Occupational Therapy Practitioners' and Students' Experiences of Diversity, Equity, and Inclusion: An International Scoping Review.

Abstract

Importance: The evolution of theory and practice in occupational therapy has been dominated by the perspectives of White, middle-class, English-speaking practitioners. The lack of diversity among occupational therapists may harm both client care and minority practitioners in the field.

Objective: To investigate the inclusion and belonging experiences of minoritized occupational therapy practitioners and students internationally.

Data sources: A scoping review explored articles published between January 2010 and July 2022 using six journal databases (Ovid MEDLINE, Scopus, Web of Science, CINAHL, Ovid ERIC, and PsycINFO). An updated search was completed using Litmaps and Google Scholar to check for articles published between August 2022 and May 2024. Study Selection and Data Collection Demographic and content codes were inductively developed and data managed via Covidence, EndNote, and NVivo.

Findings: Thirty-one studies across 17 journals highlighted four distinct minoritized groups (some study criteria included multiple identities): culturally and linguistically diverse people (n = 16), people with disabilities (n = 8), LGBTQ+ individuals (n = 8), and First Nations people (n = 2). Four themes were identified: (1) negotiating a normative cultural context, (2) feeling a sense of belonging, (3) interacting with clients, and (4) fostering equity and inclusion.

Conclusions and relevance: Minoritized groups face trade-offs between personal safety and cultural identity because institutions undervalue diversity, underscoring the need for systemic change. Occupational therapists sometimes tolerate mistreatment, emphasizing the need for policies that protect client and therapist dignity. Globally, the occupational therapy profession can improve inclusivity and reduce exclusion in education and practice by enhancing representation and promoting culturally safe work and educational environments. Plain-Language Summary: This study looked at how minority occupational therapists and students around the world experience inclusion and belonging in their profession. Researchers reviewed 31 studies published between 2010 and 2024 that focused on different minority groups, including culturally and linguistically diverse people, people with disabilities, LGBTQ+ individuals, and First Nations people. The research revealed that minority practitioners often struggle to fit into a profession largely shaped by White, middle-class, English-speaking perspectives. They sometimes face difficult choices between staying true to their cultural identity and feeling safe at work. Many experience challenges in feeling like they belong and sometimes endure unfair treatment. The findings suggest that the occupational therapy profession needs major changes to become more inclusive, including increasing diversity among practitioners and creating safer workplaces and educational settings that respect all cultures. These changes would improve both the experiences of minority practitioners and the care they provide to clients. Positionality Statement: Author reflexivity: The research team consists of Celine Rachel Serrano-Diaz, a PhD candidate, and two supervisors, Lynn V. Monrouxe and Justin Newton Scanlan. Using the pronouns she/her, Serrano-Diaz is a cisgender, heterosexual, neurodivergent woman. Born in the United States, she is a first-generation Australian immigrant settler with Filipino ancestry. Her lived experience of minoritization results from the intersections of race, gender, and disability and serves as the impetus for this study. She has an insider perspective on navigating inclusion and belonging in the profession, having spent almost 20 yr as an occupational therapist and educator in Australia. Scanlan identifies as a gay/queer, White, cisgender man. Growing up in Australia and the United States, he has a qualification in occupational therapy and a PhD. Monrouxe identifies as a White, anticolonialist, Australian-British, heterosexual, cisgender female who uses the pronouns she/her. She has lived in England, Wales, Taiwan, and Australia for significant periods. She has a degree in psychology and a PhD in cognitive linguistics. The team collaborated in a critically reflective way, considering how their identities shape individual research praxis and viewpoints, as well as how their diverse experiences of marginalization and privilege influence the research process.