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Social participation in occupational therapy: what are we talking about?

Abstract

This article presents the results of a systematic review, which aimed to investigate how researchers of Brazilian occupational therapy conceptualize social participation and which theoretical references are used or produced in the area to discuss this concept. The review consisted of searching the bibliographic productions of Brazilian occupational therapists available online in journals of the area, in LILACS and SciELO. There were 481 articles identified and, based on the exploratory and selective reading, 31 articles were considered for descriptive, critical and interpretive analysis, dealing with exploratory research and reflection/essay and case studies, experience reports, and bibliographic review. Researchers presented plurality in the definition and understanding of social participation; however, there’s still no clarity about these different ways of approaching the concept, which can be justified by the inexistence or lack of a better theoretical-conceptual foundation. Other terms, such as “participation”; “sociocultural participation”; “community participation” and “political participation” were used as synonyms of social participation. This variation in the use of terms also resulted from the different fields of action in which the studies were carried out and from the theoretical references used. Some articles did not define social participation, even if the concept was the subject of research and/or analysis. However, they used references that help understand how their authors understand social participation. As in other fields of knowledge, occupational therapy presents a multiplicity of definitions or notions of the concept that is influenced by different sciences and disciplines, which also reveals consensus and divergence.

Keywords:
Occupational Therapy; Concept Formation; Social Participation; Knowledge; Systematic Review

Resumo:

Este artigo apresenta os resultados de revisão sistemática, que visou investigar como pesquisadoras da terapia ocupacional brasileira conceituam participação social e quais referenciais teóricos são utilizados ou produzidos na área para discutir sobre esse conceito. A revisão constituiu-se de busca pelas produções bibliográficas de terapeutas ocupacionais brasileiros disponíveis online em periódicos da área, na LILACS e SciELO. Foram identificados 481 artigos e, a partir da leitura exploratória e seletiva, considerou-se 31 artigos para análise descritiva, crítica e interpretativa, que tratam de pesquisas exploratórias e estudos de reflexão/ensaio e de caso, relatos de experiência e revisão bibliográfica. As pesquisadoras apresentaram pluralidade na definição e entendimento sobre a participação social, todavia ainda há pouca clareza sobre essas diferentes formas de abordar o conceito, o que pode ser justificado pela inexistência ou escassez de melhor fundamentação teórica-conceitual. Outros termos, como: “participação”; “participação sociocultural”; “participação comunitária” e “participação política” foram utilizados como sinônimos de participação social. Essa variação no uso dos termos também decorreu dos diferentes campos de atuação nos quais os estudos foram realizados e dos referenciais teóricos utilizados. Alguns artigos não definiram participação social, mesmo que o conceito tenha sido objeto de investigação e/ou de análise. Todavia, empregaram referências que ajudam a compreender como seus autores entendem a participação social. Assim como em outros campos de conhecimento, a terapia ocupacional apresenta uma multiplicidade de definições ou noções do conceito que é influenciada por diferentes ciências e disciplinas, o que também revela consensos e divergências.

Palavras-chave:
Terapia Ocupacional; Formação de Conceito; Participação Social; Conhecimento; Revisão Sistemática

1 Introduction

The historical and social participation and from an analytical perspective can have multiple meanings. The categories “social participation”, “popular participation” and “community participation” are examples of this multiple meanings and,

[...] although having the same origin (the main category 'participation') and having convergent aspects, they have their specificities, as they analyze different realities (ESCOREL; MOREIRA, 2012ESCOREL, S.; MOREIRA, M. R. Participação social. In: GIOVANELLA, L. (Org.). Políticas e sistema de saúde no Brasil. Rio de Janeiro: Ed. FIOCRUZ, 2012. p. 853-883., p. 854).

Some areas, such as political science, education, law, sociology, and health, discuss the meaning of social participation. In sociology and health, for example, social participation is identified as the involvement of subjects in decision-making processes organized by social and political institutions (STOTZ, 2009STOTZ, E. N. Participação social. In: PEREIRA, I. B.; LIMA, J. C. F. (Org.). Dicionário da educação profissional em saúde. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio, Fundação Oswaldo Cruz, 2009. p. 293-298. Disponível em: <htpp://www.epsjv.fiocruz.br/dicionário/verbetes/parsoc.html>. Acesso em: 12 maio 2019.). The diversity of references creates inaccuracies and makes the concept complex, and the same happens in the Brazilian and international occupational therapy field.

From the perspective of the North American occupational therapy that is based on the principles of psychology and sociology, the social participation is understood as the interpersonal interactions of individuals verbally or not and with or without involvement in an activity (COLE; DONOHUE, 2011COLE, M. B.; DONOHUE, M. V. Social participation in occupational contexts: in schools, clinics and communities. Thorofare: SLACK Incorporated, 2011.). In the perspective of the Canadian Occupational Science, social participation is understood as the active engagement of people in occupations (TOWNSEND; LANDRY, 2005TOWNSEND, E.; LANDRY, J. Interventions in a societal context: enabling participation. In: CHRISTIANSEN, C. H.; BAUM, C. M. Occupational therapy: performance, participation, and well-being. Thorofare: SLACK Incorporated, 2005. p. 494-521.).

In Latin American countries (such as Chile) the social participation in the socio-critical paradigm is seen as the key to emancipation and personal and collective development to face the processes of exclusion and oppression (SOSA et al., 2015SOSA, E. et al. Visión respecto a la legislación laboral chilena, desde sujetos en situación de discapacidad con participación política. Revista Chilena de Terapia Ocupacional, Santiago, v. 15, n. 1, p. 45-56, 2015.).

The social participation in Brazil between 1980 and 1990 was approached by occupational therapists in the context of the individuals´ participation in the public life, in the confrontation with the social structure that produces inequalities and as a mechanism for the transformation of society (SOARES, 1991SOARES, L. B. T. Terapia ocupacional: lógica do capital ou do trabalho? Retrospectiva histórica da profissão no estado brasileiro de 1950 a 1980. São Paulo: Hucitec, 1991.; FRANCISCO, 2001FRANCISCO, B. R. Concepção “ingênua” e a concepção crítica da terapia ocupacional (modelos do processo). In: FRANCISCO, B. R. Terapia ocupacional. Campinas: Papirus, 2001. p. 51-72.).

