Experiences of Social Class: Learning from Occupational Therapy Students

Who is safe at work? Problematizing employment volatility during the 2008-2018 Spanish socioeconomic crisis from a critical occupational perspective

Abstract Introduction The Spanish socioeconomic crisis context has impacted on the population’s work conditions, which generates instability and workers’ fear of losing their job. Despite the recent research which addresses the work as an occupation in Critical Occupational Therapy and Science, little is known about the volatility of employment in relation to the job instability resulting from contextual changes. Objectives To explore the relationship between employment volatility, participation in daily occupations, and the health and wellbeing of workers during the Spanish socioeconomic crisis. Method A narrative qualitative methodology was conducted. Two open interviews and a personal diary were used as data generation methods. Two experiences were analyzed by adopting a thematic analysis. Results Three thematic categories illustrate how workers orchestrate their occupations in a context of employment volatility and they situate the multidimensional context of work in such circumstances as restrictive of occupational opportunities. Uncertainty generates a normalized instability in the daily life of workers, which impact occupational choices, health, and wellbeing. In addition, participants reflect on future perspectives of work associated with precarity and resignation. Conclusions The study of the employment volatility contributes to broadening the conceptualization of work as an occupation and contribute to the development of occupational justice-based practices.

“¿Quién está seguro en el trabajo?” Problematizando la estabilidad laboral durante la crisis socioeconómica española 2008-2018 desde una perspectiva ocupacional crítica

Resumen Introducción El contexto de crisis socioeconómica en España ha repercutido en las condiciones laborales de la población, generando situaciones de incertidumbre y miedo a perder el empleo por parte de los/as trabajadores/as. A pesar de las emergentes líneas de investigación que abordan el empleo como ocupación en Terapia y Ciencia de la Ocupación crítica, poco se sabe sobre la volatilidad del empleo en relación a la amenaza de pérdida del mismo derivada de cambios contextuales. Objetivos Explorar la relación entre la amenaza de pérdida de empleo, derivada de cambios contextuales, y la participación en ocupaciones cotidianas, la salud y el bienestar durante la crisis socioeconómica en España. Metodología Se llevó a cabo un estudio cualitativo exploratorio con diseño narrativo. Las técnicas de generación de datos fueron dos entrevistas semiestructuradas en profundidad y un diario personal. Se analizaron las experiencias de dos participantes mediante análisis temático. Resultados Emergieron tres categorías temáticas que ilustran cómo los/as trabajadores/as orquestan sus ocupaciones en un contexto de empleo volátil y sitúan el trabajo en un contexto multidimensional que restringe sus posibilidades ocupacionales. La inseguridad laboral genera una inestabilidad normalizada en la vida diaria, lo cual impacta en las elecciones ocupacionales, salud y bienestar de trabajadores/as. Los/as participantes reflexionan sobre sus perspectivas futuras de trabajo asociadas a la precariedad y resignación. Conclusión El estudio de la situación de amenaza de pérdida de empleo permite ampliar la conceptualización del trabajo como ocupación y contribuir en el desarrollo de prácticas basadas en la justicia ocupacional.

Social and Structural Determinants of Health: Exploring Occupational Therapy's Structural (In)competence

Background: In high-income countries, such as Canada, 50% of health outcomes are attributable to social determinants. Occupational opportunities are also structurally determined, yet these inequities are obscured by the White, Western assumptions and ableist neoliberal ideology in which the profession is deeply rooted. Purpose. To highlight the impact of structural injustices and other social determinants of health and occupation; explore the occupational therapy profession's structural competence; and build on existing knowledge to advance an agenda for action on injustice and inequity for the occupational therapy profession. Key issues. Occupational therapy's failure to prioritize education, research and action on systemic injustices and other social determinants of health and occupation reflects a lack of commitment to achieving the World Federation of Occupational Therapists' Minimal Standards. Implications. If occupational therapy is to advance knowledge and practices that address inequities in the social and structural determinants of health and occupation, we must strive towards structural competence.

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.

Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts

BACKGROUND.

Occupational therapy practice is enhanced through clear understanding of its epistemological foundations. In the area of substance use, practices are strongly functionalist.

PURPOSE.

This study unearths epistemologies through analyzing practices addressing the social needs of clients with problematic substance use.

METHOD.

This study used an exploratory qualitative approach and was based on Marxist philosophies. Qualitative interviews were conducted with nine occupational therapists experienced in working with substance users. Data were analyzed through a dialectic approach to content analysis based on the Marxist theory of labour process.

FINDINGS.

The occupational therapy practices were found to follow common principles: clients are agents of transformation in health processes; creativity is a strong element of practice and underlies the whole therapeutic process; and conditions of social reproduction compose the object of occupational therapy (i.e., what is transformed through occupational therapy practices). Two different approaches using these principles were uncovered according to the labour-process purposes: inclusive and emancipatory.

