Abstract
This scoping review interrogates anti-Black racism in occupational therapy practice and the relevant frameworks available to occupational therapy practitioners working with Black populations around the world.
Occupational therapy was founded during the segregation and Jim Crow era in the United States (Lavalley & Johnson, 2022) and consisted of mostly White, middle- and upper-class, cisgender, heterosexual, and Christian women (Iwama, 2016; Salvant et al., 2021). Having been adopted by social, educational, and rehabilitative systems globally, these origins have undoubtedly influenced how occupational therapy is practiced in contexts beyond the Global North. That is, occupational therapy services have been guided within Eurocentric, White, individualistic paradigms (Bezerra & Alves, 2022; Costa et al., 2020; Grenier, 2020) that ignore the epistemologies of non-White people and do not address racial inequalities; therefore, practice frameworks or methodologies and frames of references that center the diversity of ways of being and doing occupation are needed.
Evolving from social movements of the late 20th and early 21st centuries that advocated for human rights, accessibility, and social justice, among others, critical occupational therapy emerged as an approach aimed at challenging traditional practices that may perpetuate inequalities and addressing systemic injustices to better serve diverse populations (Ambrosio et al., 2022; Bezerra & Alves, 2022). Using critical theories as an analytic lens, occupational therapy scholars have highlighted the impacts of lack of diverse representation, equity, and inclusion in the profession (Beagan, Sibbald, Pride, & Bizzeth, 2022b; Ford et al., 2021; McConnell, 2022; Salvant et al., 2021), as well as denounced racism (Ambrosio et al., 2022; Angell, 2014; Bailliard et al., 2021; Beagan, Sibbald, Pride, & Bizzeth, 2022a; Lavalley & Johnson, 2022).
Anti-Black Racism and Occupational Therapy
Racism is a system of oppression that can occur at all levels (interpersonal, institutional, and structural) and was created to justify a hierarchy between races, with the White race as superior. Race is not based on biological or genetic origins, but rather on sociohistorical, ideological, and political structures that cause inequalities in Black populations’ power, resources, capabilities, and opportunities (Gonzalez, 1988; Kendi, 2019). 1 Racism and race are often conflated terms, with race often being used as a risk factor and not a risk marker of a group’s health outcomes (Johnson et al., 2021). In 2020, during the COVID-19 pandemic, Black populations had the highest mortality rates (Amorim et al., 2020; Atwal et al., 2021; Gonçalves et al., 2020). Simultaneously, many protests led by the Black Lives Matter (BLM) movement took place in the United States and other countries (e.g., Brazil, the United Kingdom) following the brutal murder of a Black man, George Floyd, during an arrest in Minneapolis (Atwal et al., 2021; Beagan et al., 2023; Dunbar-Smalley & Washington, 2022; Lavalley & Johnson, 2022; Murphy et al., 2024). 2
Later in 2020, the World Federation of Occupational Therapists (WFOT, 2020) recognized racism as a violation of human and occupational rights by issuing a statement condemning systemic racism and supporting BLM. In the same year, the American Occupational Therapy Association (AOTA) hosted a series of sessions titled “Be Heard—We’re Listening” to provide a platform for Black, Indigenous, and persons of color (BIPOC) to discuss their lived experiences as BIPOC occupational therapy students, practitioners, and educators (Salvant et al., 2021). In these sessions, participants shared ideas and recommendations for implementing meaningful changes, forming a collective call to action for occupational therapy education programs, practice settings, and organizations (Salvant et al., 2021). In this sense, scholars have emphasized that occupations are shaped by social markers (e.g., race, gender, class, age; Ambrosio & Silva, 2022; Lerner & Kim, 2022; Nirmul et al., 2023), and all doing, being, becoming, and belonging are shaped by the power relations of oppression (Pereira & Magalhães, 2023). Thus, the occupations of Black populations cannot be fully understood without attending to racism and colonialism (Lavalley & Johnson, 2022; Ramugondo, 2015).
