"Making change by shared doing": An examination of occupation in processes of social transformation in five case studies

BACKGROUND

As social and health inequalities deepen around the world, scholarship in occupational therapy and occupational science has increasingly emphasised the role of occupation as a powerful tool in transformative processes.

OBJECTIVE

To explore how opportunities for everyday doing together may contribute to processes of social transformation by identifying ways occupation is being taken up in socially-transformative practice.

MATERIAL AND METHODS

A generic descriptive qualitative case study design was utilised in order to describe current practice examples and identify ways occupation was being taken up in five initiatives working towards social transformation located in Canada, Germany, South Africa and the United Kingdom.

RESULTS

Focussing on the positioning of occupation within the initiatives, three themes were developed: The intentionality of the process, the nature of occupation within the initiatives, and the role of occupation within the processes of social transformation.

CONCLUSIONS AND SIGNIFICANCE

Providing examples of agency on the micro level and of engagement with socioeconomic, political and cultural power structures at the societal level, this analysis raises important considerations in addressing how occupational therapy practice can move in socially responsive and transformative directions.

Participatory Methods to Develop Health Education for PW-SCI: Perspectives on Occupational Justice

Background. Many people with spinal cord injury (PW-SCI) in the Gaza Strip in Palestine are discharged from inpatient rehabilitation with limitations in their ability to meet basic needs, and reach their full potential. There is limited evidence of how clinicians can promote occupational justice for PW-SCI. Purpose. To describe participants' perspectives revealed during a participatory action research (PAR) process used to develop an education manual for PW-SCI in Gaza, using Participatory Occupational Justice as a lens. Methods. Following ethical approval, a four-step PAR design was utilized by eight researchers to co-construct the Spinal Cord Injury Activities of Daily Living-education Manual with 54 participants from SCI rehabilitation settings in Gaza. Qualitative data from eight focus groups were analyzed using inductive thematic analysis. Findings. Two main themes were evident in the participants' viewpoints: Enabling occupational justice and Removing barriers to occupational justice. Implications. Occupational justice is a central value that needs to be considered when developing occupational therapy educational interventions for this client group. PW-SCI health education may facilitate occupational justice in practical and culturally relevant ways when participatory methods are used to develop educational resources.

Exploring potential for occupational therapy practice models within areas of social deprivation: A qualitative inquiry within a community-centred food cooperative

Background

A health inequalities gap exists between wealthy and deprived areas. Community-level occupation-focused interventions may support citizens and address inequities within their environments. Since the global financial crash of 2008 and fiscal policy changes within the United Kingdom, there has been a rise in food insecurity. Community volunteer initiatives have responded by providing for their residents. The aim of this study was to explore how occupational therapists may be agents for social change through exploring perspectives of members and volunteers from a community food cooperative in an area of social deprivation.

Methods

Eight semi-structured interviews were conducted with cooperative members and volunteers within a food cooperative established to address food insecurity in a local community. Data were analysed using thematic analysis.

Results

We found three main themes: It’s Not a Foodbank, Shared Hardship and a cross-cutting theme of Community. The results suggest occupation-focused responses can support the development of community and collective occupations thereby contributing solutions to shared problems.

Conclusion

A community-centred, rights-based approach has supported local community need where socio-economic disadvantage and health inequalities were identified. Scope exists for occupational therapists to work genuinely with (not for) communities to address occupational injustice through collective occupation.

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.

Avaliação de motéis e pousadas em relação à acessibilidade para pessoas com deficiência ou restrição de mobilidade

Resumo Introdução Pessoas com deficiência se deparam com inúmeras barreiras no desempenho da atividade sexual; dentre elas, está o acesso a locais acessíveis destinados a essa finalidade. Objetivo O objetivo do presente estudo foi mapear e avaliar a acessibilidade arquitetônica de estabelecimentos que têm como atividade-fim o sexo, tais como motéis e pousadas, localizados na região metropolitana de Belém. Método Trata-se de uma pesquisa de caráter quantitativo, transversal, descritivo, na qual foram avaliados 22 estabelecimentos, através de um questionário de avaliação de acessibilidade elaborado pelos pesquisadores, contendo 11 questões objetivas sobre a acessibilidade arquitetônica de banheiros, rampas de acesso, elevadores, sinalização, formas de comunicação, altura da cama e área de circulação. Resultados Os resultados acerca da sinalização sonora e visual demonstraram que 32% dos estabelecimentos não apresentam nenhuma das formas de sinalização, assim como comunicação alternativa e piso tátil. Em contrapartida, 82% dos estabelecimentos avaliados apresentaram altura dos interfones, interruptores e sinalizadores dentro dos padrões. Em relação à acessibilidade dos banheiros, 43% dos estabelecimentos não apresentaram nenhum mobiliário acessível. Conclusão O presente estudo demonstra resultados não satisfatórios quanto aos parâmetros básicos de acessibilidade dos motéis participantes, constituindo-se graves barreiras ao acesso do público com algum tipo de deficiência. Conclui-se que há a necessidade de maiores discussões sobre o assunto, além de fiscalização para o cumprimento das normas de acessibilidade e mobiliário acessível para que pessoas com deficiência possam usufruir desses serviços.

