Annals of International Occupational Therapy

Review Supplemental Data

Occupational Therapy and Environmental Sustainability: A Scoping Review

Diane L. Smith, PhD, OTR/L, FAOTA; Kayley Fleming, OTD, OTR/L; Lyndsay Brown, OTD, OTR/L; Amy Allen, OTD, OTR/L; Jamie Baker, OTD, OTR/L; Mary Gallagher, OTD, OTR/L

Abstract

Background:

The Intergovernmental Panel on Climate Change reports that it is very likely that global warming is caused by human activity and that climate changes are linked to what occupational therapists call “occupation.” However, the role of occupational therapy relative to environmental sustainability has not been examined extensively. This scoping review was conducted to analyze and summarize the current literature on occupational therapy and environmental sustainability and to identify gaps and limitations.

Methods:

According to established methods for a scoping review, databases, including MEDLINE, PsycINFO, CINAHL, ERIC, OT Seeker, NARIC, and the Cochrane Database of Systematic Reviews, were searched based on inclusion and exclusion criteria.

Results:

A final review of 19 articles showed themes of advocacy and professional responsibility, application of theoretical models to address environmental sustainability, methods to achieve sustainability in practice, and inclusion of environmental sustainability in occupational therapy education.

Conclusion:

The results showed several roles for occupational therapists that focus on advocacy as well as working with clients to create environmentally sustainable occupations, establishing sustainable practice, and revising educational standards. Future studies should further investigate methods to achieve environmental sustainability, the effect of environmental degradation on occupational performance, and effective occupational therapy interventions that address these issues. [Annals of International Occupational Therapy. 2020;3(3):136–143.]

Abstract

Background:

The Intergovernmental Panel on Climate Change reports that it is very likely that global warming is caused by human activity and that climate changes are linked to what occupational therapists call “occupation.” However, the role of occupational therapy relative to environmental sustainability has not been examined extensively. This scoping review was conducted to analyze and summarize the current literature on occupational therapy and environmental sustainability and to identify gaps and limitations.

Methods:

According to established methods for a scoping review, databases, including MEDLINE, PsycINFO, CINAHL, ERIC, OT Seeker, NARIC, and the Cochrane Database of Systematic Reviews, were searched based on inclusion and exclusion criteria.

Results:

A final review of 19 articles showed themes of advocacy and professional responsibility, application of theoretical models to address environmental sustainability, methods to achieve sustainability in practice, and inclusion of environmental sustainability in occupational therapy education.

Conclusion:

The results showed several roles for occupational therapists that focus on advocacy as well as working with clients to create environmentally sustainable occupations, establishing sustainable practice, and revising educational standards. Future studies should further investigate methods to achieve environmental sustainability, the effect of environmental degradation on occupational performance, and effective occupational therapy interventions that address these issues. [Annals of International Occupational Therapy. 2020;3(3):136–143.]

Findings on the effect of climate change, including exposure and vulnerability, show a high level of risk for the health of current and future populations worldwide (Watts et al., 2018). Ensuring an understanding of climate change and its effect on occupations is vital so that occupational therapists can provide interventions at the individual, group, and population levels that address concerns, such as food availability, displacement, and the physical and mental health results of extreme weather events.

This topic has been explored in professions such as nursing, public health, and social work. For example, Nicholas and Breakey (2017) discussed the concept of climate justice as an ethical and human rights issue that relates to climate change, and they called for the profession to assume a leadership role in practice, education, research, administration, and policy. Andrews (2009) suggested the development of a global climate change framework for nursing action that would influence public behavior and political action, differentiate nursing specialties to address specific climate issues, recognize differing global circumstances and needs, and promote public scholarship.

Naylor and Appleby (2013) focused on sustainability in clinical practice and found that significant improvements may require a fundamental transformation in service models, such as a stronger emphasis on prevention and care delivered in ways that are financially sustainable and environmentally sustainable. Mortimer (2010) and Potteiger et al. (2014) proposed specific sustainable clinical practices, such as low-carbon treatment options and powering down therapeutic modalities.

Finally, several health professions advocated for the inclusion of climate change in the curricula of nursing (Leffers, Levy, Nicholas, & Sweeney, 2017), public health (Fleming, Tenkate, & Gould, 2009), and social work (Beltrán, Hacker, & Begun, 2016; Boetto & Bell, 2015; Gray & Coates, 2015; Melekis & Woodhouse, 2015). These studies suggested hiring interdisciplinary faculty with expertise in ecological sustainability, the obvious inclusion of this material within the curriculum, and the need for institutional commitment.

