Approaches to culture and diversity: A critical synthesis of occupational therapy literature

Attitudes to End-of-Life Care and Voluntary Assisted Dying Amongst Members of the Australian Jewish community

The implementation of voluntary assisted dying (VAD) in the Australian State of Victoria in 2019 has stimulated discussions about end-of-life care and dying in many communities. Various attempts have been made to represent the attitudes of the Jewish community, a distinct culturally and linguistically diverse (CALD) group, in terms that suggest a unified set of opinions that opposes VAD policies. This research aimed to explore attitudes to VAD in the context of end-of-life care held by members of the Victorian Jewish community. A descriptive qualitative methodological design was employed. Ten Victorians who identify as Jewish were recruited and participated in in-depth, semi-structured interviews. Reflexive thematic analysis was carried out on the transcripts to identify key themes, attitudes and preferences in relation to end-of-life care, death and dying, and VAD. Three themes were identified: "complexity and variation", "similarities", and "factors influencing attitudes to VAD and end-of-life care". A significant degree of diversity was apparent, ranging from highly supportive of VAD to advocacy for a total repeal of the policy. The results indicate that images of how Victorian Jewish individuals feel towards VAD based on essentialised notions about the community and belief systems are not supported by the evidence. In reality, considerable diversity of attitudes exists towards VAD and end-of-life care. We conclude that it is important that policymakers and members of the broader society avoid stereotypes that falsely characterise this specific community and, by implication, other CALD groups, particularly in terms that ignore internal diversity regarding belief systems, social attitudes and ethical perspectives.

Knowledge Gaps Regarding Indigenous Health in Occupational Therapy: A National Survey

Background. There is a need for the occupational therapy profession to respond to the Truth and Reconciliation Commission of Canada Calls to Action and work towards supporting the health and well-being of Indigenous Peoples. Purpose. (1) To determine the knowledge gaps of occupational therapists about Indigenous health and (2) to create recommendations to address identified gaps and inform responses from the profession. Method. A national needs survey was created and distributed to occupational therapists across Canada to determine the knowledge of occupational therapists about Indigenous health. Survey results were analyzed using thematic analysis and descriptive statistics. Findings. Data collected from 364 survey responses informed six distinct themes representing knowledge gaps of occupational therapists related to Indigenous health as follows: lack of foundational knowledge, power relations, lifelong learner, need for appropriate tools/approaches, respectful collaboration, and environmental influences. Implications. The project offers insight into the role of the occupational therapy profession in the process of reconciliation. Insights are focused on decolonizing occupational therapy practice, building trusting relationships with Indigenous Peoples, and the provision of appropriate training for occupational therapists to engage in culturally safer practices.

Promoting Justice, Diversity, Equity, and Inclusion Through Caring Communities: Why It Matters to Occupational Therapy

The global challenges humanity faces today, such as social and economic inequalities, occupational deprivation, racism, exclusion, displacement and migration crises, violence, wars, and political oppression, all contribute to health and participation inequities (Powell & Toppin, 2021). The depth and breadth of these inequities became strikingly evident and were exacerbated with the coronavirus 2019 pandemic (Khanijahani et al., 2021). More than ever before, we need to apply an occupational perspective to create caring communities that strengthen each person's sense of belonging (Beagan, 2015; Lavalley & Johnson, 2020; Mahoney & Kiraly-Alvarez, 2019). In this column, we argue that occupational therapy academic programs have a unique role in advancing justice, equity, diversity, and inclusion through the creation of caring communities.

Knowledge Gaps Regarding Indigenous Health in Occupational Therapy: A Delphi Process

Background. The occupational therapy profession needs to respond to the calls to action from the Truth and Reconciliation Commission (TRC) to engage in the process of reconciliation with Indigenous populations. Purpose. To inform development of a survey intended to determine the knowledge gaps of occupational therapists in relation to Indigenous health. Method. A Delphi process engaging 18 occupational therapists with membership in an Indigenous health network was used to prioritize and refine potential themes identified via literature review. Findings. Results of three consensus rounds and Dunn-Bonferroni post-hoc testing demonstrated three statistically distinct hierarchical tiers of 10 priority themes to inform survey development. Implications. The consensus prioritized themes from the literature to underpin further research on occupational therapists' knowledge in relation to Indigenous health and can provide a learning scaffold for occupational therapists to support a continued response to the TRC calls to action.