Supporting Occupational Justice for Transgender and Gender-Nonconforming People Through Narrative-Informed Theater: A Mixed-Methods Feasibility Study

IMPORTANCE

Societal stigma gravely impedes occupational justice for transgender and gender-nonconforming (TGNC) people, producing vast health disparities for this population.

OBJECTIVE

To test the feasibility of an intervention to reduce stigma and improve the well-being of TGNC people.

DESIGN

A parallel, mixed-methods design was used to test feasibility in the areas of acceptability, demand, and limited efficacy.

SETTING

Community.

PARTICIPANTS

Forty-two audience members and 5 TGNC interviewees.

INTERVENTION

Virtual, narrative-informed play reading and moderated discussion about gender diversity and affirmative care. Outcomes and Measures: The valid and reliable Acceptance and Action Questionnaire-Stigma was used to assess stigma beliefs. An open-ended, qualitative question assessed TGNC interviewees' experiences.

RESULTS

Recruitment and participant responses to the intervention indicated feasibility in the areas of acceptability, demand, and limited efficacy. However, future efforts at obtaining a diverse TGNC sample are needed.

CONCLUSIONS AND RELEVANCE

The intervention decreased stigma beliefs in audience members and offered a positive experience for TGNC participants. Feasibility outcomes warrant future efficacy testing. What This Article Adds: This article adds an innovative intervention for promoting occupational justice to support the health and well-being of TGNC people. The community-based intervention facilitates change in societal attitudes and stigmatizing beliefs.

Securing occupational rights by addressing capabilities: A professional obligation

BACKGROUND

The World Federation of Occupational Therapists asserts that all occupational therapists are obligated to promote occupational rights, and has highlighted the importance of Amartya Sen's concept of 'capabilities' to the work of securing the occupational rights to which all are equally entitled.

AIMS

To outline the capabilities approach and highlight its relevance and importance for the occupational therapy profession.

MATERIAL & METHODS

Drawing from Sen's work, and that of other scholars who have critiqued and adapted his capabilities approach, this paper describes the foundational components of the capabilities approach and identifies important overlaps with issues of concern to occupational therapy.

RESULTS

Sen's capabilities approach employs a contextualised view of human wellbeing; attending to whether people have the abilities to do the things they would value doing, and whether their circumstances actually provide the real opportunities to choose to do what they would value doing.

CONCLUSIONS

The capabilities approach, with its attention to abilities and actions, options and opportunities, empowerment and choice, justice and participation, has clear relevance for occupational therapists.

SIGNIFICANCE

A capabilities perspective provides a valuable framework for occupational therapists striving towards equalising people's opportunities, possibilities and choices - their capabilities - to secure their occupational rights.

People with Disabilities and Other Forms of Vulnerability to the COVID-19 Pandemic: Study Protocol for a Scoping Review and Thematic Analysis

OBJECTIVES

To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage.

METHODS

We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis.

CONCLUSIONS

This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.

Professional competencies required by occupational therapists to facilitate the participation of persons with mental disability in work: A review of the literature

BACKGROUND

Unemployment rates are generally higher among persons with mental disabilities who experience many barriers and challenges that limit their participation in work and employment. Occupational therapy can play a key role in promoting participation and engagement in work by persons with mental disabilities.

OBJECTIVE

This review sought to identify the barriers and facilitators to work participation for persons with mental disabilities globally in comparison to Zimbabwe, and to identify the competencies related to work practice in occupational therapy curricula internationally and regionally.

METHODS

A narrative literature review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework which informed retrieval and analysis of articles published between 2012 and 2018.

