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Occupational Therapy and Environmental Sustainability: A Scoping Review

2020; Volume: 3; Issue: 3 Linguagem: Inglês

10.3928/24761222-20200116-02

2476-1230

Diane L. Smith, Kayley Fleming, Lyndsay Brown, Amy Allen, Jamie Baker, Mary Gallagher,

Climate Change and Health Impacts

Review freeOccupational Therapy and Environmental Sustainability: A Scoping Review Diane L. Smith, PhD, OTR/L, FAOTA, ; , PhD, OTR/L, FAOTA Kayley Fleming, OTD, OTR/L, ; , OTD, OTR/L Lyndsay Brown, OTD, OTR/L, ; , OTD, OTR/L Amy Allen, OTD, OTR/L, ; , OTD, OTR/L Jamie Baker, OTD, OTR/L, ; and , OTD, OTR/L Mary Gallagher, OTD, OTR/L, , OTD, OTR/L Diane L. Smith, PhD, OTR/L, FAOTA , Kayley Fleming, OTD, OTR/L , Lyndsay Brown, OTD, OTR/L , Amy Allen, OTD, OTR/L , Jamie Baker, OTD, OTR/L , and Mary Gallagher, OTD, OTR/L Published Online:January 22, 2020https://doi.org/10.3928/24761222-20200116-02Cited by:2PDFAbstract ToolsAdd to favoritesDownload CitationsTrack CitationsCopy LTI LinkHTMLAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreAbstractBackground:The Intergovernmental Panel on Climate Change reports that it is very likely that global warming is caused by human activity and that climate changes are linked to what occupational therapists call "occupation." However, the role of occupational therapy relative to environmental sustainability has not been examined extensively. This scoping review was conducted to analyze and summarize the current literature on occupational therapy and environmental sustainability and to identify gaps and limitations.Methods:According to established methods for a scoping review, databases, including MEDLINE, PsycINFO, CINAHL, ERIC, OT Seeker, NARIC, and the Cochrane Database of Systematic Reviews, were searched based on inclusion and exclusion criteria.Results:A final review of 19 articles showed themes of advocacy and professional responsibility, application of theoretical models to address environmental sustainability, methods to achieve sustainability in practice, and inclusion of environmental sustainability in occupational therapy education.Conclusion:The results showed several roles for occupational therapists that focus on advocacy as well as working with clients to create environmentally sustainable occupations, establishing sustainable practice, and revising educational standards. Future studies should further investigate methods to achieve environmental sustainability, the effect of environmental degradation on occupational performance, and effective occupational therapy interventions that address these issues. [Annals of International Occupational Therapy. 2020;3(3):136–143.]IntroductionFindings on the effect of climate change, including exposure and vulnerability, show a high level of risk for the health of current and future populations worldwide (Watts et al., 2018). Ensuring an understanding of climate change and its effect on occupations is vital so that occupational therapists can provide interventions at the individual, group, and population levels that address concerns, such as food availability, displacement, and the physical and mental health results of extreme weather events.This topic has been explored in professions such as nursing, public health, and social work. For example, Nicholas and Breakey (2017) discussed the concept of climate justice as an ethical and human rights issue that relates to climate change, and they called for the profession to assume a leadership role in practice, education, research, administration, and policy. Andrews (2009) suggested the development of a global climate change framework for nursing action that would influence public behavior and political action, differentiate nursing specialties to address specific climate issues, recognize differing global circumstances and needs, and promote public scholarship.Naylor and Appleby (2013) focused on sustainability in clinical practice and found that significant improvements may require a fundamental transformation in service models, such as a stronger emphasis on prevention and care delivered in ways that are financially sustainable and environmentally sustainable. Mortimer (2010) and Potteiger et al. (2014) proposed specific sustainable clinical practices, such as low-carbon treatment options and powering down therapeutic modalities.Finally, several health professions advocated for the inclusion of climate change in the curricula of nursing (Leffers, Levy, Nicholas, & Sweeney, 2017), public health (Fleming, Tenkate, & Gould, 2009), and social work (Beltrán, Hacker, & Begun, 2016; Boetto & Bell, 2015; Gray & Coates, 2015; Melekis & Woodhouse, 2015). These studies suggested hiring interdisciplinary faculty with expertise in ecological sustainability, the obvious inclusion of this material within the curriculum, and the need for institutional commitment.Research in the health professions on the importance of sustainability, its influence on practice, and the need for its inclusion