The Arab minority of East Jerusalem: An exploratory study of vocational rehabilitation in mental health

BACKGROUND

The Arab population of East Jerusalem with serious mental illness (SMI) is an ethnic and health status minority that has unique employment issues. Vocational rehabilitation offered to this population is guided by standard regulations that are grounded in knowledge obtained from Western communities on the employment enablers, while negligible research was done to investigate relevance of these enablers for the Arab population.

OBJECTIVE

The study aims to examine the previously well-established association between motor, cognitive, and emotional personal factors, occupation features, environmental characteristics, and vocational outcomes of job satisfaction and performance among the Arab population of East Jerusalem with SMI.

METHODS

Twenty-three men and women, aged 23-58, from this minority group who had received vocational rehabilitation participated in this cross-sectional study. They completed standard assessments of motor and cognitive skills, self-efficacy, work-environment suitability, and job satisfaction. Employers then rated their level of functioning at work.

RESULTS

No correlation was found between the outcome measurements and most of the personal factors and environmental characteristics (p > 0.05), except for an association between job satisfaction, work self-efficacy, and work control. No expected differences were found between vocational rehabilitation programs in the variables of interest (p > 0.05).

CONCLUSION

The disparity from well-established patterns of association between enablers and employment outcomes reveals unique characteristics of the investigated population and suggests the impact cultural issues has on vocational rehabilitation. The findings raise an urgent call for an in-depth investigation of the complex phenomenon of employment in this population to support sustainable employment benefits and recovery journey.

Ethnocultural Minority Workers and Sustainable Return to Work Following Work Disability: A Qualitative Interpretive Description Study

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.

Mothering a Child with ADHD in the Ultra-Orthodox Community

Mothers of children with ADHD are at risk for negative health outcomes. The socio-cultural environment and everyday experiences in life roles may influence psychological health and quality of life. The ultra-orthodox Jewish (UOJ) community is an insular community who is underrepresented in the research, and as such there are no studies exploring the experience of mothering a child in this community. Thus, this study aims to explore the lived experience of mothering a child with ADHD in the UOJ community. The study used a descriptive qualitative phenomenological approach. Ten UOJ mothers of children with ADHD underwent semi-structured in-depth interviews to explore their lived experiences of mothering a child with ADHD. Thematic analysis was carried out on the transcripts. Four main themes, along with several subthemes, emerged from the qualitative analysis: child ADHD manifestations, maternal role, social factors, and self-care. Unique characteristics of the UOJ culture were apparent throughout the themes. UOJ children with ADHD display similar manifestations of symptoms in daily life to those in the general population and maternal burden is similarly present. However, unique perceptions of their maternal role, social factors, and legitimacy for self-care shed light into the impact of this culture on their lived experience. Findings may help promote culturally sensitive health care and interventions for this understudied population.

Understanding the role and importance of occupational therapy in mental health services in Morocco: Perspectives from mental health professionals