Since then, the promotion of social participation has been present in debates and interventions in the health care; daily transformation; promotion of autonomy, well-being and independence; exercise of citizenship; access to social rights; enjoyment of goods and services; defense of deinstitutionalization processes and rupture or fragility of supportive social relationships (BARROS; LOPES; GALHEIGO, 2007BARROS, D. D.; LOPES, R. E.; GALHEIGO, S. M. Novos espaços, novos sujeitos: a terapia ocupacional no trabalho territorial e comunitário. In: CAVALCANTI, A.; GALVÃO, C. (Org.). Terapia ocupacional: fundamentação e prática. Rio de Janeiro: Guanabara Koogan, 2007. p. 354-364.).

For the authors in this review, social participation is the involvement of individuals in social groups and/or in public and community spaces, transforming the daily life and living conditions involving illness, violence, mental and/or psychological suffering, social and occupational injustice, inequality, prejudice, exclusion, and oppression.

It is a circumscribed definition in the sociology and occupational therapy field to understand it as a political and emancipatory practice, which happens in social, political, economic and cultural contexts, at micro and macro-social levels.

However, different perspectives may be worked by occupational therapy to attribute other meanings to social participation. Therefore, through systematic review, this article aimed to investigate how Brazilian occupational therapy researchers conceptualize social participation, considering the theoretical references used or produced in the area to discuss this concept and contrast the different definitions of social participation found, including those presented by the authors of this study.

Occupational therapists might widely use the concept and promote social participation is a technical responsibility and ethical and political commitment; justifying the importance and necessity of approaching this concept in the theoretical-practical field of the profession.

The paradigm changes, the socio-cultural, political and economic view, the place where it operates, and the population assisted (or sought to assist) influence the professional profile and the theoretical and practical development of the profession. Making a commitment to foster social participation or discussing it is a beginning to be a profession that transforms itself and the existing social order (GALHEIGO et al., 2012GALHEIGO, S. M. et al. People with disabilities and participation: experiences and challenges of na occupational therapy practice in the city of São Paulo, Brazil. In: POLLARD, N.; SAKELLARIOU, D. Politics of occupation-centred practice: reflexions on occupational engagement across cultures. Oxford: Wiley-Blackwell, 2012. p. 128-145.). Thus, there is a need for ethical and theoretical-conceptual professional commitment to building practices and a specific and interdisciplinary field of knowledge (CORDOBA, 2011CORDOBA, A. G. Construcición de identidades, episteme y práticas em terapia ocupacional em América Latina. San Pablo: [s.n.], 2011. Disponível em: <https://www.academia.edu/31393067/Construccion_Identidades_y_epistemes_AGC_enero_2014>. Acesso em: 30 dez. 2018.
https://www.academia.edu/31393067/Constr...
).

2 Method

This research was elaborated through a systematic review (MOHER et al., 2009MOHER, D. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine, San Francisco, v. 6, n. 7, p. 1-6, 2009. PMid:19621072.; GONÇALO et al., 2012GONÇALO, C. S. et al. Planejamento e execução de revisões sistemáticas da literatura. Revista Brasília Médica, Brasília, v. 49, n. 2, p. 104-110, 2012.) analyzing the bibliographic production in Brazilian occupational therapy published in journals of the area in the online version.

The articles were searched using the descriptors “social participation” or “participation” and “occupational therapy” in the journals: Cadernos Brasileiros de Terapia Ocupacional (available from 1990 to 2018), Revista de Terapia Ocupacional da Universidade de São Paulo (available from 2002 to 2018), Revista Baiana de Terapia Ocupacional (2004, 2005, 2007, 2012 and 2013) and Revista Interinstitucional Brasileira de Terapia Ocupacional (2017 and 2018). The Literature in the Health Sciences in Latin American and the Caribbean (LILACS) and the Scientific Electronic Library Online (SciELO) were also accessed1 1 The consultation did apply a filter for the year of publication; all the numbers of journals accessible online were considered (up to December 2018). .

The identification and selection of bibliographic production was performed in October and December 2018, in which the texts not produced by occupational therapists; foreign research results or reports; texts identified as editorial or abstracts of theses and dissertations; those texts that did not address the topic; adaptation, validation and/or translation of evaluations and instruments texts; repeated texts and those that only cited the term “social participation” in the abstract or its descriptors were excluded.

The eligibility phase was conducted by one of the authors through exploratory and selective reading. The included articles were read in full from a descriptive, analytical, and interpretative perspective (PÁDUA, 2002PÁDUA, E. M. M. Metodologia de pesquisa: abordagem teórico-prática. Campinas: Papirus, 2002.; MOHER et al., 2009MOHER, D. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine, San Francisco, v. 6, n. 7, p. 1-6, 2009. PMid:19621072.). Mapping and search of the theoretical references that define and/or discuss social participation and that were adopted by the researchers of the articles were performed.

These references were located in journals, books, and book chapters and are part of the discussions in this study. This process was performed to better identify and understand the perception (or perceptions) about social participation that has been used to support research and theoretical and practical discussions in occupational therapy. The type of study was considered for the exposition and characterization of the articles since it was extracted from the texts in its methodology section.

3 Results and Discussion

3.1 Presentation of the studies

There were 481 articles identified, and 76 of them were selected after applying the inclusion and exclusion criteria. When reading these articles, 31 studies were selected and analyzed. Figure 1 shows the flowchart according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes - PRISMA (MOHER et al., 2009MOHER, D. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine, San Francisco, v. 6, n. 7, p. 1-6, 2009. PMid:19621072.) with quantitative results of the methodological process.

Figure 1
Review Flowchart.

