Occupational Justice Research Articles

Occupational therapy in the space of artificial intelligence: Ethical considerations and human-centered efforts

Background Artificial intelligence (AI) technology is constantly and rapidly evolving and has the potential to benefit occupational therapy (OT) and OT clients. However, AI developments also pose risks and challenges, for example in relation to the ethical principles of OT. One way to support future AI technology aligned with OT ethical principles may be through human-centered AI (HCAI), an emerging branch within AI research and developments with a notable overlap of OT values and beliefs. Objective To explore the risks and challenges of AI technology, and how the combined expertise, skills, and knowledge of OT and HCAI can contribute to harnessing its potential and shaping its future, from the perspective of OT’s ethical values and beliefs. Results Opportunities for OT and HCAI collaboration related to future AI technology include ensuring a focus on 1) occupational performance and participation, while taking client-centeredness into account; 2) occupational justice and respect for diversity, and 3) transparency and respect for the privacy of occupational performance and participation data. Conclusion and Significance There is need for OTs to engage and ensure that AI is applied in a way that serves OT and OT clients in a meaningful and ethical way through the use of HCAI.

Workplace Exposures Vary Across Neighborhoods in the US: Implications on Social Vulnerability and Racial/Ethnic Health Disparities.

Ignoring workplace exposures that occur beyond the local residential context in place-based risk indices like the CDC's Social Vulnerability Index (SVI) likely misclassifies community exposure by under-counting risks and obscuring true drivers of racial/ethnic health disparities. To investigate this hypothesis, we developed several place-based indicators of occupational exposure and examined their relationships with race/ethnicity, SVI, and health inequities. We used publicly available job exposure matrices and employment estimates from the United States (US) Census to create and map six indicators of occupational hazards for every census tract in the US. We characterized census tracts with high workplace-low SVI scores. We used natural cubic splines to examine tract level associations between the percentage of racial/ethnic minorities (individuals who are not non-Hispanic White) and the occupational indicators. Lastly, we stratified each census tract into high/low occupational noise, chemical pollutant, and disease/infection exposure to examine racial/ethnic health disparities to diabetes, asthma, and high blood pressure, respectively, as a consequence of occupational exposure inequities. Our results show that racial/ethnic minority communities, particularly those that are also low-income, experience a disproportionate burden of workplace exposures that may be contributing to racial/ethnic health disparities. When composite risk measures, such as SVI, are calculated using only information from the local residential neighborhood, they may systematically under-count occupational risks experienced by the most vulnerable communities. There is a need to consider the role of occupational justice on nationwide, racial/ethnic health disparities.

Community-Based Learning: Transformative Change in OT Students’ Awareness of Occupational Justice & Community Health

Abstract Date Presented 03/21/24 Community-based learning (CBL) enabled students to address societal needs through active engagement in their community. The focus was on eradicating social and health disparities among individuals who are at risk for occupational deprivation and injustice. Primary Author and Speaker: Patricia A. Wisniewski

Fostering social participation among older adults: Perspectives of stakeholders

Background Fostering social participation for active and healthy ageing among older adults is an urgent issue in a changing society that requires new approaches from occupational therapists as well as from society at large. Aim To explore possibilities to foster social participation for older adults in society from the perspective of stakeholders. Material and methods A qualitative design was applied. 18 key informants, engaged in supporting older adults in their organisational roles as either professionals or volunteers, participated in five different focus groups discussions. Results The results involved two overarching themes that reflects different perspectives on key informants’ possibilities to foster social participation for older adults. The first theme describes how they direct their attention towards their roles within the organisations to foster social participation in their own context. The second theme describes the broader societal perspectives that they address to establish a common ground for collaboration and knowledge-sharing among different stakeholders. Conclusions The findings emphasise how addressing common challenges and developing collaboration are essential to foster older adults’ social participation. It is therefore necessary to involve policy-makers and decision-makers. Occupational therapists and researchers should consider the value of occupational justice to drive collective and social approaches.

