Exploring professional theories, models, and frameworks for justice-oriented constructs: a scoping review / Explorando teorias, modelos e estruturas profissionais para construções orientadas para a justiça: uma revisão de escopo

Abstract Introduction The role of systemic marginalization in negatively impacting the health and wellbeing of individuals and populations is well-established. Although the profession has begun to address the impact of colonialism in clinical and educational contexts, these topics are less represented in the underpinning theories, models, and frameworks that guide research, practice, and education. Objective To identify and analyze peer-reviewed journal articles about professional theories, models, and frameworks describing justice-oriented constructs. Method We searched for journal articles published between 1971 and 2021 as indexed in PubMed/Medline, EMBASE, Scopus, PsycInfo, CINAHL, and Web of Science. We used the Levac et al. methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews extension (PRISMA-ScR) and the JBI Scoping Review Network. Included articles featured theories, models, frameworks that described justice-oriented constructs. Results Forty-five articles published from 1987 to 2021 met inclusion criteria. These included 19 models, 19 frameworks, five theories, and two paradigms. The majority of articles originated in Canada, the United States, and Australia and within the past 20 years. The most commonly described constructs were inclusion, culture, and occupational justice. Conclusion This scoping review provides an overview of publications describing theories, models, and frameworks in occupational therapy literature that include justice-oriented constructs. Although justice-oriented constructs were the central topic in 35 articles, the context was not explicitly connected to professional activity. Only seven articles discussed research, which reveals a major concern considering its foundational role in the profession.

Resumo Introdução O papel da marginalização sistémica no impacto negativo na saúde e no bem-estar dos indivíduos e das populações está bem estabelecido. Embora a profissão tenha começado a abordar o impacto do colonialismo em contextos clínicos e educacionais, estes tópicos estão menos representados nas teorias, modelos e enquadramentos subjacentes que orientam a investigação, a prática e a educação. Objetivo Identificar e analisar artigos de periódicos revisados ​​por pares sobre teorias, modelos e estruturas profissionais que descrevem construtos orientados para a justiça. Método Pesquisamos artigos de periódicos publicados entre 1971 e 2021 indexados em PubMed/Medline, EMBASE, Scopus, PsycInfo, CINAHL e Web of Science. Usamos o Levac et al. metodologia e seguiumos a extensão Preferred Reporting Items for Systematic Reviews and Meta-Analyses para extensão Scoping Reviews (PRISMA-ScR) e a JBI Scoping Review Network. Os artigos incluídos apresentavam teorias, modelos e estruturas que descreviam construções orientadas para a justiça. Resultados Quarenta e cinco artigos publicados de 1987 a 2021 preencheram os critérios de inclusão. Estes incluíram 19 modelos, 19 estruturas, cinco teorias e dois paradigmas. A maioria dos artigos teve origem no Canadá, nos Estados Unidos e na Austrália nos últimos 20 anos. Os construtos mais comumente descritos foram inclusão, cultura e justiça ocupacional. Conclusão Esta revisão de escopo fornece uma visão geral das publicações que descrevem teorias, modelos e estruturas na literatura de terapia ocupacional que incluem construtos orientados para a justiça. Embora os construtos orientados para a justiça tenham sido o tema central em 35 artigos, o contexto não estava explicitamente ligado à atividade profissional. Apenas sete artigos discutiram a pesquisa, o que revela uma grande preocupação considerando o seu papel fundacional na profissão.

Climate Change and Occupational Therapy: Meeting the Urgent Need for Adaptation, Mitigation, and Resilience.

Climate change may be the most pressing existential threat to human health and wellbeing in the twenty first century. In this paper, the authors provide context and critique on barriers to climate action in the United States and other high-income countries, including the profit-driven approach to health, consumerism, and the climate change countermovement. The reciprocal connections between occupational engagement and climate damage are examined from a lens of collective and irresponsible occupations and subsequent accountability. The authors propose the United Nations' Sustainable Development Goals as a basis for recommendations occupational therapy practitioners could implement within the priorities of adaptation, mitigation, and resilience.

