Overall Status of Marketing in RT

Results indicated that the overall status of marketing in the field of RT was generally inconsistent and at best, moderately utilized. Of the 40 items within the three conceptual areas (intra, inter, extra-departmental), only 13 items showed positive responses (often/always) by 50% or more of the responses. For example, three of the five intra-departmental items indicated that 59% to 69% of the respondents "never" or "occasionally/rarely" conducted these marketing activities within the RT department. Similarly, for the inter-departmental marketing category, 56% to 85% of the respondents rarely/never engaged in the majority (9 of 13) of these marketing activities noted. Finally, results showed that the majority of respondents pursued 15 of the 22 extra-departmental activities.

In addition, several questions addressed the presence and use of either a marketing plan and/or connecting with agency marketing specialist. Less than 10% of the respondents reported having a formal marketing plan for the RT department, with only 6% doing any periodic refinement of the plan. Twenty-five percent of the respondents reported that someone employed in the RT department was specifically responsible for marketing RT. In addition, 22% had someone in RT department working directly with the agency marketing specialist (see Table 2). It is important to note that comparative Mest analyses demonstrated that CTRSs who used any of the three strategies noted above were consistently more likely to utilize the marketing techniques noted in the questions in all three categories: intra-departmental, inter-departmental, and extra-departmental.

Finally, for the most part, no differences were found within any demographic variable with the exception of "Client Population Served." Overall, CTRSs who worked with clients in physical medicine and physical disability (PM/PD) were more likely to conduct marketing efforts in all three categories: intra-departmental, inter-departmental, and extra-departmental, while CTRSs who worked in behavioral health were least likely in comparison.

Intra-Departmental Marketing

Five questions addressed marketing efforts conducted within an RT department. Although approximately 65% of the respondents indicated that they trained interns to provide examples of how RT is a goal-directed service, results showed that only 34% included how to market RT in staff orientation. In terms of gathering data to demonstrate the value of the field, 31% compiled statistics regarding RT being non-pharmacological or being effective in increasing quality of life and well-being (41%). Interestingly, 87% of the respondents indicated that their staff was competent in describing the impact of RT services in staff, team, and treatment meetings (see Table 3).

Inter-Departmental Marketing

Thirteen items addressed marketing efforts conducted between the RT department and facets within an agency. Results showed that only four items in this category were conducted by a majority of respondents. The remaining nine items garnered less than 44% positive responses. Positive responses indicated that over 77% of the respondents reported marketing directly to clients within an agency. Similarly, 69% stated that they co-treat with other services. Just over half of the respondents routinely shared important data, statistics, or current research about the positive outcomes of RT with agency decision-makers; specifically 58% about RT's non-pharmacological nature and 56% about positive effect on quality of life. The remaining nine items, however, showed only 15% to 44% use. The least conducted activities related to in-services/workshops on RT within and outside of the agency, ranging from only 15% to 25% depending on the audience. Other weak areas involved research involvement whereby only 29% sought to keep administrators up to date with latest evidence-based practice literature related to RT, and 35% sought to conduct/collaborate on research or grant projects. Similarly, only 44% shared RT patient satisfaction data with administrators/decision-makers. The last item in this section addressed using testimonials from current or former clients/families through agency or media outlets with only 27% using this technique (see Table 4).

Extra-Departmental Marketing

Twenty-two items addressed extra-departmental marketing efforts that reached out beyond the department and agency including community at large. These items represented four categories of extra-departmental marketing: contacts, signage, media, and branding. Results showed that all but seven of these items were conducted "often" or "always" by the majority of the respondents. In the sub-area of contacts, however, only 24% of the respondents reported that their RT program/department was "always" findable within four clicks (maximum effective number) on the agency webpage. Also, although 80% noted that the person who answers the phone can direct caller to RT staff, only 41% noted that this person can articulate what RT is to a caller/visitor.

Less than two-thirds of the respondents reported that RT is represented in signage within their agency. Just over half noted that RT was identified in the main directory, 64% had RT appropriate signage at their department office, and just 60% stated that the RT signage is consistent with that of other therapies. Of note, however, is that 48% of the respondents stated that they did not display their personal CTRS credential.

