Health equity, aboriginal peoples and occupational therapy

Culturally responsive occupational therapy practice with First Nations Peoples-A scoping review

INTRODUCTION

First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce-cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment.

OBJECTIVE

To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework.

DESIGN

A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors.

FINDINGS

OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident.

DISCUSSION

Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems.

CONCLUSION

To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.

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.

Scoping review of women with disabilities' livelihood occupation experiences: An equity perspective

BACKGROUND

Globally, persons with disabilities are faced with unemployment and reduced income opportunities. Barriers to employment tend to be severe for women with disabilities who occupy marginalized positions in labor markets. 'Livelihood occupations' are conceptualized for this review to denote everyday activities that are done for subsistence and survival, and to broaden presentations of activities normally termed 'work', 'employment', 'job' or 'productivity' that people do to earn money and non-monetary gain.

OBJECTIVE

This scoping review, undertaken as part of a broader interpretive phenomenological analysis of livelihood occupations of women with disabilities, maps research on the subject of livelihood occupations for women with disabilities.

METHODS

The Arksey and O'Malley framework and PRISMA extension for scoping reviews were utilized to guide the five stage scoping strategy used to screen and select sources. Data from selected sources were synthesized using deductive qualitative content analysis to fit experiential components into equity categories determined a-priori from the Equitable Total Rewards model, to determine if these experiences connote equity or lack thereof.

RESULTS

Nineteen sources, mainly from high income countries, are identified. Aspects of benefit and career inequity were largely evident in the experiences of the women across all sources.

CONCLUSION

There is considerable lack of research on experiences of livelihood occupations in low and middle income countries contexts justifying further research. Women with disabilities report experiencing inability to realize career goals and occupational choice.

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.

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.

Social and Structural Determinants of Health: Exploring Occupational Therapy's Structural (In)competence

Background: In high-income countries, such as Canada, 50% of health outcomes are attributable to social determinants. Occupational opportunities are also structurally determined, yet these inequities are obscured by the White, Western assumptions and ableist neoliberal ideology in which the profession is deeply rooted. Purpose. To highlight the impact of structural injustices and other social determinants of health and occupation; explore the occupational therapy profession's structural competence; and build on existing knowledge to advance an agenda for action on injustice and inequity for the occupational therapy profession. Key issues. Occupational therapy's failure to prioritize education, research and action on systemic injustices and other social determinants of health and occupation reflects a lack of commitment to achieving the World Federation of Occupational Therapists' Minimal Standards. Implications. If occupational therapy is to advance knowledge and practices that address inequities in the social and structural determinants of health and occupation, we must strive towards structural competence.

Approaches to Indigenous health within interprofessional education: a scoping review protocol

OBJECTIVE

This scoping review will explore the depth, breadth, and nature of existing literature on educational approaches to Indigenous health within interprofessional education learning activities, and provide a summary of available literature, identify gaps in the research, and recommend areas for further exploration.

INTRODUCTION

Interprofessional education learning activities comprise sessions where health care learners work collaboratively to address and improve the health outcomes of a given population, such as health needs among Indigenous communities. A preliminary search for existing reviews was conducted across several databases. Published literature on Indigenous health within interprofessional education learning activities exists; however, there is no comprehensive review on this topic.

INCLUSION CRITERIA

This review will consider literature on existing educational approaches to Indigenous health within interprofessional education learning activities, in particular the approaches used to teach cultural awareness, sensitivity, competency, safety, and/or humility. It will consider all forms of English-language evidence, including quantitative studies, qualitative studies, mixed-method studies, and gray literature. Participants include health care and social care professionals, educators, and students within interprofessional education learning activities.

METHODS

The JBI scoping review methodology will be used to guide our research. The following databases will be searched: MEDLINE, CINAHL Plus, PsycINFO, ProQuest ASSIA, Indigenous Studies Portal, and ERIC. We will also hand search reference lists and explore gray literature. Two reviewers will screen the search results and extract included studies using data extraction forms. The data will be presented in summary tables and a narrative summary.

