Mapping intervention practices in social occupational therapy in Brazil.

BACKGROUND: Social occupational therapy developed in Brazil in the late 1970s and early 1980s as a practice approach to the social issues experienced by vulnerable populations. AIM: The aim of this study was to analyse the theoretical-methodological framework which has supported social occupational therapy practices and interventions in Brazil. METHOD: In a scoping review following PRISMA- ScR, the following databases were searched for publications reporting the practices and interventions of social occupational therapy: Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS) and The Cochrane Library. RESULTS: Twenty-six publications met the inclusion criteria. The interventions were aimed at socially vulnerable children and young people at risk of violations of their rights. The studies employed active/participatory pedagogical methodologies which make the participant groups' protagonism central to their learning and intervention process. These approaches are supported by social and human science epistemologies. CONCLUSIONS: Social occupational therapy has inaugurated a paradigm shift by prioritising working with populations in situations of vulnerability arising from socioeconomic, cultural, political and identity issues. This perspective is anchored in theoretical approaches which are strongly linked to collective social actions which arose from the conditions of Brazil's period of military dictatorship. SIGNIFICANCE: At a time when there has been increasing emphasis on addressing marginal groups and widening health inequalities social occupational therapy practice in community development contexts around a focus on vulnerability has been of increasing interest in the wider knowledge sphere of the profession. This article presents a scoping review for anglophone readers.

"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.

Enacting social transformation through occupation: A narrative literature review.

BACKGROUND: In occupational therapy and occupational science there is a drive to confront social and health injustices through occupation-based practices with social transformation as a goal. However, scholars acknowledge a lack of theory to support this developing area of practice. AIM: To explore how occupations have been used to enact social transformation for disadvantaged communities and to elucidate socially transformative outcomes. METHODS: A narrative literature review was carried out, focussing specifically on arts-based occupations, using seven databases. Thirty-eight items were included. RESULTS: Three overarching themes emerged: experiences related to giving voice; levels of change and arts-based occupations influence social change. CONCLUSIONS: Art forms as a means of expression can support people to make demands for change. This was true whether the art form was adopted at grass roots level, or via formalized projects run by researchers or Non-Government Organizations. Whilst personal change and small scale social change outcomes were achievable, larger scale structural change was not evident. Unintended outcomes in the form of risks to participants were reported. How and why change came about was not clearly articulated; leaving a need for further exploration of the mechanisms and contexts supporting change in the growing field of social transformation through occupation.

Occupational therapy practice education: A perspective from international students in the UK.

Background: Numbers of international students enrolling on occupational therapy (OT) courses in Western institutions have increased. Previous examination of these students' experience of practice education is limited.Objective: To explore the opportunities and challenges experienced by international students in OT practice education.Methods: This study adopted a phenomenological approach, recruiting six individuals from three UK universities. Data from semi-structured interviews was given thematic analysis for result interpretation.Results: Participants identified learning OT in the workplace, working in a multidisciplinary team and personal and professional development as practice education opportunities. Language difficulties, differences in communication styles, multiple cultural differences and unfamiliarity with the National Health Service (NHS) were the main challenges. Good practice educators and supportive team members were the main contributors to positive placement experiences.Conclusions: Participants gained knowledge and skills from practice education that existing healthcare literature suggests they are expected to attain. Several challenges were highlighted regarding participation in practice education. The findings reveal a need to enhance practice educators' skills in supervising international students. Universities are recommended to invest time and resources in supporting the learning needs of these students.Significance: The first study to present international students views on OT pre-registration practice placements in the UK.

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.

Healthcare students' perceptions about their role, confidence and competence to deliver brief public health interventions and advice.

BACKGROUND: Public health improvement has long been an important focus for the United Kingdom Department of Health. The Allied Health Professions (AHP) Federation has 84,000 members, such a large number of AHP professionals should play a role in public health initiatives, but it is not clear if they or the AHP students who will be the future healthcare workforce feel themselves equipped to do so. Our aim was to understand the perceptions of AHP students about their role in delivering public health advice. METHODS: AHP students were recruited in one teaching university from different departments. Participants were final year AHP students who had completed all clinical placements related to their course. All students were emailed an invitation to participate, and those interested were asked to contact the researchers to participate in one of several focus groups. Data were recorded, transcribed, and analysed using framework analysis by two independent researchers. RESULTS: Nineteen students were recruited and participated in four focus groups. The main themes produced by the data analysis were: understanding of public health issues, perceptions of their role in this, challenges and opportunities to develop a public health role, and preparation for a public health role. CONCLUSIONS: AHP students felt that they had a role in public health advice-giving, but barriers to providing this advice included their own lack of confidence and knowledge, time, and the environment of the clinical placement. They considered that there should be more teaching on public health issues, and that these should feature in both the curriculum and on clinical placement.

