"The Effects of Culture and Gender on Occupational Therapy Practice for Adults: From Palestinian Therapists' Perspective"

As the occupational therapy profession is rooted in Western ideals, it may encounter complexities in culturally traditional settings like Palestine, especially for adults. This study reveals the challenges faced by occupational therapists in Palestine. A phenomenological qualitative approach was used, interviewing six experienced female therapists using semi-structured interviews. Purposive sampling ensured a diverse participant selection. Thematic analysis revealed several key themes, such as the continuous adaptation to Western practices to fit the Palestinian context, the value of interdependence, and the unique life balance. Results show that cultural and gender norms significantly shape occupational therapy practices in Palestine. The discussion emphasizes the theoretical necessity for cultural sensitivity in occupational therapy, advocating alignment with local values and addressing resource limitations for effective service delivery.

Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes - A Co-Design Study

Introduction

Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes.

Methods

In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping.

Results

In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures.

Discussion

The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.

Going to the Source: Discussions With Early and Mid-Career Faculty From Groups Underrepresented in Biomedical Research to Develop and Enhance CFAR Services

BACKGROUND

To include, sustain, and retain HIV-focused early career faculty from groups historically excluded from biomedical research, the Providence/Boston Center for AIDS Research (CFAR) conducted focus groups and individual interviews with early and mid-career faculty to discern their needs.

METHODS

We conducted focus groups and interviews with 15 faculty at institutions affiliated with Providence/Boston CFAR from groups underrepresented in biomedical research. The discussion was guided using the domains of an Asset Bundle Model encompassing scientific human capital, social capital, and financial capital.

RESULT

Participants' identities, including their race, ethnicity, gender, sexual orientation, and being a parent affected their vision of themselves as scientists. Participants reported confusion or limited training on or access to resources for professional development, hiring staff, meeting NIH reporting requirements, international research, support for working parents, sabbaticals, and addressing workplace conflict or unsupportive work environments. Some described feeling like they were a burden on their mentors who seemed overextended. They identified attributes of effective mentors, such as believing in and investing in the mentee; having the requisite content area expertise and self-confidence; being able to identify mentees needs and meet them where they are; and being consistent, communicative, respectful, and kind. They described a need for additional education and support preresearch and postresearch grant award management.

CONCLUSIONS

To learn how to equitably serve all interested in HIV research, CFARs should engage and include perspectives from scientists who have historically been excluded from biomedical research. Our future work will test, implement, and disseminate the ideas generated by these focus group discussions.

A critical review of cultural competence frameworks and models in medical and health professional education: A meta-ethnographic synthesis: BEME Guide No. 79

BACKGROUND

Cultural competence resides at the core of undergraduate and postgraduate medical and health professional education. The evolution of studies on cultural competence has resulted in the existence of multiple theoretical frameworks and models, each emphasising certain elements of culturally appropriate care, but generally lacking in providing a coherent and systematic approach to teaching this subject.

METHODS

Following a meta-ethnographic approach, a systematic search of five databases was undertaken to identify relevant articles published between 1990 and 2022. After citation searching and abstract and full article screening, a consensus was reached on 59 articles for final inclusion. Key constructs and concepts of cultural competence were synthesised and presented as themes, using the lens of critical theory.

RESULTS

Three key themes were identified: competences; roles and identities; structural competency. Actionable concepts and themes were incorporated into a new transformative ACT cultural model that consists of three key domains: activate consciousness, connect relations, and transform to true cultural care.

CONCLUSION

This critical review provides an up-to-date synthesis of studies that conceptualise cultural competence frameworks and models in international medical and healthcare settings. The ACT cultural model provides a set of guiding principles for culturally appropriate care, to support high-quality educational interventions.

Occupational multi-level responsiveness: Describing the skills used by occupational therapists working with children seeking asylum in Australia

BACKGROUND

Children seeking asylum face occupational deprivation and human rights violations. No research has investigated how occupational therapists work with child asylum seekers. The World Federation of Occupational Therapists promotes the Canadian Model of Client-Centred Enablement (CMCE) for occupational therapists working to promote human rights.

AIMS/OBJECTIVES

This research investigates use of CMCE skills to investigate skills occupational therapists use when working with child asylum seekers in Australian immigration detention.

MATERIAL AND METHODS

Interpretive description guided this investigation and purposive sampling was used to recruit 10 occupational therapists. Semi-structured interviews were conducted and thematically analysed.

RESULTS

Occupational multi-level responsiveness, an overarching practice skill, involved keying into individual, family and socio-political levels to respond to occupational injustices. A wide array of practice skills extending beyond the CMCE framework were used in a nuanced and interwoven manner spanning multiple levels.

CONCLUSIONS

Occupational multi-level responsiveness described occupational therapists working across macro-, meso- and micro-levels.

