Cultural influences on occupational therapy practice in Singapore: a pilot study

The Effects of Culture and Gender on Occupational Therapy Practice for Adults: From Palestinian Therapists' Perspective

As the occupational therapy profession is rooted in Western ideals, it may encounter complexities in culturally traditional settings like Palestine, especially for adults. This study reveals the challenges faced by occupational therapists in Palestine. A phenomenological qualitative approach was used, interviewing six experienced female therapists using semi-structured interviews. Purposive sampling ensured a diverse participant selection. Thematic analysis revealed several key themes, such as the continuous adaptation to Western practices to fit the Palestinian context, the value of interdependence, and the unique life balance. Results show that cultural and gender norms significantly shape occupational therapy practices in Palestine. The discussion emphasizes the theoretical necessity for cultural sensitivity in occupational therapy, advocating alignment with local values and addressing resource limitations for effective service delivery.

Understanding and optimising support resources to facilitate CALD student and supervisor allied health fieldwork experiences

BACKGROUND

Although fieldwork supervisors and culturally and linguistically diverse (CALD) students can experience challenges during allied health placements, there is little holistic understanding of how they view and use support resources to address these challenges. This study sought to identify, codify, and map the perceived value attached to support resources used or sought by CALD students and fieldwork supervisors and to ascertain areas where they could be optimised and better presented to users.

METHODS

We conducted a thematic analysis to examine interview and open-ended survey responses from CALD students (n = 18) and fieldwork supervisors (n = 161) respectively.

FINDINGS

The six generated themes depicted different patterns of perceived value in university and non-university support resources and spanned three levels of specificity: general, discipline-contextualised, and individualised. Fieldwork supervisors valued a staged approach to support resource design and use for CALD students commencing with general level resources to build foundational language skills and socio-cultural familiarisation and moving on to include disciple-contextualised supports, preplacement mechanisms to monitor student readiness, and formalised mechanisms to enable tailoring of placements. CALD students, however, often undervalued institutional general resources relative to discipline-contextualised resources. The commonality of support resources valued and sought by supervisors from different fields suggests they could be optimised for delivery via an inter-professional community of practice.

CONCLUSION

Identifying and mapping the perceived value attached to support resources provides actionable insights into how to enhance the 'fit' between resources and user needs. Drawing the often-fragmented support resources into a cohesive ecosystem focused around perceived value at different levels of specificity allows CALD students and educators to better conceptualise the types of benefits that can accrue from taking a broader and staged approach to fieldwork placement preparations. Knowing this ecosystem encapsulates what prior uses find of value may enhance perceptions of resource relevance in the minds of new users.

Occupational therapy practice with terminally ill Chinese older adults in Singapore: A qualitative exploratory study

INTRODUCTION

As the majority of occupational therapy philosophy has Western origins, occupational therapists working with palliative care clients in Singapore can provide invaluable insight into the practice of occupational therapy within a non-Western, family-centric population. This study aimed to describe occupational therapists' perceptions of the occupations of terminally ill Chinese older adults and their caregivers and explore occupational therapy practice with terminally ill Chinese older adults in Singapore.

METHODS

Eleven occupational therapists were recruited via convenience and snowball sampling. Inclusion criteria were being fully registered with the Allied Health Professionals Council (Singapore) with at least 2 years of working experience and currently working with/had experience working with terminally ill patients within the past 2 years. Interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis.

FINDINGS

Five themes were constructed from the data: (1) Independence may not be for everyone, (2) it is a family unit, (3) contributing to others' lives is important, (4) what respecting clients means, and (5) a different way of engaging. These themes describe how occupational therapists adapted their practice to better meet the needs of clients and families in Singapore.

DISCUSSION

In family-centric societies, it may be more relevant for occupational therapists to facilitate interdependence instead of independence in activities of daily living. In addition, activities that contribute to others' lives tangibly/intangibly may be more meaningful and relevant. Finally, occupational therapists could engage clients through the 'being' instead of 'doing' dimension of occupation.

