Abstract
When designing international educational collaborations, occupational science and occupational therapy educators must consider how occupational justice can be a linchpin for students’ learning. This article describes an international collaboration involving 52 undergraduate occupational science students in the United States and 41 undergraduate occupational therapy students in South Africa. The students participated in six synchronous video conferences in 2016, during which they gave group presentations about four occupational science constructs and engaged in general question-and-answer sessions. Forty percent of the students provided feedback about the interactions using a six-item open-ended electronic questionnaire, which we analyzed using directed content analysis. Our findings suggest that the collaboration helped the students develop more nuanced understandings of disciplinary constructs, international peers, and themselves, providing a platform from which to engage with the big idea of occupational justice. Refinements to this collaboration are aimed at drawing on students’ increased critical consciousness to further develop their knowledge about occupational justice.
Improved Internet reliability and accessibility are enabling educators to facilitate student interactions across diverse global contexts (Asher et al., 2014; Cabatan & Grajo, 2017; Sood et al., 2014). International educational experiences have been linked to deeper understandings of culture and complexity, expanded worldviews, and broader knowledge about occupational therapy (Asher et al., 2014; Humbert et al., 2012; Kinsella et al., 2008; Sood et al., 2014). Online international educational experiences require different faculty effort (Grajo & Aldrich, 2016) than non-technology-mediated international partnerships (Ilott et al., 2013; Tupe et al., 2015) but may have the benefit of increasing cultural sensitivity without requiring international travel (Aldrich & Grajo, 2017).
Most online international educational collaborations have relied on didactic (Sood et al., 2014) and case study (Asher et al., 2014) methods to target practice-related skills such as assessment and intervention planning. Although these approaches and topics are useful for occupational therapy multicultural education (Brown et al., 2011), technology-mediated international collaborations also can leverage students’ learning of occupational science constructs (Aldrich, 2015; Aldrich & Johansson, 2015; Cabatan & Grajo, 2017). Wiggins and McTighe (2005) underscored the power of a discipline’s “big ideas” as anchors for learning experiences, offering a helpful framework for thinking about international occupational science and occupational therapy educational collaborations. Big ideas are located at the core of a field and can range from concepts and theories to assumptions and paradoxes. Given Wiggins and McTighe’s assertion that “the challenge of defining justice” is a big idea (p. 5), the notion of occupational justice may be a promising foundation for international technology-mediated learning in occupational science and occupational therapy education.
Research is needed to determine how occupational justice might serve as a linchpin that “connect[s] the dots for the learner by establishing learning priorities” (Wiggins & McTighe, 2005, p. 66). There is growing recognition that the pursuit of justice is reflected within everyday occupational therapy practices (Aldrich et al., 2017; Bailliard & Aldrich, 2016), and international occupational therapy educational standards now foreground a focus on justice (Hocking & Townsend, 2015; Sakellariou & Pollard, 2013; World Federation of Occupational Therapists, 2016). Borrowing from Neuman (2011), Ramugondo (2015) suggested that “construct clusters” that unite related ideas (p. 494) can help students develop nuanced and complex understandings about occupation.
Therefore, to explore how construct clusters may be used to promote learning about occupational justice, we created a technology-mediated, construct cluster–focused collaboration among undergraduate occupational science students in the United States and undergraduate occupational therapy students in South Africa. This article conveys findings from a study of the first iteration of that collaboration, which took place in 2016. After describing contextual and structural elements, we outline the methods we used to ascertain what and how students learned through synchronous interactions. Our discussion focuses on the ways in which this construct-focused collaboration enabled students to engage with the big idea of occupational justice.
Structure of the Collaboration
Two institutional contexts—a midsize private university in the midwestern United States and a large public university in South Africa’s Western Cape Province—set the stage for our collaboration. Both institutions’ mission statements prioritize the pursuit of justice or the alleviation of injustice. The U.S. setting offers one undergraduate and one doctoral course on occupational justice, and in the South African setting, discussions and learning experiences related to justice and socially responsive practice are interwoven throughout the curricula. The U.S. university awards a bachelor’s degree in occupational science, an entry-level master’s degree in occupational therapy, and a post-professional doctorate in occupational therapy, whereas the university in South Africa awards an entry-level bachelor’s degree in occupational therapy, coursework- and research-focused master’s degrees in occupational therapy, and a doctor of philosophy degree in occupational therapy.
