By 2050, it is projected that the United Kingdoms (UK) population will become the most populous, with an estimate of the population being 77 million (The guardian 2017). One third of this population will be made up by the ethnic minorities (mail online 2014). The UK is a multicultural society and the figures demonstrate there will be a vast Increase of ethnic diversity within the next two decades. As a consequence, this illustrates that majority of the population using health care services will stem from diverse cultural backgrounds. Hence, issues in relation to culture are extensively viewed relevant and significant for occupational therapy practice and education (Chiang and Carlson 2003). Occupational therapy is a diverse profession therefore, it is imperative to consolidate culture and diversity within its daily practice, education and research to meet the occupational needs of all individuals (World Federation of Occupational Therapists, WFOT 2009). Conversely, Lindsay et al (2014) states, professionals have an obligation to provide culturally competent practice.
There is no one given definition of culture, however, Beagan (2015) defines culture as being a framework that delivers a ready-to-hand ideology of living in a way that feels normal to individuals, as well as providing them with a sense of identity. According to Cheung, Shah and Muncer (2002), daily activities that individuals engage in are believed to be shaped by structural and systemic factors. Within occupational therapy those regular activities are referred to as occupations and occupational therapists believe that being occupationally engaged can structure, shape and change individuals’ lives (Gallaher, Muldoon and Pettigrew 2015). Similarly, individuals’ attitudes, values, recognitions and life decisions are unequivocally formed by their way of life and culture. According to Iwama (2007) culture does not only relate to issues of diversity and inclusion, moreover, it closely correlates to occupational therapy structure and practices based on knowledge and theories. Therefore, placing culture as the core foundation of occupational therapy practice. Furthermore, occupational therapists should integrate its nature within all facets of their profession.
Occupational therapists should be culturally aware and understand the culture of their clients, in order to be seen as culturally competent practitioners. Being culturally aware can be seen as having the knowledge about cultural characteristics such as values, beliefs, history and behaviours of other ethnic or cultural groups (Quappe and Cantatore 2007). Acknowledging the clients individuality can make the intervention more meaningful as well as helping therapists to build a therapeutic relationship with their clients. Balcazar and Rodakowski (2007) state, being culturally competent as a practitioner is imperative as the occupational therapy client population is becoming increasingly diverse. Being culturally competent as an occupational therapist means having the skills to perceive which occupations are meaningful to individuals, as well as those that are influenced by their culture (Murden et al 2008). The uniqueness of occupational therapy lies in its philosophy of person-centredness and promoting individuals to participate in everyday activities to their full potential (Royal College of Occupational Therapists, RCOT 2017). The Code of Ethics and Professional Conduct for Occupational Therapists (2015) states that, occupational therapists must provide services that reflect on their values and beliefs, which includes being sensitive to cultural and lifestyle diversity. This is further supported by WFOT (2006) guidelines as it states occupational therapists must take all aspects of social and cultural diversity into account, in order to enhance the therapy given.
Discovering the various ways in which people perform occupations in relation to their culture and giving them meaning can be a challenging and enriching experience for everybody involved, both clients and therapists. There is a plethora of evidence on the lack of importance of employing culturally competent practice. This in turn, leads to restricting occupational engagement, thus, impacting on the client-therapist therapeutic relationship. Hence, promoting occupational injustice alongside deprivation of human rights (Human Rights Act 1998). Therefore, leading to having detrimental effects on clients’ health and mental wellbeing.
The rationale for carrying out this literature review arose from the gap in literature that was identified, in relation to the importance assigned to occupational therapist practitioners being culturally aware and competent. In addition, the aim of this literature review is to accentuate the prominence of occupational therapists being culturally aware in order to be culturally competent within practice. There is no given definition of what it means to be culturally aware and competent within occupational therapy practice. In addition, Darawsheh and Chard (2015) state it is pivotal for practitioners to understand the meaning and process of being culturally competent. Furthermore, as suggested by Black and Wells (2007) occupational therapists are more likely to work with individuals deriving from diverse backgrounds within their practice. Although, they may not feel ready to adapt their knowledge to the cultural values of a specific individual or a client group it is vital occupational therapists are culturally aware and competent, as this will allow them to carry out effective interventions and work in a holistic manner. Cultural competence in the context of occupational therapy has been emphasised to study as it is an additional core skill essential for effective practice.