Scholars have remarked that many occupational therapy practitioners are unprepared to work with racialized populations (Grenier, 2020; Porto & Silva, 2023) and have further noted that it is imperative that occupational therapy practitioners commit to an antiracist practice when working with diverse populations. Practitioners must rethink the Western theoretical and methodological frameworks that guide their practices and replace them with counterhegemonic frameworks. Moreover, occupational therapy students, practitioners, and educators must assume an ethical stance and political commitment and decolonize their practices (Bezerra & Alves, 2022; Pereira et al., 2022; Ruiz et al., 2021), including taking action to confront racist inequalities, interrogating the epistemologies and ontologies used, and reflecting on the impact of Whiteness in the field. It is worth highlighting that there is no singular approach to eradicating racism, which requires collective strategies aimed at antiracism, equity, justice, and inclusion (Sterman & Njelesani, 2021). Therefore, antiracist conduct must be an integral part of the practices of all occupational therapy practitioners.
The discussion of ethnic/racial issues is growing in occupational therapy, but the field has been remarkably slow in addressing racism, as well as the implications of the frameworks in the professional practice broadly. This scoping review aimed to describe and analyze the theoretical and methodological frameworks available to occupational therapy practitioners who provide services to Black populations. The research question guiding this review was “What are the theoretical and methodological frameworks available to occupational therapy practitioners who provide services to Black populations?”
Method
We conducted a scoping review to map and synthesize the literature informing occupational therapy practice with Black populations. We followed the scoping review procedures by Arksey and O’Malley (2005) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA–ScR; Tricco et al., 2018). The protocol was registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/DA7RX).
Identifying Relevant Studies
The searches were constructed in consultation with a university health science librarian. Terms applied included but were not limited to Black populations, African diaspora, racism, antiracism, and anti-Black racism related to occupational therapy or occupational therapists (see Table A.1 in the Supplemental Material, available online with this article at https://research.aota.org/ajot). Databases used in the search included MEDLINE, CINAHL, PsycINFO, LILACS, SCIELO, Web of Science, and Scopus. Included articles were published between January 2013 and April 2024, commensurate to the founding of the BLM movement. Furthermore, we included articles written in Portuguese and English because these were the languages we spoke fluently. In addition, we manually screened the reference lists of eligible articles for other sources to consider for inclusion. Articles written in languages other than English or Portuguese were excluded. Full inclusion and exclusion criteria are delineated in Table A.2 in the Supplemental Material.
Selecting Studies and Mapping the Data
Included studies described and analyzed the theoretical and methodological frameworks that inform the practices of occupational therapy practitioners who work with Black populations. There were no contextual restrictions. Full texts of all identified citations were maintained in Covidence. Each title, abstract, and keyword were screened independently for assessment against the inclusion criteria by the corresponding author (Amanda dos Santos Pereira) and by Flávia dos Santos Coelho (who selected, mapped, and extracted the data but did not coauthor the text). When any disagreements arose between the reviewers, they revisited and discussed the inclusion criteria until they came to a consensus.
Following the methodology proposed by the Joanna Briggs Institute (Peters et al., 2020), Pereira and Coelho independently extracted the following data from the included articles into a data extraction spreadsheet: names of authors, year of publication, journal, country of origin, language of publication, objective, population of focus, type of article, type of study, methodological framework, methods, theoretical framework, main findings, limitations, recommendations, and conclusion.
Collating, Summarizing, and Reporting the Results
Pereira conducted a thematic analysis of the articles. After extracting the data, we created initial codes, focusing on both semantic (surface-level meaning) and latent (underlying meaning) content, based on the research interest. These codes were then transferred to Sonix software, which helped generate a preliminary set of overarching themes and subthemes. All data extractions were coded according to these themes. Once this phase was complete, the themes were organized into thematic categories. The analysis concluded with a summary of the themes, emphasizing the focus on theoretical and methodological frameworks. All authors participated in a peer debriefing and considered organizing ideas into grouped concepts. The results were organized into four main themes, each describing the perceptions of occupational therapy professionals, students, and educators.
