"Ah, it's best not to mention that here:" Experiences of LGBTQ+ health professionals in (heteronormative) workplaces in Canada.

Introduction: Despite human rights protections for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, LGBTQ+ professionals may continue to experience discrimination working in heteronormative systems and spaces. Methods: In this qualitative study 13 health professionals (nurses, occupational therapists, and physicians) from across Canada participated in in-depth qualitative interviews to explore their experiences with work-related microaggressions and heteronormativity. Results: Heterosexist microaggressions from both patients/clients and colleagues were the norm, perpetuating and bolstered by heteronormative workplace and professional cultures. In turn, LGBTQ+ professionals navigated disclosure-decision-making, in power-laden contexts where all options carried potential negative consequences. Discussion: Drawing on the notion of "heteroprofessionalism," we argue that the concept of professional carries encoded within it demands that the occupant of that category be-or present as-heterosexual, an unmarked status that can be readily desexualized. Acknowledging sex and sexuality disrupts "professionalism." We argue that such disruption, indeed dissention, is necessary to open (hetero)professional spaces to LGBTQ+ workers.

Factors influencing LGBTQ+ disclosure decision-making by Canadian health professionals: A qualitative study.

Disclosure of LGBTQ+ identities at work may reap benefits, but may also exacerbate harms. Faced with ambiguous outcomes, people engage in complex concealment/disclosure decision-making. For health professionals, in contexts of pervasive heteronormativity where disclosure to patients/clients is deemed to violate professional boundaries, stakes are high. This qualitative study with 13 LGBTQ+ health professionals across Canada used semi-structured interviews to explore factors affecting disclosure decision-making, particularly attending to power structures at multiple levels. Most participants engaged in constant risk-benefit assessment, disclosing strategically to colleagues, rarely to clients/patients. At the individual level they were affected by degree of LGBTQ+ visibility. At the institutional level they were affected by the culture of particular professional fields and practice settings, including type of care and type of patients/clients, as well as colleague interactions. Professional power-held by them, and held by others over them-directly affected disclosures. Finally, intersections of queer identities with other privileged or marginalized identities complicated disclosures. Power relations in the health professions shape LGBTQ+ identity disclosures in complex ways, with unpredictable outcomes. Concepts of professionalism are infused with heteronormativity, serving to regulate the gender and sexual identity expression of queer professionals. Disrupting heteronormativity is essential to forge more open professional cultures.

Interpersonal, institutional, and structural racism in Canadian nursing: A culture of silence.

BACKGROUND: Alongside declarations against racism, the nursing profession in Canada needs examination of experiences of racism within its ranks. Racism at multiple levels can create a context wherein racialized nurses experience barriers and ongoing marginalization. PURPOSE: This critical interpretive qualitative study asks how interpersonal, institutional, and structural racisms intersect in the professional experiences of racialized nurses in Canada, and how nurses respond. METHODS: Self-identified racialized nurses (n = 13) from across Canada were recruited primarily through snowball sampling, and each was interviewed by phone or in person. Once transcribed, interviews were analyzed inductively, which led to the levels of racism as a guiding framework. RESULTS: From entry to nursing education throughout their careers participants experienced racism from instructors, patients, colleagues and managers. Interpersonal racism included comments and actions from patients, but more significantly lack of support from colleagues and managers, and sometimes overt exclusion. Institutional racism included extra scrutiny, heavier workloads, and absence in leadership roles. Structural racism included prevalent assumptions of incompetence, which were countered through extra work, invisibility and hyper-visibility, and expectations of assimilation. Racialized nurses were left to choose among silence, resisting (often at personal cost), assimilation and/or bolstering their credibility through education or extra work. Building community was a key survival strategy. CONCLUSIONS: Everyone in nursing needs to challenge the culture of silence regarding racism. White nurses in particular need to welcome discomfort, listen and learn about racism, then speak out to help disrupt its normative status.

Epistemic racism in the health professions: A qualitative study with Black women in Canada.