RESULTS

Fifty-one out of 227 articles were selected to inform the review. A synthesis of the literature provided insights and ideas on facilitators and barriers to work for persons with mental disabilities and the competencies related to work practice in occupational therapy curricula.

CONCLUSION

Barriers to participation in work for persons with mental disabilities are real. However, occupational therapists from different contexts have a variety of competencies to facilitate participation in work. There is a need to develop work practice competencies particular to the Zimbabwean context.

'Choice' in occupational therapy theory: A critique from the situation of patriarchy in India

Background: Dominant occupational therapy theories assert that people choose their daily occupations, and participate in occupations as autonomous agents; yet scholars insist that choices are socially-structured and inequitably available.Aim: To critically review the concept of choice in occupational therapy theory through an exploration of patriarchy in India.Material and methods: Drawing from scholarly work that addresses patriarchy in India, we employ the commonly-used occupational categories of self-care, productivity and leisure as a framework to explore the real availability of occupational choices for women.Results: Patriarchal ideology perpetuates inequitable power dynamics within Indian society. As a consequence, women, children and non-dominant men have few opportunities to make or enact occupational choices that impact their wellbeing and their lives.Conclusions: The examples provided in this paper challenge those occupational therapy theories that portray occupational engagement as the product of individual volition and unconstrained choice.Significance: Dominant occupational therapy theories are informed by specific Western assumptions that may have little relevance to people in other contexts. Critical approaches to professional assumptions are essential to avoid the imperialistic imposition of irrelevant theories, and the development and delivery of services that may be oppressive for clients who have few opportunities to make occupational choices.

Doing Occupational Justice: A Central Dimension of Everyday Occupational Therapy Practice

BACKGROUND.

The Canadian Association of Occupational Therapists (CAOT) and the American Occupational Therapy Association (AOTA) state that occupational justice is part of the domain of occupational therapy and that occupational justice is "an aspect of contexts and environments and an outcome of intervention" (AOTA, 2014, p. S9).

KEY ISSUES.

Despite the increasing focus on justice in the occupational therapy and the occupational science literature, many practitioners in traditional settings do not see its relevance to their everyday practice (Galvin, Wilding, & Whiteford, 2011) or have difficulty envisioning how to enact a justice-informed practice.

PURPOSE.

This paper demonstrates how occupational justice is germane to all settings of occupational therapy, and how it can be enacted at micro, meso, and macro levels of occupational therapy practice.

IMPLICATIONS.

We argue that occupational therapy is a justice-oriented profession at its core and will discuss how occupational justice can be enacted at all levels of practice.

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice

Background.

As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as “street-level bureaucrats” ( Lipsky, 1980/2010 ) who effect and are affected by policy.

Purpose.

Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being.

Key Issues.

By highlighting practitioners’ everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice.

Implications.

Framing occupational therapists as street-level bureaucrats reinforces practitioners’ situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists’ exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

Children and young people’s perspectives and experiences of a community wheelchair basketball club and its impact on daily life

Introduction

Although the benefits of physical activity are widely recognised, levels of inactivity are considerably higher for children and young people with disabilities than those without. Young people with disabilities struggle to access inclusive opportunities and there is a lack of research surrounding users’ experiences of disability sport more generally. This research aimed to explore members’ experiences of a community-based wheelchair basketball club and its impact on daily life.

Method

Semi-structured interviews were conducted with 11 disabled and able-bodied members of the club (aged 6–25 years) to gain an in-depth understanding of their experiences.

Findings

Inductive thematic analysis identified an overarching theme of ‘wheelchair basketball elicits strong emotions’ and four main themes of ‘positive social interactions’, ‘benefitting health and independence’, ‘changing perceptions of disability’ and ‘a meaningful occupation that opens doors’. Participants reported positive experiences of wheelchair basketball, which improved their physical and mental health whilst increasing opportunities for socialisation and encouraging acceptance of disability.

Conclusion

The findings have implications at individual, organisational and societal levels, and provide some justification for the role of occupational therapy in disability sport. The findings demonstrate the potential for inclusive community sports clubs to improve health and social outcomes for individuals, regardless of disability.

Impact of robotics and human enhancement on occupation: what does it mean for rehabilitation?

