Debate over the “social question” in occupational therapy: an integrative review

O debate sobre a “questão social” na terapia ocupacional: uma revisão integrativa

Abstract

Introduction:

“Social question” refers to the association between work and its social integration in a capitalist society, assuming a new contemporal configuration. Issues arising from the social question challenge professionals from different fields to provide relevant technical answers.

Objective:

This study aims to understand how occupational therapists have been addressing topics related to social question in occupational therapy journals indexed on Web of Science database. Method: An integrative literature review was conducted (2000-2014) using journals indexed in Thomson Reuters’ Web of Science containg the term “occupational therapy” in their titles. Overall, 32 descriptors related to social question were used in our review.

Results:

The review found 186 texts, for which the abstracts were read and filters were applied to focus on the social question. The remaining 53 texts were read in full and used in our analysis. Several occupational therapy academicians have reflected on the social question. Their focus has mainly been on promoting health and wellness. The present review has a scope limitation because it only analyzes English texts indexed in the Web of Science.

Conclusion:

Occupational therapists should go beyond health interventions in favor of approaching actions that encompass different fields in order to promote greater social participation for all in a globalized capitalist society.

Keywords:
Social Inequality; Poverty; Occupational Therapy/Trends

Resumo

Introdução:

A “questão social” refere-se à associação entre o trabalho e sua integração social em uma sociedade capitalista, permanecendo central desde o século XIX, porém assumindo novas configurações na contemporaneidade. Problemáticas decorrentes da questão social desafiam profissionais de diferentes áreas em torno da oferta de respostas técnicas relevantes.

Objetivo:

Este estudo teve como objetivo compreender como os terapeutas ocupacionais vêm abordando temas relacionados à questão social em periódicos de terapia ocupacional indexados na base Web of Science.

Método:

Foi realizada uma revisão integrativa da literatura (2000-2014) por meio de periódicos indexados na Web of Science da Thomson Reuters que contêm o termo “terapia ocupacional” em seus títulos. Foram utilizados 32 descritores relacionados à temática.

Resultados:

A revisão encontrou 186 textos, dos quais foram lidos os resumos, com a aplicação de filtros para enfocar a questão social. Os restantes 53 textos foram lidos na íntegra e analisados. Vários autores da área de terapia ocupacional têm refletido sobre a questão social, com foco, principalmente, na promoção da saúde e do bem-estar. A presente revisão tem escopo limitado, pois analisa apenas textos em inglês indexados na referida base de dados.

Conclusão:

Os terapeutas ocupacionais precisam ir além das intervenções em saúde em favor de ações que articulem diferentes setores de serviços e dialoguem com outros campos do saber, a fim de reunir elementos para promover uma maior participação social para todos em uma sociedade capitalista globalizada.

Palavras-chave:
Desigualdade Social; Pobreza; Terapia Ocupacional/Tendências

1 Introduction

The social question concept is determined, in capitalist societies, by the peculiar relationship between capital and labor: exploitation (STEIM, 2000; CASTEL, 2012). Discussions about the social question refer to the necessary understanding of the social cohesion possible within the capitalist structure and what agreement would be collectively reached to try to avoid social fracture (STEIM, 2000; CASTEL, 2012). “Social fracture” is understood as a rupture in society generated by unequal access to social goods. It could be minimized by social policies in a capitalist context (STEIM, 2000; CASTEL, 2012). The term social question first appeared in academic literature within the context of changes arising from the Industrial Revolution and changing urban working conditions (STEIM, 2000). Because of its influence on societal development, a number of scholars have attempted to understand how structural elements influence daily life by discussing the concept from a sociological perspective, associating work and social integration within a capitalist society (STEIM, 2000; CASTEL, 2012).

The term capitalist structure, meanwhile, refers to the economic, social, political, and historical elements that organize society (CASTEL, 2012). It is based on the private appropriation of capital and the sale of labor as a commodity, as argued by Karl Marx. The capitalist structure must include two dimensions to avoid social fracture, according to Castel (2012): the first one is lowering expectations of economic growth with the consequence of poverty reduction, and the second is relying on legislative and political order to recognize the social right to goods and services, counterweighing the effects of the economic order, which bars access to the same (CASTEL, 2012).

In the field of occupational therapy, which is involved with social participation and the everyday lives of certain individuals, groups and collectives, understanding the social question is related to understanding the social life and the possibilities and limitations of occupational therapists’ actions (LOPES; MALFITANO, 2017).