Research in the health professions on the importance of sustainability, its influence on practice, and the need for its inclusion in professional curricula represents a broader call to pay attention to sustainability. This stated attention is also an important area of exploration for occupational therapy.

Occupational therapists view the client, defined as an individual, group, or population, as able to achieve a state of health or wellness by engaging in meaningful occupations within a context or environment (American Occupational Therapy Association [AOTA], 2017). However, the effects of climate change, including the unpredictability and complexity of interlinked global changes, will accelerate and will affect many clients socially, economically, and environmentally (Few, 2007). Nationally and internationally, these changes pose challenges to the identity and emotional well-being of individuals and communities, will affect occupational participation and performance, and may result in occupational injustice (Townsend & Wilcock, 2004). Therefore, issues involving sustainability of the environment are appropriate and imperative for occupational therapists to consider because of their influence on the daily habits of individuals and their participation in occupations as both cause and effect (Intergovernmental Panel on Climate Change, 2018; Silva e Dutra, Martinho Roberto, Lopes Coelho, & Almeida, 2018).

The involvement of occupational therapy is appropriate not only at a community level, with regard to environmental changes created by the current climate crisis and its effect on health and participation, but also in any setting (e.g., rehabilitation units) where practitioners can adapt practice to be more globally friendly and encourage clients to modify occupations to promote ecological sustainability (Aoyama, 2014). Despite an obvious role for occupational therapy in terms of the effect of climate change on occupation, evidence of the involvement of the profession in environmental sustainability is in its infancy, especially in the United States. Therefore, we conducted a scoping review of the current literature to define the role of occupational therapy in environmental sustainability and provide the obvious next step in more robust research.

Methods

Design

Scoping reviews are used to evaluate the depth and breadth of available information on a specific topic, in this case, the role of occupational therapy in addressing issues of environmental sustainability (Arksey & O'Malley, 2005). Further, scoping reviews can be used to identify gaps in the literature (Levac, Colquhoun, & O'Brien, 2010). In our review, we used a framework for analysis that was proposed by Arksey and O'Malley (2005) and elaborated by Levac et al. (2010).

Identification of the Research Question

The first step in the review process was to develop a research question. Based on an initial reading of the literature, the following question was identified: “What is the role of occupational therapy in environmental sustainability?”

Identification of Relevant Studies

The researchers, who consisted of five occupational therapy graduate students and their faculty mentor, initially searched “environmental sustainability” (a variable in the research question), which yielded search terms relevant for each database to retrieve pertinent articles. In addition to the initial search, terms from the literature included “biodiversity,” “climate change,” “global environmental change,” “temperature variability,” “occupational science,” “sustainable development,” “occupational justice,” “resilience,” “carbon emissions,” “clean water,” “extreme weather,” “rural health,” “ecology conservation,” “recycling,” “global warming,” “air quality,” “pollution,” “medical waste,” “ecosystem services,” “nature conservation,” and “industrialization.” These terms were coupled with “occupational therapy” to provide more specific literature. A medical librarian with experience in completing scoping review searches confirmed the search strategies. Databases and sites searched included MEDLINE, PsycINFO, CINAHL, ERIC, OT Seeker, Scopus, NARIC, and the Cochrane Database of Systematic Reviews. In addition, we reviewed reference lists from selected articles and journals to identify relevant articles.

Study Selection

We retrieved full-text articles to determine whether they met the following inclusion criteria: (a) published in English from 2000 to the present and (b) related to environmental sustainability pertinent to occupational therapy and other health professions. The review excluded data from presentations, conference proceedings, non–peer-reviewed research literature, dissertations, and theses. We applied the inclusion and exclusion criteria in title, abstract, and full-text screening and pilot-tested the application of the criteria with a minimum of two articles. If a researcher could not determine whether an article met the inclusion criteria, a final decision was reached through a consensus among the team.

Procedures

From the initial 54,866 abstracts identified, 36,576 unique abstracts were screened for eligibility, from which 196 full-text articles were reviewed to determine whether they met the inclusion and exclusion criteria. Of those articles, 143 were excluded after full-text screening and 35 were excluded during data extraction. The final process resulted in 18 articles that were assessed for the type of article and outcomes relevant to the question (Figure 1).