Systemic racism within health care is increasingly garnering critical attention, but to date attention to the racism experienced by health professionals themselves has been scant. In Canada, anti-Black racism may be embodied in structures, policies, institutional practices and interpersonal interactions. Epistemic racism is an aspect of systemic racism wherein the knowledge claims, ways of knowing and 'knowers' themselves are constructed as invalid, or less credible. This critical interpretive qualitative study examined the experiences of epistemic racism among 13 healthcare professionals across Canada who self-identified as Black women. It explores the ways knowledge claims and expert authority are discredited and undermined, despite the attainment of professional credentials. Three themes were identified: 1. Not being perceived or portrayed as credible health professionals; 2. Requiring invisible labour to counter professional credibility 'deficit'; and 3. Devaluing knowledge while imposing stereotypes. The Black women in our study faced routine epistemic racism. They were not afforded the position of legitimate knower, expert, authority, despite their professional credentials as physicians, nurses and occupational therapists. Their embodied cultural and community knowledges were disregarded in favour of stereotyped assumptions. Adopting the professional comportment of 'Whiteness' was one way these health care providers strived to be perceived as credible professionals. Their experiences are characteristic of 'misogynoir', a particular form of racism directed at Black women. Anti-Black epistemic racism constitutes one way Whiteness is perpetuated in health professions institutions.

Lower-class origin professionals in Canadian health and social service professions: "A different level of understanding".

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus, to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners.

Systemic Racism in Canadian Occupational Therapy: A Qualitative Study with Therapists.

Background. Research on racism within occupational therapy is scant, though there are hints that racialized therapists struggle. Purpose. This paper examines experiences of racism in occupational therapy, including coping strategies and resistance. Method. Ten therapists from racialized groups (not including Indigenous peoples) were recruited for cross-Canada, in-person or telephone interviews. Transcripts were coded and inductively analysed, with data thematically organized by types of racism and responses. Findings. Interpersonal racism involving clients, students, colleagues and managers is supported by institutional racism when incidents of racism are met with inaction, and racialized therapists are rarely in leadership roles. Structural racism means the experiences of racialized people are negated within the profession. Cognitive sense-making becomes a key coping strategy, especially when resistance is costly. Implications. Peer supports and community building among racialized therapists may be beneficial, but dismantling structures of racism demands interrogating how whiteness is built into business-as-usual in occupational therapy.

Experiences of epistemic racism among occupational therapists / Experiências de racismo epistêmico entre terapeutas ocupacionais

Abstract Objective Epistemic racism establishes the knowledges and ways of knowing of a dominant group as legitimate, invalidating those of groups marked by racialization. Professions are demarcated by their knowledge claims, making epistemic racism a powerful mechanism of exclusion within professions. This paper examines experiences of epistemic racism in occupational therapy across Canada. Method Using a critical interpretive qualitative approach, ten therapists from racialized groups were interviewed (in-person or telephone), with transcripts coded and analyzed iteratively. Results Participants routinely experienced epistemic 'mis/fit' with the profession, rarely seeing themselves reflected in the profession's knowledge base, leadership, values or assumptions. Racialized therapists were routinely denied expertise and authority, by students, clients and colleagues. They walked a tightrope between professional assimilation and marginalization. Conclusion The presence of racialized therapists is insufficient, when their authority is consistently delegitimized and they are required to assimilate. Leadership roles for racialized therapists must be accompanied with epistemological multiplicity, destroying the domination of whiteness.

Resumo Objetivo O racismo epistêmico estabelece os saberes e formas de saber de um grupo dominante como legítimos, invalidando os de grupos marcados pela racialização. As profissões são demarcadas por suas reivindicações de conhecimento, tornando o racismo epistêmico um poderoso mecanismo de exclusão dentro das profissões. Este artigo examina experiências de racismo epistêmico em terapia ocupacional no Canadá. Método Usando uma abordagem qualitativa interpretativa crítica, dez terapeutas de grupos racializados foram entrevistados (pessoalmente ou por telefone) e as transcrições foram codificadas e analisadas indutivamente. Resultados Os participantes vivenciam rotineiramente o "desajuste" epistêmico com a profissão, raramente se vendo refletidos na base de conhecimento, liderança, valores ou suposições da profissão. Os terapeutas ocupacionais racializados eram rotineiramente negados a perícia e autoridade, por alunos, clientes e colegas. Eles caminharam na corda bamba entre a assimilação profissional e a marginalização. Conclusão A presença de terapeutas ocupacionais racializados é insuficiente, sendo sua autoridade consistentemente deslegitimada e eles são obrigados a assimilar a ordem vigente. Os papéis de liderança para terapeutas ocupacionais racializados devem ser acompanhados de multiplicidade epistemológica, destruindo a dominação da branquitude.