Seventeen of the 31 articles included were published in the Cadernos Brasileiros de Terapia Ocupacional, 9 were published in the Terapia Ocupacional da Universidade de São Paulo, 4 were published in the Revista Interinstitucional Brasileira de Terapia Ocupacional and 1 was published in the Jornal da Sociedade Brasileira de fonoaudiologia (CoDAS), as shown in Table 1. The temporal distribution showed a higher production in 2016 and 2018 and lower production in 2003, 2007, 2009 and 2017.

Table 1
Distribution of publications by their year and journal.

Table 2 shows the analyzed articles with the identification number, the title, the researchers, the origin of the work and a column with the terms used and the different conceptions of social participation (and other categories) from the synthesis since some articles did not have clear definitions.

Table 2
Articles reviewed.

Some researchers appear as authors of several studies. They are professionals who perform assistance, teaching, research, and extension activities in occupational therapy, linked to Public and Private Higher Education Institutions.

The activities are inserted in different areas, including the theoretical and practical development of care technologies and the promotion of participation, which justifies more publications on this topic. Some of these areas are Physical Rehabilitation; Collective and Mental Health; Gerontology; Assistive technology; Art and education; Cultural citizenship; Human rights; Art, Culture and Health; Community Based Rehabilitation (CBR); Participatory Local Development (PLD); Solidarity Economy and Work and Income Initiatives.

Regarding the types of study, research from the literature review; exploratory research; reflection/essay studies; case studies and experience reports were verified (Table 3).

Table 3
Distribution of publications by type of study.

Most articles (89.5%) were produced by female occupational therapists showing the choice of the term “researcher women” for the following discussions.

3.2 Social participation: presentation of meanings2 2 The meanings were shown in italics as the synthesis by the authors and/or literal quotes of the articles. Quotations were given with reference. and theoretical references

Six articles defined social participation based on different theoretical references. Three of them (13, 26 and 29) were based on the American Occupational Therapy Association proposal (AMERICAN..., 2015AMERICAN OCCUPATIONAL THERAPY ASSOCIATION – AOTA. Estrutura da prática da terapia ocupacional: domínio & processo. Revista de Terapia Ocupacional da Universidade de São Paulo, São Paulo, v. 26, p. 1-49, 2015.), describing that the social participation is involved in occupations, and one article also identified it as a possibility of socialization and circulation.

The AOTA document describes the participation and social participation. The participation concept, also found in the International Classification of Disability, Functioning, and Health (ICF), is understood as “[…] the involvement of an individual in a real-life situation” (ORGANIZAÇÃO..., 2004ORGANIZAÇÃO MUNDIAL DA SAÚDE – OMS. CIF: classificação internacional de funcionalidade, incapacidade e saúde. Lisboa, 2004., p. 13). The social participation3 3 The document defines social participation as: “The interrelationship of occupations to support desired involvement in community and family activities, and those involving peers and friends” (GILLEN; BOYT SCHELL, 2014, p 607); involvement in a subset of activities of social situations with others (BEDELL, 2012) and the interdependent social support (MAGASI; HAMMEL, 2004). “The social participation can take place in person or through remote technologies such as phone calls, computer interaction, and video conferencing” (AMERICAN..., 2015, p. 22). belongs to the domain and structure of occupational therapy practice and is one of the occupations that structure the individuals´daily life, and the activities of daily living, education, work, sleep, and leisure.

Article 11 used Occupational Science (based on LARSON; WOOD; CLARCK, 2005LARSON, E.; WOOD, W.; CLARCK, F. Ciencia ocupacional: desarrollo de la ocupación a través de uma disciplina acadêmica. In: CREPEAU, E. B.; COHN, E. S.; SCHELL, B. A. B. Willard & Spackman: Terapia Ocupacional. Buenos Aires: Medica Panamericana, 2005. p. 16-26.; WILCOCK, 1993WILCOCK, A. A theory of the human need for occupation. Journal of Occupational Science, London, v. 1, n. 1, p. 17-24, 1993. http://dx.doi.org/10.1080/14427591.1993.9686375.
http://dx.doi.org/10.1080/14427591.1993....
) and the Occupational Therapy Dictionary (JACOBS; JACOBS, 2006JACOBS, K.; JACOBS, L. Dicionário de terapia ocupacional. São Paulo: Roca, 2006.), approaching the social participation as an occupation that shows an individual and collective lifestyle constituted in a cultural and historical context. Another article (20) brought the theory of Participatory Local Development (MARTINS, 2016MARTINS, S. R. O. Desenvolvimento local: questões conceituais e metodológicas. Interações, Campo Grande, v. 3, n. 5, p. 51-59, 2016.), which understands social participation as an active, individual and collective protagonism, in the process of social transformation, to improve the conditions of the daily community and territorial life.

Despite defining social participation, Article 7 did not present a literature reference for the concept. It seems to refer to the structure of AOTA’s practice stating that: “[...] the social participation is an area of occupational performance” (ALVES; GONTIJO; ALVES, 2013ALVES, I.; GONTIJO, D. T.; ALVES, H. C. Teatro do oprimido e terapia ocupacional: uma proposta de intervenção com jovens em situação de vulnerabilidade social. Cadernos de Terapia Ocupacional da UFSCar, São Carlos, v. 21, n. 2, p. 325-337, 2013. http://dx.doi.org/10.4322/cto.2013.034.
http://dx.doi.org/10.4322/cto.2013.034...
, p. 328). When discussing the concept, Nogueira and Oliver (2018)NOGUEIRA, L. F. Z.; OLIVER, F. C. Núcleos de acessibilidade em instituições federais brasileiras e as contribuições de terapeutas ocupacionais para a inclusão de pessoas com deficiência no ensino superior. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 26, n. 4, p. 859-882, 2018. http://dx.doi.org/10.4322/2526-8910.ctoAO1743.
http://dx.doi.org/10.4322/2526-8910.ctoA...
used Social Sciences to interface with Health. In this case, social participation is

[…] a mechanism purposely intended to include segments that, in the sphere of society (or the market), in their daily life, are excluded from opportunities for choice. [...]. In any case, it is about intervening in decision-making processes that affect the collective (TEIXEIRA et al., 2009TEIXEIRA, M. L. et al. Participação em saúde: do que estamos falando? Sociologias, Porto Alegre, v. 11, n. 21, p. 218-251, 2009., p. 234-235).