‘Finding the play’ – exploring with occupational therapists practice possibilities in the context of Irish schoolyards

Background Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children’s play opportunities. Critical contextualised research is advocated to inform practice possibilities. Aims/Objectives This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice. Materials and Methods Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods. Results Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities – ‘Finding the play’ between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness. Conclusions, and Significance Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of ‘finding the play’, highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.

Politicizing Children's Play: A Community Photovoice Process to Transform a School Playground.

Contextual elements at school playgrounds compromise the right to play.An occupation-based social transformation project to foster occupational justice in play at a school playground was conducted. To better understand barriers to and facilitators of children's participation in occupations at the school playground to co-create actions that enable play. Design:A participatory methodology-Photovoice-was used. The research consisted of four phases: involving the community in the research design, community-led data generation and analysis, discussion of findings to increase the community's awareness, and a community agenda for changing the playground. Public primary school playground in northwest Spain. All children (n = 450, ages 3-12 yr), families (n = 12), and teachers (n = 15) participated. A thematic analysis of visual, textual, and oral material was conducted, including member checking. Results: The study revealed several barriers toplay, including the short recess duration, poorfloor (surface) conditions, jail-like atmosphere, andviolence. However, participants identified an ad hoclending games systemandplayground muralsadvocating for children's rights as facilitators. These findings have direct implications for improving the play environment. Conflicting priorities between children's and adults' desires and needs for the playground were unveiled, displaying the relevance of invisible contexts (i.e., social or institutional contexts) in shaping play opportunities. A critical occupational stance combined with a participatory and playful methodology generated space to unveil these conflicting priorities, reconcile agendas, raise awareness, and propose collective actions to transform the playground. Plain-Language Summary: Playing is fundamental to children's development and inclusion. This study focused on making school playgrounds better places for kids to play. Researchers found that things such as short playtimes, bad playground conditions, and violence made it tough for kids to enjoy playing, but they also discovered some good things, such as a system for borrowing games and colorfulmurals promoting children' rights. These findings show that changing the playground's physical and social environment can make a big difference for kids. By listening to kids and working together, adults and children can create playgrounds where all kids can play meaningfully and safely. Occupational therapists can promote such processes.

The occupation of self-employment in South African informal micro-enterprises

Introduction: Self-employment, in which individuals work for themselves in a small business or microenterprise to earn an income or generate a salary, has been encouraged to facilitate employment opportunities in South Africa. However, participation in self-employment within the community served by professionals such as occupational therapists is limited by many factors, including effective government initiatives, such as implementing the Small Enterprise Development Agency (SEDA) policies. To enable individuals and community participation in this type of work for those with occupational dysfunction, mainly persons with disabilities, professionals such as occupational therapists need to understand the structural, contextual and occupational outcomes related to self-employment. Based on the Framework for Occupational Justice, this study explored the occupation of self-employment in microenterprises in the low-resourced urban community of Alexandra Township.
 Method: A quantitative descriptive non-experimental design study was used to identify informal microenterprises in the community using a transect walk and community mapping. Structured interviews were conducted to complete a questionnaire with key informants (service providers and business owners) who provided perceptions on factors that impacted the occupational outcomes of microenterprises.
 Results: Structural and contextual factors from the participants' experience resulted in unjust occupational outcomes, which indicates that occupational rights, particularly participation, choice and balance, were negatively affected by the lack of opportunities, such as jobs. Occupational marginalisation and imbalance were reported since many businesses lacked adequate and appropriate space for trade. Some business owners, however, reported just occupational outcomes related to the occupational right for meaningful occupation in providing a service to the community and financial income to support themselves and their families.
 Conclusion: Occupational therapists need to play various active roles in raising the consciousness of unjust occupational outcomes and support for just occupational outcomes that are achieved in engagement in self-employment in informal microenterprises.
 Implications for practice
 Occupational therapists should take note of the factors and occupational outcomes of being self-employed identified in this study and consider the roles they could play in expediting success in this occupation for clients. Occupational therapists could assume:
 