Reflecting on conceptualisations of 'meaning' in occupational therapy / Refletindo sobre a conceptualização de 'significado' em terapia ocupacional

Abstract In this reflection essay, the authors explore how meaning is represented in occupational therapy literature. A review of occupational therapy and occupational science literature uncovers framings of meaning, meaningful, and meaningfulness that are almost exclusively 'positive'. Positioning of occupations as inherently 'positive' and assuming universal experiences of positive meanings for all members of society, overlooks individual and collective diversities. To perpetuate framings of occupations as inherently and exclusively 'positively meaningful' effectively silences experiences that do not conform to dominant assumptions and perspectives. Approaching concepts of 'meaning' more broadly may allow occupational therapists and scholars to better comprehend what people do and do not do, and why, better situating the profession to promote the espoused goals of equity, justice, and rights. Neglecting nuanced understandings of meaning may forfeit more complex examinations of occupation to other disciplines, thereby undermining disciplinary claims of expertise in the realm of occupation.

Resumo Neste ensaio reflexivo, as autoras exploram como o significado é representado na literatura de terapia ocupacional. Uma revisão da literatura em terapia ocupacional e ciência ocupacional revela enquadramentos de significado, significativo e significância que são quase exclusivamente 'positivos'. Posicionar as ocupações como inerentemente "positivas", assumindo experiências universais de significados positivos para todos os membros da sociedade, ignora as diversidades individuais e coletivas. Perpetuar os enquadramentos de ocupações como inerente e exclusivamente "positivamente significativas" efetivamente silencia experiências que não estão em conformidade com as suposições e perspectivas dominantes. Aproximar os conceitos de "significado" de forma mais ampla pode permitir que terapeutas ocupacionais e acadêmicos compreendam melhor o que as pessoas fazem e não fazem e o porquê, situando melhor a profissão para promover os objetivos defendidos de equidade, justiça e direitos. Negligenciar entendimentos matizados do que é significativo pode privar exames mais complexos sobre as ocupações, oportunizando que outras disciplinas o façam, minando assim as reivindicações disciplinares de especialização no domínio da ocupação.

Substance use and meaning: transforming occupational participation and experience / Uso de substâncias e significados: transformando participação ocupacional e experiências

Abstract Introduction We draw on activity theory of concepts to examine 'meaning of occupation' and 'substance use' beyond preconceived notions of inherent positive or negative experiences. Objective To explore nuanced meanings of substance use and associated occupations. Method An online survey and semi-structured interviews were used to collect data from professionals about prevalence of substance use, substance effects, and personal experiences. In analyzing the interview data, we attended to substance use as a discrete occupation in itself, substance use co-occurring with other occupations, and substance use altering the performance, participation, and experience of occupations. Results Three broad themes related to meaning: i) complex meanings attributed to substance use, ii) meanings of substance use as shifting and variable, and iii) meanings of substance use in the context of other occupations. Substance use enhances occupations, transforms meaning of occupations, and mitigates less desired aspects of occupations. Work, construed as positively meaningful and valued in occupational therapy literature, was a source of stress, unhappiness, and worry; substance use facilitated relaxation and pleasure. Conclusion This study furthers occupational therapy knowledge with respect to implications for conceptualization that extend beyond dualist framings and implications for occupational therapy education, practice, and policy.

Resumo Introdução Foi utilizada a teoria da atividade de conceitos para examinar o "significado da ocupação" e o "uso de substâncias" para além das noções preconcebidas de experiências inerentes positivas ou negativas. Objetivo Explorar nuances do significado do uso de substâncias e as ocupações associadas. Método Uma pesquisa online e entrevistas semiestruturadas foram usadas para coletar dados de profissionais sobre a prevalência do uso de substâncias, efeitos de substâncias e experiências pessoais. Ao analisar os dados da entrevista, observamos que o uso de substâncias é uma ocupação discreta em si, ocorrendo com outras ocupações e o uso de substâncias altera o desempenho, a participação e a experiência das ocupações. Resultados Três grandes temas relacionados ao significado: i) significados complexos atribuídos ao uso de substâncias, ii) significados do uso de substâncias como mutante e variável, e iii) significados do uso de substâncias no contexto de outras ocupações. O uso de substâncias enlaça-se às ocupações, transforma os seus significados e mitiga aspectos menos desejados das ocupações. O trabalho, considerado positivamente significativo e valorizado na literatura da terapia ocupacional, era uma fonte de estresse, infelicidade e preocupação; o uso de substâncias facilitou o relaxamento e o prazer. Conclusão Este estudo aprofunda o conhecimento da terapia ocupacional com implicações para ampliar a conceptualização para além da fragmentação dualista e oferta implicações para a formação em terapia ocupacional, para a prática e a política.

