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Abstract

Project title: Occupational therapy and professional identity: narratives of professionals through life history. Study Protocol. Design: Qualitative research, using a socio-critical paradigm and biographical-narrative method where participants were selected through theoretical sampling and snowball sampling strategy. Data collection techniques were life stories, constructed through biograms, self-reports and biographical interviews. Abductive reasoning was used along with structural analysis techniques, narrative analysis, and ATLAS. ti software. Objective: To describe and analyze the occupational construct of the professional identity of occupational therapists in Spain. Specific Objectives: (1) Analyze life events, transitions, and turning points that contribute to the outlining of the life journey of professional identity. (2) Explore the management of professional tasks. (3) Analyze the nature of the knowledge required to carry out the role. (4) Examine in detail the strategies applied to the personal engagement of occupational therapists. Study Population and Total Number of Participants: The study population consisted of professionals who are currently working as occupational therapists in Spain. The number of participants was established when data saturation was reached, with a total of nine informants.

Keywords

occupational therapy professional identity qualitative research biographical-narrative life histories biograms

Contributions to Current Understanding

An in-depth study on the impact of the characteristics that make up the professional identity of occupational therapists must be conducted by looking at the different approaches and orientations while taking into account the experiences of professionals and the meanings they attribute to the different aspects that structure the professional work, the nature of the knowledge and the strategies involved in the construction of professional identity.

Even though scientific literature provides research findings that take into account the development of professional identity in occupational therapy (Ashby et al., 2016; Binyamin, 2018; Boehm et al., 2015; Clarke, et al., 2014; Davis, 2006; Whitcombe, 2013), but we only have evidence of two studies on professional identity in Spain, one of them conducted with a population of professionals (Souto-Gómez et al., 2023a) and the other on a population of students (Morrison et al., 2018).

On the other hand, occupational therapy practice requires a broad spectrum of knowledge, more extensive than that acquired by experimental research. This is the reason why this study has as its goal to provide qualitative evidence for the practice of occupational therapy, expanding the range of research in health sciences. This study on the experiences of professionals and how they tailor their professional identity in Spain is pioneering. It also represents a unique contribution to current research and the practice of occupational therapy both in Spain and worldwide. Using a narrative biographical method, the reports of professionals on their lived experiences have a knowledge base applicable to other similar environments.

Describing and interpreting the meanings attributed by professionals and how the professional identity of occupational therapists is formed provides useful information to better understand their experiences and needs. In this way, the information presented in this regard can be especially useful for designing and implementing theoretical and practical training strategies to develop professional identity (Ashby et al., 2016; Boehm et al., 2015; Clarke et al., 2014; Krishnagiri, et al., 2019; Souto-Gomez et al., 2023b). Therefore, we consider that this study can help to develop this line of research, being our main objective to study the occupational construct of the professional identity of professionals in occupational therapy in Spain.

The theoretical framework chosen for this study is structured around the concept of professional identity (DePoy and Merrill, 1988; Mosey, 1985; Whiteford et al., 2000) since the studies of Ball (1998), Nias (1989) or those of Zeichner & Tabachnick (1985) and more specifically in occupational therapy, with the studies of Mosey (1985) all of them from the mid-80s, occupational therapy has shown an increasing interest in researching how professional identity develops. Professional identity in occupational therapy has even been the subject of multiple conferences, publications, and scientific research (Turner and Knight, 2015; Walder et al., 2021).

Research on professional identity in occupational therapy has been mainly qualitative (Walder et al., 2021), allowing for an approach to people’s lived experiences in a contextual and temporal location (Denzin and Lincoln, 2018). As professional identity is such a particular construct in terms of its structure and development, we believe that further qualitative research studies are still required, but this time from the subjective perspective of professionals to understand how their professional identity was constructed (Clarke et al., 2015; Drolet & Désormeaux-Moreau, 2016; Drolet and Sauvageau, 2016; Rees et al., 2019; Wimpenny and Lewis, 2015; Wright, 2001).