Findings
A total of 981 articles were identified, 971 from the search results and 10 from a hand search of reference lists. We removed 496 duplicate articles. The remaining 485 articles were screened by title, abstract, and keywords. Of these, we excluded 398 articles for not meeting the inclusion criteria; 87 full-text articles were assessed for eligibility. Ultimately, 48 articles were included in the review (see Figure 1; Tricco et al., 2018). Included articles are listed in Table A.3. Most articles were written in English (n = 28). No articles meeting the inclusion criteria were found in 2013 that corresponded to the beginning of the BLM movement. The years in which the most articles were published were 2021 (n = 12) and 2022 (n = 12) and referenced George Floyd’s death in 2020. A marked decrease in publications addressing the practices of occupational therapy practitioners who work with Black individuals was noted in 2023. Studies that addressed racial issues in occupational therapy for Black populations remain scarce. Most articles were research studies (n = 23). The studies were conducted in Brazil (n = 20), the United States (n = 13), Canada (n = 5), the United Kingdom (n = 4), South Africa (n = 3), and Spain (n = 1); 2 studies did not identify their country of origin.
Flow of studies through the scoping review.
Articles were published in 15 journals, with most published in the Brazilian Journal of Occupational Therapy (n = 12). Fourteen articles were published in nonoccupational therapy journals, such as the Journal of Occupational Science (n = 8), Saúde e Sociedade (n = 1), Journal of Racial and Ethnic Health Disparities (n = 1), Health Education Journal (n = 1), BMC Health Services Research (n = 1), Revista Eletrônica Acervo Saúde (n = 1), and Áskesis (n = 1).
Articles were categorized into four themes: (1) humanities and social sciences: theories and frameworks, with two subthemes—anti-Black racism theories and frameworks, and social justice, cultural rights, and power dynamics; (2) occupation-centered approaches; (3) addressing systemic inequalities through collective occupations, intersectionality, and incorporating Black epistemologies into occupational therapy practices; and (4) methodological approaches. Two articles were included in Themes 1 and 2. In the description that follows, we identify how each category is in dialogue with or can inform the practices of occupational therapy practitioners who work with Black populations.
Theme 1: Humanities and Social Sciences: Theories and Frameworks
Most of the theoretical and conceptual frameworks that inform the practices of occupational therapy practitioners are Eurocentric. To counter this perspective, occupational therapy practitioners have adopted critical frameworks to substantiate their practices and research with Black populations. These frameworks include equity and equality (Atwal et al., 2021) and diversity, equity, and inclusion (Salvant et al., 2021) that enact the full participation of stigmatized groups, as well as promote antiracism both in the profession and in society. Three articles described identity as a sociocultural production and showed that racial identity is influenced by racism (Andrade et al., 2020; Bezerra & Alves, 2022; Farias et al., 2018). Three articles reflected on how racial and cultural differences have affected mentoring for Black and minority ethnics (BMEs; Atwal et al., 2023, 2024) and leadership for women of color (Nirmul et al., 2023), which consequently affect the career advancement of these populations. 3 Beagan, Sibbald, Pride, & Bizzeth (2022b) used the critical disability studies’ “misfits” framework to describe the experience of non-White occupational therapy practitioners who, because of forms of oppression, felt that they truly did not belong to the profession and experienced trauma (Lerner & Kim, 2022).