Transforming Occupational Therapy for the 21st Century PAIRE: Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity.

Theories, models, and frameworks provide the foundation for occupational therapy education, research, and clinical practice. While most have a systems approach focus, other factors, such as societal influences and structural inequities, also contribute to health. Using a cross-sectional design, this study identified the gaps in occupational therapy models of practice and presents a novel approach, the PAIRE (Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity) Model. PAIRE is focused on achieving occupational equity through the reciprocal and intersectional impact of the provider/team, the person/people seeking occupational therapy, and the occupation-in-context, with continuous influences of access, context, and justice. We describe the components of PAIRE and illustrate its functionality in education, research, and clinical practice contexts as well as case examples.

Impact of Basic Needs Fulfillment on the Health, Well-being, and Academic Engagement of Occupational Therapy Students.

The basic needs of students may serve as unknown factors in academic engagement and well-being. Challenges in meeting these needs disproportionately impact underrepresented minority and first-generation students. The purpose of this pilot study was to explore the perceived presence and impact of basic needs on health, well-being, and academic engagement in occupational therapy students. A 43-item survey was distributed to 231 students and focused on questions addressing basic needs in physiology, safety, and belonging. Respondents reported worry over or the need to work to pay bills, no support from family/friends, and limited access to food in the past 30 days and related this to feeling stressed, not being able to do homework, not participating in class, and loss of leisure time. Ninety-four percent used student health services frequently. Recommendations to address gaps in basic needs include flexible policies, inclusive learning environments, supportive and intentional actions, and providing resources.

Scoping Review of Critical Thinking Literature in Healthcare Education.

Critical thinking is the process of analyzing and evaluating thinking to make decisions. Critical thinking exposes assumptions, biases, and beliefs that influence clinical reasoning. This scoping review sought to explore instructional approaches for advancing students' critical thinking in healthcare education. Through analysis of 15 articles, no common definition of critical thinking emerged, nor consensus found on measurement or instructional methods. Some alternative instructional methods such as case-based learning, reflective guided questions, and multiple case exposures, when compared to lecture, did significantly impact learner critical thinking. To determine if critical thinking is an instructional method that would impact implicit biases and healthcare outcomes, five author recommendations are offered from gaps in the existing literature to provide a pathway for future research. To effectively prepare students for clinical practice, long term outcomes are necessary to assess if critical thinking skills can be taught and become part of a professional growth mindset.

Northern philosophies and professional neocolonialism in occupational therapy: a historical review and critique / Filosofias do norte e neocolonialismo profissional na terapia ocupacional: uma visão histórica e crítica

ABSTRACT In this article, the authors conduct a historical review of recent philosophies influencing the Occupational Therapy profession in the United States (analytic philosophy and Continental varieties such as neopragmatism). Four philosophical categories are explored: epistemology, axiology, ontology, and praxis. The dominant strand of analytic philosophy is characterized by reductionist views of knowledge and reality, with little sustained attention to ethics and practical action. Competing but lesser recognized Continentally-inspired philosophies offer a critical and more phenomenological approach which values human subjectivities, narratives, and social agency. The authors argue that the dominance of analytic philosophy has created the intellectual foundations for neoliberalism to thrive and permeate the profession of Occupational Therapy in its curricula, practice models, reimbursement systems, and research agenda. As this Northern (United States) version of Occupational Therapy expands globally, the danger exists for professional neocolonialism to occur which can negatively influence or contradict more local ways of knowing and doing. The article concludes by offering strategies to unmask, disentangle, and dismantle Occupational Therapy from its Northern roots towards wider acceptance of Southern epistemologies, ethics, and collective action.