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Data Abstraction

After the first author (D.L.S.) performed an initial review of the abstracts, this author and the student researchers developed a data abstracting table to determine which variables to extract to help answer the research question. Data were then tabulated on a worksheet that included the author(s), year of publication, country of origin, type of publication, purpose of the study, population and sample size analyzed, methods, outcome measures, and conclusions related to environmental sustainability (Levac et al., 2010; Table A, available in the online version of the article). Tabulating was an iterative process in which the researchers continually updated the data abstracting form. To resolve uncertainty about the nature and extent of the data extracted, two researchers tabulated the same articles independently and then met to determine whether their approach to data extraction was consistent with the research question and purpose (Levac et al., 2010). Any disagreements were resolved by consensus or the decision of the first author.

Data Abstracting TableData Abstracting TableData Abstracting TableData Abstracting TableData Abstracting TableData Abstracting TableData Abstracting TableData Abstracting Table

Table A:

Data Abstracting Table

Data Analysis

A thematic analysis was conducted with qualitative strategies recommended by Levac et al. (2010) to identify themes in the literature pertaining to the role of occupational therapy in addressing issues associated with environmental sustainability. The analysis included three steps: (a) analyzing the data, (b) reporting the results, and (c) applying meaning to the results (Levac et al., 2010). Data were analyzed by first summarizing the characteristics of the article, such as the type of study, study methods, key findings, recommendations for future research, and practice changes. We then conducted further content analysis by chunking the article text into meaning units (based on the extent to which the units, either paragraphs or sentences, addressed the role of occupational therapy and other health care professions in addressing problems of sustainability) and labeling the units (Creswell & Creswell, 2018). We placed the generated codes (text chunk labels) in a taxonomy to create themes (Creswell & Creswell, 2018). Finally, we used the taxonomy to generate thematic descriptions.

Results

We identified seven articles as commentary or opinion pieces that emphasized the need for the profession to become involved in interventions that consider aspects of environmental sustainability. Three were review articles that focused on sustainable practice. Six articles discussed occupational therapy theory or model conceptualizations related to environmental sustainability. Two qualitative studies in occupational therapy were identified, one looking at daily habits and one examining the role of occupational therapy in monitoring water quality. One article focused on the inclusion of environmental sustainability in the educational curricula for occupational therapy professionals.

Thematic Analysis

We grouped the evidence into four themes: (a) advocacy/professional responsibility, (b) theoretical models to address environmental sustainability, (c) methods to achieve sustainability in practice, and (d) environmental sustainability in professional curricula.

Advocacy/Professional Responsibility

Advocacy for sustainability and health. Occupational therapists can consider how climate change and extreme weather events may expose individuals to traumatic experiences and chronic stress because of fear, economic challenges, and displacement (Goldmann & Galea, 2014). Displacement may result in disruption of routines that support engagement in meaningful occupations or interruption of social patterns that individuals use to navigate difficult circumstances. Traumatic events, such as those caused by displacement and forced migration, can result in mental health problems (Doherty & Clayton, 2011; Fritze, Blashki, Burke, & Wiseman, 2008), including posttraumatic stress disorder (Paxson, Fussell, Rhodes, & Waters, 2012; Rayment, 2010). Pereira (2008) further suggested that an occupational science perspective should be used to describe new ways to classify potential mental health problems associated with climate change and its effect on the rural environment.

Blakeney and Marshall (2009) used a participatory research design to examine connections among water quality, health, and human occupations. The findings showed that a watershed was polluted because of specific coal mining practices and a lack of adequate infrastructure. Consequently, citizens experienced occupational injustice in the forms of occupational imbalance, deprivation, and alienation.

Health professions and sustainability. The conclusion that human activity or occupation is a cause of climate change illuminates the potential of occupational therapy to help to alter human activities and occupations that are causing ecological harm (Aoyama, 2014; Dennis, Dorsey, & Gitlow, 2015). Algado and Townsend (2015) described the issue of ecosocial occupational therapy, connecting ecology with broad ideas of occupation and occupational justice. The authors proposed that doing ecology is essentially occupational and is necessarily a matter of occupational justice. They discussed future directions, including centering practice on changing the environment and pursuing additional funding for projects focused on ecological sustainability through occupation.

