Abstract
The study findings show that occupational therapy educators are motivated by a desire to influence change in the profession and are affected by the lack of diverse representation in the field.
Diversification of the allied health workforce is a long-standing issue in the United States, with minimal advances reported in the field of occupational therapy (Grenier et al., 2020; Wilbur et al., 2020). Racial and ethnic minority groups in the United States are predicted to shift to the majority in the next two decades, amplifying the need for racial concordance among health care providers and health care recipients (Banks, 2022; Etheridge et al., 2023; Wilbur et al., 2020). Taff and Blash (2017) suggested that an academic community with diverse backgrounds and ideas will encourage the appraisal and critique of the person, academy, and profession and promote a culture of belonging that invites and retains an increasing pool of diverse students who will enter the workforce. Quality, accessible health care that is framed through a social justice lens requires that students have opportunities to learn both from and with ethnically and racially diverse groups of educators in occupational therapy programs (Wilbur et al., 2020; Ramirez & Kiraly-Alvarez, 2023).
The American Occupational Therapy Association’s (AOTA’s; 2023) “2023 Compensation and Workforce Survey” revealed that representation of occupational therapy professionals has, since 2018, risen to 85% White and 91% women. In comparison, the racial majority in the profession is larger than the number of U.S. citizens who identify as White (75.5%; U.S. Census Bureau, 2023). This same survey noted that there had been increases in the past decade of the number of respondents indicating academia and research as their primary work setting; in 2014, it was 7.60%; in 2018, it was 10%; and in 2022, it was 14.82%. The data omitted from this report relate to the demographics of occupational therapy practitioners working in academia. AOTA’s (2021) “Academic Programs Annual Data Report: Academic Year 2020–2021” indicated that 76% of academics are White, and 84% are women. The data underscore the racial, ethnic, and gender underrepresentation within the profession in all settings and calls to attention a widening equity gap in the profession. Ramirez and Kiraly-Alvarez (2023) suggested increasing representation of Black, Indigenous, and people of color (BIPOC) educators and leaders as a means to make academic spaces more inclusive. According to the AOTA academic programs report, the number of students identifying as Hispanic/Latino is at a historic high, and the number of students who self-identify as Asian has also increased in the past decade, yet the number of students who identify as African American/Black has remained unchanged. Although an increase in the representation of some groups is positive, the stagnation in other areas suggests there are diversity, equity, inclusion, justice, accessibility, and belonging (DEIJAB) gaps in occupational therapy knowledge that must be further explored (Johnson et al., 2024). There is a lack of concordance between a growing racially and ethnically diverse body of students and occupational therapy faculty that threatens programs’ ability to recruit and retain BIPOC students (Etheridge et al., 2023; Salvant et al., 2021). This calls for solutions to recruit and retain BIPOC faculty. Increasing the number of BIPOC faculty can expedite change in educational institutions, leading to antiracist cultures in the profession (Etheridge et al., 2023; Ford et al., 2021; Salvant et al., 2021; Taff & Blash, 2017). Johnson et al. (2024) emphasized that occupational therapy research should intentionally prioritize the voices of historically minoritized groups as a catalyst for transforming DEIJAB outcomes that go beyond ideas and superficial practices to actions.
Recruitment and Retention of Faculty of Color
Grenier et al. (2020) warned how academic culture and informal hidden aspects of the curriculum rooted in institutional policies, evaluation procedures for admission or retention, and social norms of professional practice can serve as barriers and further oppress BIPOC faculty attempting to enter the academic settings. Reflexivity practices by decision makers at institutions to ensure White supremacy criteria are not applied to BIPOC faculty in hiring standards are important (Grenier et al., 2020). The intentional creation of inclusive spaces rather than hostile environments has been suggested as a strategy to not only recruit but also retain BIPOC faculty (Sterman et al., 2022).
An integral component of an effective, sustainable recruitment and retention plan is a commitment by academic leadership (Minor et al., 2017). Sterman et al. (2022) asserted the need for occupational therapy programs to explore and target the underrepresentation of BIPOC students and faculty. In recent literature, the voices and experiences of BIPOC students have been discussed, with findings underscoring the need for representation of and mentoring from BIPOC faculty as key elements in creating a culture of belonging (Ford et al., 2021; Sterman et al., 2022; Taff & Blash, 2017). Increasing BIPOC representation in occupational therapy faculty will influence the atmosphere and attitudes of occupational therapy educational programs and their ability to retain students who explore academia as a career pathway (Etheridge et al., 2023). The perspectives and experiences of occupational therapy educators targeted by these efforts has not been studied. In this study, we explored the experiences of BIPOC occupational therapy faculty who are stakeholders in diversification efforts to gain insight from their perspectives and to highlight what BIPOC faculty need to be successful in the academic culture.