Occupational Therapy Roles in an Indigenous Context: An Integrative Review

BACKGROUND.

Indigenous peoples experience health inequities linked in part to lack of access to culturally-relevant health care. The Truth and Reconciliation Commission of Canada (TRC) calls on all health professionals, including occupational therapists, to reduce health inequities through improved work with Indigenous communities.

PURPOSE.

This integrative review of the literature explores how occupational therapists can improve their work with Indigenous peoples.

KEY ISSUES.

Communication and building relationships are central to effective work with Indigenous communities, along with reciprocity regarding knowledge exchange. Issues surrounding service provision are a significant concern, yet improvements are unlikely to be effective unless therapists can critically examine the (mainstream) Western cultural assumptions that infuse the profession and their own practices.

IMPLICATIONS.

Though nascent, there are identified directions for occupational therapists to meet the TRC's calls for more competent health care. Researchers should explore best ways for therapists to critically interrogate taken-for-granted professional assumptions mired in Western colonialism.

Culture, Health, Function, and Participation Among American Indian and Alaska Native Children and Youth With Disabilities: An Exploratory Qualitative Analysis

OBJECTIVE

To investigate the influence of traditional culture on health, disability, and health care services among American Indian and Alaska Native (AI/AN) children and youth with disabilities.

DESIGN

Exploratory descriptive qualitative analysis.

SETTING

Tertiary children's hospital.

PARTICIPANTS

A purposively sampled group (N=17) of AI/AN youth (n=4) with disability lasting at least 6 months age 8-24 years old and parents (n=13) of AI/AN children with disability lasting at least 6 months age 6 months to 17 years old.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participant responses to semistructured interview questions regarding health beliefs, daily activities, participation in cultural activities, and experiences receiving or having their child receive health care and rehabilitation services.

RESULTS

Three themes were identified: (1) participation in cultural activities is important for health as an AI/AN person; (2) experiences participating in cultural activities with functional differences; and (3) lack of recognition of the culturally related functional needs of AI/AN children with disabilities by rehabilitation providers. Children participated in cultural activities primarily through attendance at community-wide events. Barriers to participation in cultural activities included environmental barriers and adaptive mobility devices ill-suited to rough terrain. Participants perceived addressing functional needs related to culture, and cultural activities was not an expected part of rehabilitation services.

CONCLUSIONS

AI/AN children with disabilities experience barriers to participation in cultural activities, making it hard for them to achieve their definition of ideal health. Rehabilitation services have not identified or addressed these unmet culturally related functional needs.

An integrated knowledge translation approach to develop a shared decision-making strategy for use by Inuit in cancer care: a qualitative study

Background

In relation to the general Canadian population, Inuit face increased cancer risks and barriers to health services use. In shared decision-making (sdm), health care providers and patients make health care decisions together. Enhanced participation in cancer care decisions is a need for Inuit. Integrated knowledge translation (kt) supports the development of research evidence that is likely to be patient-centred and applied in practice.

Objective

Using an integrated kt approach, we set out to promote the use of sdm by Inuit in cancer care.

Methods

An integrated kt study involving researchers with a Steering Committee of cancer care system partners who support Inuit in cancer care ("the team") consisted of 2 theory-driven phases:■ using consensus-building methods to tailor a previously developed sdm strategy and developing training in the sdm strategy; and■ training community support workers (csws) in the sdm strategy and testing the sdm strategy with community members.

Results

The team developed a sdm strategy that included a workshop and a booklet with 6 questions for use by csws with patients. The sdm strategy (training and booklet) was finalized based on feedback from 5 urban-based Inuit csws who were recruited and trained in using the strategy. Trained csws were matched with 8 community members, and use of the sdm strategy was assessed during interviews, reported as 6 themes. Participants found the sdm strategy to be useful and feasible for use.

Conclusions

An integrated kt approach of structured research processes with partners developed a sdm strategy for use by Inuit in cancer care. Further work is needed to test the sdm strategy.

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.

Indigenous perspectives on health: Integration with a Canadian model of practice

BACKGROUND.

