Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services.
Karen Hayes, Vagner Dos Santos, Moses Costigan and 1 others
PMID 36193547WHAT IT FOUND
Non-urban occupational therapy services often copied urban models and blamed rural geography for limited access.
Some Global South and First Nations work instead built services around local context and community knowledge.
Key findings
01Many papers, especially from the Global North, described transplanting urban occupational therapy services into non-urban areas and stretching them through outreach or telehealth.
02Non-urban geography and populations were often presented as the cause of limited access, with services framed as needing minimal cost and clients expected to compromise.
03Some papers, especially from the Global South and in work with First Nations communities, described services built around local context, community knowledge, and paid local assistants.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review may have missed relevant publications, and it did not search databases that may have included more Global South sources. There is no single agreed definition of non-urban, so papers using other terms may have been missed. Not all included publications were written only by occupational therapists, so other professions may have shaped the framing. Thematic analysis of published papers may miss nuance, and the authors could not ask original authors to clarify meaning. The review did not extensively consider cultural differences within non-urban settings. It reports themes in how services were described, not patient outcomes, so it cannot show which service design works.
The easy way to misread this
Do not read the alternative themes as proof that community-designed services improve patient outcomes. This review analysed how publications described service design, not patient results, so it cannot show that any approach works.