Theoretical Lens
The study’s aim was conceptualized by an anti-oppression framework that systematically identifies unconscious discriminatory actions and power imbalances and generates solutions and strategies that deconstruct power and privilege within people, groups, academies, and institutions (Elementary Teachers’ Federation of Ontario, 2021). This framework guided the semistructured interview questions, which explored the academic career journey of BIPOC faculty. Items such as “Tell me about things in your life that you feel may have acted as a barrier to you pursuing a career in academia” and “Please tell me about a situation where your identity (specifically as a BIPOC) has had an impact on your experiences as an occupational therapist in the academic world” were asked, and responses were probed. Responses to the prompts “Share with me your thoughts on making the occupational therapy profession more diverse among its educators in academia” and “Could you tell me one tool or piece of advice you would share with an occupational therapist who identifies as BIPOC, that would be useful when thinking about pursuing a career in academia?” were analyzed using the National Association of Diversity Officers in Higher Education’s (2021) Framework for Advancing Anti-Racism Strategy on Campus, to assess innovative and novel solutions that support occupational therapy programs’ and institutions’ DEIJAB initiatives.
Method
Research Design
This study had a phenomenological qualitative research design that consisted of semistructured interviews to gain insight into the lived experiences and perceptions of occupational therapy BIPOC faculty as they explored a career in academia. A demographic survey collected information about participants’ race, ethnicity, language proficiency, religion, gender identity, educational background, and professional experience.
Ethical Considerations
The Kean University Institutional Review Board approved this study, and participants provided written informed consent. Data collected during all aspects of the research were de-identified, and participants’ data were assigned a number. Demographic survey data were shared in aggregate to decrease the risk of unintentionally identifying interviewees. Research data were stored electronically and secured and were accessible only to researchers.
Recruitment Process
Participants were recruited through internet platforms, including LinkedIn, AOTA CommunOT, and the OT Program Directors email list. Shared details about the study included the research query and purpose. Purposive sampling was applied to recruit BIPOC faculty for survey completion and the semistructured interview process. Specific inclusionary criteria included being a licensed occupational therapy educator who identified as BIPOC and worked in academia in any capacity (part time, full time, adjunct, or staff). Participants who received the research study details were invited to share those details with colleagues who met the inclusion criteria to expand recruitment via a snowball approach (Creswell & Poth, 2017). The Qualtrics-based survey included an initial consent form for collecting anonymous demographic information. The second portion of the survey allowed respondents to agree or decline to participate further in the interview portion of the research. Study recruitment occurred from June through October 2024 and yielded 42 BIPOC faculty who completed the demographic survey and a cohort of 17 who agreed to be interviewed. A systematic review conducted by Hennink and Kaiser (2022) concluded that saturation is met in empirical studies with a sample of 9 to 17 participants interviewed.
Data Collection
Descriptive data from this study were collected through a demographic survey. This yielded information about the intersectionality of occupational therapy educators and demographics not collected in the AOTA (2023) workforce survey. Participants’ demographic characteristics (N = 42) can be found in Table 1. The primary data collection method to support the thematic analysis was recorded interviews, which ranged in length from 45 to 90 min. Semistructured interviews were conducted via Zoom and recorded with closed captions. Each participant was interviewed by one of us, using an interview guide. We used probing questions during interviews to support the inductive process. Concurrent field notes, postinterview debriefing, and reflexivity minimized the potential for interviewer bias and further ensured the trustworthiness and accuracy of the data collected (Nowell et al., 2017). ATLAS.ti (Version 23.2.1; ATLAS.ti Scientific Software Development, 2023) was used for verbatim transcription and analysis.
Survey Respondents’ Demographics by Race and Ethnicity
Note. Information was collected from the demographic survey. ref. = reference category.