 A collaborative role, such as referring and working with various key role players or sectors in the interest of sourcing and providing opportunities for skills development for those entering self- employment, particularly in entrepreneurial training. This may include working with the government (e.g., Department of Labour and Small Enterprise Development Agency), private sector (e.g., yes4youth), other professions (social workers and industrial psychologists) and organisations for persons with disabilities (e.g., Disabled People, South Africa
 

Occupational injustice across species

ABSTRACT COVID-19 and the prospect of a sixth mass extinction, among other crises, have underscored the urgency of recognizing humans' ethical and ecological entanglements with the more-than-human world. In light of these entanglements, this article brings together theories of occupational justice with those of animal rights in order to stimulate further discussion toward the development of a multispecies theory of occupational justice. First, a precedent and basis for nonhuman occupational rights is established in Martha Nussbaum’s capabilities approach. Second, Sue Donaldson and Will Kymlicka’s political theory of animal rights is invoked as a lens through which to understand how various types of nonhuman animals are differentially at risk for experiencing four occupational injustices: occupational deprivation, alienation, displacement, and apartheid. The article concludes that a commitment to multispecies occupational justice changes how science is practiced. Implications for occupational science and adjacent design sciences are explored, as well as directions for future research and political work.

Predictors of Population Mental Health in Montana: An Occupational Justice Perspective.

Population-level analyses can demonstrate occupational injustices and their impact on population health. The objective of this article is to examine whether population-level occupational factors are related to the mental health of Montanans. We used linear regression models of the 2021 Montana County Health Rankings to examine the association between occupational justice and mental health, adjusting for covariates. Predictor variables were access to exercise, insufficient sleep, healthy food access, food insecurity, proximal jobs, and social support. Outcome variables were frequent mental health distress and poor mental health days. Adjusted models showed significant associations between both insufficient sleep (β = 0.25, 95% confidence interval [CI] = [0.0.11, 0.40]; Table 2) and food insecurity (β = 0.32, 95% CI = [0.22, 0.43]) and poor mental health days z scores. Adjusted models also showed significant associations between insufficient sleep (β = 0.18, 95% CI = [0.10, 0.26]) and food insecurity (β = 0.19, 95% CI = [0.12, 0.25]) and frequent mental health distress. Future research should study whether targeting sleep and food security can enhance Montanans's mental health.

Explorando teorias, modelos e estruturas profissionais para construções orientadas para a justiça: uma revisão de escopo

Abstract Introduction The role of systemic marginalization in negatively impacting the health and wellbeing of individuals and populations is well-established. Although the profession has begun to address the impact of colonialism in clinical and educational contexts, these topics are less represented in the underpinning theories, models, and frameworks that guide research, practice, and education. Objective To identify and analyze peer-reviewed journal articles about professional theories, models, and frameworks describing justice-oriented constructs. Method We searched for journal articles published between 1971 and 2021 as indexed in PubMed/Medline, EMBASE, Scopus, PsycInfo, CINAHL, and Web of Science. We used the Levac et al. methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews extension (PRISMA-ScR) and the JBI Scoping Review Network. Included articles featured theories, models, frameworks that described justice-oriented constructs. Results Forty-five articles published from 1987 to 2021 met inclusion criteria. These included 19 models, 19 frameworks, five theories, and two paradigms. The majority of articles originated in Canada, the United States, and Australia and within the past 20 years. The most commonly described constructs were inclusion, culture, and occupational justice. Conclusion This scoping review provides an overview of publications describing theories, models, and frameworks in occupational therapy literature that include justice-oriented constructs. Although justice-oriented constructs were the central topic in 35 articles, the context was not explicitly connected to professional activity. Only seven articles discussed research, which reveals a major concern considering its foundational role in the profession.

