Culture and Context: Meaningful and relevant

Occupational Therapy practice and service delivery.

Kee Hean LimLecturer and Researcher in OT

Do we presume that the way we practice and deliver occupational therapy is always meaningful, effective and relevant ?

Meaning & RelevanceMeaning & Relevance

OverviewOverview

• Introduction • Context• Key definitions and concepts• Examining culture and occupation• Socio-cultural construction of

occupation and occupational therapy• Discourse• Questions

Context Context

Global

• Changing world (global economy & ease of travel)

• Free and rapid exchange of information and ideas

• Fluid boundaries and changing population in the UK

• Occupational therapy growing rapidly especially in Asia, Eastern Europe and Africa.

Culture & MeaningCulture & Meaning

“A shared system of meanings that involve ideas, concepts and knowledge, and include the beliefs, values and norms that shape standards and rules of behaviour as people go about their everyday lives”

` (Dyck, 1998,

p.68)

  

DiversityDiversity

Diversity can include dimensions of race, ethnicity, Diversity can include dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, gender, sexual orientation, socio-economic status, age,

physical abilities, religious beliefs and ideologies.physical abilities, religious beliefs and ideologies.

The concept of diversity encompasses acceptance and The concept of diversity encompasses acceptance and respect. It means understanding that each individual is respect. It means understanding that each individual is

unique, and recognizing individual differences.unique, and recognizing individual differences.((http://gladstone.uoregon.edu)http://gladstone.uoregon.edu)

SocietySociety

Priority

Behaviours

Values

Rules of conduct

Meaning and ValueMeaning and Value

‘Meaning is generally not derived without reference to society and society values some occupations above others.’

Christiansen & Townsend

(2004)

Reductionist

Individualism

Control

Holistic

Collective

AcceptancePer

spec

tives

Persp

ectiv

es

Cultural Perception of HealthCultural Perception of Health

‘The body may be seen as a single organism with physical, spiritual and emotional aspects, in which illness is caused by imbalances or blockages. The goal of health care then is to restore the balance by unblocking the flow of energy between them.’

Henley (1999)

‘In cultures with scientific orientation the body is often imagined as a machine. Problems are located in isolated organs or parts, which are then repaired or, possibly replaced.’

Helman (2000)

Organisational CultureOrganisational Culture

• How we do things around here!How we do things around here!• Focused on organisational goalsFocused on organisational goals• Priorities determined by those in Priorities determined by those in PowerPower• Reflects the Power relationship & dynamicsReflects the Power relationship & dynamics• Dictate attitudes, behaviours & normsDictate attitudes, behaviours & norms

Society, culture, family, education, organisations, peers, beliefs, socialisation, the media & press, professional

training, can all influence our view and values.

Contextual InfluencesContextual Influences

Occupational Therapists operate within Occupational Therapists operate within prevailing rules of conduct & cultureprevailing rules of conduct & culture

• Shared system of language

• Common cultural values

• Specific rules of conduct

• Established social practices

Does this exclusiveness hinder the inclusiveness of our practice?

Lim 2009

How culturally bound are our ideas?

Different constructs, beliefs, realities, perspectives, experiences and value patterns

are linked with western social context, valuing independence, personal autonomy, dominance and be & become through action (occupation).

Occupational Therapy Core Values:

Has mixed meanings within different socio-cultural context and groups

OccupationOccupation

Interdependence

Independence

Client-CentrednessClient-Centredness

• Indian MSc Occupational Therapy student• The plural ‘I’ rather than the singular ‘I’• The I is influenced and guided by the

context, place and need to belong.• Asserting the collective rather than

personal perspective and choice.

Effects of Cultural IncompetenceEffects of Cultural Incompetence

• Miscommunication and misunderstanding• Patient/client and professional relationship

affected• Non-compliance “Difficult patient!?”• Quality of care is compromised• Power dynamics• Increased frustration

Cultivating My understanding of the

Client’s Daily ‘Normal’

Occupational Occupational TherapistTherapist

Sphere of shared experience

‘‘Client’Client’

Sphere of shared experience

Expressing my daily reality from my own

‘Normal’

Client Centred & Culturally Safe Practice…Client Centred & Culturally Safe Practice…

Discourse in Occupational TherapyDiscourse in Occupational Therapy

• Diverse Worldviews challenges the Universal assumptions of over-arching frameworks and models.