A scoping study of interventions to increase the uptake of physical activity (PA) amongst individuals with mild-to-moderate depression (MMD).

BACKGROUND: Depression is the largest contributor to disease burden globally. The evidence favouring physical activity as a treatment for mild-to-moderate depression is extensive and relatively uncontested. It is unclear, however, how to increase an uptake of physical activity amongst individuals experiencing mild-to-moderate depression. This leaves professionals with no guidance on how to help people experiencing mild-to-moderate depression to take up physical activity. The purpose of this study was to scope the evidence on interventions to increase the uptake of physical activity amongst individuals experiencing mild-to-moderate depression, and to develop a model of the mechanisms by which they are hypothesised to work. METHODS: A scoping study was designed to include a review of primary studies, grey literature and six consultation exercises; two with individuals with experience of depression, two pre-project consultations with physical activity, mental health and literature review experts, one with public health experts, and one with community engagement experts. RESULTS: Ten papers met the inclusion criteria and were included in the review. Consultation exercises provided insights into the mechanisms of an uptake of physical activity amongst individuals experiencing mild-to-moderate depression; evidence concerning those mechanisms is (a) fragmented in terms of design and purpose; (b) of varied quality; (c) rarely explicit about the mechanisms through which the interventions are thought to work. Physical, environmental and social factors that may represent mediating variables in the uptake of physical activity amongst people experiencing mild-to-moderate depression are largely absent from studies. CONCLUSIONS: An explanatory model was developed. This represents mild-to-moderate depression as interfering with (a) the motivation to take part in physical activity and (b) the volition that it is required to take part in physical activity. Therefore, both motivational and volitional elements are important in any intervention to increase physical activity in people with mild-to-moderate depression. Furthermore, mild-to-moderate depression-specific factors need to be tackled in any physical activity initiative, via psychological treatments such as Cognitive Behavioural Therapy. We argue that the social and environmental contexts of interventions also need attention.

The Social Relations of a Health Walk Group: An Ethnographic Study.

It is already well established that regular walks are conducive to health and well-being. This article considers the production of social relations of regular, organized weekly group walks for older people. It is based on an ethnographic study of a Walking for Health group in a rural area of the United Kingdom. Different types of social relations are identified arising from the walk experience. The social relations generated are seen to be shaped by organizational factors that are constitutive of the walks; the resulting culture having implications for the sustainability of the experience. As there appears to be no single uniting theory linking group walk experiences to the production of social relations at this time, the findings are considered against therapeutic landscape, therapeutic mobility, and social capital theorizing. Finally, implications for the continuance of walking schemes for older people and for further research are considered.

Who occupies disability? / Quem ocupa a deficiência?

[{"text": "Locating occupational therapy within gendered and racialized systems of power, the authors consider\r\nthe intersectional nature of critical disability studies discourse and the need for occupational therapy to incorporate such values into practice. This article discusses ways in which occupational therapy as a profession and individual therapists can align with or resist the economic determination which has come to dominate medical systems. It considers some of the political background to the history of the profession and its relationship with power. This positioning of the profession is explored against the impact of neoliberal economic policy on health, rights, service delivery and disability, and against some key issues, the pressure of ageing populations and the positon of occupational therapists as women professionals. Current policies present a critical challenge to central occupational therapy tenets. Occupational therapists may find themselves working both in alliance with disabled people and disability activists, and against them.", "_i": "en"}, {"text": "Localizando a terapia ocupacional dentro de seu gênero e radicalizando os sistemas de poder, os autores consideram a natureza interseccional do discurso de estudos de deficiência crítica e a necessidade da terapia ocupacional incorporar tais valores no interior de sua prática. Este artigo discute maneiras pelas quais a terapia ocupacional como uma profissão e os terapeutas ocupacionais individualmente podem alinhar-se ou resistir à determinação econômica que passou a dominar os sistemas de saúde. Considera-se alguns dos antecedentes políticos da história da profissão e sua relação com o poder. Este posicionamento da profissão é explorado contra o impacto da política econômica neoliberal sobre a saúde, os direitos, a prestação de serviços e a deficiência, e contra algumas questões-chave, como a pressão pelo envelhecimento da população e a posição de terapeutas ocupacionais como profissão de mulheres. As políticas atuais apresentam um desafio crítico aos princípios centrais da terapia ocupacional. Terapeutas ocupacionais podem encontrar-se trabalhando tanto em aliança com as pessoas com deficiência e militantes deste campo como contra eles.", "_i": "pt"}]

Walking, sustainability and health: findings from a study of a Walking for Health group.