The Concept of Oppression and Occupational Therapy: A Critical Interpretive Synthesis.

Background. Occupational therapy and occupational science literature include growing attention to issues of justice, marginalization, and rights. In contrast, the concept of oppression has scarcely been employed. Purpose. This paper investigates how adding the concept of oppression may enhance occupational therapy approaches to injustice, prioritizing a focus on structural causes, and facilitating conscientious action. Method. A critical interpretive synthesis explored insights from authors who name oppressions in occupational therapy and occupational science literature. In total, a sample of 28 papers addressing oppression, ableism, ageism, classism, colonialism, heterosexism, racism, and/or sexism was selected for inclusion. Findings. Four themes were identified: oppression and everyday doing; effects of structures and power; responding and resisting; and oppression within occupational therapy. Implications. Incorporating oppression within the plurality of social discourse may help occupational therapists to avoid individualistic explanations, attend to relationships between social structures and constrained occupations, frame intersectional analysis, and engage in praxis.

Occupational Therapy Roles in an Indigenous Context: An Integrative Review.

BACKGROUND.: Indigenous peoples experience health inequities linked in part to lack of access to culturally-relevant health care. The Truth and Reconciliation Commission of Canada (TRC) calls on all health professionals, including occupational therapists, to reduce health inequities through improved work with Indigenous communities. PURPOSE.: This integrative review of the literature explores how occupational therapists can improve their work with Indigenous peoples. KEY ISSUES.: Communication and building relationships are central to effective work with Indigenous communities, along with reciprocity regarding knowledge exchange. Issues surrounding service provision are a significant concern, yet improvements are unlikely to be effective unless therapists can critically examine the (mainstream) Western cultural assumptions that infuse the profession and their own practices. IMPLICATIONS.: Though nascent, there are identified directions for occupational therapists to meet the TRC's calls for more competent health care. Researchers should explore best ways for therapists to critically interrogate taken-for-granted professional assumptions mired in Western colonialism.

Substance use to enhance occupational performance and experience: a critical interpretive synthesis / Uso de substâncias para melhorar o desempenho e a experiência ocupacional: uma síntese interpretiva crítica

Abstract Introduction Substance use, as an occupation, is typically portrayed as problematic and the target of occupational therapy intervention and remediation. At the same time, psychoactive substances may be used to enhance mood, cognition, occupational performance, and/or experience, a perspective that is largely absent from occupation scholarship. Objective We examine substance use in relation to the enhancement of occupation, drawing on the theoretical notion of agential realism. This theory suggests that in the social world 'reality' is not so much objective fact, stable and predictable, but rather continuously produced and reproduced, through doing and intra-active becoming. Method A selected integrative, critical interpretive synthesis of the literature was conducted. The analysis is focused on synthesizing literature about substance use and enhancement of occupation. Results Occupation does not exist independent of the doing, but also in 'becoming'. Sometimes using a substance is in itself an occupation - having a drink, or going out for coffee. Sometimes using a substance is a means to enhance another occupation - taking erectile dysfunction medication to improve sex, or amphetamines to improve studying. Sometimes using a substance simply alters the experience of an occupation - using cannabis or psychedelics to enhance the experience of listening to music. Conclusion Adopting a focus on occupation may encourage novel ways of understanding substance use and what constitutes optimal quality of life and meaningful experiences. It may also facilitate better understandings of how people employ alternative, non-substance means to achieve desired occupational outcomes.

