How Intersectionality Informs Occupational Therapy Practice, Education, and Research: A Scoping Review.

Abstract

Importance: Lack of consideration of intersectionality by occupational therapy practitioners, faculty, and researchers can result in inequities experienced by students and clients served.

Objective: To determine how intersectionality is represented in the scholarly literature used to inform occupational therapy practice, research, and education.

Data sources: A comprehensive database that includes CINAHL, MEDLINE, and PsycINFO.

Study selection and data collection: Inclusion criteria were peer-reviewed articles published between 2013 and 2023, written in English, and pertinent to the research question. The review used Covidence database and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, resulting in 36 articles identified as meeting all criteria. Any discrepancies were resolved through discussion among the authors.

Findings: A data abstraction chart was developed, and analysis resulted in themes of education, practice, and research with specific subthemes. Findings revealed that the lack of an intersectional approach in education is often viewed negatively by diverse students, who experience a lack of belonging. Suggested strategies focused on reducing isolation and revising curricula to reflect student diversity. Intersectional issues in practice showed access disparities and a lack of occupational participation for diverse clients. Suggested strategies included consideration of the multilayered identities of clients using cultural humility and consideration of context. Strategies for research focused on using a collaborative approach to represent the intersectional lived experience of diverse populations.

Conclusions and relevance: Despite limited studies, intersectionality was identified as a lens for occupational therapy educators, practitioners, and researchers and as an important strategy to address issues faced by diverse students, resulting in more effective client-centered care. Plain-Language Summary: This study reviewed literature from occupational therapy and other health professions to determine how the concept of intersectionality is used to inform practice, education, and research. The study is needed because common Western-based practice is based on an individual, White, upper-middle class, able-bodied, cisgender perspective, which does not match the demographics or needs of clients. Results show that the intersectional identities of students and clients are often not being considered. Literature is emerging to provide educational, practice, and research strategies to address the diverse needs of occupational therapy students and clients by identifying and considering multiple and intersectional identities and the effect of context. The results challenge occupational therapy educators, practitioners, and researchers to consider the use of intersectionality moving forward to provide holistic, client-centered care. Positionality Statement: Diane Smith is a cisgender, White, able-bodied occupational therapy professor with a graduate degree and numerous publications regarding disability rights and intersectionality. Alesia Ford is a cisgender, Black, neurodivergent occupational therapy practitioner with a graduate degree and publications focused on increased diversity within the profession. Helina Samson is a cisgender, Black, able-bodied occupational therapy practitioner with a graduate degree. These lenses influence and may potentially bias our interpretation regarding critique of current strategies in education, practice, and research. For the purposes of this review, please note that LGBTQIA+ is not a standardized term, and the term used by the original researchers will be used (e.g., LGBTQ, LGBT).