Ferreira and Oliver (2018FERREIRA, N. R.; OLIVER, F. C. O cotidiano de jovens com deficiência: um olhar da terapia ocupacional a partir do método photovoice. Revista Interinstitucional Brasileira de Terapia Ocupacional, Rio de Janeiro, v. 2, n. 4, p. 745-762, 2018., p. 750) were the only researcher women who presented their conception. They understand social participation as:

[...] the access and involvement in daily activities and citizenship, such as study, work, leisure, and cultural activities, political activities, among others; and the establishment of social relationships, whether in the family, friends or affective relationships.

For the authors who discussed the daily lives of young people with disabilities, this conception encompasses various dimensions of their lives and becomes broader than the view of the social participation established by AOTA and participation in ICF.

Nineteen articles (1, 2, 3, 4, 6, 8, 9, 10, 14, 15, 17, 18, 21, 22, 23, 24, 25, 27 and 30) did not define social participation, even though the concept has been the subject of investigation and/or analysis. They also employed references that help to understand how researcher women understand social participation.

The references used are international and national and belong to the core of occupational therapy or the areas of Public and Collective Health, Sociology, Philosophy, Social Work, and Communication. This plurality of references reaffirms the difficult task, in the different areas of knowledge, of defining social participation and demonstrates the multiplicity of meanings and approaches attributed to the concept, the existence of consensus, ambiguities, and divergences.

References were also identified for proposals and policies that based the field of practice, and they are supported or aimed at promoting social participation: National Mental Health Policy and Psychosocial Rehabilitation Strategies (built from this Policy); CBR; Territory Emphasis Rehabilitation (TER) and again PLD, ICF, and AOTA.

Articles 2, 3, 5, 6, 8, 12, 16, and 21 also used other concepts, such as socio-cultural participation, political participation, and community participation. From a compilation of articles 2, 3, 5, 16 and 21: sociocultural participation can be understood as the involvement of the individuals in the production, creation and artistic, cultural and corporal experimentation, associated with the relational experience, the possibilities of circulation in the territory, the emancipation and individual and cultural transformation.

In article 12, the political participation belongs to the social domain of advanced activities of daily living and means “[…] to participate in political groups such as parties and civil associations” (DIAS et al., 2014DIAS, E. G. et al. As Atividades avançadas de vida diária como componente da avaliação funcional do idoso. Revista de Terapia Ocupacional da Universidade de São Paulo, São Paulo, v. 25, n. 3, p. 225-232, 2014. http://dx.doi.org/10.11606/issn.2238-6149.v25i3p225-232.
http://dx.doi.org/10.11606/issn.2238-614...
, p. 230). Similar to this conception, Aoki and Oliver (2013)AOKI, M.; OLIVER, F. C. Pessoas com deficiência moradoras de bairro periférico da cidade de São Paulo: estudo de suas necessidades. Cadernos de Terapia Ocupacional da UFSCar, São Carlos, v. 21, n. 2, p. 391-398, 2013. http://dx.doi.org/10.4322/cto.2013.040.
http://dx.doi.org/10.4322/cto.2013.040...
interpreted political participation as involvement in public spaces (Managing Councils and forums, for example) for advocacy.

In articles 8 and 6, Aoki and Oliver (2013)AOKI, M.; OLIVER, F. C. Pessoas com deficiência moradoras de bairro periférico da cidade de São Paulo: estudo de suas necessidades. Cadernos de Terapia Ocupacional da UFSCar, São Carlos, v. 21, n. 2, p. 391-398, 2013. http://dx.doi.org/10.4322/cto.2013.040.
http://dx.doi.org/10.4322/cto.2013.040...
and Pimentel, Costa and Souza (2011)PIMENTEL, A. M.; COSTA, M. T. B.; SOUZA, F. R. Terapia ocupacional na Atenção Básica: a construção de uma prática. Revista de Terapia Ocupacional da Universidade de São Paulo, São Paulo, v. 22, n. 2, p. 110-116, 2011. http://dx.doi.org/10.11606/issn.2238-6149.v22i2p110-116.
http://dx.doi.org/10.11606/issn.2238-614...
, respectively discussed on community participation, understood as the possibility of individuals breaking with home isolation and occupying other spaces and community and territorial equipment, to transform daily life and expand access to essential rights.

Silva, Cardinalli and Lopes (2015)SILVA, C. R.; CARDINALLI, I.; LOPES, R. E. A utilização do blog e de recursos midiáticos na ampliação das formas de comunicação e participação social. Cadernos de Terapia Ocupacional da UFSCar, São Carlos, v. 23, n. 1, p. 131-142, 2015. http://dx.doi.org/10.4322/0104-4931.ctoAO513.
http://dx.doi.org/10.4322/0104-4931.ctoA...
in article 14 addressed actions at community level and used the production of Barros, Lopes and Galheigo (2007)BARROS, D. D.; LOPES, R. E.; GALHEIGO, S. M. Novos espaços, novos sujeitos: a terapia ocupacional no trabalho territorial e comunitário. In: CAVALCANTI, A.; GALVÃO, C. (Org.). Terapia ocupacional: fundamentação e prática. Rio de Janeiro: Guanabara Koogan, 2007. p. 354-364. who were based on James Midgley (1986)MIDGLEY, J. Community participation, social developmental and the State. London: Methuen, 1986. to conceptualize the community participation. For Midgley, community participation means the direct involvement of people in local issues, that is, identifying and solving community problems, demands and needs, contributing to emancipation and social development.

Articles 3, 5, 16, and 19 were the only ones that did not bring clear definitions and theoretical references that justified or explained the use and meaning of social participation. But they were included in the analysis because they contributed to the debate on the theoretical-practical dimensions in occupational therapy that contemplate the promotion or barriers of participation (social, cultural, community or political).