RESUMO Neste artigo, os autores apresentam uma visão histórica das filosofias recentes que influenciaram a profissão da terapia ocupacional nos Estados Unidos da América (variantes da Filosofia Analítica e Continental, como o neopragmatismo). Quatro categorias filosóficas são exploradas: epistemologia, axiologia, ontologia e práxis. A vertente dominante da filosofia analítica é caracterizada pela visão reducionista do conhecimento e da realidade, com pouca atenção voltada para a ética e ação prática. Competindo com ela, mas com menor reconhecimento, correntes inspiradas na filosofia continental oferecem uma abordagem crítica e mais fenomenológica que valoriza a subjetividade humana, as narrativas e a agência social. Os autores argumentam que o domínio da filosofia analítica criou as bases intelectuais para o neoliberalismo prosperar e permear a profissão da terapia ocupacional em seus currículos, modelos de prática, sistemas de reembolso e agenda de pesquisa. À medida que esta versão do Norte (Estados Unidos) da terapia ocupacional se expande globalmente, existe o perigo de ocorrer o neocolonialismo profissional, que pode influenciar negativamente ou contradizer formas mais locais de saber e de fazer. O artigo conclui oferecendo estratégias para desmascarar, desembaraçar e desmantelar a terapia ocupacional de suas raízes do Norte em direção a uma ampla aceitação das epistemologias do Sul, da ética e da ação coletiva.

Identity, civic engagement, and altruism: a phenomenological exploration of activity engagement in older adults.

BACKGROUND: Older adults' health and quality of life, proxies for aging well, are tied to activity engagement. Recent research indicates studying the perspective of older adults through their personal stories is key to understanding the phenomenon of occupational engagement as experienced day-to-day. AIM: To uncover the lived experience of older adults within their natural settings to better understand the phenomenon of activity engagement. This new knowledge informs programming options suited to older adults' wants and needs. MATERIALS/METHODS: Ten community-dwelling older adults (5 female, 5 male mean 79 years) were studied. Researchers performed phenomenological interpretive analysis (IPA) with multiple coders and member cheques to triangulate findings. RESULTS: Daily activities revolved around three themes: 1) Perspectives of self-identity are viewed as consistent throughout the lifespan; 2) Civic engagement is beneficial for social support and self-efficacy; and 3) Philosophical outlook influences activity choices and outlooks centred on altruism are critical to continued activity engagement. Seven of the ten participants expressed an overall positive outlook on aging. Three participants described a negative outlook on aging, expressed more difficulty with activity engagement, but reported desire to help others. CONCLUSIONS AND SIGNIFICANCE: These themes provide a basis for programming to increase activity engagement with older adults in the community.

Assignment Artifacts and What They Reveal About How Occupation Is Addressed in U.S. Occupational Therapy Curricula.

IMPORTANCE: Artifacts convey essential skills, tools, and concepts to students. Studies of artifacts can therefore illumine priorities for learning. OBJECTIVE: To describe the skills, tools, and concepts that assignment artifacts required students to learn, especially in relation to occupation. DESIGN: Educators submitted 243 artifacts that illustrated how their programs addressed occupation. Artifacts included syllabi, lectures, assignments, rubrics, study guides, texts, and learning objectives. A sociocultural research paradigm informed a secondary analysis of all assignment artifacts. Assignments were coded for the skills, tools, and underlying concepts students were to use, particularly related to occupation. SETTING: U.S. occupational therapist and occupational therapy assistant academic programs. PARTICIPANTS: Twenty-five U.S academic programs selected through stratified random sampling that targeted representation by geographic region and the Carnegie Classification of Institutions of Higher Education. Fifteen occupational therapy and 10 occupational therapy assistant programs consented. RESULTS: Assignment artifacts required students to interview, observe, analyze, and teach (skills); artifacts emphasized learning the Occupational Therapy Practice Framework: Domain and Process (tool). Few artifacts required students to relate skills and tools to broader concepts, including occupation. Those that did used prompts that were ancillary to the assignment. Grading rubrics seldom measured students' ability to connect skills and tools to occupation. CONCLUSIONS AND RELEVANCE: By emphasizing skills and tools detached from the concepts supporting their relevance to occupation, the artifacts reflected black box learning. Creating artifacts that reflect glass box learning can improve education. In glass box learning, artifacts are transparent and clearly delineate the skills, tools, and conceptual understandings to be gained. WHAT THIS STUDY ADDS: For researchers, the study highlights the importance of including artifacts in studies of occupational therapy education. For educators, the study gives guidance for creating assignments that clearly delineate skills, tools, and concepts.

Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature.

PURPOSE: To explore best practices for increasing cultural competency and reducing health disparities, the authors conducted a scoping review of the existing literature. METHOD: The review was guided by 2 questions: (1) Are health care professionals and medical students learning about implicit bias, health disparities, advocacy, and the needs of diverse patient populations? (2) What educational strategies are being used to increase student and educator cultural competency? In August 2016 and July 2018, the authors searched 10 databases (including Ovid MEDLINE, Embase, and Scopus) and MedEdPORTAL, respectively, using keywords related to multiple health professions and cultural competency or diversity and inclusion education and training. Publications from 2005 to August 2016 were included. Results were screened using a 2-phase process (title and abstract review followed by full-text review) to determine if articles met the inclusion or exclusion criteria. RESULTS: The search identified 89 articles that specifically related to cultural competency or diversity and inclusion education and training within health care. Interventions ranged from single-day workshops to a 10-year curriculum. Eleven educational strategies used to teach cultural competency and about health disparities were identified. Many studies recommended using multiple educational strategies to develop knowledge, awareness, attitudes, and skills. Less than half of the studies reported favorable outcomes. Multiple studies highlighted the difficulty of implementing curricula without trained and knowledgeable faculty. CONCLUSIONS: For the field to progress in supporting a culturally diverse patient population, comprehensive training of trainers, longitudinal evaluations of interventions, and the identification and establishment of best practices will be imperative.

A National Survey of Learning Activities and Instructional Strategies Used to Teach Occupation: Implications for Signature Pedagogies.

IMPORTANCE: Occupational therapy practitioners' professional identities and distinctive contributions to health care connect essentially to their knowledge of occupation. Thus, the strategies educators use to convey occupation to students and the perspectives embedded in those strategies are critical topics for researchers. OBJECTIVE: To generalize findings from a previous qualitative study of how educators in 25 U.S. occupational therapy assistant and occupational therapy programs addressed occupation to a national sample of educators. DESIGN: As part of an exploratory sequential design, a national survey of U.S. occupational therapy and occupational therapy assistant educators explored activities and strategies used to teach occupation. Data were analyzed using descriptive statistics. SETTING: An online survey about educators' practices in the academic education setting. PARTICIPANTS: Occupational therapy and occupational therapy assistant educators (N = 1,590) from all programs in the United States. Of these, 634 returned surveys, 315 of which were complete and included in the analysis, for an overall response rate of 19.8%. RESULTS: Respondents identified similar learning activities and instructional strategies as those identified in the qualitative phase of the design. Most instruction was active and experiential, requiring students to integrate various skills and content areas. Definitions of occupation, as a basis for teaching, varied. CONCLUSIONS AND RELEVANCE: The combined survey and qualitative results offered initial empirical support for occupational therapy's proposed signature pedagogies and the importance of attending to the deep and implicit structures within those pedagogies. Such structures are believed to support students' formation of a professional identity and an occupational perspective. WHAT THIS ARTICLE ADDS: This study provides evidence for the instructional strategies that educators use to convey knowledge of occupation to students. The predominant strategies support proposed signature pedagogies in occupational therapy: relational learning, affective learning, and highly contextualized active learning.

Existentialism in Occupational Therapy: Implications for Practice, Research, and Education.