BACKGROUND: Across the global landscape, mental health care still exhibits challenges because of the lack of human and professional resources to face its consequences. In Morocco, mental health problems affect mainly adolescents and young adults, with a clear impact on functional engagement in their daily lives. Occupational therapy, as a holistic and person-centered practice, may be an ideal mental health strategy to promote health and well-being through occupation, thereby enabling individuals to participate in regular daily activities. OBJECTIVE: To understand, from an intercultural perspective, the point of view of mental health professionals regarding the role and importance of occupation-based practices in Errazi Mental Health Hospital in Salé(Rabat) Morocco. METHOD: A qualitative research design was used for this study. Data collection consisted of semi-structured interviews with 12 mental health care professionals (non-occupational therapists). These results were used to gain an understanding of their perspectives regarding the main role of human occupation in mental health services in Morocco, and to incorporate an intercultural outlook in terms of occupational therapy. Data analysis was conducted in three phases, by following the grounded theory methodology. RESULTS: Two categories, “dimensions of occupation in Moroccan mental health” and “the interplay between traditional and western perspectives involving mental health” emerged from this research. Both categories included five subcategories. CONCLUSION: This study identifies how occupation-based services in Moroccan mental health care require considering not only the cultural perspective of mental health, and the sociocultural meaning rooted in occupations, but also the relevance of incorporating a community-centered approach. Moreover, it discusses how occupational therapy education in Morocco must incorporate an intercultural perspective of the therapy’s theory and practice.

Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature

Cultural safety is increasingly being taught in tertiary programmes of study for health professionals. Reflexivity is a key skill required to engage in culturally safe practice, however, there is currently limited literature examining how reflexivity is taught or assessed within cultural safety curricula. A systematic review of the literature up until November 2021 was conducted, examining educational interventions which aimed to produce culturally safe learners. Studies were limited to those with a focus on Indigenous health and delivered in Australia, Aotearoa New Zealand, Canada, and the United States. A total of 46 documents describing 43 different educational interventions were identified. We found that definitions and conceptualisations of reflexivity varied considerably, resulting in a lack of conceptual clarity. Reflexive catalysts were the primary pedagogical approaches used, where objects, people, or Indigenous pedagogies provided a counterpoint to learners’ knowledges and experiences. Information regarding assessment methods was limited but indicates that the focus of existing programmes has been on changes in learner knowledge and attitudes rather than the ability to engage in reflexivity. The results demonstrate a need for greater conceptual clarity regarding reflexivity as it relates to cultural safety, and to develop methods of assessment that focus on process rather than outcomes.

Indigenous Peoples and occupational therapy in Canada: A scoping review

Background. Calls to Action outlined by the Truth and Reconciliation Commission (TRC) necessitate critical reflection and urgent action to improve occupational therapy with Indigenous Peoples in Canada. Purpose. This scoping review aims to synthesize the literature related to Indigenous Peoples and occupational therapy practice, research, and education in Canada, and appraise empirical research using adapted Indigenous Health Research criteria. Method. A scoping review was conducted across published academic and grey literature with additional appraisal of empirical studies. Findings. A total of 6 themes emerged from 47 articles spanning from 1970 to 2020: recognizing colonial history, responding to the TRC, participating in personal and professional reflection, identifying Western ideologies, engaging in partnership in practice, and recognizing social and systemic barriers. Empirical studies met appraisal criteria inconsistently. Implications. To meaningfully engage in reconciliation, the profession of occupational therapy must generate Indigenous-led and relevant research, critically transform curricula, and address tensions between themes in practice.

Exploring emotional and social competencies in undergraduate students: Perspectives from CALD and non-CALD students

With the internationalisation of higher education, students from culturally and linguistically diverse (CALD) backgrounds represent a significant proportion of the university student body in Australia. Research literature indicates that the unique cultural and linguistic challenges experienced by these students may adversely impact their academic performance and social integration in university settings. However, less is known about how the socio-emotional competencies of undergraduate CALD and non-CALD domestic English-speaking students compare. This cross-sectional quantitative study compares the emotional and social competencies in a cohort of CALD and non-CALD occupational therapy undergraduates. Data were collected at one Australian university from a group of 360 students enrolled in the Bachelor of Occupational Therapy (Honours) course. Participants completed the Emotional and Social Competency Inventory- University edition (ESCI-U). Multivariate regression analyses were used to compare between CALD and non-CALD students, controlling for students' year level of study, age, and gender. Key findings from the regression analysis included the observation of indicate that non-CALD students having significant higher scores than CALD students on all the ESCI-U socio-emotional subscales, especially the Emotional Self-control, Achievement Orientation, Empathy and Teamwork from western perspectives. No difference was found between CALD and non-CALD student on two cognitive competencies- systems thinking and pattern recognition. These findings should be interpreted with caution considering CALD students may interpret the questions differently and demonstrate the competencies in different ways. Specific emotional and social competencies that need to be strengthened in students are discussed and recommendations are made to inform the preparation of evidence-based curricula.