Anti-Black Racism Theories and Frameworks
Articles on this subtheme investigated how all forms of racism affect Black lives, including epistemic racism (e.g., Beagan, Sibbald, Pride, & Bizzeth 2022a), which manifests when the occupational therapy practitioner does not recognize the knowledge base, leadership, values, and assumptions of Black and Indigenous people, and systemic racism (e.g., Beagan, Sibbald, Bizzeth, et al., 2022; Beagan et al., 2023; Lerner & Kim, 2022; Sandstrom & Bruns, 2017), a system of social power relations rooted in the society and operating at all levels (interpersonal, institutional, and structural) that affects the occupational engagement of non-White people. Three articles emphasized the antiracist framework, highlighting the White supremacy that permeates colonized societies (Johnson et al., 2022; Johnson & Lavalley, 2021; Lerner & Kim, 2022). Another article recommended that, to be antiracist, White people must expand their window of tolerance so they can talk about race without feeling uncomfortable (Lerner & Kim, 2022). Porto and Silva (2023), inspired by the theories of critical Whiteness studies, questioned the privileges of Whiteness and analyzed the effects of White supremacy and colonialism on the subjectivity of Black populations. Critical race theory was explored through articles that examined the possibility of transforming the relationship between society and racial power structures, along with the pursuit of racial emancipation within society (e.g., Dunbar-Smalley & Washington, 2022; Grenier, 2020; Nicholls & Elliot, 2019, 2021). Through critical feminist theories, three articles analyzed how aspects of women’s identity (e.g., class, gender, sexuality) intersect race (Ford et al., 2021; Nicholls & Elliot, 2019, 2021).
Social Justice, Cultural Rights, and Power Dynamics
Two articles addressed social justice from the perspective of democratizing access to the production and enjoyment of culture as a right guided by the Global South (Bezerra & Alves, 2022; Souza et al., 2021). Culture also can be a tool to reproduce institutionalized White supremacy and relations of power in health care settings (e.g., cultural competence; Grenier, 2020). Opposing this perspective, some articles pointed out that concepts such as cultural humility will bring awareness to cultural differences (e.g., Grenier, 2020; Lerner & Kim, 2022) and diversity (e.g., Silva, 2016). Relational–cultural theory identified how sociocultural and contextual factors affect the everyday lives of marginalized groups (Ford et al., 2021).
Theme 2: Occupation-Centered Approaches
Occupational therapy practitioners concerned about White supremacy and the lack of diversity and representation, as well as equity and inclusion in occupational therapy and occupation science, have developed critical approaches that address the impacts of oppression in the occupations of stigmatized groups. Occupational justice refers to the right that every human being has to engage in occupations of their choice (Gamieldien & van Niekerk, 2017; Wasmuth et al., 2023). However, people from marginalized groups are prevented from carrying out the occupations they want because of racism, ableism, homophobia, and other forms of oppression. In this respect, articles discussed the concept of occupational injustice, emphasizing that occupation cannot be adequately understood without attending to oppression and privilege (e.g., Johnson & Lavalley, 2021); such injustices can be occupational engagement and occupational marginalization (Parnell, 2023). From a Global South perspective, Pereira and Magalhães (2023) emphasized the need to decolonize the concept of occupational justice and question how and why all forms of oppression are constituted and reproduced. In this sense, southern occupational therapy (Ruiz et al., 2021), a notion based on the critical decolonial perspective (Bezerra & Alves, 2022; Souza et al., 2021), values cultural practices and traditional knowledge, as well as understanding the effects of colonial of power, knowledge, and being on non-White people.
Amorim et al. (2020) reflected how the everyday lives of Black populations are affected by racism, which limits their social participation (Farias et al., 2018; Valério et al., 2021). Two articles pointed out that social occupational therapy as a framework seeks to articulate the praxis with populations in processes of disruption of their social support networks, through actions at micro- and macrosocial levels (França et al., 2016; Gonçalves et al., 2020). Pizur-Barnekow et al. (2017) described that the person–environment–occupation–performance model can be used to understand aspects of the person and environment that influence occupational engagement and performance. Thus, this lens helps us understand the participation of Black people in their occupational roles.