Data Analysis
Thematic analysis followed an in vivo approach with two cycles of dynamic, iterative coding using Colazzi’s descriptive method (Morrow et al., 2015). The primary interviewer carefully listened to the recording using ATLAS.ti and edited transcriptions for accuracy. During the first coding round, both of us closely examined each transcript to identify recurrent statements in silo, practicing reflexivity to mitigate investigator bias and increasing the rigor of the analysis. Fidelity of data coding was ensured through weekly peer debriefings in which findings were discussed and a consensus was reached on the meaning of phenomena, experiences, and perceptions identified in participant statements to create codes and categories. A secondary coding round included pattern coding and data triangulation using ATLAS.ti to generate a frequency count of significant words and statements identified by both of us, further confirming the descriptive codes and categories established in the first cycle. Once a consensus was reached on themes and subthemes, member checks were performed to confirm the validity of the findings. This process included the reporting of themes, with brief descriptions shared with the 17 participants via a survey. All 17 responded, and 16 agreed to read the thematic description and rate the extent to which the themes captured what had been shared during their interview. These ratings were made on a 10-point scale that ranged from 0 (not captured at all) to 10 (captured experiences). Each of the three themes averaged 9/10 agreement.
Findings
All participants (N = 42) completed the demographics and background surveys. Table 1 summarizes their race, ethnicity, and gender demographic makeup. The majority of the respondents self-identified as Black (50%) and as female (53%). Seventy-one percent of participants held a terminal degree (n = 45): PhD = 11%, EdD = 4%, OTD = 56%. A little more than half (53%) reported being first-generation college students. Twenty-four percent of them had 8–12 yr experience in the occupational therapy profession, 61% had more than 13 yr. Of this group, 75% were full-time faculty, and 13% were adjunct faculty. From this sample, 17 BIPOC occupational therapy faculty agreed to be interviewed. The academic positions held by interviewees were instructor (n = 4), assistant professor (n = 8), associate professor (n = 2), and administrator (n = 3).
This study centered marginalized voices to explore institutional barriers to diversifying the field of occupational therapy. The road to academia does not end when one is appointed as faculty but continues into and through the academy. The three themes that emerged are framed as (1) the journey to academia, (2) the journey through academia, and (3) the role of representation in the profession.
It is important to note that one participant did not believe that diversification of occupational therapy should focus on race and ethnicity: “I don’t feel [it’s] necessary . . . to diversify the faculty based on race and ethnicity . . . because we emphasize more the diversifying faculty’s expertise.”
Theme 1: The Journey to Academia
Participants described experiences that influenced their decision to move to academia. Subthemes that emerged were defining moments, opportunities to engage in teaching, influential factors, and formal and informal mentorship.
Defining Moments
Participants described what sparked their interest in becoming an occupational therapy practitioner and eventually moving toward academia. These defining moments include serving local and global communities and the profession as inspiration to pursue an educator role. Several participants described arriving at a point in their clinical career and realizing that they wanted to do more and have a broader impact on society: “I wanted to try and give back to those students who felt like they didn’t have a voice or we’re not seen in their programs or things like that.” One participant shared the following: To be honest, I didn’t really consider it seriously until someone asked me, “Have you considered teaching?” Because I think my radar was kind of off after getting my master’s in public health to move into that nonprofit sector or, or, or management, or something like that, but not necessarily education.
Another defining moment was experiencing incidents of bias as occupational therapy students and as clinicians. Incidents of covert and overt discrimination in the classroom and workplace were shared at multiple points on the path to academia and in academic roles. One participant described how, when she was a student, “[The instructor] said that her students don’t have the capacity to pass her class because they lack the intellectual ability. She was tenured. We reported her; nothing happened.” Another participant reported how, when she was an instructor, “One of the students said ‘Well, they only hired those two so that they can meet the quota.’”
With respect to hiring experience, one participant shared this: The program director said, “I don’t know how you would be received by our students,” and I was like, “Why?” “Because you teach up here, and I don’t think they would expect you to teach up here. I think they would expect you to be a little different.” I said, “Oh, okay, is it because, like, I’m [a registered occupational therapist]; is [the] terminology different?” And they just said, “No,” and I can never get a clear-cut answer as to why they thought that about me.
Participants reported that although these incidents were difficult to endure, they also ignited a desire to influence positive change in the workforce for underrepresented groups and led to exploration of the practice area of education.
Opportunities to Engage in Teaching
Working as an adjunct instructor, laboratory instructor, and providing guest lectures were identified as entry points into academic work. Some participants (n = 15) described positive interactions when introduced to the role of instructor for invited guest lectures, laboratory instructor, and coteaching core curriculum courses as moments when the idea of teaching came to mind. The supervision of Level 1 and Level 2 fieldwork students also contributed to the appeal of teaching.
Some participants shared what had inspired them to pursue a career in academia: I think for me it was fieldwork students. . . . So, if they were Black students, they kinda naturally gravitated to the only person they saw like themselves. and so, the idea of teaching kind of came that way. One of the faculty from the university that was close to the hospital came to a site visit. . . . She’s like, . . . “I need seminar instructors,” and I’m like, “Okay, I’ll give this a try,” and I enjoyed it. And she actually was Asian herself; I [had] really never seen [recalling a first encounter with a faculty member with the same representation].
