Alaska Native Culture and Occupational Therapy: Practitioner Perspectives

PURPOSE: Care is needed that is culturally responsive to the sensibilities, social organization, and current channels of influence in communities that require health services (Wexler, 2011). Although the need for health care services for indigenous societies is well documented, little is known about how occupational therapists in Alaska integrate the cultural values and experiences of their clients into therapy services. Therefore, the purpose of this study was to examine occupational therapists’ perspectives related to the provision of occupational therapy services for Alaska Native individuals. This study examined the following research questions: (1) What barriers and needs in practice related to culture do occupational therapists experience when working with Alaska Native individuals? (2) What modifications in occupational therapy practice, if any, do occupational therapists make while working with Alaska Native individuals?

METHOD: The study used a mixed-methods descriptive survey design. The researchers used convenience and snowball sampling to recruit participants through professional contacts, email directories of Alaska employers of occupational therapists, and the Alaska Occupational Therapy Association (AKOTA) membership directory. Inclusion criteria were occupational therapists in Alaska who worked with at least three Alaska Native individuals within the past year or with at least 10 Alaska Native individuals within the past five years.

The researchers collected data using a 27-question Internet survey. The survey gathered data on demographics, practice perspectives regarding Alaska Native culture, perceived cultural awareness, and barriers and needs in practice. The researchers analyzed data using content analysis of open-ended responses and descriptive statistics including percentages, means, medians, and standard deviations for demographic and Likert-scale questions. The team of five researchers met three times for 1–3 hours to analyze open-ended responses. To support rigor, the researchers individually coded open responses line by line and then met to reach collective consensus.

RESULTS: Forty-three occupational therapists completed the survey. The results suggest that these therapists perceived communication, cultural health perspectives, and understanding of kinship as integral components of developing rapport, client-centered intervention, and successful outcomes when working with Alaska Native individuals. The most frequently reported modification therapists made related to communication strategies. Participants reported that primary barriers in therapy included difficulty engaging clients and differing perspectives of communication, time, and health.

CONCLUSION: Occupational therapists practicing in Alaska reported that their awareness of Alaska Native clients’ unique perspectives about health informed and guided occupational therapy practice. Yet these therapists also reported specific challenges in matching a productivity-minded work environment with the unique communication needs they perceived as part of therapeutic use of self when working with Alaska Native clients. Awareness of sociocultural differences between practitioners and Alaska Native clients may improve holistic, client-centered occupational therapy. Further research is needed on Alaska Native–specific populations related to improving culturally relevant care and outcomes.

IMPACT STATEMENT: This is the first known study to examine occupational therapists’ perspectives in working with Alaska Native individuals. Findings inform the need for occupational therapy practitioners to reflect on and integrate clients’ culture into practice to achieve truly holistic, client-centered practice.

References

Wexler, L. (2011). Behavioral health services “don’t work for us”: Cultural incongruities in human service systems for Alaskan Native communities. American Journal of Community Psychology, 47, 157–169. https://doi.org/10.1007/s10464-010-9380-3