As the profession of occupational therapy enters a second century, its growth in an increasingly complex and globalized world requires an adaptive and diverse philosophical foundation. The existentialist school of thought offers a complementary focus, which enhances existing philosophical foundations of the profession and supports two major tenets: (1) humans as self-making beings always in the process of becoming and (2) emotions and feelings as foundations for being-in-the-world. This article explores these two themes both in the context of existentialism and occupational therapy, and then provides an examination of existentialist utility in occupational therapy practice, research, and education.

Curriculum-Level Strategies That U.S. Occupational Therapy Programs Use to Address Occupation: A Qualitative Study.

OBJECTIVE: This study's objective was to describe curriculum-level strategies used to convey occupation to occupational therapy students. METHOD: The study used a descriptive qualitative research design. Fifteen occupational therapy and 10 occupational therapy assistant programs participated in interviews, submitted curriculum artifacts such as syllabi and assignments, and recorded teaching sessions. Data were coded both inductively and deductively and then categorized into themes. RESULTS: Occupational therapy programs designed strategies on two levels of the curriculum, infrastructure and implementation, to convey knowledge of occupation to students. The degree to which strategies explicitly highlighted occupation and steered instruction fluctuated depending on how differentiated occupation was from other concepts and skills. CONCLUSION: Two arguments are presented about the degree to which occupation needs to be infused in all curricular elements. To guide curriculum design, it is critical for educators to discuss beliefs about how ubiquitous occupation is in a curriculum and whether curricular elements portray occupation to the extent preferred.

Self-management program participation and social support in Parkinson's disease: Mixed methods evaluation.

Aims: To explore the potential influence of the Stanford Chronic Disease Self-Management Program (CDSMP) on social support in Parkinson disease (PD). Methods: This was a quasi-experimental mixed methods design. Volunteers with PD (n=27) and care partners (n=6) completed the CDSMP, questionnaires of social support and self-management outcomes, and an interview about social support in relation to CDSMP participation. PD participants (n=19) who did not participate in the CDSMP completed the questionnaires for quantitative comparison purposes. Results: Regarding the quantitative data, there were no significant effects of CDSMP participation on social support questionnaire scores; however, there were some positive correlations between changes in social support and changes in self-management outcomes from pre- to post-CDSMP participation. Three qualitative themes emerged from the interviews: lack of perceived change in amount and quality of social support, positive impact on existing social networks, and benefit from participating in a supportive PD community. Conclusions: Although participants did not acknowledge major changes in social support, there were some social support-related benefits of CDSMP participation for PD participants and care partners. These findings provide a starting point for more in-depth studies of social support and self-management in this population.

A Way of Seeing: How Occupation Is Portrayed to Students When Taught as a Concept Beyond Its Use in Therapy.

OBJECTIVE: The concept of occupation is core to learning occupational therapy, yet how occupation is taught has not been widely studied. We explored how occupation is addressed in 25 U.S. occupational therapist and occupational therapy assistant programs. METHOD: We used a basic qualitative research design, collecting data through interviews, artifacts, and video recordings of teaching. We secondarily analyzed 8 programs in which occupation was taught beyond its application in practice. RESULTS: Educators portrayed occupation as (1) a way of seeing self (students learn about themselves as occupational beings), (2) a way of seeing others (students learn about others as occupational beings), and (3) a way of seeing the profession (students learn occupation as the central focus of occupational therapy). Varied learning experiences promoted these perspectives. CONCLUSION: Three concepts-subject-centered learning, threshold concepts, and transformative learning-formed the theoretical foundation for teaching occupation as a way of seeing.

Explicit or Hidden? Exploring How Occupation Is Taught in Occupational Therapy Curricula in the United States.