For this collaboration, we connected a third-year undergraduate course in the United States with a fourth-year undergraduate course in South Africa. To determine this pairing, we identified feasible timings for our collaboration and explored topical synergies between our courses. We wanted our collaboration to increase students’ opportunities to discuss global concerns about justice and human occupation. We ultimately paired two courses on the basis of their mutual goal of developing complex understandings of occupation in context. The first author’s course introduced critical perspectives on culture, occupation, and justice, whereas the second author’s course introduced occupation-based approaches to human and social development and occupational therapy’s contribution to social change.
In line with recommendations for successful international partnerships (Witchger Hansen, 2015), we aimed to share power equally as we developed and executed this collaboration. We adopted a student-centered learning approach (Wright, 2011) and modified an existing assignment from the second author’s course to help students explore four occupational science constructs. We selected the constructs of occupational identity (Phelan & Kinsella, 2009), occupational possibilities (Laliberte Rudman, 2010), occupational choice (Galvaan, 2015), and occupational consciousness (Ramugondo, 2015) as the focus of this collaboration because this construct cluster foregrounds social, institutional, and political influences on occupation. Given that such influences are core features of ideas about occupational justice, we believed that this construct cluster would deepen students’ engagement with the notion of occupational justice.
The six synchronous video conferencing sessions that constituted the collaboration focused primarily on student-generated construct presentations. We assigned two groups to each construct in each international context, resulting in 16 groups of 5–7 students. On the basis of shared readings, the student groups compiled and presented
Their understanding of their assigned construct and its theoretical foundations,
An example of a contextually specific event or phenomenon that illustrated the construct, and
Their perspective on how knowledge of the construct might enhance the pursuit of occupational justice.
Brief question-and-answer sessions took place after each presentation.
Beyond these requirements, the students chose what to incorporate into their presentations, including other literature or media, and their examples ranged from their own lives to others’ experiences in their national contexts. Student groups in South Africa presented a single construct in each of four 60-min sessions to start the collaboration (two groups per session), and 6 wk later, student groups in the United States presented two constructs during each of two 120-min sessions (four groups per session). Each of the six sessions also included open time in which the students asked general questions about each international context and the educational experiences and cultures within those contexts. As instructors, we helped manage technology and facilitated open discussions, drawing links between ideas about occupational justice and the various constructs. The first author required attendance by all students in the United States at these sessions. Although all South African students were also expected to attend all sessions, the 80% attendance mandate for the course meant that their attendance varied when they were not presenting.
Method
Fifty-two students in the United States and 41 students in South Africa participated in this collaboration. Although we did not collect demographic data from respondents, the composition of each student group suggests respondents’ potential characteristics. In the United States, the students were primarily White (n = 48), all were female (n = 52), and all were in their early 20s (n = 52), having matriculated directly into their degree program from secondary school. The composition of the South African class was more diverse, reflecting different language and class groupings that were related, in part, to the racial classification system—“white,” “coloured,” “black,” and “Indian”—that was constructed during apartheid. Although apartheid was abolished in 1994, people of these groups still refer to themselves in relation to these racial classifications, and public universities are required to admit student bodies that reflect the country’s racial diversity. The students in South Africa therefore included a racially mixed group of black (n = 7), coloured (n = 15), white (n = 15), Indian (n = 3), and Asian (n = 1) students. Most South African students were female (N = 37), and like the class in the United States, most had entered their degree program straight from high school.
After the final synchronous session in April 2016, we electronically distributed a six-item semistructured written questionnaire to our respective student groups to gauge their understandings of the purpose of the interactions, the ways in which the interactions were or were not learning experiences for them, and what they learned about specific concepts through the interactions. The items were as follows:
Describe the purpose of the interactions you had with international student peers this semester.