Exploring the Role of Occupational Therapy and Forced Migration in Canada

BACKGROUND.

In response to increasing forced migration across the globe, Canadian occupational therapists are returning to the profession's social justice roots by exploring this emergent area of practice. Purpose. This research explores occupational therapy practices with forced migrants in a Canadian context. Method. Grounded in critical epistemologies, the researchers conducted 12 semi-structured interviews with occupational therapists, students, and researchers connected to displacement. Data were analyzed using thematic analysis. Findings. Four themes describe current occupational therapy practices related to forced migration: 1) engaging clients in new environments, 2) translating the everyday, 3) connecting and networking, and 4) advocating for occupational justice. Implications. This research contributes to the advancement of occupational therapy and forced migration by documenting the diverse and fluid nature of occupational therapy roles. Further, the paper outlines promising reflexive practices while forwarding advocacy priorities for (occupational) justice.

The Concept of Oppression and Occupational Therapy: A Critical Interpretive Synthesis

Background. Occupational therapy and occupational science literature include growing attention to issues of justice, marginalization, and rights. In contrast, the concept of oppression has scarcely been employed. Purpose. This paper investigates how adding the concept of oppression may enhance occupational therapy approaches to injustice, prioritizing a focus on structural causes, and facilitating conscientious action. Method. A critical interpretive synthesis explored insights from authors who name oppressions in occupational therapy and occupational science literature. In total, a sample of 28 papers addressing oppression, ableism, ageism, classism, colonialism, heterosexism, racism, and/or sexism was selected for inclusion. Findings. Four themes were identified: oppression and everyday doing; effects of structures and power; responding and resisting; and oppression within occupational therapy. Implications. Incorporating oppression within the plurality of social discourse may help occupational therapists to avoid individualistic explanations, attend to relationships between social structures and constrained occupations, frame intersectional analysis, and engage in praxis.

Collaborative Relationship-Focused Occupational Therapy: Evolving Lexicon and Practice

BACKGROUND.

Client-centred practice has been part of occupational therapists' identity for several decades. However, therapists have begun to question whether the term obstructs critical relational aspects of therapy.

PURPOSE.

The purpose of this article is to summarize critiques of the use of the term client-centred and propose an expanded descriptor and a fundamental shift in how occupational therapists engage with individuals, families, groups, communities, and populations.

KEY ISSUES.

Three themes summarize critiques of how client-centred practice has been envisioned: (a) the language of client-centred, (b) insufficient appreciation of how the therapist affects the relationship, and (c) inadequate consideration of the relational context of occupation. We propose collaborative relationship-focused practice that has key relational elements of being contextually relevant, nuanced, and safe, and promotes rights-based self-determination.

CONCLUSION.

We argue that these essential relational elements, along with a focus on occupations, are required to promote occupational participation, equity, and justice.

Clinicians' Views on the Need for Cultural Adaptation of Intervention for Children with ADHD from the Ultraorthodox Community