In terms of utilizing media for marketing RT, just over a third of the respondents reported being visible in agency marketing efforts and 29% participated in any media collaboration with agency, departmental, or outside (newspaper/TV) opportunities. Similarly, only 18.5% had any active RT departmental social media systems.

For the last area of extra-departmental marketing, less than half of the respondents participated in any branding efforts with 17% using a tagline, 11% using branded clothing, and 20% with RT brochures. Twenty-five percent of the respondents did not have RT nametags, and 43% did not have RT business cards (see Table 5).

Open-Ended Questions

Content analysis was conducted on the four open-ended questions to determine patterns and topical themes. Responses to the question asking for general comments were primarily about the survey itself; however a number of comments shared concerns about restrictions marketing due to HIPAA (Health Insurance Portability and Accountability Act). The remaining three open-ended questions that asked respondents to share greatest marketing needs, greatest marketing strengths, and successful strategies about marketing in the field.

Greatest RT Marketing Needs

Analysis of the open-ended responses about marketing needs data revealed seven broad topical themes. All of the themes were related to need for increased recognition in some way. The largest category addressed the need for more awareness of RT by other services, administrators, and consumers. Comments about lack of awareness by target markets also included the need for education of what RT is within the agency as well as in community. A related theme addressed the need for potential consumers as well as administrators to distinguish between RT and AP specifically. Also, the need for RT to be recognized as a legitimate service that is equal to other therapies was commonly cited. Other categories included the need for effective marketing materials (e.g., brochures, DVDs, social media, and websites), research to prove evidence-based practice, and support from management for RT marketing in particular. Of note, a significant number of respondents stated that they had no marketing needs because they did not market RT.

Greatest RT Marketing Strengths

Open-ended responses regarding marketing strengths yielded six themes, although not all actually addressed strengths, per se. Many respondents indicated that a marketing strength came from securing a presence in interdisciplinary and collaborative relationships on administrative and treatment teams and committees. In particular, working with the agency marketing committee/department was identified as a marketing strength. A second theme dealt with partnering and community involvement and outreach. A related theme noted the importance of educating decision-makers about the impact of RT. Another identified strength addressed the importance of skilled and knowledgeable RT staff suggesting that the investment in a good hire paid off as a marketing strength later on.

Two other themes emerged from this question that will be addressed in more detail in the discussion. First, a large number of respondents stated that "word of mouth" was a marketing strength. Most of these comments had no additional information or qualifiers. The second theme that presents a concern was the significant number of respondents who noted that they had "no" marketing strengths. Again, these responses offered little to no explanation.

Successful Strategies for RT Marketing

Responses to this open-ended question yielded conceptual suggestions as well as specific techniques for successfully marketing RT. This question requested information that was similar to strengths, but while strengths addressed opportunities that existed, strategies sought specific techniques that they were using that worked to marketing RT in their agency. In addition to generalized recommendations for characteristics of target audiences, respondents detailed examples in areas of types of events, unique promotion approaches, specialized communication with families, as well as particulars in terms of signage, timing, and products. Several categories of successful marketing strategies emerged from the data.

Similar to marketing strengths, respondents stressed the overall importance of visibility within the agency through membership on committees as well as partnering with other disciplines. Respondents also noted the importance of community engagement and aiding others in understanding the potential impact of RT as a treatment service. This included techniques such as hosting special events and public speaking. Another theme regarding strategies suggested a consistent presence in media output. Comments noted that exposure through brochures/newsletters, social media, videos, as well as television coverage, facilitated exposure, and communication about the benefits of RT services. A related theme addressed strong branding of RT through printed and electronic materials. Many of the respondents stressed the effectiveness of using client/patient testimonials in these outlets.

From a provision perspective, comments about the importance of quality of the RT programs as well as of RT staff emphasized the need for high standards and expectations in effective marketing of the field. The last strategy group suggested was the use of "hard" data in the form of statistics and patient satisfaction data, in promoting the effects and benefits of RT service. Once again, there were a large number of respondents who noted that they did not utilize any marketing strategies in their agency.