CONCLUSION

While occupational therapists in Singapore faced some challenges working with terminally ill clients and families due to differences between occupational therapy philosophy and practice context, by reframing their thinking, they were able to adapt their practices to meet the needs of a family-centric population.

Occupational Therapists' Perceptions of Home Program Provision for Stroke Survivors in a Lower- and Middle-Income Country: An Exploratory Study

This qualitative study aimed to understand occupational therapists' experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.

Patterns of occupational engagement among community-dwelling older adults in Singapore: An exploratory mixed method study

Introduction

The aim of this study is to understand the patterns of occupations among community-dwelling older adults in Singapore. The objectives are to describe their occupational engagement using the Activity Card Sort Singapore, understand their occupational preferences and perceived barriers and facilitators to engagement.

Methods

A convergent parallel mixed-method study was conducted over a 5-month period in 2018. Purposive and snowball sampling were used to recruit the participants. Individual 1-h interviews were conducted at participants’ homes. Quantitative data collected include demographic information, Modified Barthel Index scores and activity engagement based on the Activity Card Sort Singapore. Qualitative data was collected using semi-structured interviews.

Results

105 participants were enrolled in the study. Overall, older adults engaged mostly in instrumental and social activities. However, leisure and social activities were most preferred. Gender, educational level and age were found to influence occupational engagement. Overall, six main themes relating to perceived barriers and facilitators to occupational engagement were identified: cognition and physical status, self-efficacy, resources, affect and meaningfulness, social influence and environmental factors.

Conclusion

The findings from this study provided insights into the occupational patterns of community-dwelling older adults in Singapore and their perceived barriers and facilitators to engagement. Recommendations for practice were identified.

Occupational therapy practice education: A perspective from international students in the UK

Background: Numbers of international students enrolling on occupational therapy (OT) courses in Western institutions have increased. Previous examination of these students' experience of practice education is limited.Objective: To explore the opportunities and challenges experienced by international students in OT practice education.Methods: This study adopted a phenomenological approach, recruiting six individuals from three UK universities. Data from semi-structured interviews was given thematic analysis for result interpretation.Results: Participants identified learning OT in the workplace, working in a multidisciplinary team and personal and professional development as practice education opportunities. Language difficulties, differences in communication styles, multiple cultural differences and unfamiliarity with the National Health Service (NHS) were the main challenges. Good practice educators and supportive team members were the main contributors to positive placement experiences.Conclusions: Participants gained knowledge and skills from practice education that existing healthcare literature suggests they are expected to attain. Several challenges were highlighted regarding participation in practice education. The findings reveal a need to enhance practice educators' skills in supervising international students. Universities are recommended to invest time and resources in supporting the learning needs of these students.Significance: The first study to present international students views on OT pre-registration practice placements in the UK.

The Influence of Culture on Occupational Therapy Practice in Jordan

Background

Occupational therapy's origins draw from Western culture, values, and beliefs which may impact the application of traditional occupational therapy practice in non-Western cultures.

Purpose

This study explored how occupational therapists in Jordan facilitate occupational therapy practice within Islamic Eastern culture.

Method

A phenomenological approach was used in this study. Semistructured interviews were conducted with eleven occupational therapists that work in Jordan and have at least two years of experience. Data were analyzed using thematic analysis methods.

Results

Three central themes emerged: impact of Jordanian culture and Islamic beliefs about independence and disability on occupational therapy practice, the therapists' notions of ideal occupational therapy practice vs. daily reality, and challenges posed by workspace and the availability of equipment.

Conclusion

This study highlights the growing need to translate and expand the core values of occupational therapy to align with cultures in non-Western countries and cultures.