The Canadian Association of Occupational Therapists and the Truth and Reconciliation Commission recommend change within the Canadian health care system, respecting and valuing Indigenous health and healing practices. Adjusting the lens through which occupational therapists practice to incorporate Indigenous views of health and wellness is one potential change.

PURPOSE.

This critical interpretive synthesis of the literature incorporates Indigenous perspectives on health and wellness into the Canadian Model of Occupational Performance and Engagement (CMOP-E) framework, strengthening that model to better serve all peoples in Canada.

KEY ISSUES.

Integrating Indigenous worldviews can add to the CMOP-E the importance of balance among physical, emotional, spiritual, and mental health; the inseparability of person, community, and land; and understanding occupations as dimensions of meaning. These are incorporated in a proposed integrated model (ICMOP-E).

IMPLICATIONS.

Effectively integrating Indigenous perspectives may be an important first step in a longer journey toward engaging more respectfully with Indigenous perspectives on health and wellness.

Do occupational justice concepts inform occupational therapists' practice? A scoping review

BACKGROUND.

Occupational justice and related concepts can inform practices directed at injustice and the lack of rights in daily life. Brazilian ideas about social occupational therapy seem to be similar to these concepts about inequality.

PURPOSE.

This study aimed to answer the questions, "Do occupational justice concepts inform occupational therapists' professional actions?" and "How are occupational justice concepts connected to Brazilian ideas about social occupational therapy?"

METHOD.

A secondary analysis was undertaken of a scoping review using occupational justice and related concepts as keywords. Descriptive and categorical analyses were used to classify the extract data.

FINDINGS.

We selected 42 articles that specify occupational therapy practices, classified as individual approaches (n = 13), individual-integrated-with-social approaches (n = 22), and social approaches (n = 7). It was found that occupational justice concepts have informed individual approaches and that the second and third approaches can be connected with social occupational therapy.

IMPLICATIONS.

Dialogue for sharing knowledge, concepts, and practices of occupational therapy worldwide can be inspired by this review.

The Equity Lens for Occupational Therapy: A program development and evaluation tool: L'Equity Lens for Occupational Therapy : un outil pour le développement et l'évaluation de programme

BACKGROUND

Occupational therapists value the principles of health and health care equity and often face challenges addressing inequities within the systems in which they work.

PURPOSE

We present the Equity Lens for Occupational Therapy (ELOT), a framework to provide a practical starting point for reflecting on equity issues and the ways inequities are enacted in daily practice.

KEY ISSUES

Building on an existing occupational therapy practice model and well-established program development and evaluation processes, we overlay an equity lens. The lens provides a structured way to critically reflect on occupational therapy programs within their contexts and develop action strategies to prevent or redress inequities.

IMPLICATIONS

Taking action on the multiple ways that inequities can be embedded in occupational therapy programs within health and social systems can be a daunting task. The ELOT provides a systematic way to stimulate critical reflection and dialogue, examine practice, focus social advocacy, and take action.

Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: a study protocol

PLAIN ENGLISH SUMMARY

Tailoring and testing a peer support decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol.First Nations, Inuit and Métis (FNIM) people face higher risks for cancer compared to non-FNIM populations. They also face cultural barriers to health service use. Within non-FNIM populations an approach to health decision making, called shared decision making (SDM), has been found to improve the participation of people in their healthcare. Peer support with SDM further improves these benefits. The purpose of this study is to tailor and test a peer support SDM strategy with community support workers to increase FNIM people's participation in their cancer care.This project has two phases that will be designed and conducted with a Steering Committee that includes members of the FNIM and cancer care communities. First, a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings, and training in the SDM strategy developed for community support workers. Three communities will be supported for participation in the study and community support workers who are peers from each community will be trained to use the SDM strategy.Next, each community support worker will work with a community member who has a diagnosis of cancer or who has supported a family member with cancer. Each community support worker and community member pair will use the SDM strategy. The participation and experience of the community support worker and community member will be evaluated.The research will be used to develop strategies to support people who are making decisions about their health.