Some limitations should be noted when examining the results of this study. First, this was a self-designed survey. Although it was based on professional literature about marketing and the three conceptual area had strong reliabilities, it is important to note that it lacks some psychometric data. Second, the intent of this study was to attain a baseline of information regarding the status and extent of marketing in the field of RT. Therefore, the survey design and use of open-ended questions served primarily exploratory purposes. Further analysis based on the results that would focus on questions that emerged from this analysis should be considered in future research. Third, sampling was not stratified to strengthen representation from respondent groups that might have lower numbers of practitioners than others. Thus, CTRSs from less represented settings might not have had substantial presence in the data.

Discussion and Implications

The results of this study suggest that marketing in the field of RT is inconsistent and ranges from active to non-existent efforts. Reasons for this wide differential are not clear but suggest that the field may benefit from a comprehensive strategy. CTRSs surveyed were only moderately, at best, conducting marketing activities in their programs. Results indicated that while some CTRSs were implementing successful marketing strategies, others felt inadequately prepared or restricted with regards to developing and/or implementing marketing efforts. In addition, there appeared to be no consistent patterns among settings, population, or therapist experience.

Several concerns arose from the data. First, a significant number of respondents stated that they had no marketing needs, strengths, and/or strategies because they did not market RT in their agency. This response alone raises the possibility that CTRSs do not know the importance marketing or that they perceived they do not have the skills or opportunities to do so.

A second concern was the result showing that seemingly easy-to-achieve techniques for marketing RT within one's agency were pursued by relatively low numbers of respondents. For example, just over half of the respondents reported that they displayed their own CTRS credential for public view. The lack of posting one's CTRS credential not only deprives clients, allied therapists, and administrators the opportunity to identify a CTRS as a vetted and trained practitioner (prestige), but also potentially communicates lack of occupational pride, or unimportance of the certification by the CTRS. Whether these results indicate apathy or perhaps a sense of learned helplessness on the part of these CTRSs is unclear. In another example, results showed that almost half of CTRSs do not share RT patient satisfaction data with administration/decision-makes. This could be due to the fact that they do not collect these data or that they do not share data they have.

Third, data indicated contradictory results regarding CTRSs' ability to explain the value of RT to others. For example, a vast majority of the respondents identified themselves as able to articulate benefits of the RT field, but most also noted they do not gather current data/statistics on the benefits of RT. In addition, a slight majority reported that they routinely shared data with agency decision-makers that RT is a non-pharmacological treatment (58%) and that it increases outcomes related to quality of life (56%), however, less than 41% noted that they collected these data/facts. Also, for each of the open-ended questions (needs, strengths, strategies), very few respondents (4%, 7%, 5% respectively) suggested evidence-based practice/outcomes/research as important in these areas. These results raise the question of what information they are sharing and indicate a potential need for education and training directed at CTRSs for how to market the therapeutic benefits of the field of RT.

Last, the category of "word of mouth" was by far the most often cited "strength" as well as "marketing strategy" by the respondents. Although word of mouth can be a powerful tool, it is not clear that the effectiveness of this technique has been established. Without rigor or protocols to assure that what is shared by families and clients communicates the important elements of RT as a goal-directed, effective therapy, word of mouth has little impact in marketing. In addition, CTRSs might be relying on word of mouth as their only marketing strategy, thus, omitting opportunities to increase occupational prestige and recognition as a valid therapy.


Although many of the results of this study indicated concerns regarding the efforts as well as awareness of marketing needs in the field of RT, they also illustrated many specific areas of successful marketing by CTRSs. Therefore, the results can be used as a baseline to begin to design a strategic marketing plan that would serve as a template to assist CTRSs in increasing visibility, understanding, and occupational prestige for their programs and subsequently, for the field of RT. Data suggest that there are significant barriers that should be addressed on local levels (agencies) as well as through broad and global efforts (organizational) to address the perceived and actual lack of knowledge and/or opportunity to design and implement functional marketing strategies.