IMPLICATIONS.

Systematization of practices based on epistemological foundations strengthens occupational therapists' ability to link actions to theories.

The Dr Elizabeth Casson Memorial Lecture 2018: Occupational stories from a global city

The Dr Elizabeth Casson Memorial Lecture 2018, given on June 12th 2018 at the 42nd Annual Conference and Exhibition of the Royal College of Occupational Therapists, held at the Belfast Waterfront, Belfast, UK.

This lecture aims to set out the potential for the global occupational therapy profession to exchange knowledge for social transformation practice. It identifies the profession’s concern with narratives as a vehicle for a socially critical approach to occupation, which can be used to negotiate intervention and action. Drawing on examples from literature, history and service users, the paper suggests that narrative provides a means for relating the value of occupation beyond professional boundaries to capture popular imagination and demand for the profession. Examples are given of the critical discussion of the everyday impact of health inequity, and in addressing diversity both in the profession and engaging service users.

My lecture concludes that occupational therapy is a global network with the population of a city, and thus represents a community that can be a vibrant voice for social transformation through occupation through a reciprocal exchange of narrative. This is a collective and dialogical process which can draw on the experiences of both southern and northern hemispheres.

Transitional journeys into, and through medical education for First-in-Family (FiF) students: a qualitative interview study

BACKGROUND

There has been much interest in the transitions along the medical education continuum. However, little is known about how students from non-traditional backgrounds experience both the move to, and through Medical School, and their ambitions post-graduation. This research sought to understand the transitional journey into, and through undergraduate medical education, and future career aspirations for first-in-family (FiF) medical students.

METHODS

Based on a interpretivist epistemological perspective, 20 FiF students from one English Medical School participated in semi-structured interviews. Participants were identified according to purposive inclusion criteria and were contacted by email via the student association at the Medical School and academic year leaders. The team approach to the thematic analysis enhanced the findings credibility. This research was part of an international collaboration.

RESULTS

In the first transition, 'The Road to Medical School', a passion for science with an interest in people was a motivator to study medicine. Participants' parents' shared the elation of acceptance into Medical School, however, the support from school/college teachers was a mixed experience. In 'The Medical School Journey' transition, knowledge about the medical curriculum was variable. 'Fitting' in at Medical School was a problem for some, but studying for an elite degree elevated social status for many study participants. A source of support derived from senior medical student peers, but a medical degree could sacrifice students' own health. In the final transition, 'Future Plans', a medical career was perceived to have intrinsic value. Clarity about future aspirations was related to clinical experience. For some, career trajectories were related to a work-life balance and future NHS working conditions for Junior Doctors.

CONCLUSIONS

The transitions highlighted in this article have important implications for those educators interested in a life cycle approach to widening participation in medical education. Future research should explore the post-graduation transitions for doctors from first-in-family University backgrounds.

Predictors of academic performance and education programme satisfaction in occupational therapy students

Introduction

Thriving and performing well in entry-level programmes is important to occupational therapy students, but also for the competitive status of the institutions providing their education. The literature is sparse concerning the factors of importance for occupational therapy students’ academic performance in, and satisfaction with, their education programme.

Method

This cross-sectional study explored sociodemographic, relationship, education and work-related variables and their associations with the students’ academic performance and satisfaction with the education programme. The data were analysed with multivariate linear regression.

Results

Participants were 123 students (mean age 24 years, 80% women) enrolled in an undergraduate occupational therapy programme in Norway. Having prior experience of higher education was associated with better academic performance, whereas having occupational therapy as the highest priority line of study at entry, and spending fewer hours on self-studies, were associated with lower satisfaction with the education programme.

Conclusion

To improve academic performance, occupational therapy educators are encouraged to help students learn about the tasks, requirements, standards and culture that constitute higher education. To improve satisfaction, it may be most efficient to target students who initially indicate the most interest in studying occupational therapy.

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.

Social occupational therapy

Background.

Researchers and practitioners worldwide have advocated for the development of critical perspectives in occupational therapy to examine the structural influences of social exclusion and injustice experienced by individuals, groups, and communities. To take action against social exclusion and injustice, Brazilian occupational therapists have been developing “social occupational therapy,” referring to practice that is focused on social issues and funded outside the health system.

Purpose.

This paper presents a Brazilian perspective on the concept and practice of social occupational therapy. Illustrations are drawn from 12 studies, developed between 2008 and 2013, which were completed with socially vulnerable youth through an ongoing university-community engagement partnership in São Carlos, São Paulo State, Brazil.

Key issues.

