Participatory citizenship: Critical perspectives on client-centred occupational therapy

"Justice Becomes Our Agency." Occupational Therapists in Germany Reflect on Their Practice Processes in and with Communities

Community development and population-oriented approaches are emphasized to advance the occupational therapy profession's scope of practice to meet the increasing demands created by socio-cultural-political and economic changes. This study explored the practice processes of occupational therapists in community settings outside existing health care structures in Germany. Data was gathered through five individual qualitative interviews and one focus group and analyzed using thematic analysis. Three main themes were identified: navigating parallel processes within the larger context or system; building community connections through occupation; growing professional identity. The utilization of occupational science concepts was essential to work successfully on a community level.

Influencing discussions and use of Neuroadvancements: Perspectives of Canadian occupational therapists

BACKGROUND: The early involvement of many actors including health professionals is identified in neuroethics and neurogovernance discussions as crucial in constructing conversations around awareness, reaction, and knowledge development pertaining to the ethical, legal, and societal consequences of neuroscientific or neurotechnological advancements (NA). Occupational Therapists (OTs) have a stake in NA; however, OTs are rarely mentioned within this context. Lifelong learning (LL) could be used to increase OTs knowledge on NA and its consequences. However, LL is rarely mentioned within neuroethics and neurogovernance discussions. OBJECTIVE: The study’s purpose is to understand the role of OTs as professionals and citizens in neuroethics and neurogovernance discussions and to examine the utility of LL processes put in place for OTs to empower OTs to contribute in a meaningful way to NA discussions. METHODS: 8 semi-structured interviews with OTs were conducted and analyzed using a directed content analysis. RESULTS: Although participants believed OTs can provide a holistic perspective to neurogovernance discussions, their knowledge on NA and its consequences is limited, and LL is not used as a tool to remain informed about such consequences. CONCLUSION: More education on NA and its consequences throughout their OT degree and through LL opportunities is warranted to facilitate their involvement.

Terapia ocupacional e Paulo Freire: uma revisão de escopo

Resumo Introdução O referencial teórico e o aporte metodológico trazidos pelas obras de Paulo Freire vêm se espraiando por distintas áreas, inclusive na terapia ocupacional. Objetivo Apreender como o referencial freireano vem sendo utilizado em publicações acadêmicas da terapia ocupacional, reunindo e analisando essa literatura, para identificar eixos temáticos e lacunas presentes. Método Revisão de escopo, com levantamento de publicações nas bases de dados CINAHL, Scopus e Web of Science, focalizando artigos acadêmicos que referenciam explicitamente Paulo Freire, num período que, sem recorte inicial, foi até abril de 2020, tendo sido incluídos todos os artigos que referenciavam pelo menos uma obra do autor. Uma planilha desenvolvida no programa Microsoft Excel® reuniu os dados gerais dos artigos, cujos conteúdos foram agrupados, sintetizados e analisados a partir de conjuntos temáticos significativos. Resultados Foram identificados 56 artigos, publicados entre 1993 e abril de 2020. A obra de Freire vem sendo utilizada em publicações acadêmicas da terapia ocupacional, destacando-se o livro “Pedagogia do Oprimido” e as categorias Diálogo/Dialógica e Conscientização/Consciência crítica/política. Foram definidos e discutidos três conjuntos temáticos: 33 (58,9%) artigos que utilizam o referencial freireano para o pensar/fazer da terapia ocupacional; 10 (17,8%) em que ele parametriza a pesquisa na área; 13 (23,2%) cujas análises e proposições envolvendo a formação de terapeutas ocupacionais tomam-no como aporte. Conclusão Paulo Freire informa de diversas maneiras a terapia ocupacional, em prol de uma práxis para a transformação social, embora, em boa parte das vezes, as formulações freireanas não sejam o centro dos esforços de elaboração reflexiva.

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.

Client-centred practice in occupational therapy after stroke: A systematic review

Background: Client-centred practice aims to involve the person in making decisions during the therapeutic intervention process, giving him or her a central and active role.Objectives: To analyze the effects of client-centred practice in occupational therapy on issues related to occupational performance and participation among people with stroke and traumatic brain injury.Material and methods: A systematic review of randomized clinical trials examining the effects of a client-centred practice carried out by occupational therapists in patients with stroke or traumatic brain injury aged over 18 years was conducted. PubMed, Web of Science, Scopus, OT Seeker, PsycINFO and EBSCO were used to retrieve potentially eligible publications.Results: Eight studies, from 294 identified, were included. The extracted data showed that the application of client-centred practice in occupational therapy improved satisfaction with occupational performance compared to conventional interventions. However, client-centred practice and conventional intervention had similar effects on functionality (Activities of Daily Living), life satisfaction and burden on caregivers.Conclusions and significance: Client-centred practice has the effect of achieving greater satisfaction with occupational performance. This suggests that client-centred practice in occupational therapy helps patients to accept the new limitations on their occupational performance. Further studies are needed to determine the effects of client-centred practice on other aspects.