• Theory and practice should be in sync with local realities & needs.

• Despite acknowledging diversity, practice and service is driven by desire for standardisation and uniformity

• Focus on clinical evidence must not be at the expense of the client’s lived experience.

• Meaningful and relevant practice must be person focused, inclusive, enabling, culturally sensitive and in touch with what the clients considers to be essential to their lives…

Organisational Services Organisational Services & Provision& Provision

• How aware are you of the diversity within your local community?

• How well does your staff group reflect the diversity within your local community?

• How aware/knowledgable are you of the local minority ethnic community services or groups?

• Do you have a resources file of the local minority ethnic (non-western immigrant) and translations services?

• What opportunities are available to patient, clients/services users to access alternative treatments?

• Name three things you can do to improve the cultural awareness and competence of staff where you are.

• Your answers to these questions may indicate how equipped you are in responding and delivering culturally inclusive, sensitive and safe practice/service delivery.

Reference List

• Chaing M & Carlson G (2003) Occupational therapy in multicultural contexts: Issues and strategies British Journal of Occupational Therapy Vol.66 (12) 559-566• Dickie V, Cutchin MP & Humphry R (2006) Occupation as Transactional Experience: A Critique of Individualism in Occupational Science. Journal of Occupational Science. Vol 13 Issue 1• Fitzgerald MH, Mullavey-O’Byrne C and Clemson L (1997) Cultural issues from practice. American Journal of Occupational Therapy Vol 44, 1-21

• Gray, M and McPherson, K (2005) Cultural Safety and professional practice in occupational therapy: A New Zealand perspective Australian Occupational Therapy Journal 52 (1), 34–42

• Helman C G (2007) Culture, Health & Illness. 5th Ed, Hodder & Arnold London

• Iwama M (2003) Towards Culturally Relevant Epistemology in Occupational Therapy. American Journal of occupational therapy Vol 57, No 5 (Sept/Oct)

• Iwama M. (2005) Occupation as a cross-cultural construct. in Whiteford G.& Wright-St. Clair (eds). Occupation and Practice in Context. Sydney: Elsevier

• Kronenberg F., Algado S.A., Pollard n. (2004) Occupational Therapy Without Borders - Learning from the Spirit of Survivors, Edinburgh; Churchill Livingstone

• Lim K H (2001) A guide to Providing Culturally Sensitive and Appropriate Occupational Therapy Assessments and Interventions. Mental Health Occupational Therapy Magazine Vol 6, Issue 2, 26-29, July 2001

• Lim KH & Iwama M (2006) Emerging Models-An Asian Perspective:The Kawa River Model. In Duncan E(ed) Hagedorn’s Foundations for Practice in Occupational Therapy. Churchill Livingstone, Edinburgh

• Lim KH (2008) Working in a Transcultural Context. In: Creek J & Lougher L (eds) Occupational Therapy and Mental Health. (4 th Ed) Edinburgh, Elsevier Churchill Livingstone

• Lim KH (2008) Cultural sensitivity in context. McKay E, Craik, C., Lim, KH. & Richards, G. (eds) Advancing Occupational Therapy in Mental Health Practice. Blackwell Scientific

• Lim KH (2009) Cultural Issues in Professional Practice. In Atwal A & Jones M (eds) Preparing for Professional Practice in Health and Social Care. Wiley-Blackwell. pp77-98

• Mattingly C & Garro LC (2000) Narrative and the Cultural Construction of Illness and Healing. University of California Press, Berkeley.

• McGruder, J (2003) Culture, race, ethnicity and human diversity. In Crepeau, EB, Cohn, ES and Schell, BAB(eds.) Willard and spackman’s Occupational Therapy. 10 th ED. Lippincott Williams and Wilkins, Baltimore.

• Wells SA & Black RM (2000) Cultural Competency for Health Professionals. American Occupational Therapy Association Press.

• Wells SA & Black RM (2007) Cultural and Occupation. The American Occupational Therapy Association Press.

Contact Details:

• Kee Hean Lim• Lecturer in Occupational Therapy• e-mail: kee.hean.lim@brunel.ac.uk