Historically, occupational therapy was frequently aimed at (re)habilitating and (re)adapting individuals to their social environment (FRIEDLAND, 2011) by developing “social adaptation” actions (GALHEIGO, 1997), not necessarily based on people’s needs, but with the goal of developing their “adaptation” to social life without taking a critical approach. However, over time these goals started to be criticized and professionals began to operate under new ethical and political paradigms (LOPES, 2013; KIRSH, 2015); Lopes and Malfitano (2017), for example, argue that understanding the dimensions of capitalism, citizenship, and social rights are fundamental to practicing occupational therapy (LOPES; MALFITANO, 2017). In other words, occupational therapists need a reading lens to understand society and to develop their work. The concepts of the social question (STEIM, 2000; CASTEL, 2012), social fracture (CASTEL, 2012), social rights and citizenship (LOPES; MALFITANO, 2017) are important to our practices. Today, occupational therapy addresses topics of citizenship, (LOPES; MALFITANO, 2017) the person in their context (LAW, 1991), the influence of justice, (WILCOCK; TOWNSEND, 2000) the importance of the political (POLLARD; SAKALLARIOU; KRONENBERG, 2008) in professional action, and specific social location (BARROS; GHIRARDI; LOPES, 2005) using these to theoretically and methodologically address the social question.

Meanwhile, understandings of the social question have also shifted over time to remain contemporary and relevant to changes in the capitalist structure. Today, the social question refers to “[…] a fundamental contradiction on which a society experiences the enigma of its cohesion and tries to conjure the risk of its fracture” (CASTEL, 2012, p. 30). For Castel (2012), we live in a capitalist structure based on inequalities and organized by work, because work is what allows people to be part of their society. However, the new social configuration means that many people are unable to work; these people live lives of uncertainty and insecurity, and compose a mass of vulnerable people. This can be called the “new social question”, which is characterized by structural unemployment (CASTEL, 2012). This new understanding brings with it challenges for professionals from many fields, who must offer technical solutions to deal with the consequences of this social question and the growing number of vulnerable people.

To accomplish this goal, it is necessary to both understand specific social demands and develop creative intervention technologies to meet individual situations. It is essential, therefore, that occupational therapy be directed not only toward individuals, but also social groups and other collective bodies.

Lopes and Silva point out that

[…] social occupational therapy actions imply knowledge and monitoring close to the issues that are relevant to the social problem in which one intends to intervene, from its macro-structural understanding (LOPES; SILVA, 2007, p. 159).

Along the same lines, Ramugondo and Kronenberg (2015, p. 8) define collective occupations as

[…] occupations that are engaged in by individuals, groups, communities and/or societies in everyday contexts; these may reflect an intention towards social cohesion or dysfunction, and/or advancement of or aversion to a common good.

The authors understand occupation as always collective and able to influence life in both historical and social ways.

In this article, we focus on Brazilian social occupational therapy (BARROS; GHIRARDI; LOPES, 2005). This field conducts theoretical and practical studies in professional practices that are specifically directed toward the social field of action (LOPES; MALFITANO, 2016), dissociating the practice of occupational therapy from health and disease.

This study uses an integrative literature review to answer the question: how have occupational therapists been addressing topics related to the social question in occupational therapy journals indexed on Web of Science?

2 Method

This study is an integrative literature review, which allows us to synthesize information on all published studies on a given topic and to draw general conclusions. This method also allows for an understanding of both older themes and emerging ones (TORRACO, 2005).

This study contained six stages: 1) journal selection; 2) keywords selection; 3) delineation of search period; 4) reading all abstracts and applying the first filter; 5) reading selected texts in their entirety; and 6) compiling the results, following Torraco’s steps (TORRACO, 2005). In the first stage, the journal selection, we chose journals that defined themselves as occupational therapy publications and had an impact factor recorded in the 2013 Journal Citation Reports (JCR). The JCR is a statistical measurement published by Thompson Reuter and indexed in the Web of Science that allows researchers to evaluate and compare scientific publications and their impact on the scientific community.

Using the criteria described above, we narrowed down our review to the following journals: American Journal of Occupational Therapy, Australian Occupational Therapy Journal, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, Hong Kong Journal of Occupational Therapy, Occupational Therapy International, and Scandinavian Journal of Occupational Therapy.

During the second stage, we selected keyword descriptors. These were chosen based on the authors’ prior knowledge as social occupational therapy researchers in Brazil, coupled with terms from international literature and the World Congresses of Occupational Therapy.