We believe that occupational therapists with a low sense of professional identity experience face challenges when implementing their interventions, running the risk of becoming overwhelmed (Scanlan, 2018). Furthermore, a major danger of a weak or inconsistent professional identity carries a professional failure to adequately promote oneself. This generates a lack of recognition, remuneration, and an inability to position oneself appropriately in a competitive market or against other professions (Turner and Knight, 2015; Wilding and Whiteford, 2008).

Therefore, we considered that the biographical narrative method was the most suitable for this study since in this way we could fulfill the purpose of the study, which was: giving a voice to the professionals, capturing and describing the common meaning they give to their subjective experiences (Creswell, 2013; Denzin and Lincoln, 2018).

Background/Study Justification

Various studies focus on professional identity, but all of them give value to personal beliefs, social origin, experience, values, or recognition, among others.

The concept of professional identity presents a dynamic component and a necessary professional foundation, as suggested by Ashby et al. (2013), Clouston & Whitcombe (2008), Mackey (2007) or Raveh (1995). Furthermore, Akkerman & Meijer (2011) and Whalley (2009) highlight that professional identity can be studied from deterministic (unitary and individual, where objectivity is crucial) and relativist (multidimensional and social) perspectives (Guajardo et al., 2015; Weise, 2011).

According to Gaskell & Leadbetter (2009), professional identity incorporates the development of a holistic vision, interpersonal skill training and experiences. Furthermore, Fagermoen (quoted by Ruvalcaba-Coyaso, et al., 2011) even states that the configuration of professional identity is established through work values and the meaning that the professional assigns to his/her practice. Indeed, Binyamin (2018, 2021) y Shim et al. (2009) highlight that professional identity is associated with gender, age, degree, education, and position. Specifically, Mieg (2008) o Wright (2001) highlight the existence of three key components for the development of professional identity: self-concept, professional self-esteem, and belief control. These studies recover Hausser’s (1995) identity theory, where professional identity is an element dependent on work and satisfaction with work and is highly dependent on the person’s comparisons with others.

Indeed, identity is forged upon a professional group of similar characteristics, which from the training received and thanks to the activity developed presents constant evolutions, role developments and personal/professional satisfaction (Binyamin, 2018; Cáceres, 2016; Lamash and Fogel, 2021; Trede et al., 2012).

In this regard, Abreu (2006), Ashby et al. (2016); Guajardo et al. (2015) emphasize that the features that make up professional identity can be classified into three: (a) sociocultural influence (Hong, 2010), (b) adaptive character (Pentland et al., 2018), and (c) development of conceptual lenses that give meaning to practice (Trede et al., 2012).

We believe that professional identity in occupational therapy emerges with a person’s entry into professional education and is constructed through professional development in ongoing practice exposure (Larson et al., 2013). Perception of professional identity varies among individuals because experience and understanding are unique to each professional. Therefore, reflexivity must be encouraged among occupational therapists to improve training programmes and understand professional reality (Domingo and Fernández, 1999). Adherence to a professional identity allows people to better understand their roles within their area of practice (Lamash and Fogel, 2021). This identity refers not only to how individuals perceive themselves but also to how others perceive them and will inevitably be influenced by interactions with colleagues in the workplace (Miller and Cable, 2011).

The unique beliefs of the profession, paradigms, respect or awareness of the values of the professionals (Ashby et al., 2013; Murray et al., 2015; Turner and Knight, 2015) and the ability to implement evidence-based, occupation-focused interventions (Wilding et al., 2012) correlates with the professional identity of occupational therapists.

Despite the existing evidence in occupational therapy on professional identity, much uncertainty and confusion about this concept is detected. In part due to the heterogeneity of the groups of all ages and problems that are dealt with in occupational therapy (Ashby et al., 2013; Mackey, 2007; Scanlan et al., 2010; Turner and Knight, 2015).

Although we are aware that the development of professional identity is multifaceted and dynamic (Adams et al., 2006; Clouston and Whitcombe, 2008; Mackey, 2007; Souto-Gómez et al., 2020; Zemke, 2004), and that professions attempt to define or elucidate the nature of their changing professional identity, we can specifically state identity forging is influenced by different factors and this identity is made up of different levels.