Describe the ways in which the interactions were (or were not) learning experiences for you.
Describe how the interactions influenced your knowledge about culture, power, and occupational therapy.
Describe any other knowledge you gained from the interactions.
In what ways could the interactive sessions be improved?
What other thoughts would you like to share about the interactive sessions?
We adapted this questionnaire from a previous study of international educational interactions (Aldrich & Johansson, 2015). We invited student participation in the questionnaire through electronic communication. Given differences in university ethics board requirements, students in the United States were directed to anonymously indicate if they wished to “opt out” of the study, whereas students in South Africa were asked to “opt in.” Twenty-one students in the United States and 16 students in South Africa completed the voluntary, anonymous questionnaire, reflecting a 40% response rate.
The students generated, on average, one to two sentences per questionnaire item. We used a form of directed content analysis (Hsieh & Shannon, 2005) to analyze the 37 respondents’ answers to the six-item questionnaire. This analytical approach involves identifying key concepts or theories that shape coding at the outset (Hsieh & Shannon, 2005). In this study, we used the survey questions to provide key focus areas to guide the coding process. We separately analyzed responses for our respective student groups, developing initial ideas about codes related to content learning, culture, and justice, and then we collaboratively developed 12 provisional codes based on those ideas. From the codes, we derived three categories—(1) learning about self and others, (2) learning about the constructs and practice, and (3) feedback on interactions—and grouped student responses within each category by international context. This process allowed us to distinguish similarities and distinctions in the different data sets. The central idea highlighted across data sets was that the collaboration helped the students shift their stereotypical thinking about the “other” and learn about themselves in the process, captured in the theme “molding nuanced perspectives.”
Findings
Category 1: Learning About Self and Others
Many questionnaire responses portrayed the synchronous interactions as opportunities for the students to learn about themselves and others. For example, 1 student in the United States wrote, “I learned a lot about [my city’s] culture and the way foreigners view Americans,” and another student in the United States wrote, “I also learned how much Western culture influences other cultures in general, such as South Africans are familiar with American films and we are not familiar with South African films.” The responses of the students in South Africa mirrored this awareness of own and others’ cultures, with 1 student noting, “I was able to gain a broader understanding of the stereotypes associated with people in America and in Africa, and it was interesting to note how these were different to reality.”
Some students highlighted what they planned to do with their newly learned information about self and others; 1 South African student wrote, “I have come to appreciate our context more. It is clearly very different from the Western culture and it has encouraged me to want to adapt future occupational therapy intervention so that it is culturally relevant.” Similarly, 1 student in the United States stated, “I was amazed at how much the [South African] students knew about American culture and American issues, showing me how much more I need to learn and be aware about other cultures.”
Through these interactions, some of the students’ assumptions about power differentials were challenged, whereas others were reinforced. In this vein, 1 South African student noted that
with the United States being the world leading political power, people are quick to say that its citizens are beyond and advanced in knowledge as compared with any other country. This was [a] great interaction to break that power that was unconsciously given to the [U.S.] students. This was done when we interacted and shared our knowledge and our understanding of our environment in the best way possible. When the [U.S.] students participated, nothing flew over our heads as we were able to fully understand them and were able to ask relevant questions, showing our understanding. Eventually, the participation and understanding felt mutual, without feelings of one class being knowledgeably above the other.
In contrast, 1 South African student wrote that “the American students . . . [have] very little knowledge outside of their own country, which is something which I had hoped to be challenged but it was not.” Some students in the United States were “impressed with the [South African] students and challenged by their perspectives” but occasionally “felt like the [South African] students were talking down to us, which made it hard for us to feel comfortable asking them questions.”
We ultimately came to see the students’ responses as indicating the collaboration’s potential to shift stereotypical thinking patterns related to both self and others. The students’ responses suggested that this collaboration brought out the human character of international peer learners, enabling the students to move beyond a reliance on cultural stereotypes. This understanding was ignited by one particular response from a student in the United States, who suggested that
these presentations really allowed the students to humanize all individuals. We all come from different backgrounds, cultures, and statuses. By learning about different situations, cultural norms, and contexts, we began to learn about how to approach people with an occupational lens.