Influential Factors
Teaching opportunities also created intentional and organic relationships that built connections and provided networking opportunities for engaging in research, recommendations for full-time positions, and practical advice related to entering academia. Participants credited other individuals in pointing out their talent and potential for teaching: “It was a fieldwork educator. . . . She said, ‘Have you considered teaching?’ And I was like [shakes head “no”] ‘I’m really just trying to finish my masters, and it’s just not on my radar.’” Another recalled, “One of my instructors said. You know you seem to have the personality type to potentially some time down the road be an instructor. . . . So she put that little spark in the back of my head.”
A factor identified when pursuing a terminal degree was the ability to obtain the necessary funds. Participants cited programs offered in their clinical and academic positions that offset the cost of a doctoral degree as being a significant positive influential factor on the road to academia.
One participant cited an example of building connections that led to financial support: The physician who was in charge of the center at the time was like “You really should go back to school. . . . You do really excellent work, and I’ll support it.” And so he actually supported my education financially with some money from the center. And that’s how I actually went back to school on the weekend.
Formal and Informal Mentorship
Both formal and informal relationships with occupational therapy practitioners across practice areas had an impact on participants’ journeys to and through academia. This was discussed and described in their roles as students, clinicians, and faculty. Some participants (n = 10) expressed that early mentorship and sponsorship were integral to the recruitment and retention phases along the path to academia. Here are two examples: “I feel mentorship is key to longevity. . . . When you find someone who looks like you [that] you can identify with, there’s a lot of those unspoken norms that you don’t need to over-explain” and “I would like to see more mentorship opportunities, perhaps, for for, for, like Latinx students.”
Theme 2: The Journey Through Academia
The second theme that emerged from the exploration of the journey to academia related to the impact of being a BIPOC occupational therapy faculty member on job performance, job satisfaction, and retention. BIPOC faculty experience the attitudes, beliefs, and rules that make up the nuances of academic culture differently from members of other ethnic groups. Participants described navigating department relationships, roles, and responsibilities of being “asked to do more.” Sixteen of the 17 participants served on a department or university diversity, equity, and inclusion committee, and 11 were faculty advisors for the Coalition of Occupational Therapy Advocates for Diversity. Faculty of color are more likely to be called upon, and willing to, serve on diversity and inclusion initiatives while maintaining their scholarship requirements and balancing teaching loads (Etheridge et al., 2023). We noted a dissonance in participants when they described having to balance the desire to be a change agent in the realm of DEIJAB with the desire to maintain clinical and academic expertise.
Some participants (n = 6) shared experiences of not feeling heard or valued by colleagues and administrators in their departments, not being able to be authentic at work, having to “dim my light,” and a lack of respect for their work and talents. These factors contribute to a low sense of belonging: Sometimes [you have to] make yourself small, right . . . not ripple the waters too much . . . [you] don’t want to make waves . . . not saying things or saying things a certain way, or being as direct for the sake of other people feeling comfortable.
Theme 3: The Role of Representation in the Profession
The third and last theme emerged as participants described their journeys to, and through, academia. They reported that a lack of diverse racial and ethnic representation experienced in the classroom as a student; in the clinic, as a fieldwork student; as a practitioner, on doctoral committees, and within leadership had an influence as they traveled the path from entry-level occupational therapy student to full-time faculty and in administrative or leadership roles in academia. Participants also found power in their representation. Drawing strength from the understanding that being a representative from an underrepresented group gave them the power to influence and encourage others into the profession and bring a diversity of voices into the conversations that shape occupational therapy programs: “We lift as we rise.” They also noted that the exploitation of this power by others can at times become a burden.
Categorical Noteworthy Findings
Two questions in the interview guide were individualistic in nature and spotlighted values related to inclusivity and belonging in academia. The answers contributed to the thematic analysis but are also worthy of elaboration. The first question asked, “If you had to choose one word to describe your journey to pursuing academia, what would it be, and why?” When conducting thematic analysis, we also analyzed the one word provided by each participant in response to this question. This resulted in two categories: (1) persistence, defined as the ability to withstand, and (2) spiritual faith, defined as belief that a higher power has an impact on one’s career path. Figure 1 showcases the list of words participants supplied to highlight attributes that played a role in their experiences.
Responses to the prompt “Provide one word to describe your journey toward academia.”