in professional curricula represents a broader call to pay attention to sustainability. This stated attention is also an important area of exploration for occupational therapy.Occupational therapists view the client, defined as an individual, group, or population, as able to achieve a state of health or wellness by engaging in meaningful occupations within a context or environment (American Occupational Therapy Association [AOTA], 2017). However, the effects of climate change, including the unpredictability and complexity of interlinked global changes, will accelerate and will affect many clients socially, economically, and environmentally (Few, 2007). Nationally and internationally, these changes pose challenges to the identity and emotional well-being of individuals and communities, will affect occupational participation and performance, and may result in occupational injustice (Townsend & Wilcock, 2004). Therefore, issues involving sustainability of the environment are appropriate and imperative for occupational therapists to consider because of their influence on the daily habits of individuals and their participation in occupations as both cause and effect (Intergovernmental Panel on Climate Change, 2018; Silva e Dutra, Martinho Roberto, Lopes Coelho, & Almeida, 2018).The involvement of occupational therapy is appropriate not only at a community level, with regard to environmental changes created by the current climate crisis and its effect on health and participation, but also in any setting (e.g., rehabilitation units) where practitioners can adapt practice to be more globally friendly and encourage clients to modify occupations to promote ecological sustainability (Aoyama, 2014). Despite an obvious role for occupational therapy in terms of the effect of climate change on occupation, evidence of the involvement of the profession in environmental sustainability is in its infancy, especially in the United States. Therefore, we conducted a scoping review of the current literature to define the role of occupational therapy in environmental sustainability and provide the obvious next step in more robust research.MethodsDesignScoping reviews are used to evaluate the depth and breadth of available information on a specific topic, in this case, the role of occupational therapy in addressing issues of environmental sustainability (Arksey & O'Malley, 2005). Further, scoping reviews can be used to identify gaps in the literature (Levac, Colquhoun, & O'Brien, 2010). In our review, we used a framework for analysis that was proposed by Arksey and O'Malley (2005) and elaborated by Levac et al. (2010).Identification of the Research QuestionThe first step in the review process was to develop a research question. Based on an initial reading of the literature, the following question was identified: "What is the role of occupational therapy in environmental sustainability?"Identification of Relevant StudiesThe researchers, who consisted of five occupational therapy graduate students and their faculty mentor, initially searched "environmental sustainability" (a variable in the research question), which yielded search terms relevant for each database to retrieve pertinent articles. In addition to the initial search, terms from the literature included "biodiversity," "climate change," "global environmental change," "temperature variability," "occupational science," "sustainable development," "occupational justice," "resilience," "carbon emissions," "clean water," "extreme weather," "rural health," "ecology conservation," "recycling," "global warming," "air quality," "pollution," "medical waste," "ecosystem services," "nature conservation," and "industrialization." These terms were coupled with "occupational therapy" to provide more specific literature. A medical librarian with experience in completing scoping review searches confirmed the search strategies. Databases and sites searched included MEDLINE, PsycINFO, CINAHL, ERIC, OT Seeker, Scopus, NARIC, and the Cochrane Database of Systematic Reviews. In addition, we reviewed reference lists from selected articles and journals to identify relevant articles.Study SelectionWe retrieved full-text articles to determine whether they met the following inclusion criteria: (a) published in English from 2000 to the present and (b) related to environmental sustainability pertinent to occupational therapy and other health professions. The review excluded data from presentations, conference proceedings, non–peer-reviewed research literature, dissertations, and theses. We applied the inclusion and exclusion criteria in title, abstract, and full-text screening and pilot-tested the application of the criteria with a minimum of two articles. If a researcher could not determine whether an article met the inclusion criteria, a final decision was reached through a consensus among the team.ProceduresFrom the initial 54,866 abstracts identified, 36,576 unique abstracts were screened for eligibility, from which 196 full-text articles were reviewed to determine whether they met the inclusion and exclusion criteria. Of those articles, 143 were excluded after full-text screening and 35 were excluded during data extraction. The final process resulted in 18 articles that were assessed for the type of article and outcomes relevant to the question (Figure 1).Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.Data AbstractionAfter the first author (D.L.S.) performed an initial review of the abstracts, this author and the student researchers developed a data abstracting table to determine which variables to extract to help answer the research question. Data were then tabulated on a worksheet that included the author(s), year of publication, country of origin, type of publication, purpose of the study, population and sample size analyzed, methods, outcome measures, and conclusions related to environmental sustainability (Levac et al., 2010; Table A, available in the online version of the article). Tabulating was an iterative process in which the researchers continually updated the data abstracting form. To resolve uncertainty about the nature and extent of the data extracted, two researchers tabulated the same articles independently and then met to determine whether their approach to data extraction was consistent with the research question and purpose (Levac et al., 2010). Any disagreements were resolved by consensus or the decision of the first author.Table A. Data Abstracting TableAuthor, publication year, study locationAims of study (purpose of study)Type of articleStudy populationsOutcome measuresConclusions related to environmental sustainabiltiyAlgado, S.S.& Townsend, E.A.Described the issue of "eco-social" occupational therapy connecting ecology with broad ideas of occupation and occupational justice.Theory-reviewOccupational therapistsN/AThe authors proposed that doing ecology is essentially occupational and necessarily a matter of occupational justice. Suggested university-community partnerships focused on changing the environment.2015SpainAoyama, M.Explain the connection between occupational therapy and sustainabilityCommentaryOccupational therapistsN/AOT needs to understand that the profession has expertise on occupation and the relationship with the environment necessary with regard to sustainability.2014JapanAoyama, M., Hudson, M. J., & Hoover, K.C.Argue that the concept of "occupation" is a crucial addition to understanding the relationship of human wellbeing, human activity, and ecosystem services with occupational performance.Review-TheoryOccupational therapists and scientists.N/AOccupation should be considered to understand sustainable growth; people are more likely to adopt more sustainable occupations if changes support theirneeds; more research is needed2012JapanBlakeney, A.B.& Marshall, A.Examined connections among water quality, health and human occupations.Participatory action design.Residents of Letcher County, KentuckyInterviews regarding coal mining practices, infrastructure and occupationCitizens experienced occupational injustice in the forms of occupational imbalance, deprivation and alienation.2009USADennis, C. W., Dorsey, J. A., & Gitlow, L.Connect OT philosophy with sustainability and discuss how to integrate sustainability into practiceCommentaryOccupational therapistsN/AOTs must focus on consequences of our actions and reframe professional reasoning to include a focus on environmental sustainability2015USAGower, G.Consider the role of allied health and social care professionals in developing and delivering a low carbon or sustainable care service.Review-sustainable practiceAllied health professionalsN/ASustainable development can occur within healthcare practices and how services are provided at an individual and organizational level2013UKHocking, C., & Kroksmark, U.Examine how survey findings from the UN Global Survey on Sustainable Lifestyles can provide valuable information for OTCommentaryOccupational therapistsN/AApplication of findings to individual and community-based interventions to promote more sustainable lifestyles are suggested2013New ZealandIkiugu, M.N.Explore the effectiveness of the Modified Instrumentalism in OT (MIOT) in facilitating change in occupational choice and performance patterns to help address global issues of concern to humanityMixed method research embedded multiple-case study with an experimental-type pretest-posttest and naturalistic type phenomenological designOccupational therapy graduate studentsModified Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (MAIIIOT), The Daily Occupational Inventory (DOI), and Occupational Performance Calculation Guide (OPCG)Participants occupational choices and performance patterns change after intervention so that they engaged more frequently in occupations that were likely to impact global issues positively.2011USAIkiugu, M.N., Westerfield, M.A., Lien, J.M. et al.Examine the effectiveness of the Modified Instrumentalism in Occupational Therapy model as a