Extension, austerity, and emergence: Themes identified from a global scoping review of non‐urban occupational therapy services

Abstract

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.

Preparing occupational therapy students for practice in rural areas: a scoping review protocol

“…Where was the strategy designed and implemented? A previous scoping review of occupational therapy services provided for people in rural areas 11 found a theme, particularly in the Global North of transplanting service models from urban areas into rural areas without necessarily considering appropriateness for the rural context. It was also identified that there was a problematisation of rural people and places which normalised urban living and considered rural ways of living as inferior.…”

“…It was suggested that poor understanding of the rural context by the service designers and urban-based therapists may contribute to poor health outcomes and experiences in rural places 10. Further thematic analysis of these publications identified a hegemonic approach to rural occupational therapy services in the publications, which problematised the people and geography in rural places for not fitting within urban norms under which these services were initially developed and causing inconvenience and costs for service providers 11. Tacit suggestions that rural practice is both difficult and less prestigious have been noted in the medical literature as a hidden curriculum in undergraduate education which, while not overtly stating it, may contribute to rural practice being perceived as less desirable 12.…”

“… 10 Further thematic analysis of these publications identified a hegemonic approach to rural occupational therapy services in the publications, which problematised the people and geography in rural places for not fitting within urban norms under which these services were initially developed and causing inconvenience and costs for service providers. 11 Tacit suggestions that rural practice is both difficult and less prestigious have been noted in the medical literature as a hidden curriculum in undergraduate education which, while not overtly stating it, may contribute to rural practice being perceived as less desirable. 12 However, evidence suggests that rural practitioners who report feeling prepared for rural practice 6 13 and rural cultures/ways of living 14 are more likely to be recruited to and retained in rural practice.…”

Focusing on “what matters”: the Occupation, Capability and Wellbeing Framework for Occupational Therapy

“…That an ableist neoliberal ideology continues to energise occupational therapy in the Global North is evidenced by the profession's enthusiastic collusion with the cost-saving agenda of neoliberal austerity (College of Occupational Therapists, 2011; Green & Lambert, 2017;Hayes et al, 2023;Morley & Smyth, 2013), and ongoing commitment to assessing and addressing the occupational performance of just three forms of occupationself-care, productive and leisure (Townsend & Polatajko, 2013) despite more recent developments within the profession [e.g. ; Hammell (2020a)], and as if these are the only occupations worthy of professional attention.…”

Profile of occupational therapy services in non‐urban settings: A global scoping review

“…A secondary thematic analysis of the data, examining the underpinning values expressed in publications about non‐urban services approaches, will be presented in a subsequent article (Hayes et al, 2022 ).…”