Recommendations for Practice

Recommendations for practice span both short-term and long-term agendas as well as local and global foci. First, as noted above, results indicated that some CTRSs are not marketing RT services. In addition, for a segment of those who are marketing, results showed that there is a lack of knowledge of specific techniques for how to market in the field. Therefore, it seems important to incorporate education and training about how to market the field into RT curricula on the college/university level. Unfortunately, there is little emphasis from the field to include these skills in RT curricula. For example, NCTRC's 2014 Job Analysis Report's Knowledge areas include only one item that addresses marketing (under Advancement of the Profession which is only 7% of the exam). Academic programs should take the initiative to expand training on how to market RT. This in turn might increase marketing efforts in RT practice and eventually affect the tasks identified within the field in the future to include broader marketing skills.

Second, CTRSs should be careful not to confuse specific marketing strategies with merely "spreading the word." Reliance on word of mouth alone is not sufficient to market our services effectively. As noted earlier, occupational prestige is hinged on training and high social value (Rosoff & Leone, 1991). In this context, training does not necessarily mean additional years in school, but can be interpreted as more skills in the practitioner skill set. Similarly, high social value addresses recognition as a practice that works to meet its goals. With this said, focus should be on addressing the fact that the field of RT lacks recognition as an evidence-based, non-pharmacological, goal-driven therapy. As noted, very few respondents (4%-7%) used evidence-based practice (EBP)/outcomes/research as a marketing tool. Clearly, these results highlight the level of need for education and training directed at CTRSs on how to collect and use data in their practice and then use these data to market the field of RT Practitioners who implement these practices should take initiative to provide training and strategies to other CTRSs, state, regional, and national. Lastly, additional organized efforts from national leadership such as ATRA and the NCTRC should be employed. As national organizations, these groups have the potential to design and distribute materials that may inform and direct practicing CTRSs in strategic marketing techniques within their respective practices.

Recommendations for Research

Several recommendations exist for future research on this topic. First, to facilitate consistency and reduce variability among the questionnaire items in future research, a factor analysis should be conducted on the three main sections (Intra, Inter, Extra) to eliminate possible conceptual redundancies among the variables. This analysis would potentially strengthen the sections and eliminate items that might distract from the interpretation of the results.

Second, examining respondents' constraints (real and perceived) as well as facilitators to marketing identified by CTRSs may contribute to understanding unique marketing needs and abilities. For example, some of the respondents suggested specific barriers to designing and conducting marketing activities. Analysis indicated, however, that some of these barriers were perceived rather than real. Further research should explore what perceptions might be keeping CTRSs from pursuing marketing efforts that are available and possible to achieve. Similarly, it will be important to identify specific characteristics of the settings, support systems, and techniques of the CTRSs that are conducting successful marketing strategies in order to develop models for other to utilize in designing and improving their own marketing efforts. Finally, surveying college and university RT programs about the level and extent of curriculum content on marketing is taught to RT students could help give a perspective of what needs to be developed on the curricular level for the field.

In conclusion, results from this study provide a baseline understanding of the knowledge and experiences of CTRSs regarding marketing in the field of RT. An effort to gain more specific understanding about conditions of identified marketing constraints, as well as details about successful techniques, is warranted. As these elements are identified and understood, the foundation of a comprehensive and strategic marketing model can be built.


American Occupational Therapy Association (AOTA).(2016). Why join? Your member benefits! Retrieved from

Bedini, L., & Kelly, L. (2013). A proposed marketing model for the field of recreation therapy. Paper presented at the ATRA Research Institute, September, 2013.

Bedini, L., & Petraca, M. (2013). How many clicks to find RT: A preliminary examination of ease of access to RT information on medical websites. Unpublished manuscript.

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-2017 Edition, Recreation Therapists. Retrieved from care/recreational-therapists.htm.

Harkins, L. E. (2010). Administrative perspectives of recreational therapy services in North Carolina. (Unpublished masters thesis). University of North Carolina at Greensboro, Greensboro, NC.