SIGNIFICANCE

Understanding and enacting occupational multi-level responsiveness may support occupational therapists to plan and implement effective strategies when tackling occupational injustices. The skills identified may be applicable to other complex socio-political fields of practice. More research is needed. Further research should also investigate the occupational experiences of children seeking asylum. KEY POINTSOccupational therapists working with child asylum seekers in Australia take a multi-level approach, responding to individuals, families and socio-political structures.A three pronged approach to implementation of the occupational therapy practice process could support multi-level responsiveness to enhance practice that addresses occupational injustices.CMCE skills are not exhaustive and therapists discussed using other skills beyond those listed in the CMCE. Additional skills reflected humility and efforts towards more equal relationships between therapists and clients.

Psychological Health and Quality of Life among Ultra-orthodox Mothers of Children with Attention Deficit Hyperactivity Disorder: Impact of Occupational Experiences

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a common neuro-developmental health condition in children and adolescents. Parenting a child with ADHD can profoundly affect mothers' health. Research is limited regarding occupational experiences and their impact on health among mothers of children with ADHD (MoCwADHD). Ultra-orthodox MoCwADHD may have unique cultural circumstances that have not been studied.

AIMS

To broaden understanding of parental stress, psychological health, and quality of life (QoL) of ultra-orthodox MoCwADHD and explore a possible role of occupational experiences on these outcomes.

METHODS

Ultra-orthodox MoCwADHD (N = 114) completed a sociodemographic questionnaire and measurements to assess child ADHD symptomatology, mother's ADHD, parental stress, psychological health, QoL, and occupational experiences.

RESULTS

Participants displayed moderate parental stress, and 54.9 percent also showed psychological distress symptoms, similar to the literature on MoCwADHD in the general population. Frequency of engagement in health promoting occupations reflected patterns in line with cultural beliefs. Structure Equation Modeling showed that child ADHD negatively affected mothers' stress, psychological health and QoL. Importantly, occupational experiences directly and indirectly, via parental stress, impacted psychological health and QoL.

CONCLUSIONS

MoCwADHD impacts maternal health in the ultra-orthodox population and occupational experiences may be a modifiable target for promoting their health.

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.

The Arab minority of East Jerusalem: An exploratory study of vocational rehabilitation in mental health

BACKGROUND

The Arab population of East Jerusalem with serious mental illness (SMI) is an ethnic and health status minority that has unique employment issues. Vocational rehabilitation offered to this population is guided by standard regulations that are grounded in knowledge obtained from Western communities on the employment enablers, while negligible research was done to investigate relevance of these enablers for the Arab population.

OBJECTIVE

The study aims to examine the previously well-established association between motor, cognitive, and emotional personal factors, occupation features, environmental characteristics, and vocational outcomes of job satisfaction and performance among the Arab population of East Jerusalem with SMI.

METHODS

Twenty-three men and women, aged 23-58, from this minority group who had received vocational rehabilitation participated in this cross-sectional study. They completed standard assessments of motor and cognitive skills, self-efficacy, work-environment suitability, and job satisfaction. Employers then rated their level of functioning at work.

RESULTS

No correlation was found between the outcome measurements and most of the personal factors and environmental characteristics (p > 0.05), except for an association between job satisfaction, work self-efficacy, and work control. No expected differences were found between vocational rehabilitation programs in the variables of interest (p > 0.05).

CONCLUSION

The disparity from well-established patterns of association between enablers and employment outcomes reveals unique characteristics of the investigated population and suggests the impact cultural issues has on vocational rehabilitation. The findings raise an urgent call for an in-depth investigation of the complex phenomenon of employment in this population to support sustainable employment benefits and recovery journey.

The Pictorial Interview of Children's Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations

Introduction

Executive functions (EFs) are strongly linked to attention deficit hyperactivity disorder (ADHD). The pictorial interview of children's metacognition and executive functions (PIC-ME) assesses children's self-perceptions regarding their EF. This study is aimed at describing the cultural adaptation of the PIC-ME to the ultra-Orthodox (UO) Jewish population in Israel.

Method

In the first of three stages, 30 occupational therapists, who were experienced in working with children with ADHD from the UO population, completed a questionnaire about the suitability of PIC-ME for the UO community. In the second stage, six therapists participated in a focus group to discuss the recommendations and the adaptations made following the first stage. In the third stage, 20 UO children aged 5-10 participated in the tool validation process.

Results

First stage: most of the items of the original tool were found to be appropriate in representing the EFs of UO children and did not need to be adapted. No significant differences were found between the boys' and girls' versions regarding the tool's adaptability. However, most of the therapists suggested that the pictures in both versions needed adaptations. Second stage: additional recommendations led to the development of a final adapted version. Third stage: over 70 percent agreement was found among UO children regarding the clarity of the adapted pictures. No significant differences were found between boys and girls or between age groups.