Consumer engagement in occupational therapy health-related research: A scoping review of the Australian Occupational Therapy Journal and a call to action

INTRODUCTION

Consumer engagement in research is becoming an ethical, political, and moral imperative. The aim of this scoping review was to provide a snapshot of the current status of the emerging area of consumer engagement in occupational therapy health-related research, as published in the Australian Occupational Therapy Journal.

METHODS

A scoping review was conducted of all health-related original research published in the Australian Occupational Therapy Journal for 5½ years, plus Early View, as at June 2019. Eligible papers were examined for consumer engagement content which included any active choice or control by consumers, beyond being a research participant. A recognised six stage methodology was used with quantitative and qualitative data analysed. Two consumers collaborated in interpreting the data including finalising themes, leading theme naming, developing key discussion points, and producing recommendations.

RESULTS

Of the 123 eligible papers, 48 (39.02%) included consumer engagement. However, only two incorporated consumer engagement across all research phases-preparation, execution and translation. A total of 103 consumer engagement activities were charted and categorised across all papers. There were limited instances of consumer collaboration (14/103, 13.59%) or consumer-led research processes (15/103, 14.56%) reported. Four themes emerged: Parity in research partnerships; It's important to know the Who, What, When, How and So What of consumer involvement; Consumer engagement must be a two-way process-not a dead end street; and Meeting the challenge-being diverse and inclusive.

CONCLUSION

Comprehensive consumer-researcher partnerships may not be common-place in health-related occupational therapy research in the Australian Occupational Therapy Journal. This paper is a call to action. Occupational therapists must embrace consumer research partnerships as a demonstration of the key philosophies of enabling and empowering consumers and communities. Collaboration with two consumers in finalising data analysis, results interpretation and reporting added a diverse and valuable perspective.

Assessing environmental barriers by means of the swedish craig hospital inventory of environmental factors among people post-stroke

BACKGROUND

When occupational therapists address environmental barriers to occupational engagement, some barriers might not be possible to reduce for single individuals, because decisions have to be taken at community or societal level, for example changes in public transport. Investigating environmental barriers by means of the Swedish Craig Hospital Inventory of Environmental Factors (CHIEF-S) may increase our understanding of the environmental impact on occupation engagement and the methodological challenges to assess environmental barriers.

AIMS

To investigate and describe the magnitude of encountered environmental barriers in a group of people post-stroke and to assess psychometric properties of the CHIEF-S.

MATERIAL AND METHODS

In total, 34 participants, who had sustained a stroke in Sweden were recruited.

RESULTS

The participants reported in average 2,7 barriers and the total frequency-magnitude score of barriers (CHIEF-S score) was 0.45. The Cronbach's α for the total CHIEF-S was 0.80 and the analysis of test-retest reliability revealed ICC = 0.86. The entire instrument demonstrated better psychometric properties than the single sub-scales.

CONCLUSION

In this study, the frequency-magnitude of environmental barriers encountered by people post-stroke are reported at a group level and adds information to the cumulative knowledge generation on perceived environmental barriers in the society. However, to inform which interventions are needed at a more detailed level, other data collection methods have to be added.

Using appreciative inquiry to explore and enhance perceptions of empowerment for those experiencing homelessness: A pilot study

BACKGROUND

Individuals experiencing homelessness endure occupational injustices in the form of marginalization and deprivation at higher rates than their counterparts who are not experiencing homelessness. This population's expressed interests, needs, and desires are frequently ignored or unsolicited by a system of care that continues to exercise power over this fragile and underserved group. Marginalization and deprivation can lead to disempowerment. Few studies have been conducted that explore the perceptions of empowerment by those experiencing homelessness. Providing a "space" for the voice of those experiencing homelessness to be heard can promote occupational justice as an outcome of occupational therapy intervention.

OBJECTIVE

This pilot research sought to explore perceptions of empowerment by attendees of a day shelter for those experiencing homelessness.

METHODS

Researchers used an Appreciative Inquiry approach to elicit responses to the question, "For those experiencing homelessness who attend a day shelter, what are their perceptions of how the shelter environment supports empowerment?" This qualitative approach promotes and maintains focus on positivity and inclusivity with respect to the change process from solution identification to maintenance of identified changes. Shelter attendees participated in one of three focus groups. Based upon qualitative analysis of the data, environmental enhancements were made by the researchers and post-environmental enhancement surveys collected data related to perceptions of those enhancements to promote empowerment.

RESULTS

Six themes emerged from the data and pointed to both internal and external factors that are perceived to impact empowerment.

CONCLUSION

Results of this study can be used by occupational therapy practitioners to support and develop inclusive and empowerment-focused approaches for those experiencing homelessness.

Transcending the individual: The promise and potential of collectivist approaches in occupational therapy

BACKGROUND

In a globalised world, with injustices and inequities, occupational therapists have a moral and ethical obligation to use their knowledge and skills to work at a collective level with groups, communities, and populations rather than focus solely on individualistic approaches.