Harkins, L. E., & Bedini, L. A. (2013). Perceptions of health care administrators regarding recreation therapy in North Carolina. Annual in Therapeutic Recreation, 21,16-31.

Hinton, J. (2000). Looking up from the bottom of the barrel? Examining occupational prejudice toward recreational therapy (Unpublished doctoral dissertation). Clemson University, Clemson, SC.

Jacobs, K. (2012). PromOTing occupational therapy: Words, images, and actions. American Journal of Occupational Therapy, 66(6), 652-671.

Morris, Z. S., & Clarkson, P. J. (2009). Does social marketing provide a framework for changing health care practice? Health Policy, 91(2), 135-141.

Rosoff, S., & Leone, M. (1991). The public prestige of medical specialties: Overviews and undercurrents. Social Science and Medicine, 32(3), 321-326.

Smith, R. W, Perry, T. L., Neumayer, R. J., Potter, J. S., & Smeal, T M. (1992). Interprofessional perceptions between therapeutic recreation and occupational therapy practitioners: Barriers to effective interdisciplinary team functioning. Therapeutic Recreation Journal, 26(4), 31-42.

Thorn, B. E. (1984). Marketing therapeutic recreation services. Therapeutic Recreation Journal, 18(4), 42-47.

Leandra A. Bedini, Ph.D., LRT/CTRS

Professor and Director of Therapeutic Recreation

Department of Community and Therapeutic Recreation

University of North Carolina at Greensboro

(336) 334-3260 *

Author Note

This study was funded in part by the North Carolina Recreation Therapy Association.

DEMOGRAPHIC PROFILE                          N      %

Client Population Served by CTRS
Behavioral Health                          294   38.1
DD/ID                                       55    7.1
Geriatric Long-Term Care                   187   24.2
Physical Medicine and Physical Disability  138   17.9
Other                                       98   12.7
Total                                      772  100.0
Current Position
Administrator                               36    4.6
Therapist                                  371   47.7
Therapist/Administrator                     53    6.0
Therapist/Supervisor                       191   24.6
TR Leader/Programmer                        40    5.1
TR Leader/Supervisor                        43    5.5
Other                                       43    5.5
Total                                      777  100.0
Primary Employment Sector
Adult Day Care                              31    4.0
Community Parks & Recreation                39    5.0
Correctional Facility                       28    3.6
Disability Organization                      9    1.2
Hospital                                   291   37.4
Human Services                               6     .8
Outpatient Day Program                      23    3.0
Residential/Transitional                    70    9.0
School                                       6     .8
Skilled Nursing Facility                   146   18.8
Other                                      129   11.6
Total                                      778  100.0
Age Group Served
Older Adult                                131   16.8
Adult/Older Adult                          282   36.2
Adult                                      161   20.7
Adolescent                                  34    4.4
Pediatric/Adolescent                        45    5.8
Pediatric                                    5     .6
All Age Groups                             120   15.4
Total                                      778  100.0
Years Worked as CTRS
0-5                                        147   18.9
6-10                                       127   16.3
11-15                                      118   15.2
16-20                                      103   13.2
20-25                                       91   11.7
Over 25                                    192   24.7
Total                                      778  100.0


                                                           N      %

Formal Recreation Therapy Marketing Plan
Yes                                                      106    9.5
No                                                      1010   90.5
Total                                                   1116  100.0
Periodic Refining of Recreation Therapy Marketing Plan
Yes                                                       69    6.2
No                                                        34    3.0
Total                                                    103  100.0
Specific CTRS Responsible for Marketing
Yes                                                      194   25.3
No                                                       573   74.7
Total                                                    767  100.0
Works with Agency Marketing Specialist
Yes                                                      167   21.7
No                                                       603   78.3
Total                                                    770  100.0