Conclusions

This study presented wide agreement on the necessity for cultural adaptation of the PIC-ME to the UO population and described the adaptation process. Based on its face validity, the UO version may be a useful tool to assess the self-perception of EF among UO children. Further studies are needed to assess its psychometric properties and its usefulness as an outcome measure. The study findings may contribute to the cultural adaptation of other tools for culturally distinct populations.

Ethnocultural Minority Workers and Sustainable Return to Work Following Work Disability: A Qualitative Interpretive Description Study

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.

Mothering a Child with ADHD in the Ultra-Orthodox Community

Mothers of children with ADHD are at risk for negative health outcomes. The socio-cultural environment and everyday experiences in life roles may influence psychological health and quality of life. The ultra-orthodox Jewish (UOJ) community is an insular community who is underrepresented in the research, and as such there are no studies exploring the experience of mothering a child in this community. Thus, this study aims to explore the lived experience of mothering a child with ADHD in the UOJ community. The study used a descriptive qualitative phenomenological approach. Ten UOJ mothers of children with ADHD underwent semi-structured in-depth interviews to explore their lived experiences of mothering a child with ADHD. Thematic analysis was carried out on the transcripts. Four main themes, along with several subthemes, emerged from the qualitative analysis: child ADHD manifestations, maternal role, social factors, and self-care. Unique characteristics of the UOJ culture were apparent throughout the themes. UOJ children with ADHD display similar manifestations of symptoms in daily life to those in the general population and maternal burden is similarly present. However, unique perceptions of their maternal role, social factors, and legitimacy for self-care shed light into the impact of this culture on their lived experience. Findings may help promote culturally sensitive health care and interventions for this understudied population.

Applying 'cultural humility' to occupational therapy practice: a scoping review protocol

INTRODUCTION

Cultural humility is becoming increasingly important in healthcare delivery. Recognition of power imbalances between clients and healthcare providers is critical to enhancing cross-cultural interactions in healthcare delivery. While cultural humility has been broadly examined in healthcare, knowledge gaps exist regarding its application in occupational therapy (OT) practice. This scoping review protocol aims to: (1) describe the extent and nature of the published health literature on cultural humility, including concepts, descriptions and definitions and practice recommendations, (2) map the findings from objective one to OT practice using the Canadian Practice Process Framework (CPPF), and (3) conduct a consultation exercise to confirm the CPPF mapping and generate recommendations for the practice of cultural humility in OT.

METHODS AND ANALYSIS

We will search Ovid Medline, Ovid Embase, Ovid PsycINFO, Ebsco CINAHL Plus, ProQuest ASSIA, ProQuest Sociological Abstracts, ProQuest ERIC, WHO Global Index Medicus, and Web of Science databases. Published health-related literature on cultural humility will be included. There will be no restrictions on population or article type. Following deduplication on Endnote, the search results will undergo title, abstract, and full-text review by two reviewers working independently on Covidence. Extracted data will include descriptors of the article, context, population, and cultural humility. After descriptive extraction, data describing cultural humility-related content will be descriptively and interpretively analysed using an inductive thematic synthesis approach. The data will also be mapped to OT practice through deductive coding using the CPPF. Occupational therapists and clients will be consulted to further critique, interpret and validate the mapping and generate practice recommendations.

ETHICS AND DISSEMINATION

Ethics approval was not required for this scoping review protocol. We will disseminate the findings, which can enhance understanding of cultural humility in OT, facilitate cross-cultural encounters between occupational therapists and clients and improve care outcomes through publications and presentations.

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.

Working With Lesbian, Gay, Bisexual, and Transgender Clients: Occupational Therapy Practitioners' Knowledge, Skills, and Attitudes

IMPORTANCE

A lack of health care provider knowledge and training has been identified as one factor that contributes to health disparities for sexual and gender minority (SGM) populations.

OBJECTIVE

To explore occupational therapy practitioners' self-reported knowledge about, clinical preparedness for, and attitudes toward working with lesbian, gay, bisexual, and transgender (LGBT) clients.

DESIGN

Online survey of occupational therapy practitioners.

PARTICIPANTS AND SETTING

Respondents were recruited by means of snowball sampling through social media groups, state occupational therapy association websites, and emails. Surveys were posted to electronic occupational therapy social media sites.

MEASURES

Knowledge, clinical preparedness, and attitudes were measured using the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Information about demographic characteristics, education, and workplace was also collected.