Theme 3: Addressing Systemic Inequalities Through Collective Occupations, Intersectionality, and Incorporating Black Epistemologies Into Occupational Therapy Practices
Articles on this theme have shown how Eurocentric theories and models in occupational therapy fail to address the needs of Black populations. Thus, these articles proposed models or theories designed to support Black occupational therapy students, practitioners, researchers, and educators. Ramugondo and Kronenberg (2015), inspired by the African ethic of Ubuntu, suggested the concept of collective occupations that represents a continuum between relations of oppression and freedom, especially within underrepresented groups. Diverging from the individual–collective dichotomy supported by the European paradigm, this frame of reference examines the human interconnection that is formed from interaction with others and aims to promote social transformation and emancipation. Inspired by this concept, articles described the practices of occupational therapy practitioners who work with Black populations based on collective occupations in which they carried out artistic and cultural activities that contribute to the recognition of Afro-Brazilian culture and beauty (e.g., dances, hair braiding, tying turbans; Ambrosio et al., 2022; Pereira et al., 2022) and the rescue and maintenance of local memory, strengthening community ties and disseminating scientific and traditional knowledge and practices (Ambrosio et al., 2022; Correia et al., 2018; Dunbar-Smalley & Washington, 2022; Pereira et al., 2022). Two articles explored occupational reconstructions, defined as individuals coming together to collaborate and address a shared problem; this theory was presented as a potential approach for advancing racial justice through collective action (Dunbar-Smalley & Washington, 2022; Frank & Muriithi, 2015).
As for denouncing occupational injustices, Kronenberg and Pollard (2005) defined occupational apartheid as systematic, political, social, cultural, and economic segregation that affects the health and occupations of people from marginalized groups. In agreement with this definition, two articles sought to explore occupational apartheid (Ambrosio et al., 2022; Farias et al., 2018). Ambrosio et al. (2020) reflected on how occupational therapy at the interface with culture, from an ethnic/racial perspective, allows occupational therapy practitioners to align their practices with social markers of the Black population. Thus, the intersection between these markers generates oppression. Articles emphasized how intersectionality can inform occupational therapy (e.g., Pereira et al., 2021). Aiming to build the knowledge and practices of Latin American occupational therapy practitioners committed to counterhegemonic struggles, two articles discussed intersectionality and Amefricanidade as tools for analyzing epistemic research and practices within Brazilian and Latin American occupational therapy (Ambrosio & Silva, 2022; Pereira et al., 2022). 4 Continuing to reflect on the epistemologies of the Global South, two other articles referred to Afro-referenced occupational therapy, an occupational therapeutic approach that centralizes Black epistemologies, frameworks, and ancestral practices, aiming at the formation and restitution of Black subjectivities (Costa et al., 2020, 2023). Denouncing epistemic racism, Leite Junior et al. (2021) introduced the concept of “becoming Black” in occupational therapy to acknowledge the contributions of the Black population to the profession’s historiography and to promote diversity. Building on this, McConnell (2022) developed the racially informed care practice model, which seeks to address the psychological and physiological impacts of racism on occupations. This approach equips occupational therapy practitioners with the necessary insights to plan more effective interventions for Black individuals.
Theme 4: Methodological Approaches
This theme described the methodological approaches (see Figure 2) used by occupational therapy practitioners who work with Black populations (see Table A.3). These diverse methodologies included qualitative approaches that focused on exploring and understanding phenomena from a subjective, in-depth perspective (Ambrosio et al., 2020, 2022; Ambrosio & Silva, 2022; Atwal et al., 2024; Bezerra & Alves, 2022; Costa et al., 2020; Johnson et al., 2022; Lavalley & Johnson, 2022; Lerner & Kim, 2022; Nicholls & Elliot, 2019; Parnell, 2023; Pereira & Magalhães, 2023; Ramugondo, 2015; Ramugondo & Kronenberg, 2015; Sandstrom & Bruns, 2017; Souza et al., 2021; Valério et al., 2021; Wasmuth et al., 2023). Most of the methodological approaches used have not been occupation-centered. However, occupational therapy practitioners have used these approaches to provide a rich and detailed understanding of the social, cultural, and psychological experiences of Black populations, as well as highlighting the occupational aspects of their lives. This has led to a deep and nuanced exploration of Black subjectivity and the social markers that influence their occupations.
Methodological approaches used by occupational therapy practitioners with Black populations.