Culture is a core context within occupational therapy, with a recent literature emphasizing the importance of cultural competence, as well as culturally sensitive assessment and intervention. The recent literature has indicated the efficacy of the Cognitive-Functional intervention (Cog-Fun) for children with ADHD among the general Israeli population, yet no studies to date have examined the necessity of cultural adaptations for minority groups. The current study examines the necessity of adapting the intervention protocol and process to the Ultraorthodox (UO) population, as perceived by occupational therapists. The study included 28 occupational therapists certified to use the Cog-Fun intervention, who reported using this approach with UO children. Participants responded to an online questionnaire developed for this study, regarding characteristics of the UO population and necessary adaptions to the Cog-Fun intervention process and protocol. Findings were analyzed using descriptive statistics and qualitative content analysis. Results of the study point to the necessity of addressing various features of the UO community, including daily routines and habits, cultural values, knowledge regarding ADHD, and accessibility of information. Participants also reported a need to adapt the graphic content of the intervention materials. The qualitative data expanded on the perceptions of the participants through four main themes: (a) knowledge regarding ADHD diagnosis and intervention; (b) perceptions and attitudes regarding ADHD diagnosis and medication; (c) factors affecting communication between the OT, parents, and teachers; and (d) adapting the intervention protocol to habits, routines, and lifestyle of UO families. This study has direct implications for therapists utilizing the Cog-Fun with UO children and may also provide insights relevant to occupational therapists using other treatment approaches with children from this culture, as well as other minority or traditional groups. Furthermore, this study may serve as an important addition to the limited literature describing cultural adaptations of evidence-based interventions.

Current Landscape of Teaching Diversity in Occupational Therapy Education: A Scoping Review

IMPORTANCE

Critical research in health professions education makes clear the role of educational institutions in perpetuating problematic discourses related to diversity, as well as their potential role in dismantling and rebuilding those discourses to reflect the realities of power relations that create systemic injustice.

OBJECTIVE

To provide a comprehensive overview of current pedagogical practices and educational paradigms used by occupational therapy educators to teach concepts of, and skills for, equity and diversity.

DATA SOURCES

Seven education and health care databases were searched for articles published between 2007 and 2018.

STUDY SELECTION AND DATA COLLECTION

Consensually developed criteria were refined until an agreement rate of >80% was achieved among the authors. Inclusion criteria focused on entry-level occupational therapy education across the world and explicitly examined approaches to teaching diversity. All articles meeting the criteria were kept for full-text review (N = 87).

FINDINGS

Diversity in professional occupational therapy education programs is taught within five main underlying educational paradigms and theories: competency-based (44%), social justice (29%), critical (11%), social accountability (10%), and constructivism (6%). Within these paradigms, 14 key pedagogical practices were applied, with community service learning (37%), international service learning (25%), and didactic or course-based practices (23%) making up the majority of pedagogical practices.

CONCLUSIONS AND RELEVANCE

Although current occupational therapy research demonstrates a trend toward critical paradigms and practices, problematic cultural competency theories and uncritical international service learning practices continue to dominate occupational therapy education for diversity. Educators should implement pedagogies and approaches within critical educational paradigms.

WHAT THIS ARTICLE ADDS

This article highlights the importance to occupational therapy education of attending to coherence across educational ethics, paradigms, and learning outcomes in teaching for diversity and health equity.

Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion

The American Occupational Therapy Association’s (AOTA’s) Vision 2025 conveys a strong commitment to diversity, equity, and inclusion (AOTA, 2019). AOTA affirms the inalienable right of every individual to feel welcomed, valued, a sense of belonging, and respected while accessing and participating in society, regardless of the internal or external factors that make every individual unique. This statement supports efforts to increase diversity, equity, and inclusion within all aspects of occupational therapy, including practice, education, and research, as well as policy development and advocacy.

Moving From Cultural Competence to Cultural Humility in Occupational Therapy: A Paradigm Shift

OTHER

As the U.S. population becomes increasingly multicultural, occupational therapy practitioners must be adept at working with diverse populations. For the past 15-20 yr, many occupational therapy scholars have recognized this need, and in response, they have promoted cultural competence training. Although cultural competence has provided an important initial conceptual framework for the field, I argue that it is time to move toward a practice of cultural humility, which is defined by flexibility; awareness of bias; a lifelong, learning-oriented approach to working with diversity; and a recognition of the role of power in health care interactions. In this article, I present three main arguments why cultural humility is a more useful and critical conceptual framework than cultural competence, and I review preliminary research that examines the influence of cultural humility on patient experience. I conclude by briefly describing how cultural humility can be incorporated in occupational therapy curricula and applied in clinical and community practice settings.