Theoretical Models to Address Environmental Sustainability

Occupation and the Model of Human Occupation. Many conceptual occupational therapy models focus on the relationship between person and environment and can be used to frame issues of sustainability within health care practice, education, and research. Aoyama, Hudson, and Hoover (2012) argued that the concept of “occupation” is crucial to understanding how ecosystem services and the benefits that people obtain from ecosystems relate to constituents of human well-being, including security, basic materials for good life, health, and freedom of choice and action. The authors suggest that an occupational lens provides a means to gain a deeper understanding of why people choose or do not choose certain occupations and often take actions that are harmful to the environment and to their own well-being.

For example, the Model of Human Occupation has been suggested as a useful frame of reference to examine environmental sustainability (Wagman, 2014b). The author argued that a person's volition can be a positive or negative factor in relation to environmentally sustainable development and that personal causation may influence whether individuals act environmentally responsibly. Societal values are relevant because, for example, occupations may differ among various cultures that value sustainable practices differently. Individuals' interests, habits, routines, roles, and identities are important because they affect the way in which they conduct occupations. In addition, the environment can promote or prevent an environmentally friendly infrastructure that supports sustainable occupation.

The Modified Instrumentalism in Occupational Therapy model. Two articles examined the effectiveness of the Modified Instrumentalism in Occupational Therapy model as a framework for facilitating occupational behavior change to address climate change and related issues (Ikiugu, 2011; Ikiugu et al., 2015). Both studies determined that occupation-based interventions may increase personal awareness of the connection between occupational performance and global issues, thereby empowering people to be agents for action to ameliorate the issues. The Modified Instrumentalism in Occupational Therapy model was developed to guide occupation-based interventions to help individuals to participate in meaningful occupations in ways that promote fairness in access to resources, especially by individuals who have low incomes, are disenfranchised, and have minimal negative effect on the earth's ecosystems (Blakeney & Marshall, 2009).

Sustainable global well-being. Sustainable global well-being acknowledges each person's interdependence with the global ecosystem and upholds the idea that addressing global well-being through sustainable development helps to improve individual, community, and social well-being (Whittaker, 2012). This approach adheres to the principles of occupational justice (Townsend & Wilcock, 2004), which emphasize the human need and right to engage in occupations that are meaningful, fulfilling, and environmentally sustainable. The natural extension of a global perspective complements current client-centered interventions through reframing their meaning. For example, based on client needs, meal preparation could be explored in its most sustainable form through reflecting on the ecological context and cooking mindfully.

Methods to Achieve Sustainability in Practice

Promotion of sustainable occupations with clients. The 2012 position paper of the World Federation of Occupational Therapists on sustainability “encourages occupational therapists working with clients wishing to live more sustainable lives to promote environmentally sustainable occupational performance and lifestyles.” Occupations that sustain communities include the production, purchase, and selection of environmentally friendly goods and occupations; occupations that reuse, renovate, recycle, and respect other life forms; local paid employment that protects health and the environment; shared occupations that allow people to collaborate in creating stable community structures and health-promoting activities; and occupations such as city planning that create built environments to encourage healthy behaviors and reduce travel distances (Christiansen & Townsend, 2010). These practices can lead to a new category of human activity: “meaningful/sustainable occupations” (Aoyama, 2014).

Similarly, the Swedish Association of Occupational Therapists (2012) argued that occupational therapists can support sustainable development through individualized interventions, such as prescribing aids, assisting in housing adaptations, and developing personal strategies. For example, a cognitive aid can support a person who has reduced perception of time to minimize water usage, home adaptations can facilitate the process of sorting household waste for an individual who uses a wheelchair, and visual checklists and reminders can enable a person with an intellectual disability to shop for groceries and cook in an environmentally responsible manner.

Relationship between occupation and health. In connection with sustainable development efforts, occupational therapists can contribute their expertise on the effect of occupational limitations in relation to participation and health (Christiansen & Townsend, 2010). For example, active travel methods, such as walking or biking, are healthy, low-carbon means of transportation (Capon, 2014). Occupational therapists can work to increase the accessibility of these methods from both physical and way-finding perspectives to enable persons with disabilities to travel actively throughout the community.

Hocking and Kroksmark (2013) suggested several ways in which occupational therapists can promote healthy occupations, using occupational science to generate new understanding of ways to change human occupations to benefit the earth's ecology (Ikiugu, 2008). Examples include establishing personal gardens so that clients can grow their own food, carpooling, and promoting community bike sharing to reduce carbon emissions.