framework for facilitating occupational therapy change to address climate change.Mixed-method single subject designUniversity students and faculty membersModified Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (MAIIIOT)Participant's feelings shifted from frustration and helplessness to empowerment and desire for action to find occupation-based solutions to global issues.2015USAPereira, R.B.An occupational science perspective to describe new ways of classifying potential mental health problems associated with climate change and its impact on the rural environment.CommentaryOccupational therapistsN/ADevelopment of policy to assist, identify, treat and prevent newly described mental illness resulting fromclimate change, taking into account ecological sustainability2008AustraliaRayment, T.Define sustainable development and explain how it is linked to mental health, well-being, and occupational therapy practiceCommentaryMental health occupational therapistsN/AOTs must consider sustainable development to practice holistically; mental health OT practice can be enhanced through emphasizing sustainable development2010UKSilva e Dutra, F., Martinho Roberto, W., Lopes Coelho, B. & Almeida, R.Analyzed if spaces of sustainable practices change daily habits and the involvement in occupations that are also sustainableQualitative analysisStudents (occupational therapy an engineering)Open interviews before and after participation in socio-educational projectsAnalysis revealed daily habit changes among the participants after they were inserted in the projects. The spaces were an important locus for environmental learning and daily changes aimed at healthier and more sustainable habits.2018BrazilSwedish Association of Occupational TherapistsDescribe how occupational therapy contributes to sustainable developmentCommentaryOccupational therapistsN/ADevelopment of a position statement by the Swedish Association of Occupational Therapists supporting the pursuit of sustainable development and occupational therapy's potential role as a part of an individual's pursuit of sustainable development and a part of planning for a sustainable society.2012SwedenWagman, P.Explore what OT and occupational science can contribute to ecological sustainability and the prevention of more severe climate changeReviewOccupational therapistsStudies related to contribution of OT to climate change and ecological sustainability published between 2008–2013.Four ways OTs can contribute: adapt to prevent climate change and to existing changes, cooperate with others, explore people's occupational choices and the relationship between occupation and ecology and warn of the consequences of the changes.2014a.SwedenWagman, P.Propose the Model of Human Occupation (MOHO) as a useful conceptual model to frame occupational therapy's contribution related to sustainable development.Theoretical discussionOccupational therapistsN/AMOHO seems to provide a useful resource for occupational therapy pracitioners who wish to include an ecological perspective of sustainable development in their work. More research is needed to evaluate this concept.2014b.SwedenWhittaker, B.Describe how the occupational therapy paradigm can expand to be more global and address sustainabilityTheoretical discussionOccupational therapistsN/AOT's focus on client-centered care makes clinicians well poised to address sustainability; the term 'environment' should broaden to include the global ecosystem; and 'occupational ecology'2012UKWorld Federation of Occupational TherapistsDiscuss the WFOT's position on environmental sustainabilityCommentary/Position StatementOccupational therapistsN/AWFOT encourages OTs working with clients who want to live more sustainable lives to promote environmentally sustainable occupations. Overall research and new research partnerships are needed to develop emerging evidence. New educational materials should be developed.2012UKWorld Federation of Occupational TherapistsIdentification of guiding principles for sustainability in occupational therapy practice, education, and scholarshipCommentary/Position statementOccupational therapistsN/AGlobal health should be central to occupational therapy practice, education and research. However, if we are to be focused on global health of citizens, then our focus must also be on sustainability, environmental, social and economic.2018UKData AnalysisA thematic analysis was conducted with qualitative strategies recommended by Levac et al. (2010) to identify themes in the literature pertaining to the role of occupational therapy in addressing issues associated with environmental sustainability. The analysis included three steps: (a) analyzing the data, (b) reporting the results, and (c) applying meaning to the results (Levac et al., 2010). Data were analyzed by first summarizing the characteristics of the article, such as the type of study, study methods, key findings, recommendations for future research, and practice changes. We then conducted further content