RESULTS

Five hundred eighty-nine occupational therapy practitioners responded to the survey. Degree level (master's vs. bachelor's or less), continuing education (minimum 1-2 hr of LGBT-specific training), practice setting (mental health), minority sexual orientation, and having a close friend or family member who identifies as SGM were associated with higher mean scores on the LGBT-DOCSS. Higher religiosity and frequency of religious practice were associated with lower scores on knowledge and attitudinal awareness.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners often care for clients from backgrounds and cultures that differ from their own. Identifying gaps in education and opportunities for fostering LGBT-positive attitudes can facilitate the development of programs to improve practice with LGBT clients and help measure the effectiveness of such programs. What This Article Adds: This study provides evidence that a basic level of continuing education can improve occupational therapy practitioners' knowledge of and skills for working with LGBT populations and highlights the need to examine and change structural biases.

Cultural competence in healthcare professionals, specialised in diabetes, working in primary healthcare-A descriptive study

Self-care is the most important cornerstone of diabetes treatment. As self-care is affected by cultural beliefs, it is important for healthcare professionals to be able to adapt their educational approach and to be culturally competent. The aim of this study was to describe the cultural competence in Swedish healthcare professionals, specialised in diabetes care and to examine related factors for cultural competence. The healthcare professionals' perceived level of cultural competence was measured across three domains-Openness and awareness, Workplace support and Interaction skills-in 279 Swedish healthcare professionals from all 21 regions of Sweden, using the Cultural Competence Assessment Instrument (Swedish version-CCAI-S). Descriptive statistics were used to describe cultural competence in healthcare professionals, and linear regression was conducted to examine factors related to cultural competence. Of the healthcare professionals studied, 58% perceived that they had a high level of Openness and awareness, 35% perceived that they had a high level of Interaction skills and 6% perceived that they had a high level of Workplace support. Two factors were found to be related to cultural competence, namely, high percentage of migrant clients at the healthcare clinic and whether the healthcare professionals previously had developed cultural competence through practical experience, education and/or by themselves. In conclusion, most healthcare professionals perceived that they had cultural openness and awareness but need more support from their workplace to improve their interaction skills. Cultural competence-related education could support the healthcare professionals to develop interaction skills.

The Concept of Oppression and Occupational Therapy: A Critical Interpretive Synthesis

Background. Occupational therapy and occupational science literature include growing attention to issues of justice, marginalization, and rights. In contrast, the concept of oppression has scarcely been employed. Purpose. This paper investigates how adding the concept of oppression may enhance occupational therapy approaches to injustice, prioritizing a focus on structural causes, and facilitating conscientious action. Method. A critical interpretive synthesis explored insights from authors who name oppressions in occupational therapy and occupational science literature. In total, a sample of 28 papers addressing oppression, ableism, ageism, classism, colonialism, heterosexism, racism, and/or sexism was selected for inclusion. Findings. Four themes were identified: oppression and everyday doing; effects of structures and power; responding and resisting; and oppression within occupational therapy. Implications. Incorporating oppression within the plurality of social discourse may help occupational therapists to avoid individualistic explanations, attend to relationships between social structures and constrained occupations, frame intersectional analysis, and engage in praxis.

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.

Occupational therapy for people with mask anxiety undergoing radiotherapy

INTRODUCTION

Up to one third of people with head and neck cancer undergoing radiation therapy experience mask anxiety. However, there is limited literature guiding the role of health professionals, including occupational therapists, in managing mask anxiety. This study aimed to explore the content of occupational therapy interactions with people who have identified mask anxiety.

METHODS

A cohort of 20 participants with identified mask anxiety engaged in semi-structured interviews with occupational therapists. Theoretical thematic analysis and the framework provided by the Canadian Model of Occupational Performance and Engagement (CMOP-E) were employed to explore the content of occupational therapy interactions with people experiencing mask anxiety.

RESULTS

Theoretical thematic analysis identified 13 relevant themes with 49 codes relating to the interaction between participants and occupational therapists. Analysis of these interactions identified the occupational therapy role to be holistic and multifaceted. The cognitive, affective, and institutional components of the CMOP-E were dominantly explored by the occupational therapists with participants. Occupation, spirituality, and the cultural environment were either not addressed or minimally discussed with participants.

CONCLUSION

The management of mask anxiety during radiation therapy is a novel area of practice for occupational therapists. The results of this study suggest that the occupational therapy profession explores a range of factors with the person undergoing radiation therapy with mask anxiety, and that the CMOP-E model can be used to guide these interactions. Future research is required to further define this role and its efficacy in managing mask anxiety.

Parents' ability to access community health occupational therapy services in a disadvantaged area: A proof of concept study

INTRODUCTION

In New South Wales, children from disadvantaged backgrounds have poorer health outcomes and reduced access to health services than their more advantaged counterparts. This study aimed to identify barriers and enablers to accessing child and family occupational therapy services in a disadvantaged area.

