Introduction: Regional, rural, and remote people represent nearly half the world's population yet experience disproportionally higher disease, mortality, and disability rates, coupled with limited healthcare access. Occupational therapy has committed to occupational justice, yet no descriptive framework of services provided by occupational therapists in non-urban locations exists. Understanding current non-urban service practices will provide a basis for non-urban service development and research to reduce this inequity. Methods: Four databases were systematically searched for publications describing non-urban occupational therapy services, from any country, written in English, French, Portuguese, or Spanish, from 2010 to 2020. Publications were screened against criteria for inclusion, and data were identified using an extraction tool and presented in a frequency table, on a map, and in a searchable supporting information Table S1.Results: Only 117 publications were included discussing services provided to populations across 19 countries. They were mostly published in English (98%) and about populations from English-speaking countries (70%). Included publications discussed individualist services (65%), for defined age groups (74%), and for people with specific medical diagnoses (58%). Services were commonly provided in the client's community (56%), originating from urban locations (45%) where the provider travelled (26%) or contacted clients using telehealth (19%). Individual 1:1 enabling strategies were most described (59%), including remediation (34%), compensation (9%), or education (7%). Community enablement strategies were infrequently described (14%), focused primarily on transformation to improve existing service delivery (9%), with some redistributive justice (3%), and one community development strategy (1%). Exploratory research services accounted for the remaining studies (27%). Differences were noted between Global North and South approaches. Conclusion: Globally, occupational therapy has limited focus on non-urban services and favours individualist rehabilitative strategies provided by

Introduction: Rural communities contribute to national wellbeing, identities, economies, and social fabrics yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about nonurban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focussed services are more commonly discussed. Understanding intentions expressed in publications about nonurban service design may identify assumptions/limitations to current approaches and contribute to improved future services. Methods: Each of 117 publications identified in a scoping review was read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes.The first author reinterrogated the publications and coded data to identify relevant examples to support the identified themes. Results: Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes (i) Extension of urban practice and (ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme (iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focussed on developing non-urban communities and promoting justice.

Objective: The objective of this review is to complete a global synthesis of the evidence on occupational therapy services provided in non-urban areas. Introduction: Worldwide, non-urban populations experience higher levels of disease, mortality, and disease risk factors, yet most health services, including occupational therapy, are disproportionately located in urban areas. Research has predominantly focused on attracting therapists to non-urban practice by exploring generalized expressed needs from existing non-urban therapists, such as access to professional development, backfilling of jobs, peer and other practice supports, or enticing occupational therapy students through placement experiences. However, the types of service that non-urban occupational therapists routinely provide remains unclear. Clarifying the scope of occupational therapy services in non-urban areas will support educators and policy makers to plan curricula and services to support non-urban clinicians and communities. Inclusion criteria: This scoping review will consider qualitative and quantitative research studies and opinion pieces about occupational therapy services provided to any individuals or groups living in rural (non-urban) areas across the world. Methods: The search will be conducted in MEDLINE (Ovid), CINAHL (EBSCOhost), Emcare, and ProQuest Nursing and Allied Health, and limited to studies published from 2010 in English, French, Portuguese, or Spanish. Titles and abstracts will be screened by two independent reviewers against predefined inclusion criteria, followed by detailed assessment and appraisal by two independent reviewers. Reasons for including or excluding studies will be recorded. Data will be extracted using a charting table and presented in tabular form with a narrative summary describing how the results relate to the review question.

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