The articles 3 and 5 had occupational therapy practices inserted in the interface art, health, and culture, inspired by the care processes developed in the territory, which allows discussing social participation. They included experiences from the Programa Composições Artísticas e Terapia Ocupacional (PACTO) assembled by the Sistema Único de Saúde conducting research, teaching and extension activities at the University of São Paulo. Lima et al. (2009)LIMA, E. M. F. A. et al. Ação e criação na interface das artes e da saúde. Revista de Terapia Ocupacional da Universidade de São Paulo, São Paulo, v. 20, n. 3, p. 143-148, 2009. http://dx.doi.org/10.11606/issn.2238-6149.v20i3p143-148.
http://dx.doi.org/10.11606/issn.2238-614...
describe the development of projects that aim to ensure the participation of the individuals, assisted by occupational therapy, in sociocultural spaces.

There is a proposal of artistic making (with plastic and body experimentation); tours and visits to city events; exhibitions and fairs to show the productions made and the individual and family therapeutic follow up to welcome and meet their demands and needs, Partnerships are built with social and cultural facilities (psychosocial care centers, workshops, associations, museums, schools, workshops and social centers and cooperatives) to promote all these actions (LIMA et al., 2009LIMA, E. M. F. A. et al. Ação e criação na interface das artes e da saúde. Revista de Terapia Ocupacional da Universidade de São Paulo, São Paulo, v. 20, n. 3, p. 143-148, 2009. http://dx.doi.org/10.11606/issn.2238-6149.v20i3p143-148.
http://dx.doi.org/10.11606/issn.2238-614...
). In this sense, social participation is a starting point, a process and an arrival point of the occupational therapy practices incorporated in the art, culture and health dimension.

Article 16 considered social and cultural policies as guidelines for inclusion and socio-cultural participation. Article 19 discussed how issues of sexuality and gender affect the daily life, autonomy, inclusion and social participation of young homosexuals, among other aspects.

In the articles 4, 9, 17 and 23, the participation was defined through the ICF, and in discussions and use of keywords they were changed with the term “social participation”, suggesting that researchers used these concepts as synonyms. ICF is restricted to the term participation that, together with the activity, is part of a list of actions (which the individual is capable, has difficulties or cannot perform) and areas of life, such as: learning and application of knowledge; general tasks and demands, communication, mobility, personal care, home life, interpersonal interactions and relationships, and community, social and civic experience.

All the articles approaching between the concepts of participation and community or political participation treated them as synonyms of social participation, without pointing clear boundaries between these concepts. In general, there are also similarities in approaching concepts from the perspective of interpersonal relationships and involvement in occupations/activities in daily, public, and private life; individually and collectively and in the different contexts.

This review enabled to investigate the areas of knowledge and practice that, at the interface with occupational therapy, they have contributed to discuss social participation and identify the studied populations and intervention strategies that seek to enable social participation. Figure 2 shows these areas and their distribution by the number of articles analyzed.

Figure 2
Areas of knowledge and professional practice represented in the publications. Source: Authors.

Most of the articles are concentrated in the areas of “social,” “rehabilitation” and “art, culture, and health”. In the social area, there are studies on participatory development in communities and studies with young people with disabilities or situations of poverty or vulnerability and social risk (7, 14, 15, 18, 19, 25, 27 and 28).

All the articles promoted the social participation through specific social strategies and technologies such as expressive and artistic workshops; conversation circles; and the support for the establishment of support and sociability networks and the articulation of resources. They agree with the proposals of Barros, Lopes and Galheigo (2007)BARROS, D. D.; LOPES, R. E.; GALHEIGO, S. M. Novos espaços, novos sujeitos: a terapia ocupacional no trabalho territorial e comunitário. In: CAVALCANTI, A.; GALVÃO, C. (Org.). Terapia ocupacional: fundamentação e prática. Rio de Janeiro: Guanabara Koogan, 2007. p. 354-364. and Lopes (2016)LOPES, R. E. Cidadania, direitos e terapia ocupacional social. In: LOPES, R. E.; MALFITANO, A. P. S. Terapia ocupacional social: desenhos teóricos e contornos práticos. São Carlos: EdUFSCar, 2016. p. 29-48., who point out the search for autonomy, participation and social insertion of individuals and the production of social technologies as possible practices of occupational therapy in the social field.

The articles built on the interface “art, culture and health” (2, 3, 5 and 21) and “culture” (16, 18 and 20) approached the concept “sociocultural participation”. These are territorial and community studies whose main object of investigation was the occupational therapy practices that among other objectives, aimed at promoting the socio-cultural participation of the population in situations of vulnerability and social exclusion and people with disabilities and psychological distress.

The occupational therapy practices highlighted the promotion of experiences of artistic, cultural and leisure activities and the establishment of articulation, dialogues and actions between the community and other public and private facilities that provide services (in the areas of education, culture and health, for example) and/or protect the rights of the population (such as disability associations).

Proximity was found between occupational therapy productions in the social and art, culture, and health areas, as citizenship and human rights become articulating axes of actions. Thus, social participation is understood as a right and conquest for and of citizenship.

Similarly, they defend the participatory strategies and actions aimed at social development, the improvement of living conditions, and the resistance to forms of domination and exclusion. The role of the occupational therapist is highlighted as a social articulator and reiterates social participation as a means and end in the intervention process. According to Barros and Galvani (2016)BARROS, D. D.; GALVANI, D. Terapia ocupacional social, cultural? Diversa e múltipla? In: LOPES, R. E.; MALFITANO, A. P. S. (Org.). Terapia ocupacional social: desenhos teóricos e contornos práticos. São Carlos: EdUFSCar, 2016. p. 83-116., the relationships in and by occupational therapy in these areas have gained strength and prominence in Brazil, from the theoretical constructions and practical experiences that problematize the issues of inequality of access to rights and retake social movements and cultural diversity as forms of expression, capturing and solving demands and needs and promoting participation.