Education Burnout and Engagement in Occupational Therapy Undergraduate Students and Its Associated Factors

Introduction

Burnout syndrome has been characterized as a process of chronic responses to occupational stress in certain employee groups. However, this phenomenon has also been reported in other participant groups including university students. The Maslach Burnout Inventory-Student Survey (MBI-SS), composed of the Exhaustion, Cynicism and Efficacy subscales, was used to evaluate burnout in this sample group while the Utrecht Work Engagement Scale (UWES) was used to gather data related to engagement, a positive psychology construct composed of the three factors, namely vigor, dedication, and absorption. To date, no studies considered these factors in relation to occupational therapy students. This begs the question, is there a relationship between occupational therapy students' self-reported levels of burnout and engagement?

Objectives

The study objectives are to (1) ascertain the self-reported levels of burnout and engagement in a sample of Australian Occupational undergraduate therapy students, and (2) analyze the sociodemographic, occupational and academic characteristic associated with these levels.

Methods

Participants were 225 Australian undergraduate occupational therapy students from Monash University completed the MBI-SS and the UWES for students. Descriptive, bivariate and multiple linear regression analyses were performed.

Results

Regarding MBI-SS burnout dimensions, exhaustion was associated with age, year level of enrolment and hours of direct time spent working on occupational therapy studies, explaining 15% of its variance. Cynicism and efficacy were associated with age, year level of enrolment and hours of indirect time, accounting for 16% of its variance. For the UWES engagement dimensions, year level of enrolment and hours of indirect time spent working on occupational therapy studies were significant predictors of vigor, explaining 27% its variance while while age, gender, year level of enrolment, hours of indirect time spent working on occupational therapy studies, and hours spend per week engaged in self-care activities accounted for 23% of the variance of dedication. Finally, age, year level of enrolment, and hours of indirect time spent working on occupational therapy studies explained 27% of the variance of absorption.

Conclusion

The results indicate that a number of demographic and academic study variables are significantly associated with burnout syndrome and education engagement reported by undergraduate occupational therapy students.

Barriers and facilitators to cultural competence in rehabilitation services: a scoping review

BACKGROUND

There is an important need to evaluate whether rehabilitation services effectively address the needs of minority culture populations with North America's increasingly diverse population. The objective of this paper was therefore to review and assess the state of knowledge of barriers and facilitators to cultural competence in rehabilitation services.

METHOD

Our scoping review focused on cultural competence in rehabilitation services. Rehabilitation services included in this review were: audiology, speech-language pathology, physiotherapy, and occupational therapy. A search strategy was developed to identify relevant articles published from inception of databases until April 2015. Titles and abstracts were screened by two independent reviewers according to specific eligibility criteria with the use of a liberal-accelerated approach. Full-text articles meeting inclusion criteria were then screened. Key study characteristics were abstracted by the first reviewer, and findings were verified by the second reviewer.

RESULTS

After duplicates were removed, 4303 citations were screened. Included articles suggest that studies on cultural competence occur most frequently in occupational therapy (n = 17), followed by speech language pathology (n = 11), physiotherapy (n = 6), and finally audiology (n = 1). Primary barriers in rehabilitation services include language barriers, limited resources, and cultural barriers. Primary facilitators include cultural awareness amongst practitioners, cultural awareness in services, and explanations of health care systems.

CONCLUSION

To our knowledge, this review is the first to summarize barriers and facilitators to cultural competence in rehabilitation fields. Insufficient studies were found to draw any conclusions with regards to audiological services. Minimal perspectives based on patient/caregiver experiences in all rehabilitation fields underscore a research gap. Future studies should aim to explore both patient/caregiver and practitioner perspectives as such data can help inform culturally competent practices.

The cultural brokerage work of occupational therapists in providing culturally sensitive care

Background.

The important place of culture within occupational therapy is widely recognized, and there is increasing emphasis on addressing the diversity of clients.

Purpose.

This study explores how occupational therapists perform cultural brokerage when providing culturally sensitive care to immigrant families.

Method.

A descriptive qualitative methodology was used for this study. A purposive sample of 17 occupational therapists from two Canadian paediatric rehabilitation centres were interviewed.

Findings.

