"Being Holistic Is a Lot to Ask": A Qualitative, Cross-National Exploration of Occupational Therapists' Perceptions and Experiences of Holistic Practice

Being holistic is often used by occupational therapists to describe their practice and philosophy worldwide. This study explores the perspectives of 33 occupational therapists, working in 13 different countries, on their understanding of holistic epistemology and practice and how they seek to incorporate holism in their work. On the basis of a qualitative study design, individual interviews were conducted with the participants by 18 Norwegian undergraduate occupational therapy students, supported by their supervisors. The authors subsequently analyzed the transcribed data, using a thematic analysis approach. Three principal themes emerged: (1) holism as a broad and narrow concept, (2) being holistic spans from treating body parts to teaching marginalized children, and (3) being holistic is a lot to ask. When talking about holism and holistic practice, participants described their holistic practices in various ways, and their accounts reflected different understandings and cultural contexts. Participants characterized a holistic approach as one emphasizing the importance of occupations and activities and helping patients regain independence in their everyday lives. However, they also highlighted the specific challenges they faced, including cultural factors and inadequate resources. Significantly, participants from both Western and non-Western contexts emphasized the importance of holistic practice, suggesting that a dichotomous understanding of Eastern versus Western philosophical approaches does not necessarily make sense in occupational therapy interventions. Therapists' degree of commitment to client-centered practice appears of greater relevance. With its international perspective, our study sheds light on important areas of contemporary occupational therapy practice, including the difficulties occupational therapists face when seeking to cover "everything" in an effort to be more holistic.

Changing Perspectives of Local Therapists Eight Years after the Implementation of an Occupational Therapy Service in a Unique Himalayan Cross-Cultural Setting

Background. Whether concepts and principles of Occupational Therapy (OT) can successfully be applied to non-Western and cross-cultural settings is being intensively discussed. Aims/Objectives. We explored the changing perspectives of local occupational therapists (OTs) eight years after the implementation of an OT service in a Himalayan cross-cultural setting in terms of (1) treatment applied, (2) professional identity, and (3) cross-cultural interactions. Material and Methods. A qualitative study design was chosen, and semistructured interviews were conducted in all employed practitioners (a) during implementation and (b) eight years later (n = 7). Questions were carefully formulated in order to narrow down the intended issues but respecting crosscultural differences. The framework method was implemented for data analysis. Findings. Long-term empowering local OTs resulted in the successful development of a sustainable OT department in a unique Himalayan cross-cultural setting. Practitioners became aware of their therapeutic potentials, a clear sense of professional identity was developed, and it was recognised that sensitive cross-cultural practice is only achieved by an ongoing and intentional cultural learning process. Conclusions and Significance. Our findings suggest that OT can be applied to non-Western cross-cultural settings.

Current Landscape of Teaching Diversity in Occupational Therapy Education: A Scoping Review

IMPORTANCE

Critical research in health professions education makes clear the role of educational institutions in perpetuating problematic discourses related to diversity, as well as their potential role in dismantling and rebuilding those discourses to reflect the realities of power relations that create systemic injustice.

OBJECTIVE

To provide a comprehensive overview of current pedagogical practices and educational paradigms used by occupational therapy educators to teach concepts of, and skills for, equity and diversity.

DATA SOURCES

Seven education and health care databases were searched for articles published between 2007 and 2018.

STUDY SELECTION AND DATA COLLECTION

Consensually developed criteria were refined until an agreement rate of >80% was achieved among the authors. Inclusion criteria focused on entry-level occupational therapy education across the world and explicitly examined approaches to teaching diversity. All articles meeting the criteria were kept for full-text review (N = 87).

FINDINGS

Diversity in professional occupational therapy education programs is taught within five main underlying educational paradigms and theories: competency-based (44%), social justice (29%), critical (11%), social accountability (10%), and constructivism (6%). Within these paradigms, 14 key pedagogical practices were applied, with community service learning (37%), international service learning (25%), and didactic or course-based practices (23%) making up the majority of pedagogical practices.

CONCLUSIONS AND RELEVANCE

Although current occupational therapy research demonstrates a trend toward critical paradigms and practices, problematic cultural competency theories and uncritical international service learning practices continue to dominate occupational therapy education for diversity. Educators should implement pedagogies and approaches within critical educational paradigms.

WHAT THIS ARTICLE ADDS

This article highlights the importance to occupational therapy education of attending to coherence across educational ethics, paradigms, and learning outcomes in teaching for diversity and health equity.

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.

Crossing cultures: health promotion for senior migrants in the Netherlands

A health promotion programme focusing on the meaning of everyday activities was implemented and evaluated to test its usefulness for community-dwelling seniors in the Netherlands. To evaluate how senior migrants with a Surinamese-Hindustani background and professionals received the programme, and how it could be contextualized and improved in line with their values and expectations. A responsive evaluation methodology was followed to foster reflexive learning in and among stakeholders as the basis for programme contextualization. The evaluation consisted of three phases. Outcomes of former phases served as input for subsequent phases. Methods included interviews and focus groups with seniors and professionals. Open and selective coding techniques were used to analyse the interactively derived data. A. small group of women was interested and followed the programme. It was not individual concerns or daily life problems that dominated, but the wish to become well informed, to maintain functional capacities and to continue their roles in the family and community. Striking differences in perspectives between professionals and migrants related to conflict between the underlying Western values of the programme (independence, personal control and autonomy) and the values of the migrants (interdependence, predestination, rebirth and destiny). Awareness among professionals of their own cultural background and the values of the migrant seniors was enhanced, but adapting the programme to the local context and values appeared far more complicated than originally expected. Adaptation requires intensive collaboration with participants and cultural brokers in the community.

Sustaining international partnerships: the European Master of Science Programme in Occupational Therapy, a case study

International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions in Denmark, the Netherlands, Sweden, Switzerland and the UK since 1999. Data collection methods were documentary analysis and the reflections of a purposive sample of six key informants. Cohort and outcome data, from 193 students from 31 countries who enrolled between 1999 and 2011, are reported. Each cohort comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize joint decision making and accountability; and 4) the stimulus and satisfaction associated with internationalization. The main limitations are considering the OT-EuroMaster as an intrinsic case study and using opportunistic data collection that undermines the rigor and transferability of the findings. Future opportunities include doctoral networks, transnational research and sharing our curricula design with other Regions to spread the collaborative, capacity building endeavours more widely.