Meaningful and relevant Occupational Therapy practice and service delivery. By Kee Hean Lim (Lecturer and Researcher in OT) presented at the OT Enfield Conference (Feb. 2014)

1. Culture and Context:
Meaningful and relevant Occupational
Therapy practice and service delivery.
Kee Hean Lim
Lecturer and Researcher in OT

2. Do we presume that the way we practice
and deliver occupational therapy is always
meaningful, effective and relevant ?
Meaning & RelevanceMeaning & Relevance

3. OverviewOverview
• Introduction
• Context
• Key definitions and concepts
• Examining culture and occupation
• Socio-cultural construction of occupation
and occupational therapy
• Discourse
• Questions

4. ContextContext
Global
• Changing world (global economy & ease of travel)
• Free and rapid exchange of information and ideas
• Fluid boundaries and changing population in the UK
• Occupational therapy growing rapidly especially in
Asia, Eastern Europe and Africa.

5. Culture & MeaningCulture & Meaning
“A shared system of meanings that involve
ideas, concepts and knowledge, and
include the beliefs, values and norms that
shape standards and rules of behaviour
as people go about their everyday lives”
`
(Dyck, 1998, p.68)

6. DiversityDiversity
Diversity can include dimensions of race, ethnicity,Diversity can include dimensions of race, ethnicity,
gender, sexual orientation, socio-economic status, age,gender, sexual orientation, socio-economic status, age,
physical abilities, religious beliefs and ideologies.physical abilities, religious beliefs and ideologies.
The concept of diversity encompasses acceptance andThe concept of diversity encompasses acceptance and
respect. It means understanding that each individual isrespect. It means understanding that each individual is
unique, and recognizing individual differences.unique, and recognizing individual differences.
((http://gladstone.uoregon.edu)http://gladstone.uoregon.edu)

7. SocietySociety
Priority
Behaviours
Values
Rules of conduct

8. Meaning and ValueMeaning and Value
‘Meaning is generally not derived without
reference to society and society values
some occupations above others.’
Christiansen & Townsend (2004)

9. Reductionist
Individualism
Control
Holistic
Collective
Acceptance
Perspectives
Perspectives

10. Cultural Perception of HealthCultural Perception of Health
‘The body may be seen as a single organism
with physical, spiritual and emotional aspects,
in which illness is caused by imbalances or
blockages.
The goal of health care then is to restore the
balance by unblocking the flow of energy
between them.’
Henley (1999)
‘In cultures with scientific orientation the body
is often imagined as a machine. Problems are
located in isolated organs or parts, which are
then repaired or, possibly replaced.’
Helman (2000)

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

12. Society, culture, family, education, organisations, peers,
beliefs, socialisation, the media & press, professional
training, can all influence our view and values.
Contextual InfluencesContextual Influences

13. Occupational Therapists operate withinOccupational Therapists operate within
prevailing rules of conduct & cultureprevailing rules of conduct & culture
• Shared system of language
• Common cultural values
• Specific rules of conduct
• Established social practices
Does this exclusiveness hinder the
inclusiveness of our practice?
Lim 2009

14. How culturally bound are our ideas?
Different constructs, beliefs, realities,
perspectives, experiences and value
patterns
are linked with western social context, valuing
independence, personal autonomy, dominance
and be & become through action (occupation).
Occupational Therapy Core
Values:

15. Has mixed meanings within different
socio-cultural context and groups
OccupationOccupation

16. Interdependence
Independence

17. Client-CentrednessClient-Centredness
• Indian MSc Occupational Therapy student
• The plural ‘I’ rather than the singular ‘I’
• The I is influenced and guided by the
context, place and need to belong.
• Asserting the collective rather than
personal perspective and choice.