Based on the above, we chose 48 descriptive terms. Of these, 33 were present in the articles surveyed; the other 16 did not appear. These 33 terms were: citizenship, community, community rehabilitation, community integration, community participation, community reintegration, cultural competence, culture, disaster, ecological, education, school, homeless, human rights, low-income, migrant/immigrant, occupational justice, occupational rights, power, prisoners, policy/public policy, refugees, social aspects, social competence, social inclusion/social interaction, social justice, social participation/social networks, social stigma, socioeconomic disadvantage, socioeconomic factors, unemployment, violence, and war. (The 16 keywords that we did not find in our search include: child labor, discrimination, illegal work, no formal job, poverty/indigence, prison/prison population, prostitution/prostitute, racism/racialism, slave labor, social assistance, social goods, social perspective, solidarity, territory, trafficking in person, and vulnerability).

During the third stage, we decided to cover the period from 2000 to 2014. This timespan was chosen because of the period of expanding literature on social occupational therapy in Brazil (BARROS; GHIRARDI; LOPES, 1999; BARROS; GHIRARDI; LOPES, 2002), and the growing discussion about occupational justice in Anglophone literature. We would like to find the literature about this topic during this period based on these factors. Each of these approaches represents different ways to address the social question; the first focuses on social action, and the second on justice.

Table 1 shows the distribution of the articles, according to the journal, the articles’ year of publication and percentage relative to them. The acronym of magazines: American Journal of Occupational Therapy (AJOT), Australian Occupational Therapy Journal (AOTJ), Scandinavian Journal of Occupational Therapy (SJOT), British Journal of Occupational Therapy (BJOT), Canadian Journal of Occupational Therapy (CJOT), Hong Kong Journal of Occupational Therapy (HKJOT), Occupational Therapy International (OTI).

Table 1
Number of articles/journal/publication year.

Journal Acronym	Year (20..)												Articles/ Journal			%
	00	01	02	03	04	05	06	07	08	09	10	11	12	13	14
AJOT		3	3	3	2	4	4	3	2	9	3	6	5	2	2	51	27.41
AOTJ	2	1	1	1	1	2	2	2	3	3	5	9	5	1	8	46	24.73
SJOT	1		2	1	4		1	5	3		5			5	2	29	15.60
BJOT			1						4	7	3	4		4		23	12.37
CJOT	1	1	3	2	1	2	1	1	1					3	3	19	10.21
HKJOT						1	1	2	1	2		1	1			9	4.84
OTI					3			2	2			1		1		9	4.84
Total/ Year	4	5	10	7	11	9	9	15	16	21	16	21	11	16	15	186	100

In the fourth stage, we read the abstracts of the 186 texts brought up by our search. This included an overview of the article identification data (title, journal’s name, country, and year of publication), keywords, objectives, target population, results, discussion, and/or conclusion. We then applied the following inclusion criteria: articles that named themselves as related to the social question; those that described the socioeconomic question; articles that referred to the social question either as their theoretical point of view or as the grounding of practice/experience; those that understood the social question as addressing issues concerning the establishment and functioning of society; and articles mainly linking the social question to socioeconomic and cultural factors. After applying these criteria, 53 articles remained.

In the fifth stage, we read the full text of those 53 articles. We noted the following: type of publication, predominant population, authors’ theoretical concepts, identification of how the text referred to the social question (individual/clinical vs. collective), any explicit relationship with the health sector, and implications for the field of occupational therapy (professional practice, research, and knowledge production).

In the sixth stage, we compiled the results, describing the articles. We sought to know what kind of discussion has been proceeded in occupational therapy about the social question, outside of the health system.

Applying the results all the stages described above, we would like to answer the question: how have occupational therapists been addressing topics related to the social question in the indexed English database? For this, we developed a questionnaire to be filled throughout the reading of each article. The questions were about the types of articles (research, literature review, case report or theoretical paper); population groups studied in the articles; theoretical concepts presented; clinical and individual or community and/or social aspects of occupational therapy; and the specificity of the discussion in professional practice. These topics were important to approach relevant elements to understand the knowledge published by these articles.

After that, we conducted a critical reflection in a comprehensive approach to the data in order to analyze the occupational therapy literature which address the social question.

3 Results

53 articles were found after applying all filters, presented in Table 2. These selected articles use 12 of the keywords listed in the study. The highest incidence was of the word homeless (11), followed by social inclusion/social interaction (10). Table 3 shows the distribution of articles according to descriptor, journal, and publication year.

Table 2
List of the articles.

