Factors influencing LGBTQ+ disclosure decision-making by Canadian health professionals: A qualitative study.

Disclosure of LGBTQ+ identities at work may reap benefits, but may also exacerbate harms. Faced with ambiguous outcomes, people engage in complex concealment/disclosure decision-making. For health professionals, in contexts of pervasive heteronormativity where disclosure to patients/clients is deemed to violate professional boundaries, stakes are high. This qualitative study with 13 LGBTQ+ health professionals across Canada used semi-structured interviews to explore factors affecting disclosure decision-making, particularly attending to power structures at multiple levels. Most participants engaged in constant risk-benefit assessment, disclosing strategically to colleagues, rarely to clients/patients. At the individual level they were affected by degree of LGBTQ+ visibility. At the institutional level they were affected by the culture of particular professional fields and practice settings, including type of care and type of patients/clients, as well as colleague interactions. Professional power-held by them, and held by others over them-directly affected disclosures. Finally, intersections of queer identities with other privileged or marginalized identities complicated disclosures. Power relations in the health professions shape LGBTQ+ identity disclosures in complex ways, with unpredictable outcomes. Concepts of professionalism are infused with heteronormativity, serving to regulate the gender and sexual identity expression of queer professionals. Disrupting heteronormativity is essential to forge more open professional cultures.

Epistemic racism in the health professions: A qualitative study with Black women in Canada.

Systemic racism within health care is increasingly garnering critical attention, but to date attention to the racism experienced by health professionals themselves has been scant. In Canada, anti-Black racism may be embodied in structures, policies, institutional practices and interpersonal interactions. Epistemic racism is an aspect of systemic racism wherein the knowledge claims, ways of knowing and 'knowers' themselves are constructed as invalid, or less credible. This critical interpretive qualitative study examined the experiences of epistemic racism among 13 healthcare professionals across Canada who self-identified as Black women. It explores the ways knowledge claims and expert authority are discredited and undermined, despite the attainment of professional credentials. Three themes were identified: 1. Not being perceived or portrayed as credible health professionals; 2. Requiring invisible labour to counter professional credibility 'deficit'; and 3. Devaluing knowledge while imposing stereotypes. The Black women in our study faced routine epistemic racism. They were not afforded the position of legitimate knower, expert, authority, despite their professional credentials as physicians, nurses and occupational therapists. Their embodied cultural and community knowledges were disregarded in favour of stereotyped assumptions. Adopting the professional comportment of 'Whiteness' was one way these health care providers strived to be perceived as credible professionals. Their experiences are characteristic of 'misogynoir', a particular form of racism directed at Black women. Anti-Black epistemic racism constitutes one way Whiteness is perpetuated in health professions institutions.

Lower-class origin professionals in Canadian health and social service professions: "A different level of understanding".

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus, to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners.

Systemic Racism in Canadian Occupational Therapy: A Qualitative Study with Therapists.

Background. Research on racism within occupational therapy is scant, though there are hints that racialized therapists struggle. Purpose. This paper examines experiences of racism in occupational therapy, including coping strategies and resistance. Method. Ten therapists from racialized groups (not including Indigenous peoples) were recruited for cross-Canada, in-person or telephone interviews. Transcripts were coded and inductively analysed, with data thematically organized by types of racism and responses. Findings. Interpersonal racism involving clients, students, colleagues and managers is supported by institutional racism when incidents of racism are met with inaction, and racialized therapists are rarely in leadership roles. Structural racism means the experiences of racialized people are negated within the profession. Cognitive sense-making becomes a key coping strategy, especially when resistance is costly. Implications. Peer supports and community building among racialized therapists may be beneficial, but dismantling structures of racism demands interrogating how whiteness is built into business-as-usual in occupational therapy.

Experiences of epistemic racism among occupational therapists / Experiências de racismo epistêmico entre terapeutas ocupacionais

Abstract Objective Epistemic racism establishes the knowledges and ways of knowing of a dominant group as legitimate, invalidating those of groups marked by racialization. Professions are demarcated by their knowledge claims, making epistemic racism a powerful mechanism of exclusion within professions. This paper examines experiences of epistemic racism in occupational therapy across Canada. Method Using a critical interpretive qualitative approach, ten therapists from racialized groups were interviewed (in-person or telephone), with transcripts coded and analyzed iteratively. Results Participants routinely experienced epistemic 'mis/fit' with the profession, rarely seeing themselves reflected in the profession's knowledge base, leadership, values or assumptions. Racialized therapists were routinely denied expertise and authority, by students, clients and colleagues. They walked a tightrope between professional assimilation and marginalization. Conclusion The presence of racialized therapists is insufficient, when their authority is consistently delegitimized and they are required to assimilate. Leadership roles for racialized therapists must be accompanied with epistemological multiplicity, destroying the domination of whiteness.

Resumo Objetivo O racismo epistêmico estabelece os saberes e formas de saber de um grupo dominante como legítimos, invalidando os de grupos marcados pela racialização. As profissões são demarcadas por suas reivindicações de conhecimento, tornando o racismo epistêmico um poderoso mecanismo de exclusão dentro das profissões. Este artigo examina experiências de racismo epistêmico em terapia ocupacional no Canadá. Método Usando uma abordagem qualitativa interpretativa crítica, dez terapeutas de grupos racializados foram entrevistados (pessoalmente ou por telefone) e as transcrições foram codificadas e analisadas indutivamente. Resultados Os participantes vivenciam rotineiramente o "desajuste" epistêmico com a profissão, raramente se vendo refletidos na base de conhecimento, liderança, valores ou suposições da profissão. Os terapeutas ocupacionais racializados eram rotineiramente negados a perícia e autoridade, por alunos, clientes e colegas. Eles caminharam na corda bamba entre a assimilação profissional e a marginalização. Conclusão A presença de terapeutas ocupacionais racializados é insuficiente, sendo sua autoridade consistentemente deslegitimada e eles são obrigados a assimilar a ordem vigente. Os papéis de liderança para terapeutas ocupacionais racializados devem ser acompanhados de multiplicidade epistemológica, destruindo a dominação da branquitude.