ABSTRACT

Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol Background First Nations, Inuit and Métis ("FNIM") people face increased cancer risks in relation to general populations and experience barriers to health service use. Shared decision making (SDM) has been found to improve peoples' participation and outcomes in healthcare and peer support with SDM further improves these benefits. The purpose of this study is to tailor and then field test, by and with FNIM communities, a peer support SDM strategy for use in cancer care. Methods This project has 2 theory-driven phases and 5 stages (a-e). A core research team that includes members of the Aboriginal Cancer Control Unit of Cancer Care Ontario communities and academic researchers, will work with a Steering Committee. In phase 1, (stage a) a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings and (stage b), training developed that will i) introduce participant communities to SDM, and ii) train community support workers (CSWs) within these communities. Next (stage c), three communities will be approached for voluntary participation in the study. These communities will be introduced to SDM in community meetings, and if in agreement then CSWs from each community will be recruited to participate in the study. One volunteer CSW from each community will be trained to use the peer support SDM strategy to enable phase 2 (field test of the peer support SDM strategy).During phase 2 (stage d), each CSW will be matched to a volunteer community member who has had a diagnosis of cancer or has supported a family member with cancer and is familiar with Ontario cancer systems. Each CSW-community member pair (3 to 4 pairs/community) will use the tailored peer support SDM strategy; their interaction will be audio-recorded and their participation and experience evaluated (total of 9 to 12 interviews). As well (stage e), data will be collected on health systems' factors related to the use of the peer support SDM strategy. Discussion Findings will develop peer support SDM strategies to enhance participation of FNIM people in cancer care decisions, advance knowledge translation science, and support a proposal to conduct a multi-site implementation trial.

Educational content related to postcolonialism and indigenous health inequities recommended for all rehabilitation students in Canada: a qualitative study

BACKGROUND

Postcolonial analysis can help rehabilitation providers understand how colonization and racialization create and sustain health inequities faced by indigenous peoples. However, there is little guidance in the literature regarding inclusion of postcolonialism within rehabilitation educational curricula. Therefore, this study explored perspectives regarding educational content related to postcolonialism and indigenous health that rehabilitation students in Canada should learn to increase health equity.

METHODS

This qualitative study involved in-depth, semi-structured interviews with 19 individuals with insight into postcolonialism and health in Canada. Data were analyzed collaboratively to identify, code, and translate themes according to a structured six-phase method.

RESULTS

Four themes emerged regarding educational content for rehabilitation students: (1) the historic trauma of colonization and its ongoing impacts on rehabilitation for indigenous peoples; (2) disproportionate health burden and inequitable access to health services; (3) how rehabilitation is related to Indigenous ways of knowing; and (4) why rehabilitation is well-positioned to address health inequities with Indigenous Peoples.

CONCLUSION

Results call for reflection on assumptions underpinning the rehabilitation professions that may unintentionally reinforce health inequities. A postcolonial lens can help rehabilitation educators promote culturally safe services for people whose ill health and disability are linked to the effects of colonization. Implications for Rehabilitation Given the powerful, ongoing effects of colonization and racialization on health and disability, recommendation #24 from the Truth and Reconciliation Commission of Canada calls for the education of health professionals related to Indigenous history, rights, and anti-racism. However, there is little curricula on these areas in the education of rehabilitation professional students or in continuing education programs for practicing clinicians. This is the first study to investigate expert perspectives on content related to postcolonialism and indigenous-settler inequities that should be included in the education of rehabilitation students in Canada. According to the participants in this study, rehabilitation educators in Canada should consider incorporating the following four themes into curricula to better address Indigenous-settler inequities in the context of rehabilitation: (1) the historic trauma of colonization and its ongoing impacts on rehabilitation for Indigenous Peoples in Canada; (2) disproportionate health burden and inequitable access to health services; (3) how rehabilitation is related to Indigenous ways of knowing; and (4) why rehabilitation is well-positioned to rise to the challenge of addressing health inequities with Indigenous Peoples in Canada. Postcolonialism is useful for rehabilitation providers because it is an approach that redirects the focus of problems from Indigenous People to the systems of oppression (specifically colonization and racialization) that cause ill health and disability.