WHAT THIS ARTICLE ADDS

This article provides a clear articulation of what cultural humility is, how it differs from cultural competence, and how it can be applied in occupational therapy.

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.

Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

The role and scope of occupational therapy in Africa

Purpose: Occupational therapy (OT) is a global health profession that promotes participation in meaningful occupations to enhance well-being, particularly for persons with disabilities. Occupational therapy is relatively new in many African countries and there is limited research regarding the role of OT in this region. Thus, this study aims to understand the role and scope of OT in Africa by exploring its unique contribution to healthcare and cultural considerations for practicing OT in various African contexts.Methods: We conducted an exploratory qualitative descriptive study involving semi-structured interviews with 15 occupational therapists from 11 African countries. Interview questions focused on participants' work activities, rewards and challenges of their work, and perceived contribution to healthcare. We audio-recorded and transcribed interviews followed by inductive thematic analysis.Results: All participants described maintaining multiple roles. Four main themes (with sub-themes) emerged: advocacy (clients and the profession), collaboration (multi-disciplinary team, professional support, and internationally), maintaining core OT principles (occupation, function, participation, empowerment, and holistic practice), and contextual considerations (community-based services, practice approaches, sustainability, cultural norms, and spirituality).Conclusions: Occupational therapists working in African contexts have a unique and challenging role involving advocacy and collaboration. They need to maintain core OT values whilst addressing contextual considerations to ensure culturally relevant practice.Implications for RehabilitationOccupational therapists have an important role in promoting health and well-being; however, practice is influenced by the cultural context.Occupational therapists in Africa maintain multiple roles, including advocacy for their clients and the profession, and collaboration within a multidisciplinary team, for professional support and internationally.African occupational therapists need to be rooted in core OT principles whilst considering their unique context to ensure culturally relevant practice.

A Narrative Phenomenological Approach to Transformative Learning: Lessons From Occupational Therapy Reasoning in Educational Practice

Transformative learning involves the questioning of worldviews and underpins shifts in values and identity that are integral to critical occupational therapy practices. Cognitive theories of transformative learning name, but do not address, the experiential dimensions of transformation. The aim of this article is to conceptualize transformative learning from the perspective of narrative phenomenology in occupational therapy. An argument is presented that draws on research in occupational therapy professional reasoning and that makes visible the dimensions of transformation that are inherently experiential and meaning oriented. Three key concepts for a transformative pedagogy are defined and illustrated: scenes, emplotment, and embodied metaphors. The article concludes with the types of learning objectives for which this approach is suited and the pedagogical values that underpin these teaching practices. This article adds to the domain of health care education by defining and illustrating experiential and meaning-based practices as signature pedagogies for transformative learning.

Essential Elements for Advancing Cultural Humility through a Community-Based Physical Therapy Practicum in a Métis Community

Purpose: This article reveals MPT practicum participant perceptions of the impact that a community-based practicum in a Métis community had on their learning in the area of cultural humility and cultural safety. Method: The impact of this community-based practicum intervention in a Métis community on MPT student education was explored using phenomenological descriptive methodology, with data gathered via exit interviews conducted on completion of the community-based practicum. Concepts of cultural humility and safety from the literature, along with themes emerging from practicum participant interviews, informed the analysis and theme development. Results: Participants' experiences were categorized into three themes: (1) realizing Métis community strengths; (2) learning from experiences and shaping future practice; and (3) prioritizing relationships. Findings support that participants demonstrated the practice of cultural humility as a result of engaging in the community-based practicum. Conclusions: Our results highlight the importance of (1) community engagement, (2) community-informed practicum design based on strong relationships, (3) a backbone of reflective practice, and (4) a base of community and student readiness to support practicum success. These essential elements support a cultural humility approach to implementing MPT practicums in Indigenous communities, as well as a practice in reconciliation.

