An overview of barriers, facilitators, and themes associated with occupational therapy practice in Canada

Abstract

Background To advance occupational therapy practice, we need to understand factors that support and hinder occupational therapists’ engagement in health services and better understand how occupational therapy is being represented in practice. With respect to factors that support and hinder occupational therapy practice, the first objective of this thesis was to identify barriers and facilitators to the integration of occupational therapists into primary care services in Canada and provide recommendations from the literature supporting occupational therapist inclusion in primary care. With respect to understanding occupational therapy practice, the second objective of this thesis was to identify the roles/activities of occupational therapists present in the Canadian and Australian literature.

Methods An environmental scan was conducted to address the first objective. Data were gathered from three sources: Cumulative Index to Nursing and Allied Health Literature Plus with Full Text (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Canadian Journal of Occupational Therapists (CJOT). For the second objective, an environmental scan and gap analysis were performed. Data for objective 2 were gathered from the database: Cumulative Index to Nursing and Allied Health Literature Plus with Full Text (CINAHL).

Results With respect to the first objective, six barriers and three facilitators were found. The six barriers were: 1. a lack of understanding amongst health care professionals, policy makers and occupational therapists regarding an occupational therapist’s roles and services provided in primary care; 2. limited research involving an occupational therapist's integration within primary care; 3. a lack of funding for occupational therapy services within primary care; 4. a lack of understanding amongst health care professionals, politicians, and the public of the effectiveness of occupational therapy services; 5. a lack of shared understanding amongst occupational therapists regarding the distinction between primary care and primary health care; and 6. limited interactions between the primary care teams and occupational therapists. The three facilitators were: 1. occupational therapists’ engagement in interprofessional practice; 2. occupational therapists’ broad scope of practice (the generalist role); and 3. advocacy for occupational therapy roles in primary care. Regarding the second objective, Australia was identified as a comparison country for Canada. One hundred sixty-seven descriptors of occupational therapy roles/job titles/positions were identified in the Canadian and Australian literature and were categorized into nine themes for occupational therapy practice. These nine themes were: providing direct client care; leadership within the profession; liaison between client, family, and health professionals; occupational therapists providing education; research in occupational therapy; advocate for the client; professional practice; advocate for profession; and leadership outside the profession. Of these nine themes, the three most prevalent were: providing direct client care; leadership within the profession; and liaison between the client, family, and health professionals.

Conclusions This thesis provides essential information that can be used to improve the utilization of occupational therapists working within Canada's primary care setting. Interprofessional practice is an essential facilitator to the integration of occupational therapists within primary care. It is essential to foster understanding of occupational therapy practice amongst the public, other health professionals, and occupational therapists as this will be vital to occupational therapists’ inclusion in health care practice. Moreover, advocating for the profession and educating others on occupational therapy practice is vital for occupational therapists both within and outside of practice. Increasing health professionals' exposure to occupational therapists’ roles and services within primary care, is necessary to foster a greater understanding of how occupational therapists fit within primary care. Occupational therapy research, advocacy, leadership, and interprofessional practice are essential resources for creating awareness and understanding regarding the profession’s roles and scope of practice. This work draws attention to occupational therapy roles/activities represented in the Canadian and Australian literature. Based on our research, there are several opportunities for occupational therapists to increase awareness amongst the general public, health professionals, and politicians regarding occupational therapy roles and services in Canada primary care. These opportunities involve occupational therapists directly addressing key barriers and facilitators to occupational therapist integration into practice.