The articles included in these areas (2, 7, 14, 16, 18, 20, 21, 25 and 28); the production on PLD (20), article 1 (inserted in rehabilitation) and 31 (inserted in education) addressed the social participation as a political practice-oriented to the social and cultural transformation of the individuals, which reveals the understanding of a participation that happens in social, political, economic and cultural contexts. Therefore, the perspectives of these authors approximate the conception of the authors of this review.

In the research by Toldrá and Nascimento (2016)TOLDRÁ, R. C.; NASCIMENTO, C. L. Estudo da aplicação dos componentes Atividade e Participação da Checklist da CIF em pessoas com Esclerose Múltipla e sua relação com os Core Sets. Cadernos de Terapia Ocupacional da UFSCar, São Carlos, v. 24, n. 4, p. 723-732, 2016. http://dx.doi.org/10.4322/0104-4931.ctoAO0641.
http://dx.doi.org/10.4322/0104-4931.ctoA...
who analyzed the application of categories of the activities and participation component based on the ICF Checklist, the issue of community, social and civic life was added to the domain of political life and citizenship. Researchers identified limitations of the ICF and contributed to broaden the notion of participation, which also reaches the political dimension. Also, the direct relationship between the restriction of participation and functionality and disability issues remains.

Article 31, which covers the area of education, highlighted the relationship between the processes of social participation, inclusion, and permanence of people with disabilities in higher education. The researchers approached social participation in a political dimension, from the Social and Health Sciences. Therefore, understanding the possibilities or restrictions on the participation of this population involves discussions about the exercise of citizenship, access to rights and understanding about disability.

The articles in the rehabilitation area (1, 4, 17, 22, 23, 24, and 30) composed results of researches conducted with people with disabilities on physical dysfunction and TER. Articles on physical dysfunction used the ICF as a theoretical reference and, in general, analyzed the implications of intrinsic and extrinsic factors to disability and the subject on activities and daily life, which included the analysis of social participation. Another article discussed the development of community projects based on CBR principles to highlight TER as a care modality for people with disabilities.

CBR has become known in Brazil since the late 1980s, in a context of expanding Primary Health Care (PHC) and the creation of community services focused on health promotion and disease and complications prevention. In this scenario, the concept of community participation has been incorporated into the discussions of occupational therapists (BARROS; LOPES; GALHEIGO, 2007BARROS, D. D.; LOPES, R. E.; GALHEIGO, S. M. Novos espaços, novos sujeitos: a terapia ocupacional no trabalho territorial e comunitário. In: CAVALCANTI, A.; GALVÃO, C. (Org.). Terapia ocupacional: fundamentação e prática. Rio de Janeiro: Guanabara Koogan, 2007. p. 354-364.; DE CARLO; BARTALOTTI, 2001DE CARLO, M. M. R. P.; BARTALOTTI, C. C. Caminhos da terapia ocupacional. In: DE CARLO, M. M. R. P.; BARTALOTTI, C. C. Terapia ocupacional no Brasil: fundamentos e perspectivas. São Paulo: Plexus, 2001. p. 19-40.).

The article inserted in the area of assistive technology (13) is also related to discussions on rehabilitation, outlining accessibility as a facilitator and architectural barriers as a restriction for social participation of people with disabilities. From these studies (in rehabilitation and assistive technology), social participation has an individual and private dimension, but, above all, a public, cultural and collective dimension. According to Silva (2016)SILVA, A. C. C. Organizações de e para pessoas com deficiência no município de São Carlos – SP: tecendo fios de histórias, conquistas e desafios. 2016. 158 f. Dissertação (Mestrado em Terapia Ocupacional) – Universidade Federal de São Carlos, São Carlos, 2016., people need material and immaterial resources and access to rights to participate.

Two articles (6 and 8) within the scope of PHC addressed territorial and community experiences with the population with disabilities. Given the reality of these people - marked by social isolation, low education, unemployment, and fragility of support networks - there is a need to develop actions that favor social participation in and from the territory.

Among these actions, the researchers described individualized household and family interventions (for autonomy, independence, and functional improvement) and territorial interventions (collective actions in partnership with the community and social facilities). They are articles based on different references (Public Health, Public Health, and CBR), but complement each other by defending social (or community) participation as a need of people and for the exercise of social control4 4 In this study and in accordance with the bibliographic production analyzed, social control is understood as “[...] the control of civil society over the State, in the context of the formulation, monitoring and evaluation of compliance with public policies”, in order to meet the needs and demands of the population and ensure full access to “[...] essential rights such as education, housing, employment and social assistance” (SILVA, 2016, p. 32-33) (CAMPOS; MISHIMA, 2005CAMPOS, C. M. S.; MISHIMA, S. M. Necessidades de saúde pela voz da sociedade civil e do Estado. Cadernos de Saúde Pública, Rio de Janeiro, v. 21, n. 4, p. 1260-1268, 2005. http://dx.doi.org/10.1590/S0102-311X2005000400029.
http://dx.doi.org/10.1590/S0102-311X2005...
; OLIVER et al., 2004OLIVER, F. C. et al. Participação e exercício de direitos de pessoas com deficiência: análise de um grupo de convivência em uma experiência comunitária. Interface - Comunicação, Saúde, Educação, Botucatu, v. 8, n. 15, p. 275-288, 2004. http://dx.doi.org/10.1590/S1414-32832004000200007.
http://dx.doi.org/10.1590/S1414-32832004...
).

The articles in the health area (11, 12, 26, and 29) were oriented with perspectives of AOTA, ICF and Occupational Science. The researchers studied occupations that structure daily life, delimit social roles and may contribute (or not) to the well-being and health of adolescents, burn victims, the elderly population and caregivers. The occupations studied were: activities of daily living and instrumental activities of daily living, work, study, play, sports, leisure, and sleep. The social participation is among these occupations, translated as engagement in leisure, sports, religious, political, social and circulation activities.