METHODS

This was a mixed methods study that included: (a) a retrospective analysis of de-identified routinely collected Community Health service utilisation data from 2016 to 2017, and a (b) face to face interview guided survey with parents and carers.

RESULTS

The retrospective data analysis showed outreach at the targeted suburbs' Early Childhood Health Centres (ECHC) improved attendance for families living in these suburbs. Parents' responses indicated that they were able to access the Community Health Centre (CHC) and certain barriers to accessing the service remain, including difficulty in parking and not having a license or car to attend appointments. Low health literacy was also a barrier to accessing health appointments as parents were unaware of the range of services provided at CHC, did not know how to make appointments, or that these services did not generate out-of-pocket expenses to clients. Conversely, enablers that would make it easier for parents to attend appointments include the provision of home visits, after hours and weekend appointments, and outreach such as delivering services in community spaces such as the ECHCs, library, or mosque.

CONCLUSION

This research suggests that outreach occupational therapy services are valued by families in this disadvantaged area and contribute towards improving access to allied health services for disadvantaged families with young children. However, additional work is required to increase awareness among disadvantaged families on the role of allied health in improving child development outcomes and to reduce some of the transport and logistical issues that can reduce access to health care.

Moving From Cultural Competence to Cultural Humility in Occupational Therapy: A Paradigm Shift

OTHER

As the U.S. population becomes increasingly multicultural, occupational therapy practitioners must be adept at working with diverse populations. For the past 15-20 yr, many occupational therapy scholars have recognized this need, and in response, they have promoted cultural competence training. Although cultural competence has provided an important initial conceptual framework for the field, I argue that it is time to move toward a practice of cultural humility, which is defined by flexibility; awareness of bias; a lifelong, learning-oriented approach to working with diversity; and a recognition of the role of power in health care interactions. In this article, I present three main arguments why cultural humility is a more useful and critical conceptual framework than cultural competence, and I review preliminary research that examines the influence of cultural humility on patient experience. I conclude by briefly describing how cultural humility can be incorporated in occupational therapy curricula and applied in clinical and community practice settings.

WHAT THIS ARTICLE ADDS

This article provides a clear articulation of what cultural humility is, how it differs from cultural competence, and how it can be applied in occupational therapy.

Occupational Therapy Practice Framework: Domain and Process—Fourth Edition

The fourth edition of the Occupational Therapy Practice Framework: Domain and Process (hereinafter referred to as the OTPF–4), is an official document of the American Occupational Therapy Association (AOTA). Intended for occupational therapy practitioners and students, other health care professionals, educators, researchers, payers, policymakers, and consumers, the OTPF–4 presents a summary of interrelated constructs that describe occupational therapy practice.

The Influence of Culture on Occupational Therapy Practice in Jordan

Background

Occupational therapy's origins draw from Western culture, values, and beliefs which may impact the application of traditional occupational therapy practice in non-Western cultures.

Purpose

This study explored how occupational therapists in Jordan facilitate occupational therapy practice within Islamic Eastern culture.

Method

A phenomenological approach was used in this study. Semistructured interviews were conducted with eleven occupational therapists that work in Jordan and have at least two years of experience. Data were analyzed using thematic analysis methods.

Results

Three central themes emerged: impact of Jordanian culture and Islamic beliefs about independence and disability on occupational therapy practice, the therapists' notions of ideal occupational therapy practice vs. daily reality, and challenges posed by workspace and the availability of equipment.

Conclusion

This study highlights the growing need to translate and expand the core values of occupational therapy to align with cultures in non-Western countries and cultures.

Occupational Therapy for South Asian Older Adults in the United Kingdom: Cross-Cultural Issues

Introduction

There is limited understanding of the cultural needs of diverse Black and Minority Ethnic populations such as South Asian older adults, which may be perpetuating occupational injustices and health inequalities faced by these groups. Although cultural considerations are intrinsic to person-centred occupational therapy and increasingly relevant to the changing landscape of health and social care, the profession is criticised for its western-centric focus. This study aimed to gain understanding of the current cross-cultural issues in supporting South Asian older adults in the UK, as perceived by occupational therapists.

Method

A constructivist qualitative design supported by thematic analysis was used, involving seven occupational therapists in the United Kingdom who participated in semi-structured interviews via Skype/telephone.

Findings

Cross-cultural issues were illustrated through the following themes: ‘when the barriers go down’ – cultural mismatch in individualist vs. collectivist worldviews; ‘invasion of the family home’ – cultural inappropriateness of standard interventions; and ‘I go into every assessment assuming nothing’ – recognition of and response to challenges.

Conclusion

This study provides insight into cross-cultural issues in occupational therapy for South Asian older adults, revealing a gap between theory and practice in integrating cultural humility. It highlights the need for a more inclusive, person-centred approach to support culturally diverse populations.