analysis by chunking the article text into meaning units (based on the extent to which the units, either paragraphs or sentences, addressed the role of occupational therapy and other health care professions in addressing problems of sustainability) and labeling the units (Creswell & Creswell, 2018). We placed the generated codes (text chunk labels) in a taxonomy to create themes (Creswell & Creswell, 2018). Finally, we used the taxonomy to generate thematic descriptions.ResultsWe identified seven articles as commentary or opinion pieces that emphasized the need for the profession to become involved in interventions that consider aspects of environmental sustainability. Three were review articles that focused on sustainable practice. Six articles discussed occupational therapy theory or model conceptualizations related to environmental sustainability. Two qualitative studies in occupational therapy were identified, one looking at daily habits and one examining the role of occupational therapy in monitoring water quality. One article focused on the inclusion of environmental sustainability in the educational curricula for occupational therapy professionals.Thematic AnalysisWe grouped the evidence into four themes: (a) advocacy/professional responsibility, (b) theoretical models to address environmental sustainability, (c) methods to achieve sustainability in practice, and (d) environmental sustainability in professional curricula.Advocacy/Professional ResponsibilityAdvocacy for sustainability and health. Occupational therapists can consider how climate change and extreme weather events may expose individuals to traumatic experiences and chronic stress because of fear, economic challenges, and displacement (Goldmann & Galea, 2014). Displacement may result in disruption of routines that support engagement in meaningful occupations or interruption of social patterns that individuals use to navigate difficult circumstances. Traumatic events, such as those caused by displacement and forced migration, can result in mental health problems (Doherty & Clayton, 2011; Fritze, Blashki, Burke, & Wiseman, 2008), including posttraumatic stress disorder (Paxson, Fussell, Rhodes, & Waters, 2012; Rayment, 2010). Pereira (2008) further suggested that an occupational science perspective should be used to describe new ways to classify potential mental health problems associated with climate change and its effect on the rural environment.Blakeney and Marshall (2009) used a participatory research design to examine connections among water quality, health, and human occupations. The findings showed that a watershed was polluted because of specific coal mining practices and a lack of adequate infrastructure. Consequently, citizens experienced occupational injustice in the forms of occupational imbalance, deprivation, and alienation.Health professions and sustainability. The conclusion that human activity or occupation is a cause of climate change illuminates the potential of occupational therapy to help to alter human activities and occupations that are causing ecological harm (Aoyama, 2014; Dennis, Dorsey, & Gitlow, 2015). Algado and Townsend (2015) described the issue of ecosocial occupational therapy, connecting ecology with broad ideas of occupation and occupational justice. The authors proposed that doing ecology is essentially occupational and is necessarily a matter of occupational justice. They discussed future directions, including centering practice on changing the environment and pursuing additional funding for projects focused on ecological sustainability through occupation.Theoretical Models to Address Environmental SustainabilityOccupation and the Model of Human Occupation. Many conceptual occupational therapy models focus on the relationship between person and environment and can be used to frame issues of sustainability within health care practice, education, and research. Aoyama, Hudson, and Hoover (2012) argued that the concept of "occupation" is crucial to understanding how ecosystem services and the benefits that people obtain from ecosystems relate to constituents of human well-being, including security, basic materials for good life, health, and freedom of choice and action. The authors suggest that an occupational lens provides a means to gain a deeper understanding of why people choose or do not choose certain occupations and often take actions that are harmful to the environment and to their own well-being.For example, the Model of Human Occupation has been suggested as a useful frame of reference to examine environmental sustainability (Wagman, 2014b). The author argued that a person's volition can be a positive or negative factor in relation to environmentally sustainable development and that personal causation may influence whether individuals act environmentally responsibly. Societal values are relevant because, for example, occupations may differ among various cultures that value sustainable practices differently. Individuals' interests, habits, routines, roles, and