Title:	Journal	Author(s)	Year
Keyword: HOMELESS
The Meaning of Computers to a Group of Men Who Are Homeless	American Journal of Occupational Therapy	MILLER, K. S.; BUNCH-HARRISON, S.; BRUMBAUGH, B.; KUTTY, R. S.; FITZGERALD, K.	2005
The Meaning of Family Routines in a Homeless Shelter	American Journal of Occupational Therapy	SCHULTZ-KROHN, W.	2004
The Process and Outcomes of a Multimethod Needs Assessment at a Homeless Shelter	American Journal of Occupational Therapy	FINLAYSON, M.; BAKER, M.	2002
Homeless adults engagement in art: First steps towards identity, recovery and social inclusion	Australian Occupational Therapy Journal	THOMAS, Y.; GRAY, M.; MCGINTY, S.; EBRINGER, S.	2011
Exploring occupation and it meaning among homeless men	British Journal of Occupational Therapy	CHARD, G.; FAULKNER, T.; CHUGG, A.	2009
Occupational therapist’s perceptions of their role with people who are homeless	British Journal of Occupational Therapy	GRANDISSON, M.; MITCHELL-CARVALHO, M.; TANG, V.; KORNER-BITENSKY, N.	2009
Leaving homelessness and addiction: Narratives of an occupational transition	Scandinavian Journal of Occupational Therapy	HEUCHEMER, B.; JOSEPHSSON, S.	2006
Exploring the occupations of homeless adults living with mental illnesses in Toronto	Canadian Journal of Occupational Therapy	ILLMAN, S. C.; SPENCE, S.; O’CAMPO, P. J.; KIRSH, B. H.	2013
Occupation and the process of transition from homelessness.	Canadian Journal of Occupational Therapy	MARSHALL, C. A.; ROSENBERG, M. W.	2014
On the edge of the possible: considering homelessness.	Canadian Journal of Occupational Therapy	TSANG, A.; DAVIS, J. A.; POLATAJKO, H. J.	2013
An occupational therapy service to hotels for homeless people: na orverview	British Journal of Occupational Therapy	PARMENTER, V.; FIELHOUSE, J.; BARHAM, R.	2013
Keyword: MIGRANT
The meaning of leisure for well-elderly Italians in an Australian community: Implications for occupational therapy	Australian Occupational Therapy Journal	MILLER, K. S.; BUNCH-HARRISON, S.; BRUMBAUGH, B.; KUTTY, R. S.; FITZGERALD, K.	2008
New-immigrant women in urban Canada: insights into occupation and sociocultural context	Occupational Therapy International	MARTINS, V.; REID, D.	2007
The cultural brokerage work of occupational therapists in providing culturally sensitive care	Canadian Journal of Occupational Therapy	LINDSAY, S.; TE´TRAULT, S.; DESMARIS, C.; KING, G. A.; PIE´RART, G.	2014
People detained for prolonged periods in immigration detention experienced significant psychological and interpersonal difficulties that make it difficult to rebuild their lives following release from detention	Australian Occupational Therapy Journal	BENNETT, S.; CAMPBELL, E.	2014
Keyword: OCCUPATIONAL JUSTICE
Social and occupational justice barriers in the transition from foster care to independent adulthood	American Journal of Occupational Therapy	PAUL-WARD, A.	2009
Occupational justice and client-centred practice: dialogue in progress	Canadian Journal of Occupational Therapy	TOWNSEND, E.; WILCOCK, A. A.	2004
Reflexions on ... Positive aging and its implications for occupational possibilities in later life	Canadian Journal of Occupational Therapy	RUDMAN, D. L.	2006
Occupational Justice - Bridging theory and practice	Scandinavian Journal of Occupational Therapy	NILSSON, I.; TOWNSEND, E.	2010
Social occupational therapy: conversations about a brazilian experience	Canadian Journal of Occupational Therapy	MALFITANO, A. P. S.; LOPES, R. E.; MAGALHÃES, L.; TOWNSEND, E. A.	2014
Occupational performance and self-determination: the role of the occupational therapist as volunteer in two mountain communities	Australian Occupational Therapy Journal,	BOYLE, M.	2014
Occupational justice - bridging theory and practice	Scandinavian Journal of Occupational Therapy	NILSSON, I.; TOWNSEND, E.	2014
Keyword: OCCUPATIONAL RIGHTS
Refletions on ... Well-being and occupational rights	Canadian Journal of Occupational Therapy	HAMMELL, K. W.	2008
Keyword: PRISIONERS
Reflections on ... Canadian occupational therapists’ contributions to prisioners of war in World War II	Canadian Journal of Occupational Therapy	COCKBURN, L.	2005
Keyword: REFUGEES
Development and evaluation of an occupational therapy program for refugee high school students	Australian Occupational Therapy Journal	COPLEY, J.; TURPIN, M.; GORDON, S.; MCLAREN, C.	2011
Refugee settlement workers’ perspectives on home safety issues for people from refugee backgrounds	Australian Occupational Therapy Journal	CAMPBELL, E. J.; TURPIN, M. J.	2010
Understanding the occupational deprivation of refugees: a case study from Kosovo	Canadian Journal of Occupational Therapy	WHITTEFORD, G. E.	2005