Adapting occupational therapy practice for sustainability. Wagman (2014a) discussed four ways in which occupational therapists can adapt their practice to contribute to ecological sustainability: (a) adapting to existing results of climate change and encouraging participation in occupations adapted to be more ecologically sustainable; (b) cooperating with other health professions at the individual and group levels to address climate issues; (c) exploring people's occupational choices with consideration of culture (Aoyama et al., 2012; Hudson & Aoyama, 2008); and (d) raising societal awareness of the negative effects of climate change on occupational performance.

One study indicated that health professionals, such as occupational therapists, might consider reworking their service delivery methods by, for example, using telehealth or telerehabilitation (Gower, 2013). Rehabilitation professionals could reduce travel mileage through the use of virtual case conferences and video calls with clients or by pooling or loaning resources. Health professionals also may limit waste through the hierarchy of avoid, reuse, and recycle (Gower, 2013).

Environmental Sustainability in Professional Curricula

The World Federation of Occupational Therapists (2018) suggested guiding principles for sustainability in occupational therapy education. These guidelines include a recommendation for “including content in curricula to help occupational therapy students acquire knowledge and develop competence in working with individuals and communities to help interested service users adopt sustainable lifestyles and adapt to the adverse consequences of climate change” (p. 41). In the United States, the current standards of the Accreditation Council for Occupational Therapy Education (2018) could be loosely interpreted to include climate change in the areas of social determinants of health and factors, policy issues, and social systems, although these do not address environmental sustainability or climate change specifically.

Discussion

This scoping review identified several themes in the literature that help to answer the research question of what role occupational therapy should play in environmental sustainability. First, the literature supported the idea that occupational therapists serve as advocates to promote occupations that support or increase sustainability (e.g., use of public transportation). Although advocacy is reflected similarly in other health care literature (Nicholas & Breakey, 2017), our findings show that this theme relates to the potential leadership role of occupational therapy in advocating specifically for sustainable occupations, habits, and routines for both occupational therapists and their clients.

Conceptual models endorse the role of occupational therapy through the professional emphasis on the relationship between persons and sustainable environments to guide interventions such as developing occupations (e.g., recycling) that sustain health in the broadest sense. This idea is significant and is consistent with conceptual models to guide sustainability in other professions. However, conceptual models in occupational therapy differ in that they purposefully and specifically look at the relationship between the person, the environment, and the meaningful occupations of the client, whether that client is an individual, a group, or a community. For example, an occupational therapist who works with families and young children could encourage clients to walk or bike rather than drive to work or school, or acute care therapists could advocate for their hospital to begin using compostable plastic bags or gloves.

Similar to the literature in other professions (Mortimer, 2010; Naylor & Appleby, 2013; Potteiger et al., 2014), studies in the occupational therapy literature outlined ways to adapt practice to be more sustainable, including adapting practice to be less wasteful, encouraging clients to participate in sustainable occupations, using telerehabilitation, and increasing societal awareness with clients.

Although the World Federation of Occupational Therapists (2012) argued for educational standards for occupational therapists to include modules for environmental sustainability, the standards of the Accreditation Council for Occupational Therapy Education (2018) are not specific, and the literature in this area is scarce. Suggestions from other professions that could be incorporated into the occupational therapy curricula include integrating climate change into education to ensure that the knowledge, skills, and insights critical for clinical practice are incorporated into practice, research, and policy courses (Leffers et al., 2017). Other suggestions include hiring interprofessional faculty with expertise in ecological sustainability and institutional commitment to this cause (Fleming et al., 2009; Melekis & Woodhouse, 2015).

Other suggestions that could be adapted would be to integrate these issues into the existing curricula through place-based or community experiences that are included in the educational standards for occupational therapy (Beltrán et al., 2016; Boetto & Bell, 2015; Gray & Coates, 2015).

Limitations

One limitation of the study was that only a few articles focused on environmental sustainability using a rigorous research design. Most studies were descriptive, including commentaries and calls to action. Many articles were reviews, few discussed interventions, and even fewer tested them. Another limitation was the lack of literature focused specifically on occupational therapy as a profession and its potential contribution to environmental sustainability, especially regarding education, which made the development of themes challenging.

Implications for Occupational Therapy

This scoping review illustrates the need for further evidence of the role of occupational therapy in environmental sustainability. Examples of environmentally conscious individual and community-based interventions within the scope of occupational therapy practice could be used for future studies that measure the efficacy of sustainable practices (Christiansen & Townsend, 2010; Gower, 2013; Hocking & Kroksmark, 2013; Swedish Association of Occupational Therapists, 2012; Wagman, 2014a, 2014b).