According to Hong (2010), six factors influence identity forging: value, self-efficacy, commitment, emotions, knowledge and beliefs. This professional identity is built at four levels (Koski-Heikkinen et al., 2014): (a) personal development, (b) fostering of theoretical knowledge, (c) confluence of pedagogical skills, and (d) improvement of labor skills. This set of factors and levels facilitates reflection (Binyamin, 2018; Cochran-Smith, et al., 2008; Kinsella and Whiteford, 2009), which generates solid values, signs of belonging and professional development over different stages (before, during and after training) (Drolet & Désormeaux-Moreau, 2016; Drolet and Sauvageau, 2016; Edwards & Dirette, 2010; Rensh et al., 2016). All this promotes the development of identity within a constant process of construction, deconstruction and reconstruction (Lidskog et al., 2008; Rees et al., 2019; Scanlan, 2018; Souto-Gómez, et al., 2023c). Ultimately, professional identity is a complex and multidimensional system of representations developed over time (MacLure, 2006).

Despite this and as previously stated, scientific literature lacks research findings on the development in Spain of occupational therapy professionals' identity through a biographical narrative method. Therefore, this described situation offers an opportunity to explore this scenario, thus being a sufficiently transcendent justification to generate additional research on how is the process that occupational therapy professionals undergo to shape their professional identity in Spain.

Objectives

The primary goal is to describe and analyze the occupational construct of Occupational Therapists' professional identity in Spain.

With this aim, the following specific objectives were established: (1) Analyze life events, transitions and turning points that allow describing the trajectory of the professional identity; (2) Explore the management of their professional work; (3) Analyze the nature of the knowledge demanded by the role; (4) Investigate the strategies used in the personal involvement of occupational therapists.

Explanation and Justification of the Method

In this project, qualitative research was applied to answer the research question and objectives, based on the socio-critical paradigm (Alvarado and García, 2008; Ceolin et al., 2017). This paradigm aims to transmute social relationships and transform the difficulties arising from them.

This study was conducted from a critical perspective, as occupational therapists experience potential practice inequality in various contexts and a hierarchical integration (Tamayo, 2011). However, its goal is not to homogenize different disciplines, but rather, through the personal experience of professionals based on nonconformity and social indignation, to generate alternatives for change, as Sousa (2006) states, to fight for equality emphasizing the recognition of difference.

The biographical-narrative method (Bolívar et al., 2001; Landín and Sánchez, 2019) has been used, which is in line with the ontological-epistemological position of the research. This method (Moriña, 2017) has allowed us to clarify and understand the meaning of the gathered experience, approaching occupational therapy professionals to understand the undergone process, where we focus on narratives organized chronologically and thematically as a specific genre of discourse. Furthermore, the biographical-narrative method has facilitated the analysis of the representation of the process experienced by the person, the symbolic system, the elements of professional identity (Verd and Lozares, 2016) and the collective memory of occupational therapists (Bolívar et al., 2001).

As Verd & Lozares (2016) state, the primary feature of the narrative biographical method is its temporal and longitudinal approach, designed to collect information over an extended period. Additionally, the biographical method reflects for Pujadas (1992) the subjective discourse of a person based on his or her history, hands-on experience, (repetition) and relationship with communication-based on the social norms and customs of a community.

As Connelly & Clandinin (cited in Landín and Sánchez, 2019) point out, this method is ideal for studying the interactions that occupational therapy professionals make in an environment, forging an individual and social identity. The experience of occupational therapy professionals allows us to have knowledge focused on the influence of time, reflecting hands-on experience, and its subjective personal implications, centred on recollection and memorization Landín and Sánchez, 2019 quoting Ricouer).

This method allows for clarifying and explaining the qualities of occupational performance in the narrative of experience (Landín and Sánchez, 2019 quoting Contreras & Pérez), reflecting on relevant aspects such as life path, its goals and the difficulties producing a transformative experience that allows for analyzing and interpreting the occupational reality (Morales and Taborda, 2021). The narrative of life history allows for “the creation of meaning in retrospect” (Chase, 2015, p. 69). Therefore, through this biographical narrative method, the reconstruction of the life stories of occupational therapists based on the critical incidents in their trajectory is sought, as the understanding of the social, family or educational conditions that influenced this professional identity and professional and personal development (Domingo and Fernández, 1999).