Experiences in occupational therapy with afghan clients in Australia	Australian Occupational Therapy Journal	MARONEY, P.; POTTER, M.; THACORE, V. R.	2014
Working with populations from a refugee background: An opportunity to enhance the occupational therapy educational experience.	Australian Occupational Therapy Journal	SMITH, Y. J.; CORNELLA, E.; WILLIAMS, N.	2014
Keyword: SOCIAL COMPETENCE
An occupational perspective on the assessment of social competence in children	British Journal of Occupational Therapy	LIM, S. M.; RODGER, S.	2008
Keyword: SOCIAL INCLUSION / SOCIAL INTERACTION
Diversity and inclusion within an occupational therapy curriculum	Australian Occupational Therapy Journal	TRENTHAM, B.; COCKBURN, L.; CAMERON, D.; IWAMA, M.;	2007
An evaluation of the impact of a social inclusion programme on occupational functioning for forensic service user	British Journal of Occupational Therapy	FITZGERALD, M.	2011
Gardening and belonging: reflections on how social and therapeutic horticulture may facilitate health welbeing and inclusion	British Journal of Occupational Therapy	DIAMANT, E.; WATERHOUSE, A.	2010
ELSiTO. A collaborative european initiative to foster social inclusion with persons experiencing mental illness	Occupational Therapy International	AMMERAAL, M.; KANTARTZIS, S.; BURGER, M.; BOGEAS, T.; VAN DER MOLEN, C.; VERCRUYSSE, L.	2013
Community integration outcomes after traumatic brain injury due to physical assault.	Canadian Journal of Occupational Therapy	KIM, H.; COLANTONIO, A.; DAWSON, D. R.; BAYLEY, M. T.	2013
The benefits of knitting for personal and social wellbeing in adulthood: findings from na international survey	British Journal of Occupational Therapy	RILEY, J.; CONKHILL, B.; MORRIS, C.	2013
Meta-synthesis of qualitative studies concluded that the social environment was the most influential environmental factor to impact participation of youths with disabilities	Australian Occupational Therapy Journal	WALLEN, M.; IMMS, C.	2014
Unserstanding social inclusion as an international discourse: implications for enabling participation	British Journal of Occupational Therapy	PEREIRA, R. B.; WHITEFORD, G. E.	2013
Young persons with visual impairment: Challenges of participation., Early Online	Scandinavian Journal of Occupational Therapy	SALMINEN, A. L.; KARHULA, M.E.	2014
Global policy and local actions for vulnerable populations affected by disaster and displacement	Australian Occupational Therapy Journal	SINCLAIR, K.	2014
Keyword: SOCIAL JUSTICE
Health disparities: examination of evidence relevant for occupational therapy	American Journal of Occupational Therapy	BASS-HAUGEN, J. D.	2009
Social Justice and Resource Utilization in a Community-Based Organization: A Case Illustration of the Role of the Occupational Therapist	American Journal of Occupational Therapy	BRAVEMAN, B.; BASS-HAUGEN, J. D.	2009
Occupational deprivation: A consequence of Australia’s policy of assimilation	Australian Occupational Therapy Journal	ZELDENRYK, L.	2006
Keyword: SOCIAL PATICIPATION / SOCIAL NETWORKS
Social Participation and Functional Ability from Age 75 to Age 80	Scandinavian Journal of Occupational Therapy	SORENSEN, L. V.; AXELSEN, U.; AVLUND, K.	2002
Occupational therapy interventions to improve leisure and social participation for older adults with low vision: a systematic review.	The American Journal of Occupational Therapy	BERGER, S.; MCATEER, J.; SCHREIER, K.; KALDENBERG, J.	2013
Comparing participation patterns in out-of-school activities between israeli jewish and muslim children	Scandinavian Journal of Occupational Therapy	ENGEL-YEGER, B.	2013
Participation: are we there yet	Australian Occupational Therapy Journal	IMMS, C.; GRANLUND, M.	2014
Participation in social internet-based activities: five seniors’ intervention processes	Scandinavian Journal of Occupational Therapy	LARSSON, E.; NILSSON, I.; LUND, M. L.	2013
Social participation: redesign of education, research, and practice in occupational therapy	Scandinavian Journal of Occupational Therapy	PIŠKUR, B.	2013
Keyword: SOCIOECONOMIC FACTORS
Sociodemographic effects on activities preference of typically developing Israeli children a youths	American Journal of Occupational Therapy	ENGEL-YEGER, B.	2009
Experiences of social class: learning from occupational therapy students	Canadian Journal of Occupational Therapy	BEAGAN, B. L.	2007
Progression routes and attainment in occpational therapy education: the impacto f backgrownd characteristics	British Journal of Occupational Therapy	WATSON, J.	2013
Keyword: UNEMPLOYMENT
Empirical lessons about occupational categorization from case studies of unemployment	Canadian Journal of Occupational Therapy	ALDRICH, R. M.; MCCARTY, C. H.; BOYD, B. A.; BUNCH, C. E.; BALENTINE, C. B.	2014