Fostering positive spaces in public health using a cultural humility approach

Culturally competent frameworks used within health care systems are contributing to the discrimination and marginalization of sexually and/or gender diverse persons. In this discursive paper, we argue that cultural humility ought to be implemented as the best practice approach for fostering sexually and gender diverse positive spaces in public health settings. A paradigm shift away from cultural competence frameworks toward cultural humility is necessary. This shift can be achieved by enhancing educational opportunities for public health nursing students and professionals and by recruiting organizational leaders to be champions for systemic change. In order to achieve this, we must establish effective educational programs that espouse cultural humility practices and develop valid measurement tools for assessing the provision of culturally humble care. This would equip educators, students, practitioners, and organizational leaders with the necessary tools to guide and assess their performance. Integrating a culturally humble approach will ultimately enhance self-reported cultural safety in public health spaces and reduce health inequities experienced by sexually and/or gender diverse clients and staff members.

Embracing Cultural Diversity: Meaningful Engagement for Older Adults With Advanced Dementia in a Residential Care Setting

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities' residents' needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

Predictors of self-perceived cultural responsiveness in entry-level physiotherapy students in Australia and Aotearoa New Zealand

BACKGROUND

Ensuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels.

METHODS

A cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer's Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis.

RESULTS

A total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05).

CONCLUSIONS

These results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.

Valeurs liées à la profession d’ergothérapeute : les répertorier pour les définir

Description.

Des imprécisions et des confusions conceptuelles caractérisent les écrits sur les valeurs liées à l’ergothérapie.

But.

Répertorier des valeurs liées à l’ergothérapie, proposer des énoncés qui les définissent et procéder à leur validation de contenu.

Méthodologie.

Une recension des écrits ( n = 52) et la consultation d’ergothérapeutes ( n = 26) ont permis de documenter et de définir une série de valeurs. Le répertoire issu de ces démarches a été soumis à un test de fonctionnalité auprès d’ergothérapeutes ( n = 5), puis présenté à des ergothérapeutes détenant une expertise en éthique ( n = 6) pour en évaluer la validité de contenu des définitions des valeurs.

Résultats.

Le répertoire proposé comprend 33 valeurs suivies de leur définition que les experts ont jugées claires et représentatives des réalités qu’elles désignent. Les résultats montrent que le répertoire est considéré comme exhaustif.

Conséquences.

Cette étude a permis de répertorier et de définir des valeurs qui constituent des idéaux susceptibles de guider la pratique ergothérapique et de soutenir les revendications ainsi que les compétences culturelles et éthiques des ergothérapeutes.

Cumulative stigma among injured immigrant workers: a qualitative exploratory study in Montreal (Quebec, Canada)

Purpose: This paper presents the phenomenon of stigmatisation among injured immigrant and ethnocultural minority workers experiencing a long-standing disability. Stigmatisation was one of the main findings of our study, the aim of which was to gain insight into the work rehabilitation process in the context of intercultural relations in Quebec. Various categories of stakeholders took part in the study, which sought to describe their experiences and perspectives and to identify the constraints, barriers, facilitators, and specific needs they encounter in terms of intercultural competencies.Methods: A purposive sample of 40 individuals was selected and divided into four groups: workers (N = 9), clinicians (N = 15), workers' compensation board rehabilitation experts (N = 14), and workplace representatives (N = 2). Semi-structured interviews were conducted using the critical incident technique, combined with an "explicitation" interviewing technique. Data collection and analysis procedures were based on grounded theory.Results: This study shows that immigrant and ethnocultural minority workers may experience stigmatisation as a cumulative process involving different concomitant parts of their "identity": age, gender, social class, ethnicity, mental health, and occupational injuries. Cumulative stigma may aggravate personal distress and feelings of shame, rejection, and disqualification from full social acceptance. Negative anticipatory judgements made by practitioners may undermine the therapeutic relationship and breach mutual trust and confidence.Conclusions: The phenomenon of stigmatisation is well documented in the sociological and health literature, but studies tend to focus on only one type of stigma at a time. Future research should focus on the cumulative process of stigmatisation specifically affecting immigrant and ethnocultural minority workers and its potentially damaging impact on self-concept, healthcare delivery, rehabilitation interventions, and the return to work.Implications for rehabilitationThe repetition of certain clinical situations with people from certain groups should not lead practitioners to undue generalizations, even if they may sometimes be accurate; these generalizations must always be verified on a case by case basis.Ethnicity and culture, along with other social attributions, should serve as working hypotheses or support tools in health communication, not as hindrances to clinical reasoning.Practitioners should deepen their understanding of the patient's treatment expectations and the support available for rehabilitation in his family and community.Stigma in the context of care is linked to the idea of conforming to the proposed institutional models of care (including expected beliefs, attitudes, and behaviours). Therefore, practitioners should be aware that alleged differences, misunderstanding or disagreements can highlight an asymmetry in practitioner-patient power relationships.Organisations should also promote exchange and reflection on how to adapt their institutional models to avoid asymmetrical power relations.Intercultural training should be promoted at the various organisational levels so that managers, decision-makers, and practitioners share a common knowledge of the challenges of intervention in multi-ethnic settings.