                                                        N      %

Gives Recreation Therapy Marketing at
Staff Orientation
Never                                                 345   31.0
Occasionally/Rarely                                   389   34.9
Often                                                 219   19.7
Always                                                161   14.5
Total                                                1114  100.0
Trains Interns on Value or Recreation Therapy
Never                                                 206   18.5
Occasionally/Rarely                                   279   20.3
Often                                                 288   25.9
Always                                                338   30.4
Total                                                1111  100.0
Compiles Stats on Recreation Therapy as
Non-pharm Treatment
Never                                                 377   34.0
Occasionally/Rarely                                   389   35.1
Often                                                 222   20.0
Always                                                121   10.9
Total                                                 109  100.0
Complies Stats on Recreation Therapy &
Quality of Life
Never                                                 291   26.2
Occasionally/Rarely                                   364   32.8
Often                                                 285   25.7
Always                                                171   15.4
Total                                                 111  100.0
Speak Up in Meetings to Describe Recreation Therapy
Never                                                  26    2.5
Occasionally/Rarely                                   104   10.1
Often                                                 316   30.7
Always                                                582   56.6
Total                                                 028  100.0


                                                       N      %

Shares with Decision-Makers Recreation Therapy as
Nonpharmacological Treatment
Never                                                124   12.8
Occasionally/Rarely                                  286   29.5
Often                                                331   34.2
Always                                               228   23.5
Total                                                969  100.0
Shares with Decision-Makers of Recreation Therapy
& Quality of Life
Never                                                114   11.8
Occasionally/Rarely                                  317   32.7
Often                                                317   32.7
Always                                               220   22.7
Total                                                968  100.0
Recreation Therapy In-Services for Decision-Makers
Never                                                263   27.3
Occasionally/Rarely                                  464   48.1
Often                                                180   18.7
Always                                                57    5.9
Total                                                964  100.0
Recreation Therapy In-Services for Other Disciplines
Never                                                242   25.1
Occasionally/Rarely                                  466   48.2
Often                                                199   20.6
Always                                                59    6.1
Total                                                966  100.0
Recreation Therapy In-Services for Community
Never                                                457   47.3
Occasionally/Rarely                                  362   37.4
Often                                                110   11.4
Always                                                38    3.9
Total                                                967  100.0
RT TR In-Services to Non-RT Professionals
Never                                                308   31.8
Occasionally/Rarely                                  390   40.3
Often                                                210   21.7
Always                                                60    6.2
Total                                                968  100.0
Informs Administration on Recreation Therapy EBP
Never                                                283   29.3
Occasionally/Rarely                                  399   41.3
Often                                                210   21.7
Always                                                75    7.8
Total                                                967  100.0
Markets Recreation Therapy Directly to Patients
Never                                                 67    7.0
Occasionally/Rarely                                  158   16.5
Often                                                315   33.0
Always                                               415   43.5
Total                                                955  100.0
Markets Recreation Therapy within Local Community
Never                                                262   27.2
Occasionally/Rarely                                  311   32.3
Often                                                242   25.1
Always                                               148   15.4
Total                                                963  100.0
Shares Patient Satisfaction with Administration
Never                                                223   23.0
Occasionally/Rarely                                  320   33.1
Often                                                244   25.2
Always                                               181   18.7
Total                                                968  100.0
Seeks to Co-Treat with Other Disciplines
Never                                                 77    8.0
Occasionally/Rarely                                  218   22.7
Often                                                343   35.7
Always                                               324   33.7
Total                                                962  100.0
Collaborates on RT-Related Research
Never                                                311   32.2
Occasionally/Rarely                                  314   32.5
Often                                                219   22.7
Always                                               122   12.6
Total                                                966  100.0
Posts Testimonials
Never                                                410   42.5
Occasionally/Rarely                                  298   30.9
Often                                                171   17.7
Always                                                85    8.8
Total                                                964  100.0