Table 3
Distribution of articles according to descriptor, journal and publication.

Keyword	Nº	Journal	Nº.	Year/Nº
Homeless	11	American Journal of Occupational Therapy	3	2002 - 1 2004 - 1 2005 - 1 2006 - 1 2009 - 2 2011 - 1 2013 - 3 2014 - 1
		Australian Occupational Therapy Journal	1
		British Journal of Occupational Therapy	3
		Canadian Journal of Occupational Therapy	3
		Scandinavian Journal of Occupational Therapy	1
Social inclusion / Social interaction	10	Australian Occupational Therapy Journal	3	2010 - 1 2011 - 1 2012 - 1 2013 - 4 2014 - 3
		British Journal of Occupational Therapy	4
		Canadian Journal of Occupational Therapy	1
		Occupational Therapy International	1
		Scandinavian Journal of Occupational Therapy	1
Occupational justice	7	American Journal of Occupational Therapy	1	2004 - 1 2006 - 1 2009 -1 2010 - 1 2014 - 3
		Australian Occupational Therapy Journal	1
		Canadian Journal of Occupational Therapy	3
		Scandinavian Journal of Occupational Therapy	2
Social participation / Social networks	6	American Journal of Occupational Therapy	1	2002 - 1 2013 - 4 2014 - 1
		Australian Occupational Therapy Journal	1
		Scandinavian Journal of Occupational Therapy	4
Refugees	5	Australian Occupational Therapy Journal	4	2005 - 1 2010 - 1 2011 - 1 2014 - 2
		Canadian Journal of Occupational Therapy	1
Migrants / Immigrants	4	Australian Occupational Therapy Journal	2	2007 - 1 2008 - 1 2014 - 2
		Canadian Journal of Occupational Therapy	1
		Occupational Therapy International	1
Social justice	3	American Journal of Occupational Therapy	2	2006 - 1 2009 - 2
		Australian Occupational Therapy Journal	1
Socioeconomic factors	3	American Journal of Occupational Therapy	1	2007 - 1 2009 - 1 2013 - 1
		British Journal of Occupational Therapy	1
		Canadian Journal of Occupational Therapy	1
Prisoners	1	Canadian Journal of Occupational Therapy	1	2005 - 1
Occupational rights	1	Canadian Journal of Occupational Therapy	1	2008 - 1
Social competence	1	British Journal of Occupational Therapy	1	2008 - 1
Unemployment people	1	Canadian Journal of Occupational Therapy	1	2014 - 1

The type of publication can shed light on the kinds of papers occupational therapists are using to publish in journals in this topic. Research articles predominated (34), followed by theoretical texts (12), literature reviews (6), and one case report. The research articles types are: quantitative (10), qualitative (9), case study (7), descriptive (3), exploratory descriptive (3), participative (1) and historical (1).

Next, we took an overview of the population groups in the articles analyzed. Most studies focused on homeless populations (11), which was followed in popularity by adolescents and young people (9). One text refers to more than one population group. This information could be useful in understanding what kinds of group populations are related to the social question in the occupational therapy references. Table 4 provides the information.

Table 4
Mentioned populations.