The second question was “What advice would you offer to an occupational therapy practitioner who identifies as BIPOC pursuing a career in academia?” Participants offered the following advice: ▪ “Be true to yourself, true to [your] vision, true to [your] values. . . . Don’t let the naysayers get you down.” ▪ “Be resilient; don’t let anybody dim your sparkle.” ▪ “Ask questions.” ▪ “Seek mentorship.” ▪ “Seek early mentors.” ▪ “Find a supportive network of [people of color].” ▪ “Develop your expertise and stay true to it.” ▪ “Negotiate well; get it on the front end of your contract.” ▪ “Have a five-year plan.”
Discussion
The insights we explored in this study shed light on the experiences of BIPOC occupational therapy academicians and how they experience the hidden curriculum of occupational therapy programs and institutions of higher learning in the United States (Etheridge et al., 2023; Horton et al., 2021). The pathway to academia for BIPOC faculty is a journey that begins as a student in an entry-level program and evolves in field, clinic, and community work; pursuit of terminal degrees; and the transition into and through academia. The experiences our participants shared can add nuance to plans for attracting, recruiting, and retaining a racially and ethnically diverse pool of occupational therapy practitioners (Banks, 2022; Etheridge et al., 2023; National Association of Diversity Officers in Higher Education, 2021). Participants discussed not initially seeing themselves in the role of faculty; this was attributed to early defining moments of not being heard or feeling valued, feeling unwelcomed, and covert and overt discrimination. These findings are consistent with occupational therapy literature reports of student experiences; however, they highlight the impact of these experiences on one’s career path (Ford et al., 2021; Salvant et al., 2021; Sterman et al., 2022). A strategy to diversify occupational therapy and improve the experiences of BIPOC occupational therapy students entails diversifying occupational therapy faculty; however, the early academic experiences of occupational therapy professional culture that our participants described are barriers to attracting students to research and work in academia.
Horton et al. (2021) emphasized the importance of systematic change for the successful recruitment and retention of faculty of color. The academic climate is a deciding factor in whether BIPOC faculty remain at a particular institution. To mitigate these concerns, some scholars have suggested that BIPOC faculty be included in search and hiring committees and that an across-the-board commitment and willingness to mentor adjunct faculty and doctoral students of color be made so as to grow representation from within the academy (Minor et al., 2017; Ramirez & Kiraly-Alvarez, 2023). Mentoring was seen as an important tool to minimize feelings of isolation and support newer staff through publication, promotion, and tenure processes. It also had a bidirectional influence on emotional and social well-being (Horton et al., 2021; Minor et al., 2017).
Our findings support the claim that BIPOC occupational therapy faculty are being called to participate in these types of mitigation efforts. Although this can become a burden, it is also a source of empowerment and an internal source of drive and determination. Open dialogue in professional development planning (retention) that explores what aspects of teaching, service, and scholarship are empowering and fulfilling, with the understanding that the motivating factors are shaped by a racialized lived experience in the profession and wider U.S. society, is recommended.
Recruitment of a diverse occupational therapy professoriate can be strengthened with early and intentional exposure to teaching experiences. Our participants described feeling a spark to become an occupational therapy educator when they were provided the opportunity to teach. It was the transactional interaction with this role that brought to the front of their minds, hearts, and spirit the desire to teach, even when there was a lack of direct racial/ethnic representation.
Limitations
The intent of qualitative research is to understand the experiences of a select group of individuals and not to generalize the findings, as in quantitative research (Creswell & Poth, 2017). Therefore, occupational therapy stakeholders should not assume that the experiences reported by our participants are reflective of all educators who identify as BIPOC. A potential limitation is that both of us are BIPOC occupational therapy faculty, and so strategies to mitigate bias were integral to the study design. The research method and analysis were well designed in terms of rigor and trustworthiness.
Implications for Occupational Therapy Education
We hope that this work highlights the value of intentionally centering underrepresented voices in conversations at all levels and access points to the occupational therapy profession. Institutions of higher education and the allied health care workforce can use these findings to enhance initiatives to attract, recruit, and retain BIPOC into the field.
Conclusion
These findings create an opportunity for further research to explore the needs of educators of color and the important links among these educators’ success, the recruitment and retention of students of color, how to diversify the profession, and ultimately align the occupational therapy workforce with a growing ethnically and racially diverse society.
Footnotes
Acknowledgments
We acknowledge the work of Kean University occupational therapy students who contributed to the institutional review board process (Rachel Lanzalotti, MSOT, OTR/L; Therese Meily, OTD student; and Matthew Ungerer, OTD student) and the article’s organization (Bianca DeSousa, master’s student).