OBJECTIVES

To review the literature exploring the question: What do occupational therapists do in their everyday practice that could be characterised as having a collectivist orientation?

METHOD

A scoping review with searches on Web of Science, Scopus and CINAHL databases with the keywords 'occupational therapy' AND collectiv*.

RESULTS

161 articles were found and after screening of abstracts and/or full text, 19 were included. Articles were published in English (13) and Portuguese (6), in 12 different journals and one book, from 1988 to 2018. They were categorised as focussing on: social welfare - collectivism (n = 2); collective occupations (n = 11); and collective oriented practices (n = 6).

CONCLUSION

A clear definition of collectivist approaches in occupational therapy practice was not found. What was evident, however, was a focus on experiential accounts of working with groups of people and the methods and processes utilised. It is argued that occupational therapy needs to further develop knowledge and practices aimed at injustices grounded in a collectivist epistemology.

‘Keeping busy with purpose’: How meaningful occupation can shape the experience of forced migration

Forced migration creates multiple barriers to everyday life, including individual’s access to dignified and meaningful daily occupations. Without the activities that form family life, self-care, work, leisure, and community participation, individuals can find themselves struggling to fill the hours in their days and feeling they exist on the margins of society. This article reflects the findings of a small-scale phenomenological study exploring the meaning of everyday occupations to people seeking asylum in the UK. A series of in-depth interviews, conducted with 10 people, explored the role of daily occupation in their country of origin and in the UK. The study found that restrictions on daily activities had a significant impact on their well-being and sense of self-worth. They highlighted how limited their opportunities were and acknowledged the value of meaningful daily occupations as a means to ‘keep busy with purpose’. There is growing evidence that occupation has the potential to be of benefit to people during the post-migratory period: maintaining health, preserving key skills, retaining a sense of self, and increasing integration. This study shows the multiple gains associated with purposeful activity, including how the right kind of occupation can promote self-worth at a time when people often feel devalued. The article encourages the reader to consider how increased access to activity can promote well-being and to consider challenging the occupational injustices behind asylum policy.

“The Bigger Picture”: Occupational Therapy Practitioners’ Perspectives on Disability Studies

OBJECTIVE. This qualitative study explored occupational therapy practitioners’ perspectives about integrating principles from the field of disability studies (DS) into clinical education and practice.

METHODS. After a conference presentation about DS, three simultaneous focus groups were conducted with 27 occupational therapy practitioners. A constant comparative, grounded-theory approach was used to identify themes across groups.

RESULTS. Identified themes included convergences and divergences between the profession of occupational therapy and the field of disability studies, influence of perspectives of disability on service delivery, clinician navigation of systemic barriers, and incorporation of DS-aligned intervention strategies into practice.

CONCLUSION. Despite points of alignment, occupational therapy has not fully addressed DS critiques. Practitioners recognized professional, systemic, and societal barriers and the need for more educational experiences, resources, and professional reflexivity and dialogue to inform the integration of DS concepts into practice.

Critical dialogical approach: A methodological direction for occupation-based social transformative work

BACKGROUND

Calls for embracing the potential and responsibility of occupational therapy to address socio-political conditions that perpetuate occupational injustices have materialized in the literature. However, to reach beyond traditional frameworks informing practices, this social agenda requires the incorporation of diverse epistemological and methodological approaches to support action commensurate with social transformative goals.

AIM

Our intent is to present a methodological approach that can help extend the ways of thinking or frameworks used in occupational therapy and science to support the ongoing development of practices with and for individuals and collectives affected by marginalizing conditions.

METHOD

We describe the epistemological and theoretical underpinnings of a methodological approach drawing on Freire and Bakhtin's work.

RESULTS

Integrating our shared experience taking part in an example study, we discuss the unique advantages of co-generating data using two methods aligned with this approach; dialogical interviews and critical reflexivity.

DISCUSSION

Key considerations when employing this approach are presented, based on its proposed epistemological and theoretical stance and our shared experiences engaging in it.

SIGNIFICANCE

A critical dialogical approach offers one way forward in expanding occupational therapy and science scholarship by promoting collaborative knowledge generation and examination of taken-for-granted understandings that shape individuals assumptions and actions.

Collective occupation in public spaces and the construction of the social fabric

Background.

Contemporary research is expanding understandings of occupation beyond that of the individual’s doing, including the shared and social nature of occupation. The concept of collective occupation has been introduced to capture this broader understanding.

Purpose.

This study aimed to explicate the concept of occupation in a Greek town.

Method.

Ethnographic methodology was used and primary data were collected through observation, participation, and informal interviews. Analysis involved a hermeneutic process to develop a narrative of occupation in the town, including action, setting, and plots.

Findings.

Occupation, a dynamic and multidimensional process, served to maintain the self, family, and social fabric and balance between and within them. Collective occupation maintained the social fabric through three forms: informal daily encounters in public spaces, organization and associations, and celebration and commemoration.

Implications.

Occupational therapists may consider engaging with the potential power of such collective occupation when working toward social change to enable just and inclusive societies.

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.