Most research methodologies have focused on individual perspectives rather than collective or group ones, which are also vital for forming a more comprehensive understanding of social, psychological, and cultural phenomena and occupational aspects. These individual-focused approaches enable occupational therapy practitioners to explore specific cases of how Black individuals perceive their identity, needs, and occupations. These approaches are pivotal to enacting change in their lives by providing a deeper, personalized understanding of their unique experiences and challenges. However, practices that transcend the individual perspective offer an opportunity for occupational therapy practitioners to advocate for more inclusive policies (Josephsson, 2017). These perspectives help recognize and address the structural factors that affect Black populations, promoting broader systemic change within the field.
Discussion
Academic publications have shown that most theories, approaches, and frameworks are imposed by the dominance of modern Eurocentric rationality in the occupational therapy profession, which neglects oppression and racial inequalities (Murphy et al., 2024). In contrast, to address racism, White supremacy, and colonization legacy, occupational therapy practitioners have at their disposal critical theories and counterhegemonic paradigms that scrutinize neoliberalism, colonialism, and racism and the effects of this system on occupations. Among the results of this scoping review, we found articles that used more than one theory and theoretical framework, and some of these frameworks do not dialogue with each other because they originate from different paradigms (e.g., understanding racism through the lenses of intersubjectivity theories, critical feminist theory, and racial and psychoanalysis). Different notions about context and frameworks have been raised, for example, by Lerner and Kim (2022), who understood that intersectionality, equity, and equality are contexts; 5 however, in most of the articles, they are conceptualized as frameworks (Ambrosio & Silva, 2022; Atwal et al., 2021; Pereira et al., 2022). 6 Most articles discussed racism and race but did not provide a definition of what a concept is. Furthermore, most authors did not declare their own positionality, which makes it impossible for the reader to know who and from what epistemological situation they are speaking. Of the few articles that declared positionality, most authors identified themselves as White. In studies addressing race, clear definitions of race and racism would be in order, beyond the mentioning of social locations and positionality statements. This would allow readers to better understand the theories explaining racialization, how racism occurs, and how the author’s social markers shape how doing, being, becoming, belonging, and engaging with Black occupational therapy service recipients take place.
It is important to note that in this review, models (see Pereira et al., 2024) are not our focus; in some countries such as Brazil, practice models have not been created or adopted because, according to some occupational therapy practitioners, models from the Global North do not address widespread social issues in Brazilian society (Cruz, 2018; Pereira et al., 2024). In the development of occupational therapy in Brazil, the sociopolitical context of the 1970s—marked by a new democratic order, coupled with the creation of the Unified Health System, the antiasylum movement, and the advocacy for the rights of people with disabilities—played a crucial role in sparking discussions among occupational therapy practitioners about establishing a critical approach to occupational therapy that diverged from the international models from which it originated (Cruz, 2018). As a result, many Brazilian occupational therapy practitioners now draw on alternative references, such as progressive philosophy, education, sociology, and anthropology, to engage with the unique Brazilian context, with the aim of promoting emancipation and social participation. As mentioned, most of the articles identified were published in the Brazilian Journal of Occupational Therapy. Brazilian occupational therapy has gained international recognition for its research and practices with Black populations, which advocate for emancipation, social participation, and empowerment through occupations, as well as denouncing racism in the profession (Beagan et al., 2023).
Understanding that occupations are inherently racialized, occupational therapy scholars across the globe have developed practice models and frameworks to support Black occupational therapy students, practitioners, researchers, and educators. Practice models such as racially informed care have examined the impact of racism on the roles of people of color (McConnell, 2022). In addition, some frameworks have focused on promoting social transformation, emancipation, and justice by engaging in collective occupations, which are informed by Black cultural knowledge and traditional practices (Ramugondo & Kronenberg, 2015).