In shifting the students’ understandings about themselves and others, this collaboration helped foster the students’ critical awareness of their similarities, differences, and interactional styles, enhancing their occupational perspectives and raising awareness about their positioning as global peers.
Category 2: Learning About Constructs and Practice
As was intended, the use of student-generated presentations as the basis of this collaboration appeared to deepen the students’ understanding of the four assigned constructs. One student in South Africa noted that “it was interesting to see how the differences in culture between the students [in South Africa] and [the United States] influenced the way in which constructs were understood and applied.” Likewise, 1 student in the United States wrote that
The concepts made way more sense when applying them to my culture and explaining things from an emic perspective to the [South African] students; then trying to comprehend their [examples] on the same concepts allowed me to view the meaning from an etic view.
Despite their diversity, student-generated examples from the construct presentations highlighted connections between the two seemingly disparate international contexts. Students from both universities wrote about the significance of seeing similar injustices exemplified in both contexts, and 1 South African student suggested that “once you understand the constructs, it helps you to better understand how power relations influence your engagement in occupations and how this is influenced by culture.” In the question-and-answer sessions that followed the construct presentations, the students discussed whether their international peers’ examples resonated with them. Many students addressed the contextual relevance of disciplinary constructs and examples in their questionnaire responses; a student in South Africa noted that “the students were able to learn more about the origins of the construct and see how it can potentially be used in unique contextual examples.”
The students also extrapolated understandings about occupational therapy practice on the basis of their discussion of the assigned constructs. A student in the United States summarized what the interactions taught her regarding the political dimensions of human occupation:
I learned that our job as OTs is not to simply help clients perform occupations. Our job is to be culturally sensitive, to acknowledge the political structures that promote or prohibit certain occupations for groups of people, and to work toward an occupationally just society. We are obligated to make our practice political, even if it complicates our job or makes us uncomfortable.
Similarly, a student in South Africa commented that the presentations
highlighted the difference that I feel there is between the understanding of occupational therapy and its scope. For example, I feel that there was insight into the ways in which different cultures/countries practice as based on the context in which they exist.
This student’s remark illustrated the perceived importance of taking a context-based view of issues related to human occupation. Although the collaboration was focused more on disciplinary knowledge than it was on professional practice, students in both contexts used their interactions to develop their knowledge about occupational therapy practices in their own and another part of the world.
Thus, although the ostensible purpose of the interactions from the students’ perspectives was to learn about the assigned constructs, the interactions also exemplified for the students how real people take up disciplinary concepts and apply them to professional practice across different contexts. Some students described this understanding as reinforcing the importance of occupational justice, but most students discussed how the collaboration exemplified the contextual factors that shape learning and occupational therapy practice.
Category 3: Feedback on Interactions
Through their questionnaire responses, the students also highlighted both elements of the collaboration that were useful for learning and aspects that could be changed. Both sets of students provided positive overall feedback on the interactions, illustrating the energetic and productive nature of the collaboration and the opportunity it offered to expand their views about different contexts, their relationship to their global peers, and the profession they were aiming to join. A student in South Africa noted that “getting to know each other as students of the field was interesting in that we were able to relate on a human level that was influenced by the mutual connection to occupational therapy and science.”
The students found the general question-and-answer sessions particularly helpful for learning about one another and about human occupation. For example, a student in the United States highlighted that “the question-and-answer sessions allowed us to ask basic and complex questions that we would have otherwise [not] had the opportunity to ask,” and a student in South Africa commented,
I found the open questions at the end of the session most beneficial and interesting because it allowed us to learn more about their context in a way that is not portrayed over the media. The media often portrays America and Americans a certain way that they have certain views, but talking to our fellow students was interesting as it challenged the way that Americans are often portrayed within the media, and this was therefore helpful in challenging our own perceptions.