Resumo Introdução O uso de substâncias, como uma ocupação, é tipicamente retratado como problemático e alvo de intervenção e remediação da terapia ocupacional. Ao mesmo tempo, substâncias psicoativas podem ser usadas para melhorar o humor, a cognição, o desempenho ocupacional e/ou a experiência, sendo, contudo, uma perspectiva que está muito ausente nos estudos de ocupação. Objetivo Examinar o uso de substâncias em relação ao aprimoramento da ocupação, com base na noção teórica de realismo agencial. Essa teoria sugere que, no mundo social, a 'realidade' não é um fato objetivo, estável e previsível, mas sim continuamente produzido e reproduzido, através do fazer e do tornar-se intra-ativo. Método Uma síntese interpretativa crítica integrativa selecionada da literatura, conforme conduzida. A análise está focada na síntese de literatura sobre uso de substâncias e aprimoramento da ocupação. Resultados A ocupação não existe independentemente do que está sendo feito, mas também do "tornar-se". Às vezes, o uso de uma substância é em si uma ocupação - tomar um drink ou sair para tomar um café. Às vezes, usar uma substância significa um meio de melhorar outra ocupação - tomar medicamentos para disfunção erétil para melhorar o sexo ou anfetaminas para melhorar o estudo. Às vezes, o uso de uma substância altera simplesmente a experiência de uma ocupação - usar cannabis ou psicoativos para melhorar a experiência de ouvir música. Conclusão A adoção de um foco na ocupação pode incentivar novas maneiras de entender o uso de substâncias e o que constitui uma qualidade de vida ideal e experiências significativas. Também pode facilitar uma melhor compreensão de como as pessoas empregam meios alternativos e não substanciais para alcançar os resultados ocupacionais desejados.

"You Always Remain Slightly an Outsider": Workplace Experiences of Academics from Working-Class or Impoverished Backgrounds.

Debates surrounding class inequality and social mobility often highlight the role of higher education in reducing income inequality and promoting equity through upward social mobility. We explore the lived experience of social mobility through an analysis of 11 semistructured interviews with Canadian academics who self-identified as having working-class or impoverished family origins. While economic capital increased substantially, cultural capital and habitus left many feeling like cultural outsiders. Isolation-both chosen and imposed-reduced professional networks, diminishing social capital. Caught between social worlds, participants mobilized symbolic capital in moral boundary marking, aligning themselves strategically with either their current class status or their working-class roots. While upward social mobility is a path toward reducing economic inequality, the lived experience of social mobility suggests it may exact a high emotional cost.

Les débats autour des inégalités de classes et de la mobilité sociale mettent souvent en évidence le rôle de l'enseignement supérieur dans la réduction des inégalités de revenus et la promotion de l'équité par le biais d'une mobilité sociale ascendante. Nous explorons l'expérience vécue de la mobilité sociale en analysant onze entretiens semi-structurés avec des universitaires canadiens qui se sont identifiés comme issus de la classe ouvrière. Tandis que le capital économique augmentait considérablement, capital culturel et habitus laissaient beaucoup se sentir étrangers à la culture. Isolement-à la fois choisi et imposé-a restreint les réseaux professionnels, limitant le capital social. Pris au piège entre des deux mondes sociaux, les participants ont mobilisé un capital symbolique sous forme de limites morales, s'alignant stratégiquement avec leur statut de classe actuel ou leurs racines dans la classe ouvrière. Si la mobilité sociale réduit les inégalités économiques, elle peut avoir un coût émotionnel élevé.

Indigenous perspectives on health: Integration with a Canadian model of practice.

BACKGROUND.: The Canadian Association of Occupational Therapists and the Truth and Reconciliation Commission recommend change within the Canadian health care system, respecting and valuing Indigenous health and healing practices. Adjusting the lens through which occupational therapists practice to incorporate Indigenous views of health and wellness is one potential change. PURPOSE.: This critical interpretive synthesis of the literature incorporates Indigenous perspectives on health and wellness into the Canadian Model of Occupational Performance and Engagement (CMOP-E) framework, strengthening that model to better serve all peoples in Canada. KEY ISSUES.: Integrating Indigenous worldviews can add to the CMOP-E the importance of balance among physical, emotional, spiritual, and mental health; the inseparability of person, community, and land; and understanding occupations as dimensions of meaning. These are incorporated in a proposed integrated model (ICMOP-E). IMPLICATIONS.: Effectively integrating Indigenous perspectives may be an important first step in a longer journey toward engaging more respectfully with Indigenous perspectives on health and wellness.

Beyond bare bones: critical, theoretically engaged qualitative research in public health.