The authors discuss possibilities and challenges for developing a socially committed, transformative occupational therapy outside the health system.

Implications.

Occupational therapists may wish to seize opportunities to address social issues and attract funding beyond health services.

Progression Routes and Attainment in Occupational Therapy Education: The Impact of Background Characteristics

Introduction:

United Kingdom government agendas promoting widening participation in higher education and diversification of the health and social care workforce have contributed to changing student profiles in pre-registration occupational therapy education. Sixty-seven percent of the 2005 intake was mature, and students increasingly enter with a range of ‘non-traditional’ academic backgrounds. A small body of evidence suggests that final degree marks are indistinguishable for occupational therapy students holding traditional and non-traditional entry qualifications, but none of these studies considered students unable to complete or the potential influence of socioeconomic background or gender.

Method:

The progression routes and academic achievements of 239 consenting occupational therapy students from a single programme were analysed using inferential statistics and binary logistic regressions to explore the influence of entry qualifications, age at entry, gender, and socioeconomic background.

Findings:

None of these characteristics had a statistically significant impact on graduates' final degree marks. The regressions, however, highlighted male gender and less privileged socioeconomic backgrounds as significant predictors of poorer outcomes regarding passing at Level 4, 5, and 6, and achievement of a ‘good’ (upper second or first class) honours degree.

Conclusion:

The findings raise important questions about how a profession that promotes social justice supports diversity amongst its own ranks.

Occupation, well-being, and culture: Theory and cultural humility / Occupation, bien-être et culture : la théorie et l’humilité culturelle

Background.

The Canadian Model of Occupational Performance and Engagement depicts individuals embedded within cultural environments that afford occupational possibilities. Culture pertains not solely to ethnicity or race but to any dimension of diversity, including class, gender, sexual orientation, and ability.

Purpose.

This paper highlights specific dimensions of cultural diversity and their relationships to occupational engagement and well-being.

Key issues.

Cultural variations constitute the basis for a socially constructed hierarchy of traits that significantly determine occupational opportunities and impact mental health and well-being. Cultural humility is an approach to redressing power imbalances in client-therapist relationships by incorporating critical self-evaluation and recognizing that cultural differences lie not within clients but within client-therapist relationships.

Implications.

It is proposed that theoretical relevance would be enhanced if culturally diverse perspectives were incorporated into theories of occupation. Cultural humility is advocated as an approach to theoretical development and in efforts to counter professional Eurocentrism, ethnocentrism, and intellectual colonialism.

The Impact of Chronic Low Back Pain on Leisure Participation: Implications for Occupational Therapy

Aim:

Chronic low back pain can reduce engagement and participation in all areas of daily life. Previous research has focused on employment and vocational rehabilitation initiatives, with less attention paid to its impact on leisure. This paper examines the difficulties men with chronic low back pain experienced in the maintenance of their leisure activities. It explores the connection between leisure and social networks and the potential barriers to resuming leisure occupations due to chronic low back pain.

Method:

This ethnographic study examined the experiences of 11 men involved in a vocational rehabilitation programme in New South Wales, Australia. Data were gathered using participant observation and semi-structured interviews.

Findings:

Chronic low back pain has a critical impact on leisure occupations. It creates two barriers to a client's engagement in former leisure occupations: physical restrictions and financial barriers.

Conclusion:

The findings build on knowledge of how leisure impacts on social dimensions of health and wellbeing. Occupational therapists can play an important role in enabling people with chronic low back pain to re-engage in leisure. These interventions may reduce the social isolation experienced by individuals due to the loss of leisure activity.

Culture and Diversity among Occupational Therapists in Ireland: When the Therapist is the ‘Diverse’ One

Introduction:

Literature in occupational therapy, although paying increased attention to cultural differences and diversity, has largely ignored the situation of therapists who are themselves members of social and cultural minority groups. ‘Difference’ is assumed to be exclusively an attribute of the client.

Method:

This qualitative study explored the professional experiences of 12 occupational therapists in Ireland who self-identified as disabled or ethnic minority group members.

Findings:

Participants reported challenges with colleagues and managers, which revolved primarily around cultural differences in the norms and expectations guiding social interactions, communications and practice styles. Overt discrimination was reported only by disabled therapists. With clients, again there were clashes of cultural values, but participants also experienced overt and covert prejudice and intolerance. This was particularly difficult to respond to in the context of client-centred practice.

Conclusion:

Cultural competence, as the prevailing approach to diversity, emphasises suspending one's own values to facilitate those of clients. This demand may be inappropriate for minority therapists who may face prejudice and discrimination. In contrast, cultural humility and critical reflexivity emphasise negotiating values in the context of social power relations, an approach that may better position occupational therapy to benefit from a diverse workforce.