The collaboration allowed for the development of relationships with others who had previously been positioned as fundamentally different, and the construct presentations and examples were seen as positive ways of learning that allowed exploration beyond the students’ usual cultural vantage point, causing theoretical concepts to come alive. One student in the United States explained that the presentations “gave me something tangible to relate to while studying. The personal examples that related to each concept were the things that I would remember most while studying and trying to understand occupational science terms.”
In addition to their positive comments, both sets of students suggested potential improvements related to the quality of peer engagement and the structure of the synchronous sessions. The students in the United States expressed disappointment in the apparent disengagement of the students in South Africa during the U.S.-focused presentations. Several students in South Africa suggested that all sessions should be compulsory for them and that the format of the sessions might be changed to avoid repetition in presentations and resultant audience fatigue. Some students in the United States also noted challenging comments and views that the students in South Africa put forward during the sessions, conveying that they “felt judged by the other university in a negative way” and that the interactions “were not [learning experiences] when either side made outlandish comments, that neither professor stood up and said that what they were saying was rude to either side.”
These points of feedback underscore the complexity of this collaboration and the ways in which the students’ learning was not always associated with positive emotions. Although the students noted benefits of expanding their understandings, their questionnaire responses also highlighted the challenges that can accompany international educational interactions.
Theme: Molding Nuanced Perspectives
Beyond understandings that might have developed through student collaborations in a single country, the disparate nature of these two international contexts seemed to put contextual differences and similarities—and the ways in which they influenced learning, interactional styles, and professional practice—into sharp relief for the students. Through this collaboration, our students not only developed their understandings of assigned constructs but also came to see each other as future professional peers and occupational beings. Accordingly, this collaboration appeared to provide an opportunity for the students to see themselves, others, and theoretical concepts in ways that both challenged and resonated with their previously held views. The feedback on the interactions indicates that this was not always an easy or comfortable process, but it also provided invaluable learning that is not always possible in intranational spaces. The interactions that occurred through this collaboration helped mold nuanced perspectives and emphasized the necessity of engaging with complex ideas from multiple vantages.
Discussion
In many ways, our findings reinforce existing ideas about the potential of international collaborations to promote nuanced and complex understandings of culture, worldviews, and occupational therapy. Specifically, our findings affirmed the power of international collaborations to enrich students’ understanding and appreciation of disciplinary concepts (Aldrich, 2015; Aldrich & Johansson, 2015) and their strong links with context, as well as in widening understandings about professional practice (Asher et al., 2014; Humbert et al., 2012; Kinsella et al., 2008; Sood et al., 2014) and culture (Cabatan & Grajo, 2017). We designed this collaboration to help students explore occupational science constructs and understand how those constructs might be taken up across different contexts; as indicated by the students’ feedback, our collaboration achieved that goal.
In addition, this collaboration appeared to be a mechanism for promoting the development of nuanced perspectives of global peers and the application of theory across vastly different contexts. A critical approach united the construct cluster’s focus on occupation in context, and that approach seems to have promoted shifts in students’ thinking. Although occupation-centered constructs (Fisher, 2013) focus on human phenomena, their abstract nature can make it challenging for students to apply or question the constructs’ assertions. By making these constructs concrete through peers’ examples, this collaboration brought the humanity of these constructs—and the people who take them up—into sharper focus. Given the students’ comments about how differently the constructs were taken up across contexts, this collaboration seemed especially to provide an important vehicle for illustrating how Western cultural ideals do not always translate across international contexts (Hammell, 2013). We believe that this kind of educational collaboration can lay important foundations for critical consciousness (Aldrich & Grajo, 2017; Kumagai & Lypson, 2009) by demonstrating the need to critically evaluate the contextual relevance of ideas in a global profession and discipline.
The development of critical consciousness can also lay the foundation for students’ consideration of issues related to occupational justice. Previous authors have discussed the complexities of realizing occupational justice in practice and the nuanced and critical thinking required to understand one’s own and others’ positions (Bailliard, 2016; Thibeault, 2013). The students’ questionnaire responses explicitly discussed increases in their awareness of and sensitivity to issues of diversity and cultural relevance, providing evidence of potential changes in their critical consciousness and showing how the collaboration could serve as a springboard for further exploration of occupational justice as a big idea.