Occupational Concepts: An Underutilized Resource to Further Disabled People and Others Being Occupied: A Scoping Review

Background: Being occupied is an important factor in human well-being and ranges from paid and unpaid work to activities of daily living. Various occupational concepts that do not contain health in the phrase such as “occupational justice” are employed to engage with the social barriers people experience in being occupied. The aim of this study was to understand better to what extent the non-health occupational concepts are used in the academic literature to discuss the social barriers disabled people face in being occupied and whether these occupational concepts are used to enrich discussions in areas that impact the reality of occupation in general such as equity/equality, diversity and inclusion (EDI), science and technology governance, well-being and the impact of environmental issues. Methods: a scoping review of academic abstracts employing SCOPUS, the 70 databases of EBSCO-HOST and Web of Science was performed. Results: We found 24,104 abstracts for the 28 occupational concepts we used in general and 624 abstracts in conjunction with disability terms. Of these 28 occupational concepts, “occupational performance” was mentioned the most (in 9739 of the 24,104 and 397 of the 624 abstracts). The next concept “occupational engagement” was already present in one tenth or less. Occupational justice was present in 700 of the 24,104 and 14 of the 624 abstracts. Furthermore, within the 24,104 and 624 abstracts EDI, science and technology governance, environmental topics, and well-being measures were rarely or not mentioned. Most of the 624 abstracts originated from occupational therapy journals. Only 23 of the 624 abstracts originated from journals with “disability”, and none with “disability studies” in the title. Conclusion: Non-health occupational concepts are underutilized in discourses that focus on decreasing the social barriers to being occupied in general and in relation to disabled people, which is a missed opportunity and should be fixed.

The Lived Experience of Persons with Spinal Cord Injuries Engaging in Remote Work: A South African Perspective.

In South Africa, traumatic SCI cases are disproportionately high in comparison to other countries. Low retention and maintenance of work for persons with SCIs are further exasperated by structural barriers and societal stigma. Persons with SCIs have the ability to contribute to the labour market, and doing so could lead to the improvement of their quality of life and socioeconomic status. Addressing engagement in work as a meaningful occupation for persons with SCIs is essential to mitigate occupational risk factor and uphold occupational justice. Currently, there is a paucity of literature on remote work practices for persons with SCIs. This study seeks to add to this body of knowledge to increase occupational therapists' awareness of the possibility of remote work to facilitate the inclusion of persons with SCIs in the open labour market. This phenomenological study explored the facilitators and barriers of engaging in remote work in the open labour market for paid employment, as experienced by persons with SCI within the Gauteng metropole, South Africa. Data was collected via semistructured interviews from four participants and analysed thematically. Four themes were generated from the data: (1) intrinsic facilitators of remote work, (2) extrinsic facilitators of remote work, (3) intrinsic barriers to remote work, and (4) extrinsic barriers to remote work. Remote work can be utilised to include persons with SCIs in their chosen occupation of work and is a holistic and client-centred approach. Remote work should not be seen as the sole method of inclusion but can also be used in conjunction with traditional office work to accommodate persons with SCIs in the workplace.

‘Getting old is not all bingo and knitting’. An exploration of positive ageing and occupational participation through engagement with community leisure activities: a qualitative study

Background/Aims Loneliness and social isolation have a negative impact on the health and wellbeing of older adults. The aim of this study was to explore the lived experiences of a group of older adults involved in a range of occupational-focused leisure activities provided by the Weekday Wow Factor, a small social enterprise led by an occupational therapist to understand their perceptions of positive ageing and occupational participation. Methods This small-scale qualitative research project explored the experiences of participants attending a weekly daytime disco that took place in a city centre nightclub. Participants also engaged in a number of other activities offered by the Weekday Wow Factor and discussed these during the focus groups. A total of 26 participants took part in four focus groups, with topics for discussion being informed by the 4D cycle of appreciative enquiry: discovery, dream, design and destiny. Results Three overarching themes with sub-themes were found: mental wellbeing with sub-themes of social isolation, occupational participation and health promotion; inclusivity with sub-themes of positive ageing and community; and engagement with sub-themes of environment, occupational flow and occupational justice. Conclusions Activities that facilitated friendship, a feeling of usefulness and belonging to a community were valued by participants, along with a sense of adventure from a range of activities that are not traditionally associated with older people. These activities need to be easily accessible to the community with implications for public transport and the social prescribing agenda. Occupational justice is important to the provision of community-based resources for older people to promote healthy and active ageing, which contributes to wellbeing.