Healthcare providers and community perspectives on expedited partner therapy (EPT) for use with gay, bisexual and other men who have sex with men

OBJECTIVES

Expedited partner therapy (EPT) is an effective strategy to reduce rates of chlamydia and gonorrhoea infection and ensure sexual partners are treated. Currently, EPT is provided to heterosexual patients; however, EPT is not routinely recommended for use with gay, bisexual and other men who have sex with men (GBMSM) because of concerns about HIV coinfection. The objective of the qualitative study was to understand provider and community views on the use of EPT with GBMSM.

METHODS

Using convenience sampling methods, we recruited a sample of 18 healthcare providers and 21 GBMSM to participate in in-depth, semistructured interviews. Interviews were conducted over the phone and included questions about knowledge, experiences and potential barriers and facilitators to the use of EPT with GBMSM.

RESULTS

Most providers wanted to provide EPT to GBMSM and believed that the potential barriers and concerns to EPT use were not unique to a patient's sexual orientation. Several providers noted that they were currently providing EPT to GBMSM as part of HIV prevention services. Community members were generally unaware of EPT as a service and most indicated that they would only use EPT if they were in a committed relationship. Barriers included partner allergies and resistance, pharmacy protocols, structural concerns (eg, insurance coverage, pharmacists onsite and transportation) and potential disclosure issues. Facilitators included cultural humility and telemedicine with patients' partners to overcome these barriers.

CONCLUSIONS

Acceptability of EPT use for both chlamydia and gonorrhoea was high among providers and community members. Barriers to EPT use, including concerns about patients' partners' allergies and resistance, disclosure concerns and linkage to HIV prevention services can be overcome through cultural humility trainings and telemedicine. Changing EPT recommendations at the national level to be inclusive of GBMSM is critical to curtail the rising STI and HIV epidemic.

Cultural humility as a form of social justice: Promising practices for global school psychology training

In an increasingly diverse global context in which school psychologists strive to ensure appropriate educational services for all, addressing social injustice is critical. Cultural humility can serve as a link between cultural diversity and social justice, providing a deep awareness that allows school psychologists to understand themselves and their interactions with diverse students and families. Additionally, cultural humility provides a lens for framing advocacy necessary to address social justice concerns. This article reviews the literature on cultural humility and suggests promising practices for training school psychologists as culturally humble practitioners.

Using Occupational Justice as a Linchpin of International Educational Collaborations

When designing international educational collaborations, occupational science and occupational therapy educators must consider how occupational justice can be a linchpin for students' learning. This article describes an international collaboration involving 52 undergraduate occupational science students in the United States and 41 undergraduate occupational therapy students in South Africa. The students participated in six synchronous video conferences in 2016, during which they gave group presentations about four occupational science constructs and engaged in general question-and-answer sessions. Forty percent of the students provided feedback about the interactions using a six-item open-ended electronic questionnaire, which we analyzed using directed content analysis. Our findings suggest that the collaboration helped the students develop more nuanced understandings of disciplinary constructs, international peers, and themselves, providing a platform from which to engage with the big idea of occupational justice. Refinements to this collaboration are aimed at drawing on students' increased critical consciousness to further develop their knowledge about occupational justice.

Fostering positive spaces in public health using a cultural humility approach

Culturally competent frameworks used within health care systems are contributing to the discrimination and marginalization of sexually and/or gender diverse persons. In this discursive paper, we argue that cultural humility ought to be implemented as the best practice approach for fostering sexually and gender diverse positive spaces in public health settings. A paradigm shift away from cultural competence frameworks toward cultural humility is necessary. This shift can be achieved by enhancing educational opportunities for public health nursing students and professionals and by recruiting organizational leaders to be champions for systemic change. In order to achieve this, we must establish effective educational programs that espouse cultural humility practices and develop valid measurement tools for assessing the provision of culturally humble care. This would equip educators, students, practitioners, and organizational leaders with the necessary tools to guide and assess their performance. Integrating a culturally humble approach will ultimately enhance self-reported cultural safety in public health spaces and reduce health inequities experienced by sexually and/or gender diverse clients and staff members.

Valeurs liées à la profession d’ergothérapeute : les répertorier pour les définir

Description.

Des imprécisions et des confusions conceptuelles caractérisent les écrits sur les valeurs liées à l’ergothérapie.

But.

Répertorier des valeurs liées à l’ergothérapie, proposer des énoncés qui les définissent et procéder à leur validation de contenu.

Méthodologie.

Une recension des écrits ( n = 52) et la consultation d’ergothérapeutes ( n = 26) ont permis de documenter et de définir une série de valeurs. Le répertoire issu de ces démarches a été soumis à un test de fonctionnalité auprès d’ergothérapeutes ( n = 5), puis présenté à des ergothérapeutes détenant une expertise en éthique ( n = 6) pour en évaluer la validité de contenu des définitions des valeurs.