Population		Nº
Homeless		11
Adolescents and Young People		9
Refugees		5
Elderly People		4
Migrants		4
Unemployed/Underemployed People		2
Others	Children (indigenous 1, with deficiency 2, with impaired social participation 1)	4
	Ethnic Groups	3
	Occupational Therapy Students	3
	Occupational Therapists	2
	Women	2
	HIV-Positive Persons	1
	Forensic Service Users	1
	Prisoners	1
	No population specified	13

We analyzed the texts to see what kinds of issues they were approaching. We were interested to know if they were focused on health issues or if they were going further by looking at the social question in is various dimensions. As expected, when filtering for population groups we found a predominant number centered on the social question, with no discussion of health issues or disease processes. Of the analyzed texts, 67.92% (36) did not discuss the social question using a health intervention approach and 26.41% (14) did so partially or in dialogue with other fields. Only 5.67% (3) directly referred to health interventions. The vast majority of texts, however, focused on possible actions to improve individual health and well-being without specifically describing health interventions.

To emphasize this subject, we described the theoretical references, according to the terminology applied by the authors. (Note: one text could have more than one reference). There was a multiplicity of theoretical frameworks used to ground the research in the texts, which went beyond the keywords we searched for. The most common references cited the theoretical concept of occupational justice (14 sources) and/or social inclusion (10 sources). Therefore, from 2000-2014 it can be inferred that international literature focused on the importance of occupational therapy in addressing systems of injustice that make it impossible for people to conduct their lives. Table 5 shows this.

Table 5
Theoretical concepts that are presented.

Presented theoretical concepts		Nº
Occupational Justice		14
Social Inclusion		10
Social Participation		9
Critical Perspective in Occupational Therapy		5
Rights and Citizenship		7
Occupational Rights		5
Social Justice		4
Social Policy		1
Others	Culture and Occupation	6
	Occupational Deprivation	5
	Occupational Alienation	4
	Occupational Marginalization	2
	Social Classes	2
	Ethnicity	2
	Human Occupation Model	1
	Occupational Risk Factors	1
	Occupational Engagement	1
	Social Policy	1
	Social Exclusion	1
	Prejudice	1
	Economic Factors	1
	Neoliberalism	1
	Child Development	1
	International Classification of Functioning - ICF	1
	Social Competence	1
	Empowerment	1

In reading the papers, we tried to identify their points of view: did they focus on the clinical and individual?; were they more concerned with disease, diagnosis, and treatment?; or did they address the community and/or social aspects of occupational therapy? 48 of the papers (90.57%) predominantly focused on the collective, community, and/or social aspects. These texts were ranked according to socioeconomic and community issues. The remaining 9.43% (5 texts) approached the issue from somewhere between the individual and collective perspective, concentrating on the individual within his/her social context. None of the listed texts used a clinical approach or focused on biomedical issues for diagnosis and treatment.

Finally, we analyzed the results based on the articles’ professional practice, research, and knowledge production. We observed that 90.57% (48) explicitly related their discussions to the professional practice of occupational therapy, 1.89% (1) focused on interdisciplinary practice without emphasizing occupational therapy, and 7.54% (4) did not mention professional practice at all. Altogether, 96.23% (51) directly discussed occupational therapy research and knowledge while 3.77% (2) did not mention the issue.

4 Discussion

The 53 texts analyzed are a small number compared to the overall production of the journals analyzed in the given period. Hammell and Iwama (2012, p. 388) point out that

[…] much of the occupational therapy theoretical literature predominantly focuses on individual issues such as volition, personal causation, habituation, mastery, and motor skills.

It is possible to assume, therefore, that a few percentage of occupational therapy literature deals with the social question.

In addition, Fransen et al. (2015, p. 266) argue that occupational therapy should take place from a citizenship perspective and in public spaces that make such activity possible, since

[…] the recognition that the participation of people in public life as citizens of their society is constructed and shaped by social, political, cultural, economic, and racial/ethnic values indicates the importance of power and privilege as social determinants.

When considering the issues and populations investigated in the analyzed papers, therefore, it becomes clear that occupational therapists are challenged by the contemporary demands of a globalized society. Researchers have developed solutions to these challenges in different locations and with different population groups.

Although human health remains relevant to the practice of occupational therapy, it is insufficient. It is important, therefore, to ask what occupational therapy researchers’ roles should be when addressing issues that are not related to health intervention. However, while 67.92% of the articles studied did not focus on health interventions directly, they still aimed to promote health and well-being and addressed this issue from the standpoint of intervening in occupational performance. This is confirmed by other studies, which focus on individual and social approaches. In a historical review of occupational justice and its related concepts, Malfitano, Souza and Lopes (2016, p. 176) show the predominance of individual approaches (n=425), compared with collective approaches (n=370), pointing out that the

[…] increased focus on social contexts and socio-economic aspects suggests the need for studies to further explore how occupational justice and related concepts stimulate occupational therapy and occupational science to be more socially responsive.