Additionally, the results from this study can be used to update the standards of the Accreditation Council for Occupational Therapy Education (2018) to state explicitly the need for occupational therapy programs to teach the professional responsibility to consider environmental sustainability in practice. Occupational therapists can advocate for sustainable policies that affect individuals, their environment, and their occupations, and they can use multiple models to guide their practice while considering environmental sustainability and the effects of climate change (Ikiugu, 2011; Ikiugu et al., 2015; Wagman, 2014b). More studies on the efficacy of sustainable occupational therapy interventions are needed to quantify the unique value of occupational therapy in promoting human activities that contribute to improved individual, community, and global health.

Conclusion

This scoping study analyzed relevant health care literature on the role of occupational therapy in environmental sustainability. Further investigation of environmental sustainability, the effect of environmental degradation on occupational performance, and effective interventions that address these issues should be supported to increase the understanding of the role of occupational therapy in addressing climate change. Incorporating findings from other health fields, such as strategies to improve occupational therapy education in environmental sustainability, could help to define and develop the potential role of the profession. Both a continued focus on gathering evidence and rigorous research into effective strategies are necessary to allow occupational therapists to assume a leadership role in supporting sustainable practice.

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Data Abstracting Table

Author, publication year, study locationAims of study (purpose of study)Type of articleStudy populationsOutcome measuresConclusions related to environmental sustainabiltiy
Algado, S.S. & Townsend, E.A. 2015 SpainDescribed the issue of “eco-social” occupational therapy connecting ecology with broad ideas of occupation and occupational justice.Theory-reviewOccupational therapistsN/AThe authors proposed that doing ecology is essentially occupational and necessarily a matter of occupational justice. Suggested university-community partnerships focused on changing the environment.
Aoyama, M.2014JapanExplain the connection between occupational therapy and sustainabilityCommentaryOccupational therapistsN/AOT needs to understand that the profession has expertise on occupation and the relationship with the environment necessary with regard to sustainability.
Aoyama, M., Hudson, M. J., & Hoover, K.C. 2012 JapanArgue that the concept of “occupation” is a crucial addition to understanding the relationship of human wellbeing, human activity, and ecosystem services with occupational performance.Review-TheoryOccupational therapists and scientists.N/AOccupation should be considered to understand sustainable growth; people are more likely to adopt more sustainable occupations if changes support their needs; more research is needed
Blakeney, A.B. & Marshall, A. 2009 USAExamined connections among water quality, health and human occupations.Participatory action design.Residents of Letcher County, KentuckyInterviews regarding coal mining practices, infrastructure and occupationCitizens experienced occupational injustice in the forms of occupational imbalance, deprivation and alienation.
Dennis, C. W., Dorsey, J. A., & Gitlow, L. 2015 USAConnect OT philosophy with sustainability and discuss how to integrate sustainability into practiceCommentaryOccupational therapistsN/AOTs must focus on consequences of our actions and reframe professional reasoning to include a focus on environmental sustainability
Gower, G. 2013 UKConsider the role of allied health and social care professionals in developing and delivering a low carbon or sustainable care service.Review-sustainable practiceAllied health professionalsN/ASustainable development can occur within healthcare practices and how services are provided at an individual and organizational level
Hocking, C., & Kroksmark, U. 2013 New ZealandExamine how survey findings from the UN Global Survey on Sustainable Lifestyles can provide valuable information for OTCommentaryOccupational therapistsN/AApplication of findings to individual and community-based interventions to promote more sustainable lifestyles are suggested
Ikiugu, M.N. 2011 USAExplore the effectiveness of the Modified Instrumentalism in OT (MIOT) in facilitating change in occupational choice and performance patterns to help address global issues of concern to humanityMixed method research embedded multiple-case study with an experimental-type pretest-posttest and naturalistic type phenomenologic al designOccupational therapy graduate studentsModified Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (MAIIIOT), The Daily Occupational Inventory (DOI), and Occupational Performance Calculation Guide (OPCG)Participants occupational choices and performance patterns change after intervention so that they engaged more frequently in occupations that were likely to impact global issues positively.