The articles 10 and 24 adopted the context of the Brazilian psychiatric reform and the assumptions of psychosocial rehabilitation as fundamentals, to defend the discourses and actions in occupational therapy in mental health aimed at the reinsertion and social participation of patients in the community. Approaches different to the asylum model are emphasized, and they mention the construction and/or rescue of territorial networks; expansion of spaces and community leisure activities; expansion of mental health actions in PHC and strengthening of interdisciplinary and cross-sectional actions and dialogues.

According to Nicácio (1994)NICÁCIO, M. F. O processo de transformação em saúde mental em Santos: desconstrução de saberes, instituições e cultura. 1994. 174 f. Dissertação (Mestrado em Ciências Sociais) – Pontifícia Universidade Católica de São Paulo, São Paulo, 1994., Almeida and Trevisan (2011)ALMEIDA, D. T.; TREVISAN, E. R. Interventions strategies within occupational therapy consonant with the transformations in mental health care in Brazil. Interface - Comunicação, Saúde, Educação, Botucatu, v. 15, n. 36, p. 299-308, 2011. http://dx.doi.org/10.1590/S1414-32832010005000030.
http://dx.doi.org/10.1590/S1414-32832010...
, the psychiatric reform collaborated with the reformulation of mental health care and occupational therapy actions. Thus, the care process foresees the creation of forms and spaces of social participation and the promotion of autonomy and citizenship through substitute services; expansion of the therapeutic setting with development of actions in the community space; co-participation and accountability of the patient for their therapeutic project and Customer-Centered Practice. This last item corresponds to the theoretical framework that assists the occupational therapist and users in the construction of care, to identify demands and barriers that prevent social participation and performance in different occupations.

The articles corroborated this statement; however, they also presented realities that reflect the lack of services and limitation of practices (inside and outside the core of occupational therapy) and public policies that encourage social participation.

Faced with the different theoretical references and paradigms adopted by occupational therapists, there are variations and even controversies and ambiguities in the understanding of social participation. There were few articles with clearer and more organized definitions and positions about the concept.

The approximations with definitions brought in the North American and Canadian international literature and with psychology, sociology, and health were also noticed. This reveals the influence of different sciences and disciplines on occupational therapy, the multiplicity of ways of understanding participation (and its categories), and possible consensus or confusion within and outside occupational therapy in trying to define the concept.

According to Houaiss and Villar (2004)HOUAISS, A.; VILLAR, M. S. Minidicionário Houaiss da língua portuguesa. Rio de Janeiro: Objetiva, 2004., the act of defining concepts is to establish a precise meaning to explain and delimit them. In some productions, generalist ideas and little in-depth about social participation were found. There is a predominance of notions of social participation, that is, presentation of ideas and views of authors anchored or not in specific literature.

It is not proper to say that one conception is more used than others, especially when interdisciplinarity is posed as a contemporary model for the development and consolidation of science. Therefore, approaching social participation from different points of view contributes to the process of knowledge construction in occupational therapy, within its specificity and in inter and transdisciplinary contexts.

Also, it is appropriate to find articles by occupational therapists who addressed the concepts of community and political participation rather than social participation (or use it concurrently). The choice of one of them follows the conceptual field, as in the case of CBR and PHC, which use the term community participation. This shows that occupational therapy did not create the concepts, but adapted and used them according to their specificities, areas, and population assisted.

Alejandro Cordoba (2011)CORDOBA, A. G. Construcición de identidades, episteme y práticas em terapia ocupacional em América Latina. San Pablo: [s.n.], 2011. Disponível em: <https://www.academia.edu/31393067/Construccion_Identidades_y_epistemes_AGC_enero_2014>. Acesso em: 30 dez. 2018.
https://www.academia.edu/31393067/Constr...
reported the possibility of occupational therapies. In this sense, the different epistemological positions; the various ways of understanding the world and man; the plurality in the ways of producing care and the difference in social, community, cultural and historical contexts do not show an occupational therapy, but occupational therapies.

Research elaborated by Galheigo et al. (2018)GALHEIGO, S. M. et al. Produção de conhecimento, perspectivas e referências teórico-práticas na terapia ocupacional brasileira: marcos e tendências em uma linha do tempo. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 26, n. 4, p. 723-738, 2018. http://dx.doi.org/10.4322/2526-8910.ctoAO1773.
http://dx.doi.org/10.4322/2526-8910.ctoA...
regarding the historical-epistemological foundations of occupational therapy in Brazil, the epistemological positioning was reaffirm, that is, the incorporation and/or substitution of different theoretical-methodological references, the consequent production of knowledge and practices and the insertion in new fields they are related to the historical, political and social landmarks of the country.

There are influences from the implementation of public policies, the recommendations of international organizations, and the diffusion of new technologies and trends and movements within occupational therapy for the advancement and professional recognition. Thus, contemporary production in occupational therapy is marked by the coexistence of various perspectives and languages, which produce different occupational therapies in Brazil. This diversity can demarcate, at the same time, power and fragility for the area (GALHEIGO et al., 2018GALHEIGO, S. M. et al. Produção de conhecimento, perspectivas e referências teórico-práticas na terapia ocupacional brasileira: marcos e tendências em uma linha do tempo. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 26, n. 4, p. 723-738, 2018. http://dx.doi.org/10.4322/2526-8910.ctoAO1773.
http://dx.doi.org/10.4322/2526-8910.ctoA...
).

The potency is revealed through the theoretical-conceptual and methodological diversification that produces a critical occupational therapy and involved with the construction of transformative and emancipatory practices. On the other hand, fragility is the scarce conceptual, and methodological coherence and the

[...] risk of an insufficient discernment of the foundations used, producing a disordered mixture of concepts, theoretical contributions and production of practices (GALHEIGO et al., 2018GALHEIGO, S. M. et al. Produção de conhecimento, perspectivas e referências teórico-práticas na terapia ocupacional brasileira: marcos e tendências em uma linha do tempo. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 26, n. 4, p. 723-738, 2018. http://dx.doi.org/10.4322/2526-8910.ctoAO1773.
http://dx.doi.org/10.4322/2526-8910.ctoA...
, p. 734).