The experience of flow by people living with disabilities: A meta-study of qualitative research

ABSTRACT Background Experiencing flow, an optimal psychological state, can support health and well-being. A developmental perspective on flow so far examines strategies to facilitate these experiences in the face of developmental losses such as ageing. People with disabilities experience restrictions in participation and thus fewer occupations that potentially induce flow. Therefore, contributions to this perspective can be gained from disabled people’s experiences. Thus, this meta-study synthesises qualitative research literature to determine the contribution to a developmental perspective on flow in people with disabilities. Methods Following a systematic search of four databases (PsycInfo (EBSCO), PubMed, CINAHL (EBSCO), Scopus) 10 qualitative, peer-reviewed studies were included, and critically appraised. Findings as well as methodologies, and underlying theories were analysed and synthesised. Findings Various methodologies have been used to explore flow experiences of people with disabilities. Incongruencies between underlying theories and chosen methods, as well as lack of researcher reflexivity impacted the trustworthiness of some studies. All studies originated within occupational therapy research and were located in the global North, implying assumptions about occupation and well-being and a rehabilitation framework. The individuals’ choice and control, and adaptations of environment and occupation emerged from the meta-synthesis as important factors to experiencing flow. Conclusion To enhance opportunities for flow in the lives of people with disabilities, a shift of perspective from individual impairments towards issues of accessibility and occupational justice is needed. Based on this meta-study, critical disability theory and participatory frameworks are recommended for future research to explore strategies to enhance access to flow inducing occupations.

The relationship of productivity-based wages to human rights and occupational justice – an exploratory study

ABSTRACT Background Productivity-based wage systems are intended to enhance the labour market participation of people with disabilities. Limited scholarship exists regarding the impact of such policies in practice. This qualitative study explored stakeholder perspectives on the Australian Supported Wage System (SWS), including perceptions of fairness and equity. Methods Document review provided context and background for the study. 14 semi-structured interviews were subsequently conducted with a range of stakeholders with knowledge of the SWS. Results Four primary themes were identified, related to assessment processes, value contributions of the system, practice risks and challenges, and ethical tensions. Conclusions The SWS appears to enhance worker choice and inclusion. A variety of factors may reduce the quality of these outcomes, however, and employment systems should support a range of evidence-informed approaches to ensure equitable employment outcomes.

Critical reflections about plural law, Western constructions of human rights, and occupational justice: From Indigenous and African cosmovisions

ABSTRACT Importance: This is a provocative, interactive dialogue calling for expansion and enrichment of the concept of occupational justice beyond its first publication in 2000. It is necessary to refine the concept beyond its roots in Western contexts, bringing it into dialogue with ideas of plural law to think about human rights and occupational justice from different experiences such as African and Indigenous. Objective: This study aims to discuss the applicability and representativeness of occupational justice terminology in different contexts. Theoretical and epistemic research: This theoretical and epistemic research presents a critical reflection about decolonizing everyday practices by building occupational justice comprehension based on organic and plural circular rights and justice. Findings: Human rights are not universal in their applicability; rather, they are specific to Western culture. Concepts of occupational justice based on human rights have not questioned this logic, therefore, universalizing these precepts of occupational justice is a new form of epistemic and cognitive colonization of the discipline. Reflecting on the plural construction of occupational rights and justice based on Indigenous and African cosmovisions points us to paths of the right to life in its diversity. The idea is to build everyday organic justice open to various rationalities and to multiple ways of existing, feeling, and doing. Conclusions and relevance: In order to decolonize, it is necessary to uncover existing ways of life and be open to other inventive possibilities of everyday life, seeking a break with modern rationality. This critical reflection is a pathway to decolonizing everyday practices and actions. It starts building the concept based on organic, circular, and plural rights and justices.

