Occupational therapy and culture: a literature review

Abstract

Background: Occupational therapy has culture as a relevant phenomenon of interest. Culture appears increasingly often in occupational therapy research, from diverse approaches and foci. As culture is difficult to define, and has political and ethical implications, an investigation into its usage is warranted. Aim: To identify and describe how culture as a broad phenomenon is expressed in OT research published between 2006 and 2011, regarding knowledge development in the discipline and its impact on practice. Methods: A qualitative study was carried out, using an integrative literature review. Thirty-nine studies in English were included. Results: From the analysis, two dimensions concerning expressions of culture emerged: “culture is alive” and “occupational therapy as a culture”. Aside from these dimensions, a group of forces that have an impact on these dimensions is described. Conclusions: In its understanding of expressions of culture, occupational therapy stands at a crossroads between traditional and critical approaches. A lack of critical insight into professional knowledge increases the risk that occupational therapy will remain satisfied with the current understanding of culture, based on the dominant knowledge. The discipline could fail to address the political, ethical, and theoretical issues required to reach the targeted diversity in its practice.     

Cultural Safety and professional practice in occupational therapy: A New Zealand perspective

This research examined occupational therapists' attitudes to Cultural Safety for Maori clients. The main research tool was a semi-structured qualitative research interview. A cross-case analysis method was used to determine the major recurring themes. Thirteen participants with varied occupational therapy training backgrounds were interviewed. Current Cultural Safety education is designed to challenge health professionals' attitudes towards those culturally different from themselves. Results suggest that maturity and personal experiences had significant bearing on these attitudes. Implications for occupational therapy include implementing a policy that stipulates compulsory Cultural Safety education as part of professional development. Findings may have relevance for other countries where significant ethnic differentials in health service success exist, such as Australia.     

Reflections of occupational therapists working as members of a research team

Aim:  This qualitative study explored the effects of clinician participation in a randomised clinical trial on subsequent practice.
Method:  Eight occupational therapists responded to open-ended questions delivered by email about their reflections on participating in clinical research and its impact on their practice. Qualitative analysis uncovered therapists' motivation to participate in research, what they felt that they gained, and if and how research participation influenced practice.
Results:  Clinicians learned about research, practice, and their own clinical biases through their participation in clinical research.
Conclusion:  Our findings suggest that participation in research may contribute to shrinking the research-practice gap.     

Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members

Background/Aim:  The occupational therapy profession is in need of self-examination in view of the extent to which culturally constructed meanings of occupation guide its work within an increasingly diverse practice environment.
Methods:  Semistructured interviews were completed with 14 individuals who defined themselves as minority group members in order to gain an understanding of their experience of the occupational therapy process.
Results:  Five themes emerged: the importance of social location, the need for safety and acceptance, avoiding omissions, understanding differences in occupation, and the face of discrimination.
Conclusions:  Cultural and sexual identities influence occupational choices and interface with the social location of the therapist to influence the therapeutic process. Despite holistic and client-centred values, the comprehensive nature of occupational therapy is not experienced by clients of minority groups. Practice models are needed that provide directives for the establishment of alliances with minority clients and that highlight the significance of exploring occupational choices, experiences of oppression and the impact of the therapists' culture on the therapeutic process.     

Informing fieldwork design: Key elements to quality in fieldwork education for undergraduate occupational therapy students

Aim:  In this current climate of escalating student fees, students as paying consumers expect a quality fieldwork experience. However, the ability of universities to deliver quality fieldwork programs is compromised by the increasing pressure experienced by fieldwork educators to meet productivity targets in the face of diminishing resources. This paper details how one university, Monash University, sought input from stakeholders to design a fieldwork program.
Methods:  This qualitative study utilised focus groups to inform the researchers of stakeholders' perceptions of what constitutes quality fieldwork education. A total of five focus groups were held, involving 47 occupational therapists practising in Victoria.
Results:  The major findings include the need to provide ongoing professional development for fieldwork educators, the need to develop tangible strategies in recognition of their contribution towards fieldwork education, and the imperative for closer collaboration between universities and fieldwork educators.
Conclusions:  Based on literature and in response to the focus group discussions, Monash University has implemented a number of measures to ensure the successful implementation of quality fieldwork education. These include providing ongoing professional development for fieldwork educators to enhance their role, addressing fieldwork educators' concerns about project placements and supporting students with fieldwork relocation. Most importantly, this study demonstrates the need for educational institutions to take the lead in dialogue with the profession to enhance a collaborative response to constant changes in health-care directions. The importance of ongoing research to inform quality fieldwork education is critical to moving the profession forward.     