                                                    N      %

Findable in Four "Clicks" on Computer
Never                                             227   26.2
Occasionally/Rarely                               246   28.3
Often                                             185   21.3
Always                                            210   24.2
Total                                             868  100.0
Person Answering Phone Can Direct Callers
Never                                              53    6.1
Occasionally/Rarely                               125   14.3
Often                                             232   26.6
Always                                            463   53.0
Total                                             873  100.0
Person Answering Phone Can Articulate Recreation
Never                                             208   18.6
Occasionally/Rarely                               305   27.3
Often                                             226   20.3
Always                                            130   11.6
Total                                             869  100.0
Recreation Therapy Department Clearly Listed in
Never                                             102   12.1
Occasionally/Rarely                               156   18.5
Often                                             219   25.9
Always                                            367   43.5
Total                                             844  100.0
Signage in Main Directory
Never                                             234   27.3
Occasionally/Rarely                               185   21.6
Often                                             174   20.3
Always                                            264   30.8
Total                                             857  100.0
Signage Consistent with Other Therapies
Never                                             183   21.2
Occasionally/Rarely                               170   19.7
Often                                             196   22.7
Always                                            313   36.3
Total                                             862  100.0
Signage in Recreation Therapy Office
Never                                             158   18.4
Occasionally/Rarely                               149   17.4
Often                                             196   22.8
Always                                            355   41.4
Total                                             858  100.0
Staff's Recreation Therapy Credential Displayed
Never                                             252   29.7
Occasionally/Rarely                               158   18.6
Often                                             122   14.4
Always                                            317   37.3
Total                                             849  100.0
Visible in Agency Marketing
Never                                             296   34.1
Occasionally/Rarely                               252   29.0
Often                                             162   18.7
Always                                            158   18.2
Total                                             868  100.0
Active Social Media
Never                                             572   65.7
Occasionally/Rarely                               137   15.7
Often                                              82    9.4
Always                                             80    9.2
Total                                             871  100.0
Invites Clients and Staff to "Like"
Never                                             619   71.9
Occasionally/Rarely                               112   13.0
Often                                              64    7.4
Always                                             66    7.7
Total                                             861  100.0
Submits Stories of Recreation Therapy
Never                                             368   42.3
Occasionally/Rarely                               281   32.3
Often                                             133   15.3
Always                                             89   10.2
Total                                             871  100.0
Media to Boost Value
Never                                             449   52.0
Occasionally/Rarely                               246   28.5
Often                                             107   12.4
Always                                             62    7.2
Total                                             864  100.0
Seeks Collaboration with PR/Marketing
Never                                             343   40.9
Occasionally/Rarely                               248   29.6
Often                                             143   17.1
Always                                            104   12.4
Total                                             838  100.0
Has Own Tagline
Never                                             554   63.8
Occasionally/Rarely                               166   19.1
Often                                              86    9.9
Always                                             63    7.2
Total                                             869  100.0
Has Recreation Therapy Name Badges
Never                                             222   25.6
Occasionally/Rarely                                67    7.7
Often                                              99   11.4
Always                                            478   55.2
Total                                             866  100.0
Brand Recreation Therapy Clothing
Never                                             655   75.2
Occasionally/Rarely                               115   13.2
Often                                              47    5.4
Always                                             54    6.2
Total                                             871  100.0
Brands Recreation Therapy Materials
Never                                             362   41.7
Occasionally/Rarely                               190   21.9
Often                                             131   15.1
Always                                            186   21.4
Total                                             869  100.0
Has Recreation Therapy Business Cards
Never                                             372   42.7
Occasionally/Rarely                               155   17.8
Often                                             109   12.5
Always                                            236   27.1
Total                                             872  100.0
Presence in Public Places
Never                                             262   30.2
Occasionally/Rarely                               261   30.1
Often                                             188   21.7
Always                                            156   18.0
Total                                             867  100.0
Visible Recreation Therapy Journals/Books
Never                                             459   52.9
Occasionally/Rarely                               248   28.6
Often                                              94   10.8
Always                                             67    7.7
Total                                             868  100.0
Own Recreation Therapy Brochures
Never                                             523   60.7
Occasionally/Rarely                               159   18.5
Often                                              81    9.4
Always                                             98   11.4
Total                                             861  100.0
COPYRIGHT 2017 American Therapeutic Recreation Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Article Details
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Author:Bedini, Leandra A.
Publication:Annual in Therapeutic Recreation
Date:Jan 1, 2017
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