Activists, researchers, and educators around the world have pointed out the impacts of racism on occupation, and they have developed critical frameworks that address the effects of oppression in the occupations of stigmatized groups. To confront racism, authors have presented specific antiracist actions that occupational therapy practitioners can take, including discussing race openly without discomfort (Lerner & Kim, 2022), addressing White supremacy, reflecting on their positionality, engaging in ongoing self-reflexivity (Grenier, 2020; Johnson et al., 2022; Johnson & Lavalley, 2021; Porto & Silva, 2023), and carrying out artistic and cultural activities that contribute to the recognition of Black culture and beauty (Ambrosio et al., 2020; Farias et al., 2018; Pereira et al., 2022; Silva, 2016).
Latin American scholars, inspired by the theory of decoloniality, emphasized how the interconnection of the three axes of domination—capitalism, colonialism, and patriarchy—shape the occupations and occupational engagement of marginalized populations (Bezerra & Alves, 2022; Souza et al., 2021). Guided by this theory, authors have discussed the distinctions between the Global North and Global South, noting that the Global South refers to the countries that are still dealing with the consequences of colonization today (Bezerra & Alves, 2022; Ruiz et al., 2021; Souza et al., 2021). The process of decolonizing knowledge in occupational therapy is possible but not limited to southern epistemologies, such as southern occupational therapy (Ruiz et al., 2021; Souza et al., 2021), that understand the impacts of coloniality of power, knowledge, and being above non-Whites (Bezerra & Alves, 2022; Souza et al., 2021). Afro-referenced occupational therapy that centralizes Black epistemologies (Costa et al., 2020, 2023) and brings recognition to the contributions of the Black population in the historiography of the profession (Leite Junior et al., 2021) is also recommended. Authors have described intersectionality and Amefricanidade as tools for analyzing epistemic research and practices in Latin American occupational therapy (Ambrosio & Silva, 2022; Pereira et al., 2022). In addition, some authors pointed out social occupational therapy as a framework that takes actions at micro- and macrosocial levels (Farias et al., 2018; França et al., 2016; Gonçalves et al., 2020).
In research and practice with Black populations, occupational therapy practitioners have predominantly been guided by qualitative methodologies, which provide a deeper understanding of internal dimensions by considering people’s subjectivity (Frank & Polkinghorne, 2010). Although these methodological approaches have provided meaningful insights, there are still gaps in applying these findings to the development or refinement of occupational therapy theories and frameworks that more effectively address the specific needs of Black populations. Qualitative approaches can be used to refine existing occupational therapy theories or create new frameworks that are specifically tailored to the challenges faced by Black populations. These theories should incorporate the intersectional nature of Black identities, recognizing that race, gender, and class are interconnected influences on occupation rather than separate categories (Pereira & Magalhães, 2023).
Moreover, the findings of this review can help shift the focus from merely understanding Black subjectivity to actively empowering individuals through the development of antiracist and decolonized occupational therapy practices. To deepen the field’s work with Black populations, qualitative methodologies should be expanded to include more participatory or community-based research approaches (Atwal et al., 2023; Correia et al., 2018). This would allow Black communities to take a more active role in shaping occupational therapy practices, fostering a more inclusive approach wherein the research agenda is directly influenced by the communities being served. In doing so, occupational therapy practices would be better aligned with the real-world needs and aspirations of these communities.
On the basis of this review, we identified that the discussion on ethnic/racial issues is growing in the field but is still scarce. There are gaps in the literature regarding the scholarship on the frameworks that inform the practices of occupational therapy practitioners with Black populations. Only a few models, theories, and frameworks were developed to support Black occupational therapy students, practitioners, and educators. The reflections summarized in this study could help advance the practice of these professionals with Black populations. Thus, the importance of considering theoretical and methodological frameworks in professional practices with Black populations becomes evident. Because of the racism that shapes occupation, occupational therapy students, practitioners, and educators must be committed to antiracism and be guided by counterhegemonic frameworks to enact interventions capable of promoting social change.