Limitations
Although our findings suggest exciting paths for future exploration, they must be understood within the study’s limitations. First, nearly 60% of the voices in each student group were not represented in questionnaire responses, so it is possible that a majority of both classes did not experience this collaboration in the ways described in this article. Second, the students may have interpreted their learning experiences in the context of the overall courses that housed this collaboration, and thus the perspectives they shared may not have been focused solely on their experiences with the collaboration itself. Third, with no comparison group, we cannot conclude that some of the learning described above would not have occurred if the students had instead interacted with peers within their national context. Finally, we did not quantify the students’ basic understandings of themselves and their peers or their levels of cultural sensitivity before or after their interactions, so we cannot definitively assert that their level of critical consciousness changed as a result of this collaboration. Despite these limitations, we are confident that our study has revealed important paths for developing future international educational collaborations that are focused on big ideas in occupational science and occupational therapy.
Future Directions
Despite the support we found for the benefits of this international educational collaboration, there were challenges in this first iteration of interactions. In an effort to privilege the student-centered nature of the learning experience, we deliberately operated as facilitators to provide maximum space for the students to talk with one another. Although we independently attempted to help the students process comments made during the interactions, their feedback indicated that we needed to more clearly explain our teaching approach and help them understand their and our respective roles during challenging conversations. We therefore retooled the subsequent 2017 and 2018 iterations of our collaboration to include shared language that each instructor used to describe how the sessions would proceed. We also added an exploratory session in which student representatives from each class introduced their class and their local and national contexts, taking responsibility for positioning themselves and setting the tone for relationships with their future global colleagues.
Furthermore, although the justice-focused orientation of our courses, programs, and universities appeared to provide a linchpin for the students’ interpretation of the interactions—in terms of both their conceptual learning and their goals for future occupational therapy practice—the students seemed to engage more deeply with the assigned constructs and each other than with the notion of occupational justice. Given this outcome, we recognized a need to offer more consolidated opportunities for students to apply their understandings to real-world examples of injustices (Rentmeester et al., 2016). In response, we increased the number of sessions for our subsequent collaborations to add two occupational justice panels, in which students applied their knowledge of the four constructs to assigned discussion pieces on occupational justice. We hoped this added element would pave the way for deeper connections between the constructs and larger ideas about occupational justice, reflecting a more effective approach to teaching for meaning and big ideas (Wiggins & McTighe, 2005). At the time of publication, data regarding students’ perspectives on the 2017 and 2018 iterations of this collaboration were under analysis.
Implications for Occupational Therapy Practice
This research has the following implications for occupational therapy practice:
International educational collaborations can provide a platform for increasing students’ understanding of themselves, international peers, occupational science constructs, and occupational therapy practice.
Making occupational justice a focus of internationalized learning requires synergies among institutional contexts and course content as well as opportunities for students to connect their critical consciousness directly to ideas about occupational justice.
Conclusion
International educational collaborations hold the potential to help students understand themselves as members of a global community of people who choose to use an occupational lens and to interrogate and apply critical occupation-centered constructs. From a curricular and course design perspective, this study underscores the potential of this online learning experience to make students’ perspectives more nuanced, and it also illuminates how a focus on occupational justice could be made more explicit. Future research can more directly measure potential shifts in students’ critical consciousness that may result from such learning experiences, as well as the ways in which such experiences may shape the development of students as critical occupational therapy practitioners (Hammell, 2015) and socially responsive occupational scientists (Farias & Laliberte Rudman, 2016). We are hopeful that expanded opportunities for and approaches to international educational interactions will facilitate deeper exploration and elucidation of key occupation-centered ideas and their relationship to the big idea of occupational justice.
Footnotes
Acknowledgments
We are grateful to our students for helping to co-create this international educational collaboration and appreciate the support of our institutions to continue this work.