While qualitative inquiry has been a part of the Canadian Journal of Public Health (CJPH) for many years, CJPH does not yet have the reputation as a home for qualitative research that has a critical focus and that is cqqqonversant with contemporary developments in social theory and qualitative methodology. This paper describes efforts to establish CJPH as a welcoming home for critical, theoretically engaged qualitative research in public health. The paper introduces the Special Section that heralds the forward vision for qualitative research at CJPH. We specify what we mean by critical, theoretically engaged qualitative research and make the case for its significance for public health research and practice. We describe changes made in how qualitative manuscript submissions are handled at CJPH and highlight the contribution to public health scholarship made by the articles that comprise the Special Section. We issue an invitation to the public health community to support and participate in our vision to enhance critical, theoretically informed qualitative research in public health.

What about the men? Gender parity in occupational therapy: Qu'en est-il des hommes? La parité hommes-femmes en ergothérapie.

BACKGROUND: Gender parity is frequently raised as an equity issue in occupational therapy, with strategies proposed to recruit more men. PURPOSE: This article explores whether this is a legitimate equity concern. KEY ISSUES: Most employment is gender segregated; when gender balances change, the field either re-genders feminine or creates gender-segregated internal divisions. Men avoid feminized jobs because they pay less and hold less social status. They are a "step down" for men. In such jobs, men are disproportionately pushed into management positions, with better pay, more prestige, and less hands-on care. Equity issues concern structural barriers to success in particular employment fields. Though they may feel discomfort in a feminized field, men do not face structural barriers in occupational therapy. IMPLICATIONS: Broader challenges to traditional gender norms are needed, but there is no evidence that gender parity is an equity concern or that recruitment targeting masculinity would make a difference.

"You feel you have to be made of steel": The strong Black woman, health, and well-being in Nova Scotia.

The "strong Black woman" construct has been well-documented in the United States as both an aspirational icon and a constricting burden for African-heritage women. It has not been examined among African-Canadians. Drawing on qualitative interviews and standardized measures with 50 African-heritage women in Eastern Canada, our analysis reveals their perceptions of the construct as both strongly endorsed as a source of cultural pride, yet also acknowledged to take a terrible toll on health and well-being. The construct arises from and directly benefits racism. It is imperative that health professionals understand the ways it shapes health and help-seeking behaviors.

Occupational injustice: A critique.

BACKGROUND: Although the idea of occupational injustice pervades the occupational therapy literature, there has been little scholarly debate concerning this construct or the parameters of the five identified forms of occupational injustice. PURPOSE: The aims of this paper are to highlight conceptual confusions, foreground some inherent questions that have been neither acknowledged nor addressed, and question the theoretical and practical utility of five manifestations of occupational injustice. KEY ISSUES: Few theorists have contributed to the occupational injustice literature. Significant definitional confusion exists concerning the five forms of occupational injustice with some forms described as subsets of others. The inherent problems of judging occupational injustice have not been addressed. IMPLICATIONS: If occupational injustice were understood as a violation of occupational rights-human rights to achieve well-being through occupation-many of the problems of identifying a situation of occupational justice or injustice would be resolved. Using the capabilities approach to human rights would facilitate this endeavour.

Approaches to culture and diversity: A critical synthesis of occupational therapy literature.

BACKGROUND: The 2007 position statement on diversity for the Canadian occupational therapy profession argued discussion was needed to determine the implications of approaches to working with cultural differences and other forms of diversity. In 2014, a new position statement on diversity was published, emphasizing the importance of social power relations and power relations between client and therapist, and supporting two particular approaches: cultural safety and cultural humility with critical reflexivity PURPOSE: This paper reviews and critically synthesizes the literature concerning culture and diversity published in occupational therapy between 2007 and 2014, tracing the major discourses and mapping the implications of four differing approaches: cultural competence, cultural relevance, cultural safety, and cultural humility. KEY ISSUES: Approaches differ in where they situate the "problem," how they envision change, the end goal, and the application to a range of types of diversity. IMPLICATIONS: The latter two are preferred approaches for their attention to power relations and potential to encompass a range of types of social and cultural diversity.

Family physician perceptions of working with LGBTQ patients: physician training needs.

BACKGROUND: Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. METHOD: In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. RESULTS: Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. CONCLUSIONS: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.