This systematic review reaffirms the considerations of Córdoba (2011)CORDOBA, A. G. Construcición de identidades, episteme y práticas em terapia ocupacional em América Latina. San Pablo: [s.n.], 2011. Disponível em: <https://www.academia.edu/31393067/Construccion_Identidades_y_epistemes_AGC_enero_2014>. Acesso em: 30 dez. 2018.
https://www.academia.edu/31393067/Constr...
and Galheigo et al. (2018)GALHEIGO, S. M. et al. Produção de conhecimento, perspectivas e referências teórico-práticas na terapia ocupacional brasileira: marcos e tendências em uma linha do tempo. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 26, n. 4, p. 723-738, 2018. http://dx.doi.org/10.4322/2526-8910.ctoAO1773.
http://dx.doi.org/10.4322/2526-8910.ctoA...
. When reading the texts used as a reference by the researchers, they have chosen one or several concepts that build a multiplicity and theoretical-conceptual and practical particularity. As an example, there are the productions in mental health, because, besides using the concept of social participation, they also opt for the concepts of emancipation, empowerment and social control.

Consequently, occupational therapists focus on the different ways of understanding and acting on the real. They create ways to talk about occupational therapy identities and to follow inter and transdisciplinary paths that generate meanings of belonging to a certain way of thinking and acting. However, the use (or non-use) of concepts only become coherent when there is a problematization of the historical, political and social context of which the occupational therapist is part and (des) constructs his episteme, identities, and practices.

Therefore, it is necessary to critically analyze the reductionist and individualized approaches that, although they consider the participation as “being and getting involved in social life”, little argue that this life can be (and probably will be) immersed in macro-social, political and cultural conflicts. The same can be considered for the definition restricted to the issue of socialization and circulation, not going beyond the conditions and life possibilities of the individuals and limited to living (of relationship with others) in society.

The issue of social participation needs to be shifted from the private and individual sphere of the individuals to public, historical, cultural, collective life and power relationships, emancipatory and inclusion processes and opportunities for access to rights. It becomes urgent when society is inserted in the globalization process with strong presence of neoliberal alternatives of production and distribution of inequalities, as in Brazil because there is a centrality in economic growth, technological innovation, and austerity policies, which invest little guaranteeing fundamental rights.

These discussions are crucial for occupational therapy, as the profession is willing to help people transform everyday life and participate in social life. Critically addressing the knowledge, foundations, and practices built by and in occupational therapy provides the meeting or creation of possibilities to transform the episteme and reorient the methods, strategies and assistance resources that are appropriate to the real-life contexts of individual and collective individuals.

4 Finals Considerations

This systematic review identified how social participation is understood and addressed by Brazilian authors, who were occupational therapists. Some intrinsical understandings are related to political practice, as in the definition defended by the authors of this article were found.

It explained the areas of knowledge and practice and what populations are important for social participation and some intervention strategies to be promoted. It should be noted that there is little clarity on these different definitions, justifying the lack or scarcity of better theoretical and conceptual foundation. Therefore, there is the exposition of ideas about the concept rather than a described and grounded explanation about social participation.

There is a need to better base the theoretical productions on occupational therapy, to understand the process of constitution and consolidation of the profession in different fields of knowledge and practice. Thus, to understand where occupational therapy is or wants to go, it is necessary to know where it is coming from.

Most of the analyzed productions contemplated exploratory investigations and practical experiences, and there were no articles that aimed to analyze social participation in a theoretical and conceptual way. Therefore, this review becomes relevant and unprecedented in the area since occupational therapy has been working to foster social participation.

This review has limitations because the selection of articles was conducted by an author and was restricted to Brazilian publications of online journals. It is intended to expand the systematic review as part of the first author's doctoral thesis, to make a more meaningful and comprehensive research on bibliographic production in occupational therapy in Brazil, seeking studies in other data sources (such as the gray literature), available in print and online.

  • 1
    The consultation did apply a filter for the year of publication; all the numbers of journals accessible online were considered (up to December 2018).
  • 2
    The meanings were shown in italics as the synthesis by the authors and/or literal quotes of the articles. Quotations were given with reference.
  • 3
    The document defines social participation as: “The interrelationship of occupations to support desired involvement in community and family activities, and those involving peers and friends” (GILLEN; BOYT SCHELL, 2014, p 607); involvement in a subset of activities of social situations with others (BEDELL, 2012) and the interdependent social support (MAGASI; HAMMEL, 2004). “The social participation can take place in person or through remote technologies such as phone calls, computer interaction, and video conferencing” (AMERICAN..., 2015AMERICAN OCCUPATIONAL THERAPY ASSOCIATION – AOTA. Estrutura da prática da terapia ocupacional: domínio & processo. Revista de Terapia Ocupacional da Universidade de São Paulo, São Paulo, v. 26, p. 1-49, 2015., p. 22).
  • 4
    In this study and in accordance with the bibliographic production analyzed, social control is understood as “[...] the control of civil society over the State, in the context of the formulation, monitoring and evaluation of compliance with public policies”, in order to meet the needs and demands of the population and ensure full access to “[...] essential rights such as education, housing, employment and social assistance” (SILVA, 2016SILVA, A. C. C. Organizações de e para pessoas com deficiência no município de São Carlos – SP: tecendo fios de histórias, conquistas e desafios. 2016. 158 f. Dissertação (Mestrado em Terapia Ocupacional) – Universidade Federal de São Carlos, São Carlos, 2016., p. 32-33)
  • Funding Source This work was carried out with the support of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Financing Code 001.

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Publication Dates

  • Publication in this collection
    11 Nov 2019
  • Date of issue
    Oct-Dec 2019

History

  • Received
    30 Jan 2019
  • Reviewed
    02 Apr 2019
  • Reviewed
    18 June 2019
  • Accepted
    03 July 2019
Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br