Purpose: People with disabilities face participation challenges in all occupations. Scientific and technological advancements impact the occupational landscape of humans. This scoping review aimed to ascertain the academic engagement with occupation in relation to robotics and human enhancement focusing in particular on how people with disabilities and rehabilitation were mentioned.Method: SCOPUS and the 70 databases of EBSCO host were searched. Manifest and latent content coding and thematic grouping of codes relevant to answering the review questions was performed.Results: Only four articles engaged with occupation in relation to human enhancement. As to occupation and robotics, some occupational fields were visible and not others; occupational health and safety was the most visible one; people with disabilities were covered from a medical, therapeutic angle and not in relation to social issues caused by the occupational impact of robotics. Change in the scope, meaning, and clients of rehabilitation efforts related to occupation enabled by human enhancement and robotics was not covered.Conclusions: The gaps found should be filled. The impact of robotics and human enhancement on the occupational landscape indicates the need for rehabilitation to think beyond recovery to the species typical as a goal. The ultrabilitation concept could help to meet this need.Implications for rehabilitationAdvances in robotics and human enhancement beyond species-typical levels modify the occupational landscape, human ability expectations in this setting, and the meaning and scope of disability and rehabilitation (clinical and community based).There is a need to elucidate the impact of these changes on the meaning, scope and goals of recovery-oriented rehabilitation.The recently coined term "ultrabilitation" creates space to discuss an ability expectation creep triggered by developments in robotics and human enhancement, particularly within occupation focused rehabilitation.

Begging abroad in Sweden: An interview study

Background: The occurrence of begging by poor people from other countries in the European Union (EU) is now common in Scandinavia. They have a challenging life, but there is little knowledge about their own perceptions of their stay abroad.Aim: To explore the experiences of EU citizens begging in Sweden.Material: A descriptive design was used. Data were gathered through individual interviews conducted in Romanian and translated into Swedish. These were analysed using conventional content analysis. Participants were 20 EU citizens aged 19-64 years with experience of begging in Sweden.Results: The identified main category, "A hard time abroad to improve one's life", contained four categories - "Endurance is required to make a living"; "Exposed to others' attitudes and kindness"; "Handling being away"; and "A better life is the driving force".Conclusions and significance: EU citizens who beg face occupational injustice, spending many hours in non-preferred activity of begging and with few leisure activities, although no generalizations can be drawn based on this study. The importance of a friendly attitude and environmental support when abroad was also shown. Since occupational justice is within the scope of occupational therapy, occupational therapists have the skills to contribute in collaboration with others.

Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts

BACKGROUND.

Occupational therapy practice is enhanced through clear understanding of its epistemological foundations. In the area of substance use, practices are strongly functionalist.

PURPOSE.

This study unearths epistemologies through analyzing practices addressing the social needs of clients with problematic substance use.

METHOD.

This study used an exploratory qualitative approach and was based on Marxist philosophies. Qualitative interviews were conducted with nine occupational therapists experienced in working with substance users. Data were analyzed through a dialectic approach to content analysis based on the Marxist theory of labour process.

FINDINGS.

The occupational therapy practices were found to follow common principles: clients are agents of transformation in health processes; creativity is a strong element of practice and underlies the whole therapeutic process; and conditions of social reproduction compose the object of occupational therapy (i.e., what is transformed through occupational therapy practices). Two different approaches using these principles were uncovered according to the labour-process purposes: inclusive and emancipatory.

IMPLICATIONS.

Systematization of practices based on epistemological foundations strengthens occupational therapists' ability to link actions to theories.

Critical reflections on occupational justice: Toward a rights-based approach to occupational opportunities

BACKGROUND

Occupational justice is cited throughout the occupational science and occupational therapy literatures despite little scholarly attention either to its definition or to how situations of occupational justice are identifiable.

PURPOSE

This paper aims to contribute a critique of occupational justice, explore the concepts of justice and (occupational) rights, and support a capabilities approach to inform rights-based occupational therapy practices.

KEY ISSUES

No clear definition of occupational justice or differentiation from social justice exists despite the longevity of the concept, and theorists frequently confuse the concepts of justice and rights. A rights-based focus provides an unambiguous mandate for occupational therapists, with the capabilities approach offering a cross-disciplinary framework to inform rights-based practices.

IMPLICATIONS

The concept of occupational rights is consistent with the rights-based focus advocated by the disabled people's movement, articulated by the United Nations' Convention on the Rights of Persons With Disabilities, and affirmed by the World Federation of Occupational Therapists' position on the centrality of occupation to health, well-being, and human rights.