Not only is it tacitly understood that walking is good for health and well-being but there is also now robust evidence to support this link. There is also growing evidence that regular short walks can be a protective factor for a range of long-term health conditions. Walking in the countryside can bring additional benefits, but access to the countryside brings complexities, especially for people with poorer material resources and from different ethnic communities. Reasons for people taking up walking as a physical activity are reasonably well understood, but factors linked to sustained walking, and therefore sustained benefit, are not. Based on an ethnographic study of a Walking for Health group in Lincolnshire, UK, this paper considers the motivations and rewards of group walks for older people. Nineteen members of the walking group, almost all with long-term conditions, took part in tape-recorded interviews about the personal benefits of walking. The paper provides insights into the links between walking as a sustainable activity and health, and why a combination of personal adaptive capacities, design elements of the walks and relational achievements of the walking group are important to this understanding. The paper concludes with some observations about the need to reframe conventional thinking about adherence to physical activity programmes.

A narrative of cultural occupational performance / Uma narrativa de performance ocupacional cultural

This article considers the occupational performance of cultural participation, specifically that of the author's personal experience of being a "worker writer" and grassroots activist in the Federation of Worker Writers and Community Publishers (FWWCP). The FWWCP was a UK based organisation made up of co-operative publishers, history, literacy and writing workshops which produced narratives and other forms of writing about ordinary people's experiences of everyday life in contemporary Britain. The author relates these experiences to occupational therapy's concern with the meaning of occupation, and uses heuristic methods to reflect on the connections between this form of community activism through cultural activity and occupational concepts. The paper explores issues of the representation of social class and political consciousness which have not been visible in the professional discourse on occupation. It concludes that there is a strong case for the exploration of autobiographical and community writing in developing understanding of the cultural basis of occupation.

Este artigo discute a performance ocupacional de participação cultural, especificamente a partir da experiência pessoal do autor em ser um "escritor trabalhador" e ativista de base na Federação de Trabalhadores Escritores e Editores Comunitários (FWWCP). A FWWCP era uma organização sediada no Reino Unido que realizava edições cooperativos, histórias, alfabetização e oficinas de escrita, que produziram narrativas e outras formas de escrita sobre experiências da vida cotidiana na Grã-Bretanha contemporânea. O autor relaciona essas experiências com a preocupação da terapia ocupacional sobre o significado da ocupação e utiliza métodos heurísticos para refletir sobre as conexões entre essa forma de ativismo comunitário, através da atividade cultural, e os conceitos de ocupação. O artigo explora as questões da representação de classe social e de consciência política que não têm sido visíveis no discurso profissional em ocupação e conclui que existe um forte argumento para a exploração de escrita autobiográfica e escrita em comunidade no desenvolvimento da compreensão sobre a base cultural da ocupação.

Participatory citizenship: Critical perspectives on client-centred occupational therapy.

BACKGROUND/AIMS: This article aims to discuss client-centred practice, the current dominant approach within occupational therapy, in relation to participatory citizenship. Occupational therapists work within structures and policies that set boundaries on their engagement with clients, while working with complex, multidimensional social realities. METHODS: The authors present a critical discussion shaped by their research, including a survey, discussions at workshops at international conferences, and critical engagement with the literature on occupational therapy, occupation, and citizenship. CONCLUSION: A focus on citizenship suggests reframing professional development based on the participation in public life of people as citizens of their society. While occupational therapists often refer to clients in the context of communities, groups, families, and wider society, the term client-centred practice typically represents a particular view of the individual and may sometimes be too limited in application for a more systemic and societal approach. SIGNIFICANCE: The authors question the individual focus which has, until recently, been typical of client-centred occupational therapy. Placing citizenship at the core of intervention is a transformative process that assumes all people are citizens and conceives of health as a collective issue, influencing the way we educate, do research, and practise.

Operationalizing community participation in community-based rehabilitation: exploring the factors.

PURPOSE: The purpose of this article is to critically discuss issues that pertain to the operationalization of community participation in community-based rehabilitation (CBR). METHOD: Data were drawn from an international, questionnaire-based survey of occupational therapists involved in CBR conducted through the World Federation of Occupational Therapists. A search of CINAHL. PsychInfo and Medline databases for articles on CBR was performed and both descriptive articles and analytical ones were included. RESULTS: Although there are guidelines on the nature of CBR these do not always match its application in practice. Active involvement of local communities in CBR projects is often limited, threatening the sustainability of CBR programmes. Furthermore, the failure to acknowledge the sociopolitical underpinnings and the cultural nature of disability is likely to compromise the nature of disabled people's involvement in CBR. CONCLUSIONS: There is confusion and lack of clarity about the nature of CBR. Educational modules on CBR should be made available to professionals. These should consider the importance of community involvement and context-specific and culture-sensitive programmes in practice.

Developing services for younger people with dementia.

The services available for younger people with dementia (typically between 45 and 65 years of age) are underdeveloped. This article describes how one trust has addressed the problem through a 'coffee shop' project. This drop-in facility allows younger people with dementia and their carers to meet informally, support each other and access a range of services, such as counselling, medical information, help with benefits and legal advice.