It is also confirmed by theoretical studies which explore the necessity of occupational therapy actions to go beyond individualism through a critical approach (GERLACH, 2017).

Adapting to the changing global reality does not mean occupational therapists should restrict themselves to promoting health or disease and/or disability prevention. As we found in our analysis, addressing the social question means exploring social inequalities and seeking to develop interventions that are not limited to the improvement of individual or collective health conditions. Instead, occupational therapists are tackling broader actions to deal with issues related to violence, gender, and social class that can affect the dignified life of affected populations.

Several discussions with critical approaches are taking place among authors in different parts of the world. Hammell and Iwama (2012) talk about the environment influencing occupations rather than narrowly focusing on the health system perspective, thereby addressing conditions of inequality in people’s lives; Guajardo, Kronenberg and Ramugondo (2015) explore the necessity of southern occupational therapies related to different contexts and realities, expanding the subject and groups of intervention; Labierte-Rudman (2018) calls for a social transformation for occupational therapy and occupational science based on knowledge and actions; Sakellariou and Pollard (2017) bring together a range of authors discussing different practices and theoretical knowledge in Occupational Therapy.

For example, it is not possible to successfully help the homeless population when limiting treatment to mental illnesses, alcoholism, and/or drug use. Instead, interventions must be combined with public policies and social services in order to ensure that this group, normally barred from social rights, has access to their basic human rights.

It is important to highlight that the texts found are not focus on biomedical aspects, what demonstrates a bigger vision in Occupational Therapy. They are approaching some points around social question. However, they are majority still related to health and well-being, which are important aspects, but they are not the totality of occupational therapy actions focusing on social question.

Perhaps part of the reason occupational therapy has broadened its scope is due to the inefficiency and even failure to deal with the social question. We assume here a stance on the failure and, in many cases, inefficiency of health interventions to deal with the social question. In the social field, occupational therapists have found that their work is more successful when they take a different approach and move outside of the healthcare system to work with other sectors, including social work, education, justice, and culture (LOPES; MALFITANO, 2017; LOPES, 2013; BARROS; GHIRARDI; LOPES, 2005; LOPES; SILVA, 2007; BARROS et al., 2011; LOPES; MALFITANO, 2016).

Another possible reason for the widening perspective of occupational therapy is that restricting intervention to promoting health and well-being when dealing with the social question runs the risk of socially medicalizing at-risk populations. Ilich (1974) defines medicalization as the creation of non-existent diseases that have a social background. Pussetti (2010) expresses the same criticism when describing the increase in mental health problems among immigrants in Europe, particularly in Portugal, a phenomenon she calls “immigrant depression”. She points out that there is a increasing number of cases that disregard the individual’s complex social situation and experience, which is permeated by the precariousness of their socioeconomic living conditions. The result is a medical diagnosis and, often, prescribed medication. However, the occupational therapist’s role in addressing the social question through health interventions remains unclear. This is an area that could be benefited by further research.

5 Conclusion

The study demonstrates that there are occupational therapists concerned with the contemporary social question. While our study was conducted on a small scale, our results show that within the confines of our study, which included seven occupational therapy journals, researchers are beginning to work with diverse populations and a range of theoretical frameworks.

It is important to note that we exclusively focused on occupational therapy journals and did not take into consideration other journals in the field of occupational science, for example, those that unite a large quantity of works by occupational therapists. This was intentional, as our objective was to discuss the application of the social question specifically within the field of occupational therapy. However, this could be the basis for a wider study that explores the subject in occupational science more broadly.

It is recognized that our results are limited; it investigated only English-language journals indexed in Thomson Reuters’ Web of Science. Worldwide, there are many occupational therapy articles in many languages that are not necessarily indexed in our chosen database. This criteria does limit the scope of our research as many important occupational therapy journals are not indexed in JCR, and our focus on English-language journals meant that we did not consider the occupational therapy field outside the Anglophone world. Nevertheless, our results show significant representation and the possibility of trend identification.

Occupational therapists must move beyond health interventions. Further research should address the possibility of occupational therapists shifting their work to interventions in other sectors through theoretical and methodological contributions that deal with the social question and can bring about a greater social participation for all in a globalized capitalist society. As researchers working within Brazilian social occupational therapy, we are interested in the possibility of developing knowledge and practices directed toward expanding social participation and not “exclusively” promoting health and well-being.

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Publication Dates

• Publication in this collection
  Dec 2018

History

• Received
  06 July 2018
• Accepted
  29 Aug 2018