Empowerment and occupation: A new perspective

Background.

The idea of empowerment permeates the occupational therapy literature yet has received little critical reflection from occupational therapy’s theorists.

Purpose.

This paper aims to explore the concept of empowerment and highlight a recent definition that resonates with occupational therapists’ core values.

Key Issues.

Empowerment is generally understood to be a process of bestowing power and giving ability to someone deficient in both. However, a new definition provides a framework for understanding how empowerment might enhance people’s capabilities.

Implications.

The World Bank’s depiction of empowerment fits well with occupational therapists’ beliefs in the importance of the ability and opportunity to “do,” providing a framework for action. This framework focuses on people’s capabilities: their freedom—or opportunity—to choose what they wish to do and to be and their ability to act on these wishes. Moreover, the World Bank’s assertion that empowered people have freedom of both choice and action suggests empowerment is a relevant concept for occupational therapists.

Feeling like a stranger: negotiations with culture as experienced by Chilean occupational therapists

BACKGROUND

Although occupational therapy has begun to focus on the subject of culture, few studies have examined how occupational therapists outside the English-speaking countries reflect on it.

AIM

To explore how Chilean occupational therapists reflect on their personal and professional experiences in regard to the complexity of culture, and its different understandings and expressions.

METHODS

This qualitative study uses content analysis to establish common trends in participants' experiences. A validation phase and data triangulation were implemented to ensure trustworthiness.

RESULTS

Culture is experienced as a continuous negotiation in personal and professional terms. One central theme, 'negotiating through the dynamism of culture', and three categories, 'dealing with power', 'understanding local and global identities', and 'crossing the boundaries into the client's land', emerged. These experiences are complex, chaotic, and highly context-dependent.

DISCUSSION

During therapeutic encounters, practitioners and clients may experience cultural barriers even if their differences are not obvious in cultural terms. As a result of this finding, we recommend the inclusion of culture and cultural issues in professional training. The impact of a multicultural research team is discussed. Future research should explore how the construct of culture is introduced in occupational therapy professional training in Chile.

Development of a Cultural Awareness Scale for Occupational Therapy Students in Latin America: A Qualitative Delphi Study

Cultural awareness is a key issue in healthcare worldwide. Valid and reliable assessments are needed to assess cultural awareness for occupational therapy students. The purpose of this study was to develop a scale to assess cultural awareness for Latin American occupational therapy students. A Delphi design was implemented considering four rounds with experts from four countries. A 30-item scale in Spanish was developed to assess three categories of items: personal, therapeutic strategies and persons' cultures. The experts highlighted local features for professional practice as a key aspect of the scale. Local differences in practice were considered with the profession's traditions and prevailing knowledge across the scale. A participatory strategy and an international group of experts enriched the cultural relevance. A subsequent study of statistical reliability is required (the scale is not presented in an extended version here). Further research should consider the application of the scale and strategies to improve cultural awareness across the curricula. Copyright © 2016 John Wiley & Sons, Ltd.