Ikiugu, M. N., Westerfield, M.A., Lien, J.M. et al. 2015 USAExamine the effectiveness of the Modified Instrumentalism in Occupational Therapy model as a framework for facilitating occupational therapy change to address climate change.Mixed-method single subject designUniversity students and faculty membersModified Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (MAIIIOT)Participant's feelings shifted from frustration and helplessness to empowerment and desire for action to find occupation-based solutions to global issues.
Pereira, R.B. 2008 AustraliaAn occupational science perspective to describe new ways of classifying potential mental health problems associated with climate change and its impact on the rural environment.CommentaryOccupational therapistsN/ADevelopment of policy to assist, identify, treat and prevent newly described mental illness resulting from climate change, taking into account ecological sustainability
Rayment, T. 2010 UKDefine sustainable development and explain how it is linked to mental health, well-being, and occupational therapy practiceCommentaryMental health occupational therapistsN/AOTs must consider sustainable development to practice holistically; mental health OT practice can be enhanced through emphasizing sustainable development
Silva e Dutra, F., Martinho Roberto, W., Lopes Coelho, B. & Almeida, R. 2018 BrazilAnalyzed if spaces of sustainable practices change daily habits and the involvement in occupations that are also sustainableQualitative analysisStudents (occupational therapy an engineering)Open interviews before and after participation in socio-educational projectsAnalysis revealed daily habit changes among the participants after they were inserted in the projects. The spaces were an important locus for environmental learning and daily changes aimed at healthier and more sustainable habits.
Swedish Association of Occupational Therapists 2012 SwedenDescribe how occupational therapy contributes to sustainable developmentCommentaryOccupational therapistsN/ADevelopment of a position statement by the Swedish Association of Occupational Therapists supporting the pursuit of sustainable development and occupational therapy's potential role as a part of an individual's pursuit of sustainable development and a part of planning for a sustainable society.
Wagman, P. 2014a. SwedenExplore what OT and occupational science can contribute to ecological sustainability and the prevention of more severe climate changeReviewOccupational therapistsStudies related to contribution of OT to climate change and ecological sustainability published between 2008–2013.Four ways OTs can contribute: adapt to prevent climate change and to existing changes, cooperate with others, explore people's occupational choices and the relationship between occupation and ecology and warn of the consequences of the changes.
Wagman, P. 2014b. SwedenPropose the Model of Human Occupation (MOHO) as a useful conceptual model to frame occupational therapy's contribution related to sustainable development.Theoretical discussionOccupational therapistsN/AMOHO seems to provide a useful resource for occupational therapy pracitioners who wish to include an ecological perspective of sustainable development in their work. More research is needed to evaluate this concept.
Whittaker, B. 2012 UKDescribe how the occupational therapy paradigm can expand to be more global and address sustainabilityTheoretical discussionOccupational therapistsN/AOT's focus on client-centered care makes clinicians well poised to address sustainability; the term ‘environment’ should broaden to include the global ecosystem; and ‘occupational ecology’
World Federation of Occupational Therapists 2012 UKDiscuss the WFOT's position on environmental sustainabilityCommentary/Po sition StatementOccupational therapistsN/AWFOT encourages OTs working with clients who want to live more sustainable lives to promote environmentally sustainable occupations. Overall research and new research partnerships are needed to develop emerging evidence. New educational materials should be developed.
World Federation of Occupational Therapists 2018 UKIdentification of guiding principles for sustainability in occupational therapy practice, education, and scholarshipCommentary/Position statementOccupational therapistsN/AGlobal health should be central to occupational therapy practice, education and research. However, if we are to be focused on global health of citizens, then our focus must also be on sustainability, environmental, social and economic.
Authors

Dr. Smith is Professor and Doctoral Capstone Coordinator, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts. Dr. Fleming is Occupational Therapist, Melmark New England, Andover, Massachusetts. Dr. Brown is Occupational Therapist, League School of Greater Boston, Walpole, Massachusetts. Dr. Allen is Occupational Therapist, Cambridge Health Alliance, Cambridge, Massachusetts. Dr. Baker is Occupational Therapist, Aspire Development Services, Lynn, Massachusetts. Dr. Gallagher is Occupational Therapist, Harbor Area Early Intervention, Boston, Massachusetts.

The authors have no relevant financial relationships to disclose.

Address correspondence to Diane L. Smith, PhD, OTR/L, FAOTA, Professor and Doctoral Capstone Coordinator, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129; e-mail: dsmith2@mghihp.edu.

Received: May 14, 2019
Accepted: November 21, 2019
Posted Online: January 22, 2020

10.3928/24761222-20200116-02

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