Occupational Justice: Staff Member’s Understanding of the Role of Occupational Therapy within Organizations Serving Persons Experiencing Homelessness

The purpose of this descriptive study was to explore the understanding of occupational justice and occupational therapy’s role among staff members working within organizations serving persons experiencing homelessness. A survey was developed to determine if staff (N = 43) understood what occupational therapists can do to help persons experiencing homelessness. Responses were split almost equally between agree/strongly agree and disagree/strongly disagree. Most or 95% (n = 38) of respondents stated their organization would be interested in increasing programming to support the ideas of occupational justice. This suggests that occupational therapy can fill a need in these organizations to promote occupational justice.

First-Generation Palestinian Refugees in Jordan: Experiences of Occupational Disruption From an Occupational Justice Perspective.

Only a limited amount of research has investigated the impact of prolonged refugee status of Palestinian refugees who have been displaced for more than 70 yr. To explore lived experiences of Palestinian refugees in Jordan and understand their occupational disruption. Thematic analysis guided by descriptive phenomenology with one-on-one and group interviews. An AlBaqa'a community-based rehabilitation center or participants' homes. First-generation Palestinian refugees who fled Palestine and live in Jordan. Fifteen Palestinians, mainly widowed women in their 70s, participated in this study. Ten completed interviews, and five participated in two group interviews. Four themes emerged: (1) Palestinian pride, (2) trauma leaving one's home country, (3) challenges of living in a host country, and (4) internalized prejudice. After 70 yr, prolonged refugeeism has led to occupational disruption and negative implications for occupational justice, especially in the absence of social justice. The area most negatively affected was social participation; however, participants still had a great sense of pride about their homeland and their heritage. What This Article Adds: This foundational research explores the occupational injustices of the protracted refugee status of first-generation Palestinians in Jordan and identifies meaningful interventions to promote the alleviation of occupational disruption.

Health Equity & Occupational Justice: Examining the Association Between Disability & Health Care Discrimination Among Sexual & Gender Minorities

Abstract Date Presented 04/21/2023 Sexual and gender minorities with a disability have significantly higher rates of health care discrimination than those without. Understanding such disparities can help OT practitioners promote occupational justice and health equity. Primary Author and Speaker: Kelsey A. Gately Contributing Authors: Allyson Baker, Monique Dawes, Jennifer Swanberg, Samantha Rosenthal

Meaningful Engagement as a Predictor of Psychological Well-Being for Adults With Low Income.

The activities that people engage in influence their well-being. Adults with low income have limited resources, which can affect their engagement in meaningful activities. Exploring the connection between meaningful engagement and well-being is an important step in providing occupational justice for this marginalized population. To examine whether engagement in meaningful activities uniquely contributes to well-being for adults with low income after controlling for demographic variables. Cross-sectional exploratory study design. Community agencies serving adults with low income, a local library, and a university union hall in northwest Ohio. Adults with low income (N = 186). Participants completed a demographic questionnaire, the Engagement in Meaningful Activities Survey (EMAS), and the World Health Organization-5 Wellbeing Index (WHO-5). We examined the influence of demographics and EMAS on the WHO-5. We identified a moderate correlation between the EMAS and WHO-5 (r = .52, p ≤ .05). Linear regression revealed an R2 = .27, F(7, 164) = 8.75, p < .001, with the EMAS and participant attributes as predictor variables. The R2 changed to .02 (p = .85) without the EMAS in the model. Findings support the need for and use of meaningful activities to support well-being and health for adults with low income. What This Article Adds: Findings build on the evidence supporting the role of engagement in meaningful activities by drawing connections to a well-known and widely used measure of subjective psychological well-being and applying these connections to adults with low income. Occupational therapy practitioners can use measures such as the EMAS to strategically infuse aspects of meaning that promote engagement and foster well-being.