Occupation-based practices and homelessness: A scoping review

Background.

Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession.

Purpose.

This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness.

Method.

A scoping review was conducted, including evidence from both occupational therapy and non–occupational therapy sources.

Findings.

One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief.

Implications.

Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions.

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

BACKGROUND

The 2007 position statement on diversity for the Canadian occupational therapy profession argued discussion was needed to determine the implications of approaches to working with cultural differences and other forms of diversity. In 2014, a new position statement on diversity was published, emphasizing the importance of social power relations and power relations between client and therapist, and supporting two particular approaches: cultural safety and cultural humility with critical reflexivity

PURPOSE

This paper reviews and critically synthesizes the literature concerning culture and diversity published in occupational therapy between 2007 and 2014, tracing the major discourses and mapping the implications of four differing approaches: cultural competence, cultural relevance, cultural safety, and cultural humility.

KEY ISSUES

Approaches differ in where they situate the "problem," how they envision change, the end goal, and the application to a range of types of diversity.

IMPLICATIONS

The latter two are preferred approaches for their attention to power relations and potential to encompass a range of types of social and cultural diversity.

Sharpening our critical edge: Occupational therapy in the context of marginalized populations

Background.

An emerging and important area of occupational therapy practice involves engaging with various individuals and population groups who live in marginalizing conditions that result in health inequities.

Purpose.

This paper calls for more critical and intersectional analyses of occupational therapy in the context of marginalized populations.

Key Issues.

Intersectionality has the potential to reveal important and complex interactions among social systems that create and sustain marginalization and to inform more nuanced, contextualized, and socially responsive forms of occupational therapy. Central to this process is the co-construction of knowledge with people who experience marginalization. Engaging in this work requires occupational therapists to undertake ongoing critical reflexivity to attend to our sociohistorical positioning of power and privilege in relation to marginalized populations.

Implications.

Complicating our discourse on marginalized populations is imperative to enacting our critical potential in working toward social justice and health equity.

Cultural adaptation of a shared decision making tool with Aboriginal women: a qualitative study

Background

Shared decision making (SDM) may narrow health equity gaps experienced by Aboriginal women. SDM tools such as patient decision aids can facilitate SDM between the client and health care providers; SDM tools for use in Western health care settings have not yet been developed for and with Aboriginal populations. This study describes the adaptation and usability testing of a SDM tool, the Ottawa Personal Decision Guide (OPDG), to support decision making by Aboriginal women.

Methods

An interpretive descriptive qualitative study was structured by the Ottawa Decision Support Framework and used a postcolonial theoretical lens. An advisory group was established with representation from the Aboriginal community and used a mutually agreed-upon ethical framework. Eligible participants were Aboriginal women at Minwaashin Lodge. First, the OPDG was discussed in focus groups using a semi-structured interview guide. Then, individual usability interviews were conducted using a semi-structured interview guide with decision coaching. Iterative adaptations to the OPDG were made during focus groups and usability interviews until saturation was reached. Transcripts were coded using thematic analysis and themes confirmed in collaboration with an advisory group.

Results

Aboriginal women 20 to 60 years of age and self-identifying as First Nations, Métis, or Inuit participated in two focus groups (n = 13) or usability interviews (n = 6). Seven themes were developed that either reflected or affirmed OPDG adaptions: 1) “This paper makes it hard for me to show that I am capable of making decisions”; 2) “I am responsible for my decisions”; 3) “My past and current experiences affect the way I make decisions”; 4) “People need to talk with people”; 5) “I need to fully participate in making my decisions”; 6) “I need to explore my decision in a meaningful way”; 7) “I need respect for my traditional learning and communication style”.

Conclusions

Adaptations resulted in a culturally adapted version of the OPDG that better met the needs of Aboriginal women participants and was more accessible with respect to health literacy assumptions. Decision coaching was identified as required to enhance engagement in the decision making process and using the adapted OPDG as a talking guide.

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.

Client-centred practice in occupational therapy: critical reflections

AIMS

The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices.

MAJOR FINDINGS

Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power.

PRACTICE CONCLUSION

Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.