We believe that this approach to the theme to be studied represents an innovative contribution to the study of professional identity, being useful for researchers who carry out qualitative research.

Materials and Methods

Study Period

It was carried out from October 2021 to May 2023. Fieldwork was conducted from November 2022 to April 2023.

Scope of the Study

This study emerged from a Spanish context directed by Occupational Therapy professionals with extensive research, teaching, and professional experience. The study was conducted in five phases (Figure 1). The gatekeeper was an Occupational Therapy professional, who is a specialist in the field of study and collaborated in several work groups of different Occupational Therapy professional colleges. Additionally, this person helped to locate participants (Hernández and Mendoza, 2018).

Figure 1.

Flow chart of research stage in the study.

Data Collection

Data collection was not preconfigured, but rather flexible and adjusted to different emerging events. Data collection ended once all the necessary information was gathered and data saturation was achieved.

Life histories were used to collect data. Life histories (Goodson, 1992) facilitate understanding of participants’ personal and professional trajectories, with an objective narrative including additional information from other sources to construct a path. Comparison of life stories between participants always with their consent allows for representing their motivation trajectory for work, specifying the concurrent or divergent points in the cycles (Domingo and Fernández, 1999).

Life histories (Pujadas, 1992) were constructed using three techniques.

1. Biographical Interviews (Moriña, 2017): Four stages were followed in the development of this instrument. In the first stage, an initial script was designed along with the main topics (deductive) based on the research question, research objectives and related studies conducted in similar contexts. Subsequently, nine experts (five international experts and four Spanish experts) validated the interview question script. In the second stage, two external Spanish evaluators reviewed this data collection instrument. In the third stage, a pilot test was conducted with two people who met the selection criteria to assess the adequacy of the questions and adjustment of the interview (note that these people were not included in the group of final participants in the study). Following the initial tests, new questions emerged during the pilot test (Carpenter and Suto, 2008). The fourth stage involved conducting biographical interviews with the participants, transcribing and systematizing the data into four files: literal, thematic, chronological and personal/individual (Pujadas, 2000). The entire narration from each session was transcribed to serve as a basis for the next.

At the field entry, the biographical interviews were conducted by the same researcher (AISG) with an average duration of each interview of 2 hours. Two sessions were required in most interviews to work again on information gaps (Pujadas, 2000).

The interviews were conducted through MS Teams for practical reasons and to adapt to the participants schedules, since they were located all over Spain.

2. Biogram (Domingo and Fernández, 1999): understood as a gradual graphical structure that collects the events that chronologically structure the personal and professional development of occupational therapists, where times and spaces that have configured professional identity are highlighted. These same authors point out that this technique also refers to the decisions adopted, to the changes observed both individually and collectively within the life trajectory.

3. Self-reporting (Cortés et al., 2014; Moriña, 2017) complements the aforementioned techniques. Self-reporting consists of a document in which the participant in the research narrates in the first person those aspects they consider most significant to the study topic we propose. Life stories emerged thanks to the use of this technique as a starting point (Moriña, 2017). Through this technique, we can obtain a descriptive-explanatory, structured reflection that implies the personal involvement of the narrator (Domingo and Fernández, 1999).

Sampling/Recruitment

Participants

Participant selection was conducted through a process of theoretical sampling, wherein we consciously selected cases to study based on the establishment of pre-existing criteria (Glase and Strauss, 1967; Moriña, 2017; Patton, 2002). Additionally, we used the snowball sampling strategy (Cohen et al., 2000; Hernández and Mendoza, 2018) where some key informants put us in contact with other participants. The informants were professionals working as occupational therapists in Spain, totaling nine people.

Selection Criteria

• Inclusion criteria: (1) Professional currently working or having worked as an Occupational Therapist for the Public Administration or in the private sector; (2) With at least five years of experience.