identities are important because they affect the way in which they conduct occupations. In addition, the environment can promote or prevent an environmentally friendly infrastructure that supports sustainable occupation.The Modified Instrumentalism in Occupational Therapy model. Two articles examined the effectiveness of the Modified Instrumentalism in Occupational Therapy model as a framework for facilitating occupational behavior change to address climate change and related issues (Ikiugu, 2011; Ikiugu et al., 2015). Both studies determined that occupation-based interventions may increase personal awareness of the connection between occupational performance and global issues, thereby empowering people to be agents for action to ameliorate the issues. The Modified Instrumentalism in Occupational Therapy model was developed to guide occupation-based interventions to help individuals to participate in meaningful occupations in ways that promote fairness in access to resources, especially by individuals who have low incomes, are disenfranchised, and have minimal negative effect on the earth's ecosystems (Blakeney & Marshall, 2009).Sustainable global well-being. Sustainable global well-being acknowledges each person's interdependence with the global ecosystem and upholds the idea that addressing global well-being through sustainable development helps to improve individual, community, and social well-being (Whittaker, 2012). This approach adheres to the principles of occupational justice (Townsend & Wilcock, 2004), which emphasize the human need and right to engage in occupations that are meaningful, fulfilling, and environmentally sustainable. The natural extension of a global perspective complements current client-centered interventions through reframing their meaning. For example, based on client needs, meal preparation could be explored in its most sustainable form through reflecting on the ecological context and cooking mindfully.Methods to Achieve Sustainability in PracticePromotion of sustainable occupations with clients. The 2012 position paper of the World Federation of Occupational Therapists on sustainability "encourages occupational therapists working with clients wishing to live more sustainable lives to promote environmentally sustainable occupational performance and lifestyles." Occupations that sustain communities include the production, purchase, and selection of environmentally friendly goods and occupations; occupations that reuse, renovate, recycle, and respect other life forms; local paid employment that protects health and the environment; shared occupations that allow people to collaborate in creating stable community structures and health-promoting activities; and occupations such as city planning that create built environments to encourage healthy behaviors and reduce travel distances (Christiansen & Townsend, 2010). These practices can lead to a new category of human activity: "meaningful/sustainable occupations" (Aoyama, 2014).Similarly, the Swedish Association of Occupational Therapists (2012) argued that occupational therapists can support sustainable development through individualized interventions, such as prescribing aids, assisting in housing adaptations, and developing personal strategies. For example, a cognitive aid can support a person who has reduced perception of time to minimize water usage, home adaptations can facilitate the process of sorting household waste for an individual who uses a wheelchair, and visual checklists and reminders can enable a person with an intellectual disability to shop for groceries and cook in an environmentally responsible manner.Relationship between occupation and health. In connection with sustainable development efforts, occupational therapists can contribute their expertise on the effect of occupational limitations in relation to participation and health (Christiansen & Townsend, 2010). For example, active travel methods, such as walking or biking, are healthy, low-carbon means of transportation (Capon, 2014). Occupational therapists can work to increase the accessibility of these methods from both physical and way-finding perspectives to enable persons with disabilities to travel actively throughout the community.Hocking and Kroksmark (2013) suggested several ways in which occupational therapists can promote healthy occupations, using occupational science to generate new understanding of ways to change human occupations to benefit the earth's ecology (Ikiugu, 2008). Examples include establishing personal gardens so that clients can grow their own food, carpooling, and promoting community bike sharing to reduce carbon emissions.Adapting occupational therapy practice for sustainability. Wagman (2014a) discussed four ways in which occupational therapists can adapt their practice to contribute to ecological sustainability: (a) adapting to existing results of climate change and encouraging participation in occupations adapted to be more ecologi