18. Effects of Cultural IncompetenceEffects of Cultural Incompetence
• Miscommunication and misunderstanding
• Patient/client and professional relationship
affected
• Non-compliance “Difficult patient!?”
• Quality of care is compromised
• Power dynamics
• Increased frustration

19. Cultivating My
understanding of the
Client’s Daily ‘Normal’
OccupationalOccupational
TherapistTherapist
Sphere of shared experience
‘‘Client’Client’
Sphere of shared experience
Expressing my daily
reality from my own
‘Normal’
Client Centred & Culturally Safe Practice…Client Centred & Culturally Safe Practice…

20. Discourse in Occupational TherapyDiscourse in Occupational Therapy
• Diverse Worldviews challenges the Universal assumptions of over-
arching frameworks and models.
• Theory and practice should be in sync with local realities & needs.
• Despite acknowledging diversity, practice and service is driven by
desire for standardisation and uniformity
• Focus on clinical evidence must not be at the expense of the client’s
lived experience.
• Meaningful and relevant practice must be person focused, inclusive,
enabling, culturally sensitive and in touch with what the clients
considers to be essential to their lives…

21. Organisational ServicesOrganisational Services & Provision& Provision
• How aware are you of the diversity within your local community?
• How well does your staff group reflect the diversity within your
local community?
• How aware/knowledgable are you of the local minority ethnic
community services or groups?
• Do you have a resources file of the local minority ethnic (non-
western immigrant) and translations services?
• What opportunities are available to patient, clients/services users
to access alternative treatments?
• Name three things you can do to improve the cultural awareness
and competence of staff where you are.
• Your answers to these questions may indicate how equipped you
are in responding and delivering culturally inclusive, sensitive and
safe practice/service delivery.

22. Reference List
• Chaing M & Carlson G (2003) Occupational therapy in multicultural contexts: Issues and strategies British Journal of Occupational Therapy Vol.66 (12) 559-566
• Dickie V, Cutchin MP & Humphry R (2006) Occupation as Transactional Experience: A Critique of Individualism in Occupational Science. Journal of Occupational Science. Vol 13
Issue 1
• Fitzgerald MH, Mullavey-O’Byrne C and Clemson L (1997) Cultural issues from practice. American Journal of Occupational Therapy Vol 44, 1-21
• Gray, M and McPherson, K (2005) Cultural Safety and professional practice in occupational therapy: A New Zealand perspective Australian Occupational Therapy Journal 52 (1),
34–42
• Helman C G (2007) Culture, Health & Illness. 5th
Ed, Hodder & Arnold London
• Iwama M (2003) Towards Culturally Relevant Epistemology in Occupational Therapy. American Journal of occupational therapy Vol 57, No 5 (Sept/Oct)
• Iwama M. (2005) Occupation as a cross-cultural construct. in Whiteford G.& Wright-St. Clair (eds). Occupation and Practice in Context. Sydney: Elsevier
• Kronenberg F., Algado S.A., Pollard n. (2004) Occupational Therapy Without Borders - Learning from the Spirit of Survivors, Edinburgh; Churchill Livingstone
• Lim K H (2001) A guide to Providing Culturally Sensitive and Appropriate Occupational Therapy Assessments and Interventions. Mental Health Occupational Therapy Magazine Vol
6, Issue 2, 26-29, July 2001
• Lim KH & Iwama M (2006) Emerging Models-An Asian Perspective:The Kawa River Model. In Duncan E(ed) Hagedorn’s Foundations for Practice in Occupational Therapy.
Churchill Livingstone, Edinburgh
• Lim KH (2008) Working in a Transcultural Context. In: Creek J & Lougher L (eds) Occupational Therapy and Mental Health. (4th
Ed) Edinburgh, Elsevier Churchill Livingstone
• Lim KH (2008) Cultural sensitivity in context. McKay E, Craik, C., Lim, KH. & Richards, G. (eds) Advancing Occupational Therapy in Mental Health Practice. Blackwell Scientific
• Lim KH (2009) Cultural Issues in Professional Practice. In Atwal A & Jones M (eds) Preparing for Professional Practice in Health and Social Care. Wiley-Blackwell. pp77-98
• Mattingly C & Garro LC (2000) Narrative and the Cultural Construction of Illness and Healing. University of California Press, Berkeley.
• McGruder, J (2003) Culture, race, ethnicity and human diversity. In Crepeau, EB, Cohn, ES and Schell, BAB(eds.) Willard and spackman’s Occupational Therapy. 10th
ED. Lippincott
Williams and Wilkins, Baltimore.
• Wells SA & Black RM (2000) Cultural Competency for Health Professionals. American Occupational Therapy Association Press.
• Wells SA & Black RM (2007) Cultural and Occupation. The American Occupational Therapy Association Press.

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