• Exclusion criteria: (1) Retired professionals (2) Professionals who graduated in Occupational Therapy abroad.

• Withdrawal criteria: (1) Voluntary withdrawals from the study.

Recruitment Strategy

First, we contacted the Deans of the Professional Colleges of Occupational Therapy. These people were tasked with publishing/spreading the information through their communication channels to the Occupational Therapy community.

People who volunteered were contacted by phone to explain the rationale and objectives of the study, and if they agreed to participate, a meeting was arranged. The interview was carried out during the meeting and the information about the study was explained again and provided in writing.

The interviews were conducted virtually, so the information was sent by email or by post. All participants signed an express informed consent document to participate in the research after having read the information sheet.

Justification of the Sample Size

The participant selection phase ended when theoretical saturation was reached as recommended by Morse (1995). At that point, the necessary elements were available to construct a theory on this topic, being aware as Denzin (2010) states that “reality in its complexity can never be completely captured”.

Data Handling/Analysis

Data Coding

Data coding was conducted following three generic cycles. See Figure 1. (Round 10).

Data Analysis

To analyze the data, two researchers (AISG and MATV) first independently reviewed the transcripts. Structural analysis techniques (Moriña, 2017) and narrative analysis (Onwuegbuzie et al., 2012). Were applied in the analysis process. Regarding narrative analysis, thematic narrative analysis was used, where interviews themselves are the object of study, taking into account their structure and narration (Riessman, 2008).

Furthermore, in the structural analysis, the approach proposed by Miles and Huberman (1994) was adopted, developing a system of categories and codes supported by the qualitative data analysis software ATLAS. ti (Scientific Software Development GmbH, Berlin, Germany). Subsequently, a structural description was developed to reflect how activities were undertaken within their specific context. Finally, the researchers drafted a story map by establishing a chronology of the events, lived experiences, and the occupational therapists' assessment through an information analysis technique such as the biogram (Vera, 2010).

Ethics

To safeguard ethical principles of research involving human subjects, the study was submitted to the Research and Teaching Ethics Committee of the University of xx and a favourable report was granted on October 6th, 2021, with the file code 2021–034.

As relevant actions, the following can be highlighted: (1) For each Dean of Professional College, an introduction letter, an express consent model for participating in the research and an explicit consent model for the collection of data to be used in this research were included (an indispensable ethical requirement for volunteers to participate in the study). Thanks to the advertising of professional associations and colleges a study population was reached. The team assessed whether this population met the selection criteria; (2) The participants were given the two mentioned documents together with a socio-demographic form. These documents complied with the data protection regulations included in the following section; (3) Personal data have not been used to identify people during the study, using an alphanumeric coding, all as a guarantee of confidentiality of the information, based on the good practice standards of the Helsinki Declaration (Manzini, 2000); (4) Each of the informants was informed that his/her participation was strictly voluntary and that they could withdraw at any time even having signed the documents, without any justification and any subsequent negative consequence or effect. (5) The condition was respected that any data collected of a personal nature, audio recordings and transcriptions were destroyed at the end of the research, thus complying with the ethical and legal considerations detailed in the research protocol of the Research and Teaching Ethics Committee of the UDC.

The study follows 29 out of 32 items of the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007).

Confidentiality of the Information

All data gathered and generated during this study follow the guidelines of the Reglamento de la Unión Europea (CE) 2016/679 del parlamento europeo y del consejo de 27 de abril de 2016, relativo a la protección de las personas físicas en lo que respecta al tratamiento de datos personales y a la libre circulación de estos datos . Furthermore, we also followed the provisions of Ley Orgánica 3/2018, de 5 de diciembre, de protección de Datos personales y garantía de los derechos digitales (2018).

To ensure the informants' confidentiality, all data were collected individually and coded with an alphanumeric code only known by the researchers. Once the interviews were transcribed and the study finished, the original audio recordings were destroyed. Finally, all documents containing sensitive information were registered in a protected system at the Faculty of Sociology (University of A Coruña) to which only the researchers have access.

