Date Presented 03/27/20
This systematic review examined OTs’ practices at the community level by locating and appraising current research evidence and describing practice roles and opportunities. Internationally, OTs practice with communities in diverse settings to improve community-level health, well-being, and inclusion. Practice can be strengthened through advocacy, education, and policy change, as well as rigorous research that defines community and describes community engagement.
Primary Author and Speaker: Nerida Hyett
Contributing Authors: Amanda Kenny, Carol McKinstry, Chontel Gibson
PURPOSE: Internationally, occupational therapists recognize the importance of community practice and identify communities as clients of occupational therapy. Occupational therapists’ practise at the community-level aims to improve community health, well-being, and inclusion and to address population health issues and priorities. There is, however, limited understanding of how occupational therapists’ practise beyond individuals, to work with communities. Additionally, the scope and efficacy of occupational therapists’ practise with communities has not been reviewed.
The research question guiding this systematic review was “How do occupational therapists practise with communities to enhance community-level health, well-being, and inclusion?”
DESIGN: A systematic review method was utilised to search the peer-reviewed research literature and to identify relevant studies for review and appraisal. The systematic review was mixed method, enabling the appraisal of qualitative and quantitative and mixed methods studies.
METHOD: Systematic searches of four research databases were undertaken, including Medline, CINAHL, ProQuest Central, and Scopus. Key terms related to “occupational therapy” and “community practice”. The inclusion criteria for article selection was 1. English language, 2. Research article published in peer-reviewed journal, 3. Must identify occupational therapist, 4. Must identify a type or form of community-level practice with community engagement. Student projects were excluded.
The Covidence™ computer application was used for article screening processes. All titles were reviewed by at least two researchers, with conflicts resolved through discussion. Reviewer agreement ranged from moderate to substantial agreement (weighted Kappa scores 0.41 – 0.62 between three reviewers). A total of n=722 articles were identified for title and abstract screening (after duplicates were removed). A total of n= 209 full-text articles were assessed for inclusion. The final n= 25 articles were critically appraised using the Mixed Methods Appraisal Tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to report study results.
RESULTS: The 25 included articles illustrate the scope and potential value of occupational therapists’ practise with communities. Research was conducted predominantly in the United States of America and Canada. Occupational therapists practising at a community-level were situated within community health services, primary care services, community-based rehabilitation programs, private health centers, schools, and community-led groups. Occupational therapists’ practice roles are diverse, ranging from capacity building in schools, community development projects, consultation and design for community mobility and accessibility, children’s playground design and construction, and health promotion and education. Included studies were predominantly qualitative research articles. The study appraisals highlight that research rigour needs to improve to strengthen the evidence base. Key issues identified were inconsistent definitions of community and descriptions of community engagement.
CONCLUSION: Occupational therapists practise in diverse roles at the community-level, which have potential to improve community-level health outcomes. The results can strengthen existing community-level practice roles and assist in advocating for the development of new positions for occupational therapists within community initiatives. Knowledge gaps and research rigour must be addressed to improve occupational therapists’ capacity to design and deliver interventions that enhance community health, wellbeing and inclusion, and target population health priorities.