Occupational therapists experiences of implementing a new complex intervention in collaboration with researchers: a qualitative longitudinal study

Background: This study was conducted in the context of a randomized controlled trial where occupational therapists (OTs) in collaboration with researchers implemented a client-centred activity of daily living intervention (CADL) for persons with stroke.

Objective: The aim was to identify and describe over time the OTs’ experiences regarding the collaboration with the researcher in their role as implementers of a new complex intervention.

Method: Focus group interviews were conducted with 33 OTs, two, six and 12 months after they had participated in a five-day workshop. The interviews were analysed using a grounded theory approach.

Results: Three categories were identified: (1) Including in the scientific world, (2) Involving as an implementer of science and (3) Integrating in a partnership. One core category emerged: The implementation of client-centred intervention enabled the fusion of practice and science. An increased experience of using CADL and support from the researchers changed the OTs’ attitudes towards engaging in research from being an outsider to the scientific world to being included and then becoming a part of the research as an implementer of science.

Conclusions: To create a context built on a collaborative partnership between practitioners and researchers enabled the fusion of practice and science.     

Defining sensory modulation: A review of the concept and a contemporary definition for application by occupational therapists

Background: Sensory interventions are prevalent amongst adult mental health practitioners and are supported by major stakeholders and policy makers across the world. The term commonly used by occupational therapists applying sensory practices is sensory modulation, however this term has evolved.

Aims: This paper aims to investigate and clarify the definition of ‘sensory modulation’ for application by occupational therapists.

Method: A framework guided this concept analysis on sensory modulation. A summative content analysis approach was employed to code results.

Results: Six conceptual themes for sensory modulation were identified. 81% of authors defined sensory modulation as consisting of more than one of these themes. 18% of authors defined sensory modulation as both a neurophysiological process and means to regulate behaviour.

Conclusion: The concept of sensory modulation has evolved in occupational therapy practice. The authors summarise with the following proposed definition of sensory modulation for contemporary occupational therapy practice: ‘Sensory modulation is considered a twofold process. It originates in the central nervous system as the neurological ability to regulate and process sensory stimuli; this subsequently offers the individual an opportunity to respond behaviourally to the stimulus’.

Significance: A contemporary definition of ‘sensory modulation’ has been identified for occupational therapy practice.     

Development of a group-based self-management programme for individuals with chronic fatigue syndrome: a pilot study

Objective: The aim of the study was to develop a group-based self-management programme for individuals with chronic fatigue syndrome (CFS) by using the participants’ experiences with the initial version of the programme, which intends to promote coping with the illness in a primary healthcare setting. Methods: An initial programme was developed, based on self-efficacy theory and the concepts of client-centred practice and empowerment. Subsequently, the programme was tested and further developed by drawing on the participants’ experiences with the programme. Focus-group interviews were applied. The interviews were analysed using thematic analysis. Results: The initial programme was found to be feasible, although several modifications regarding the content and practical organization of the programme were proposed. Conclusion: In line with the participants’ experiences, the final self-management programme was developed, which includes short presentations of eight topics, exchange of experiences among participants, goal-setting, construction of action plans, and relaxation exercises, in addition to a meeting for relatives. The programme will be provided in eight biweekly sessions and be led by juxtaposed peer counsellors and occupational therapists. The effects of the final programme will be evaluated in a randomized controlled trial.     

Primary health care utilization by immigrants as compared to the native population: a multilevel analysis of a large clinical database in Catalonia

Abstract

Background: Research presented at scientific meetings is inaccessible to clinicians, unless the findings are subsequently published in a journal. Aims: To assess the publication rate of studies presented at 10 European General Practice Research Network (EGPRN) meetings between 1999 and 2006. Methods: Survey by e-mail or postal questionnaire among all presenters. Results: Information was obtained on 251 presentations (response rate 60%). In total, 113 out of these 251 (45%) presentations had been published. However, only 60% of the research findings were published in English Medline-listed journals, whereas 20% were not Medline-listed. The most frequently cited reason for non-publication was that the paper had not been submitted yet at time of follow up (103 responses). The main reason for non-submission was that the research presented had not been completed yet.

Conclusion: Presentations at EGPRN meetings commonly concern research ideas or ongoing research. In this light, the ratio of published work to presented work compares well with the corresponding ratios found for international meetings in other specialist fields. This survey was also meant as an audit of the EGPRN meetings and gives better insight in needs for future strategy.