Informed Consent

A meeting was organized in which researchers explained the objectives of the study to the participants and verbally informed them of the implications of their participation. It was emphasized that all the information collected would be handled confidentially. The participants were informed that their refusal to be interviewed would have no consequence and that they could stop the interview at any time. Finally, those who accepted to participate signed an express consent document to participate in the research and an explicit consent for the collection of personal data.

Rigour

To ensure methodological rigour, the strategies used were detailed (Castillo & Vásquez, 2003; Lincoln and Guba, 1985):

Credibility

Correspondence between the way the participant perceived the concepts and how researchers depicted the points of view (Creswell, 2013; Patton, 2002; Schwandt et al., 2007) was obtained. The length of stay in the field was sufficient to generate credibility, and we established a methodological triangulation to analyze the phenomenon through different approaches (Okuda and Gómez-Restrepo, 2005). Referring to the triangulation of researchers, the data analysis was carried out independently by each researcher and subsequently submitted to be compared, and member checking (Flick, 2014) was also conducted to confirm the interpretations.

Dependability

Evidence was provided by supplying details on the paradigm and method used, along with each researcher’s theoretical stance. Additionally, we explained the selection criteria, the techniques used, and the data collection context with subsequent analysis. The reliance conducted in this study has been internal since researchers generated similar topics with the same data (Franklin and Ballau, 2005).

Transferability

The context has been precisely described, establishing that the transfer shall never be total because there are no two identical contexts (Erlandson et al., 1993; Stake, 2010).

Implications for Research and Dissemination

This research study is innovative as it provides insight into the life course and its influence on the professional experience of occupational therapists, with the aim to analyze professional identity. The method used, and especially the use of different techniques (biographical interviews, biograms, self-reports) to outline life stories, is unique for this type of topic.

The study of professional identity from the narrative biographical method shall allow occupational therapists to enhance reflectivity as a self-critical component and in this way to surpass cognitive processes of analysis of the professional reality. As Bolívar et al. (2001) mention, the elaboration of biographies allows for improving professional practice by reflecting in a diachronic way on one’s path.

The findings of this study can be useful for designing and implementing instruments of confrontation and reconstruction of professional practice, intervention strategies based on the professional characteristics of the occupational therapist, and promoting continuous training adapted to the characteristics of a professional identity. To conclude, this study can be useful when designing and developing curricular subjects in occupational therapy studies due to its adaptation to a professional social reality that enables the forging of professional identity.

Footnotes

Acknowledgements

The authors wish to thank all the women interviewed for their participation in the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

Research and Teaching Ethics Committee of the University of A Coruña and a favourable report was granted on October 6th, 2021, with the file code 2021–034.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors have been studying the formation of professional identity in social and health sciences professionals since 2015. Authors AISG and MATV acknowledge financial support from the Official College of Occupational Therapists of Galicia (COTOGA), Spain, under Grant number: CSD18-080422, which facilitated the conduct of this research. Additionally, the publication of this article was supported by the open-access article publication grant from the Professor Novoa Santos Foundation, the managing entity of the Biomedical Research Institute of A Coruña (INIBIC).

Correction (October 2023):

Affiliation for first author and Figure 1 have been corrected in this version.

ORCID iDs

Ana-Isabel Souto-Gomez

Miguel-Angel Talavera-Valverde

Luis-Javier Marquez-Alvarez

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Occupational Therapy and Professional Identity: Narratives of Professionals Through Life History. Study Protocol

Abstract

Keywords

Contributions to Current Understanding

Background/Study Justification

Objectives

Explanation and Justification of the Method

Materials and Methods

Study Period

Scope of the Study

Data Collection

Sampling/Recruitment

Participants

Selection Criteria

Recruitment Strategy

Justification of the Sample Size

Data Handling/Analysis

Data Coding

Data Analysis

Ethics

Confidentiality of the Information

Informed Consent

Rigour

Credibility

Dependability

Transferability

Implications for Research and Dissemination

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Ethical Approval

Funding

Correction (October 2023):

ORCID iDs

References