Résultats.

Le répertoire proposé comprend 33 valeurs suivies de leur définition que les experts ont jugées claires et représentatives des réalités qu’elles désignent. Les résultats montrent que le répertoire est considéré comme exhaustif.

Conséquences.

Cette étude a permis de répertorier et de définir des valeurs qui constituent des idéaux susceptibles de guider la pratique ergothérapique et de soutenir les revendications ainsi que les compétences culturelles et éthiques des ergothérapeutes.

International Educational Interactions and Students' Critical Consciousness: A Pilot Study

Online technologies facilitate connections between students around the world, but their impact on occupational science and occupational therapy students' critical consciousness about culture is underexplored. In this article we present research on five groups of occupational science and occupational therapy students across two cohorts at one Midwestern university. We used a pretest-posttest group design and the Multicultural Experiences Questionnaire to investigate the potential influence of students' exposure to international educational interactions on their multicultural experiences and desires. Of 157 students surveyed, those who experienced the greatest number of international educational interactions demonstrated statistically significant increases in their desire to become acquainted with other people of different backgrounds and to explore their own prejudices and biases. Given the transformative potential of international educational interactions, future research must assess the ways in which such interactions affect critical cultural consciousness apart from other educational content and design.

Justice and U.S. Occupational Therapy Practice: A Relationship 100 Years in the Making

At 99 years old, occupational therapy is a global health care profession with a growing orientation toward justice. Because much of the occupational justice discourse has developed outside the United States, parallels between the profession's ethos and its current focus on justice must be examined more closely in this country. Although occupational therapy practitioners in the United States are better equipped than their predecessors with language and theories that explicitly emphasize justice, the potential for bringing that focus to bear depends on practitioners' willingness to think differently about their practices. We argue that a focus on justice can be naturally integrated with curriculum standards by emphasizing the link between cultural humility, client-centeredness, and embodied habits of "seeking out unknown others." Outside formal education, practitioners can be encouraged to think of justice as something that already intersects with practice, not something that practitioners must choose whether to take up.

Mentoring the Mentors of Underrepresented Racial/Ethnic Minorities Who are Conducting HIV Research: Beyond Cultural Competency

The majority of literature on mentoring focuses on mentee training needs, with significantly less guidance for the mentors. Moreover, many mentoring the mentor models assume generic (i.e. White) mentees with little attention to the concerns of underrepresented racial/ethnic minorities (UREM). This has led to calls for increased attention to diversity in research training programs, especially in the field of HIV where racial/ethnic disparities are striking. Diversity training tends to address the mentees' cultural competency in conducting research with diverse populations, and often neglects the training needs of mentors in working with diverse mentees. In this article, we critique the framing of diversity as the problem (rather than the lack of mentor consciousness and skills), highlight the need to extend mentor training beyond aspirations of cultural competency toward cultural humility and cultural safety, and consider challenges to effective mentoring of UREM, both for White and UREM mentors.

Feeling like a stranger: negotiations with culture as experienced by Chilean occupational therapists

BACKGROUND

Although occupational therapy has begun to focus on the subject of culture, few studies have examined how occupational therapists outside the English-speaking countries reflect on it.

AIM

To explore how Chilean occupational therapists reflect on their personal and professional experiences in regard to the complexity of culture, and its different understandings and expressions.

METHODS

This qualitative study uses content analysis to establish common trends in participants' experiences. A validation phase and data triangulation were implemented to ensure trustworthiness.

RESULTS

Culture is experienced as a continuous negotiation in personal and professional terms. One central theme, 'negotiating through the dynamism of culture', and three categories, 'dealing with power', 'understanding local and global identities', and 'crossing the boundaries into the client's land', emerged. These experiences are complex, chaotic, and highly context-dependent.

DISCUSSION

During therapeutic encounters, practitioners and clients may experience cultural barriers even if their differences are not obvious in cultural terms. As a result of this finding, we recommend the inclusion of culture and cultural issues in professional training. The impact of a multicultural research team is discussed. Future research should explore how the construct of culture is introduced in occupational therapy professional training in Chile.

Cultural Humility

Diversity is being increasingly recognized as an area of emphasis in health care. The term cultural humility is used frequently but society’s understanding of the term is unclear. The aim of this article was to provide a concept analysis and a current definition for the term cultural humility. Cultural humility was used in a variety of contexts from individuals having ethnic and racial differences, to differences in sexual preference, social status, interprofessional roles, to health care provider/patient relationships. The attributes were openness, self-awareness, egoless, supportive interactions, and self-reflection and critique. The antecedents were diversity and power imbalance. The consequences were mutual empowerment, partnerships, respect, optimal care, and lifelong learning. Cultural humility was described as a lifelong process. With a firm understanding of the term, individuals and communities will be better equipped to understand and accomplish an inclusive environment with mutual benefit and optimal care.