OBJECTIVE: Occupation is considered core and threshold knowledge for occupational therapy, yet how it is conveyed through education is not well understood. This study examined how the concept of occupation was taught in occupational therapy and occupational therapy assistant curricula in the United States. METHOD: Using a qualitative descriptive research design, in-depth interviews, video recordings, and artifacts of teaching occupation were collected from 25 programs, chosen using stratified random sampling. Interview data were analyzed using an inductive, constant comparative approach; video and artifact data were analyzed deductively using findings from the interviews. RESULTS: Instructional methods were innovative and ranged from didactic to experiential. The degree to which occupation was present in instruction ranged from explicit to implicit to absent. CONCLUSION: Although educators valued teaching occupation, the concept was still elusive in some instructional methods and materials. Occupation knowledge and pedagogical content knowledge may have influenced how explicitly occupation was taught.

Diversity and Inclusion in Occupational Therapy: Where We Are, Where We Must Go.

Diversity is a fundamental element of the AOTA Centennial Vision and a critical aspect for the visibility, growth, and sustainability of the occupational therapy profession. In this article, the authors suggest that, while the profession has been aware of the need for a diverse workforce and has taken steps to increase diversity and cultural competency, a more structured, comprehensive, and action-oriented approach must be considered to address an issue which impacts professional roles and client engagement, satisfaction, and well-being. Informed by the value-added and mutual accommodation models of cultural diversity, the authors provide specific strategies and actions which promote diversity and inclusion at the personal, institutional/organizational, and professional levels.

Energizing Occupation as the Center of Teaching and Learning.

The concept of occupation has experienced a renewal in the past 3 decades and is widely accepted as the core subject in occupational therapy. Professional education has a critical stewardship role in continually enhancing how occupation is taught and understood to enrich new occupational therapy practitioners' ability to grasp the purpose of the profession and reason clinically in complex practice environments. The authors discuss three questions that frame approaches educators can use to effectively centralize occupation in teaching and learning environments: (1) To what degree is a curriculum and its courses and class sessions subject centered? (2) To what degree do instructional processes create links to occupation? and (3) To what degree do instructional processes expose and promote complex ways of knowing needed for learning occupation? Keeping occupation in the foreground is important to facilitate new research, teaching methods, and curricular relevance to practice.

The illusion of client-centred practice.

AIM: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession's philosophical basis and espoused commitment to client-centred practice. FINDINGS: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession's espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine's expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession's core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. CONCLUSION: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.

Value and challenges of research on health professions' core subjects in education.

Professions are organized around central concerns, or core subjects. Knowledge of a field's core subject is indispensable to effective practice, reasoning, and professional identity. In health professions education, however, core subjects are often obscured by the plethora of topics and skills that must be taught, rendering them largely implicit in the learning process. Core subjects and how they are addressed in curricula thus remain under-researched in health professions education. The scarcity of research can be attributed to the need for (1) explicating core subjects as the basis for learning, (2) language that describes professional education as connecting all learning to a field's core, and (3) research methods that go beyond early phases of research development, including a conceptual framework for understanding and studying core subjects. This paper presents strategies addressing each of these challenges that were developed through a pilot and a subsequent large national study of occupational therapy education. These strategies provide a foundation for dialogue and future research on the nature and function of core subjects in health professions education.

The Accountability-Well-Being-Ethics framework: a new philosophical foundation for occupational therapy.

BACKGROUND: The context that supported occupational therapy's inception has been replaced with new challenges brought on by globalization and dramatic changes in health care. Thus, the profession's philosophical grounding needs to be reframed to (a) achieve balance between science-driven and holistic elements, (b) operate within larger contexts on problems brought on by sociopolitical and natural determinants of health, and (c) maintain an ethical identity across all arenas of practice. PURPOSE: This paper presents a brief discussion of the philosophical underpinnings in occupational therapy's history, outlines new global challenges for the profession, and proposes a new framework to address these challenges through education, practice, and research. KEY ISSUES: Occupational therapy finds itself practising in a growing number of middle- and low-income countries where its roles and values need to be context and culture specific. IMPLICATIONS: The Accountability-Well-Being-Ethics framework guides the three domains of education, research, and practice to be relevant in an increasingly complex world.