This study had several limitations. We excluded gray literature, books, and conference abstracts; these works may provide important context for future research on occupational therapy practice in diverse communities. Furthermore, articles published before 2013 were excluded. Also, including languages other than English and Portuguese may provide additional insights on non-Western frameworks that guide occupational therapy practice in other global contexts.
Implications for Occupational Therapy Practice and Education
The findings of this study have the following implications for occupational therapy practice and education: ▪ Occupational therapy students, practitioners, researchers, and educators must understand that Black populations’ occupations, as doing, being, becoming, and belonging, are shaped by social markers. To promote true social transformation, changes must occur at the interpersonal, structural, and institutional level; being antiracist is imperative. ▪ In the classroom, educators should incorporate critical frameworks that address racial issues (e.g., they can discuss content about racism and discrimination throughout curricula; support diverse approaches to activities of daily living, such as understanding the care needs for different hair, skin, and body types; and recognize the importance of beliefs, spirituality, and culture in practices). Furthermore, critical frameworks addressing racial issues should also be incorporated into continuing education courses and workshops to ensure ongoing learning and awareness in professional development. ▪ Occupational therapy academic programs must review professional education that reinforces White supremacy and Eurocentric knowledge; thus, decolonizing the curricula is a moral imperative. ▪ AOTA, WFOT, and other occupational therapy professional organizations across the world are challenged to take a stance on denouncing racism and implement antiracist approaches. ▪ Educators, researchers, and practitioners can incorporate and honor Black culture, values, and knowledge in interventions and investigations.
Conclusion
This review identified that, historically, the occupational therapy profession has neglected to address oppression and racial inequalities. Engaging critical approaches may serve as guideposts for occupational therapy practitioners to better examine the lack of diversity representation, equity, and inclusion, beyond denouncing anti-Black racism within the profession. The literature suggests occupational therapy practitioners must adopt more comprehensive antiracist actions and approaches and should be guided by counterhegemonic and decolonial frameworks. Moreover, White occupational therapy students, practitioners, researchers, and educators must interrogate the epistemologies and ontology used and reflect on their Whiteness and positionality.
In this review, we summarized several theoretical and methodological perspectives that can inform occupational therapy practitioners who provide services to Black populations, which enhances antiracism. More studies are needed to investigate the effectiveness and limitations of those frameworks. We contend that occupational therapy practitioners cannot fully understand the occupations and occupational engagement of these populations without attending to the intersections of their social markers. We hope this review contributes to a practice of critical self-analysis—to reflect on one’s own practices and enact actions to address the inequalities produced by racism in the profession.
Supplemental Material
Supplementary material for Understanding the Theories and Frameworks That Guide Occupational Therapy Practice With Black Populations: A Scoping Review
Supplementary material, sj-pdf-1-aot-10.5014_ajot.2025.051068.pdf for Understanding the Theories and Frameworks That Guide Occupational Therapy Practice With Black Populations: A Scoping Review by Amanda dos Santos Pereira, Khalilah Robinson Johnson and Lilian Magalhães in The American Journal of Occupational Therapy
Footnotes
*Indicates articles included in the scoping review.
1In this article, we use the term Black to include all people of African ancestry regardless of country of origin.
2The BLM movement was founded in 2013 by Alicia Garza, Patrisse Cullors, and Opal Tometi. It emerged as a Black-centered political movement in response to the acquittal of George Zimmerman, the man who murdered Trayvon Martin. The movement gained national momentum in 2014 following the deaths of Michael Brown and Eric Garner; and since then, it has grown into a global movement advocating for racial justice and equality.
3The terms BME, BIPOC, and women of color refer to different subgroups of people; however, in this article, we use these terms as they appeared in the referenced articles to maintain consistency with the original authors’ language.
4 Amefricanidade, a concept developed by Lélia Gonzalez, provides a basis to conceptualize thinking of the everyday life of Black and Indigenous people living in Central and South America (see Gonzalez, 1988).
6A theoretical framework is developed from one or more theories that a researcher constructs to support and guide a study (see Varpio et al., 2020).
Acknowledgments
This study was funded in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil (Finance Code 001).
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