Critical reflexivity in client-centred therapeutic relationships

AIM/OBJECTIVES

This paper explores how a particular form of reflection--critical reflexivity--can support clinicians in developing a more nuanced understanding of therapeutic relationships, and work to advance the goal of client-centred practice.

METHODS

A critical autobiographical narrative was written, and critical reflexivity adopted, as methods to critically examine the therapeutic relationship.

FINDINGS

Critically reflexive stories have the potential to advance client-centred therapeutic relationships by inspiring the (re-)consideration of practices, and by interrogating interpretive systems.

DISCUSSION

Understandings and practices that potentially limit the extent to which therapeutic relationships are client centred include (i) Dichotomous thinking, (ii) Objectification, (iii) The economic imperative, and (iv) Knowledge generation.

CONCLUSION

The critical autobiographical account points to ways in which critical reflexivity on the therapeutic relationship has the potential to foster critical questioning, interrogate interpretive systems, attune to subjectivities, contribute to practice-based knowledge, resist violation, foster compassionate practice, and develop new understandings of relevance to client-centred practice.

SIGNIFICANCE

This critical examination of the therapeutic relationship supports occupational therapists in more fully realizing the profession's core value of client-centred practice.

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.

A scoping review of time-use research in occupational therapy and occupational science

BACKGROUND

Time use is a defining interest within occupational therapy and occupational science. This is evident through the range of contributions to the disciplinary knowledge base. Indeed it has been suggested that time-use methods are amongst the most established research techniques used to explore aspects of human occupation. However, the extent and nature of such activity in occupational therapy and occupational science has not been examined to date.

AIM

This study sought to map the extent and nature of time-use research in occupational therapy and occupational science journals and the extent to which studies explored the relationship between time-use and health.

METHOD

A scoping review method was used.

RESULTS

Sixty-one studies were included. Scandinavian countries contributed the largest number of studies (n = 16, 26%). While time-use diaries were used most frequently (n = 30, 49%) occupational therapists and occupational scientists have developed a range of data-collection instruments. Forty-nine studies (80%) focused on time-use in clinical or defined population sub-groups. Ten studies (16%) included an empirical examination of the relationship between time-use and health.

CONCLUSION

Future research should examine time-use and health amongst well populations across the lifespan and in different parts of the world.

Self-determination among frail older persons – a desirable goal older persons’ conceptions of self-determination

Purpose

– Self-determination is governed by ethical and legal rights in western society. In spite of that, older people are still restricted by others in their decision-making processes. The purpose of this paper is to explore older persons’ different conceptions of self-determination.

Design/methodology/approach

– A qualitative phenomenographic interview study on frail older persons (n=15).

Findings

– Three categories emerged, showing the variations of conception of self-determination as experienced by frail older people: first, self-determination changes throughout life; second, self-determination is being an agent in one's own life; and third, self-determination is conditional. In summary, while self-determination is changeable throughout life, and older persons want to be their own agents, and struggle to be that, certain conditions must be met to make it possible for them to be able to exercise self-determination.

Practical implications

– Suggestions for supporting and strengthening frail older persons’ self-determination, and indirectly their well-being and health: to have a person-centered approach, treat them with dignity and respect and give them opportunities to influence and to feel involved; to improve their health literacy by, for example, supporting them with enough knowledge to be able to exercise self-determination; to make them feel safe and secure in relationships, such as with family and caregivers.

Originality/value

– This study explores frail older persons’ own conceptions of self-determination to be able to gain knowledge of how professionals can support them so that they may experience self-determination in life.

The cultural brokerage work of occupational therapists in providing culturally sensitive care

Background.

The important place of culture within occupational therapy is widely recognized, and there is increasing emphasis on addressing the diversity of clients.

Purpose.

This study explores how occupational therapists perform cultural brokerage when providing culturally sensitive care to immigrant families.

Method.

A descriptive qualitative methodology was used for this study. A purposive sample of 17 occupational therapists from two Canadian paediatric rehabilitation centres were interviewed.

Findings.

Participants encountered several cultural and structural constraints in providing culturally sensitive care. To overcome these constraints, clinicians used four strategies: (a) translating between health systems for clients, (b) bridging different meanings of occupational therapy to make it relevant for clients, (c) establishing long-term relationships by building trust and rapport, and (d) working with clients’ relational networks to help them navigate the health system.

Implications.

Occupational therapists should advocate for both the individual needs of immigrant families and for institutional level resources to better meet the needs of diverse clients.