Participants encountered several cultural and structural constraints in providing culturally sensitive care. To overcome these constraints, clinicians used four strategies: (a) translating between health systems for clients, (b) bridging different meanings of occupational therapy to make it relevant for clients, (c) establishing long-term relationships by building trust and rapport, and (d) working with clients’ relational networks to help them navigate the health system.

Implications.

Occupational therapists should advocate for both the individual needs of immigrant families and for institutional level resources to better meet the needs of diverse clients.

Occupation, well-being, and culture: Theory and cultural humility / Occupation, bien-être et culture : la théorie et l’humilité culturelle

Background.

The Canadian Model of Occupational Performance and Engagement depicts individuals embedded within cultural environments that afford occupational possibilities. Culture pertains not solely to ethnicity or race but to any dimension of diversity, including class, gender, sexual orientation, and ability.

Purpose.

This paper highlights specific dimensions of cultural diversity and their relationships to occupational engagement and well-being.

Key issues.

Cultural variations constitute the basis for a socially constructed hierarchy of traits that significantly determine occupational opportunities and impact mental health and well-being. Cultural humility is an approach to redressing power imbalances in client-therapist relationships by incorporating critical self-evaluation and recognizing that cultural differences lie not within clients but within client-therapist relationships.

Implications.

It is proposed that theoretical relevance would be enhanced if culturally diverse perspectives were incorporated into theories of occupation. Cultural humility is advocated as an approach to theoretical development and in efforts to counter professional Eurocentrism, ethnocentrism, and intellectual colonialism.

Working with immigrant families raising a child with a disability: challenges and recommendations for healthcare and community service providers

PURPOSE

Although providing culturally sensitive care is an important element of family-centered rehabilitation very is little known about providers' experiences working with immigrant families in pediatric settings. The purpose of this study is to develop a better understanding of the experiences of service providers working with immigrant families raising a child with a physical disability.

METHOD

We draw on a qualitative approach involving in-depth interviews and focus groups with healthcare and community service providers (n = 13) in two multi-cultural Canadian cities.

RESULTS

The findings indicate that healthcare and community service providers encounter several challenges in providing care to immigrant families raising a child with a disability. Such challenges include the following: (1) lack of training in providing culturally sensitive care; (2) language and communication issues; (3) discrepancies in conceptualizations of disability between healthcare providers and immigrant parents; (4) building rapport; and (5) helping parents to advocate for themselves and their children. Service providers also have several recommendations for improving services to better meet the needs of immigrant families.

CONCLUSION

Clinicians should be cognizant of how culture influences the care they provide to clients. More training opportunities are needed for enhancing culturally sensitive care.

IMPLICATIONS FOR REHABILITATION

• Pediatric rehabilitation providers working with immigrant families raising a child with a disability should engage in training and education around culturally sensitive care to better meet the needs of these clients. • More time is needed when working with immigrant families to build trust and rapport. • Clinicians need to be sensitive around gender issues and try to involve both parents in the decision making around the care for their child. • Healthcare providers should help clients to become more aware of the resources available to them in the hospital and in the community.

Clair V, Bunrayong W, Vittayakorn S, Rattakorn P. The Promise of Internationally Collaborative Research for Studying Occupation: The Example of the Older Women's Food Preparation Study

Growing awareness of the Western perspectives underpinning occupational science and occupational therapy's values, theories, and evaluation tools has given rise to questions about culturally relevant knowledge and practice with non-Western populations. To make sense of attempts to develop cross-cultural knowledge taking place within the profession and discipline, the authors review epistemological perspectives and methodological advances in anthropology and psychology. Thus informed, they both summarize and critique constructivist and positivist approaches to knowledge development and practice that cross or resist the crossing of cultures. The authors outline a multicultural collaborative research method that supports extending and refining the profession's knowledge in a way that both honors local perspectives and reveals concepts that cross cultures. Insights from a study that explored the meaning of food preparation to older Thai, American, and New Zealand women provide illustrative examples.