Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services.

Introduction: Rural communities contribute to national wellbeing, identities, economies, and social fabrics, yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about non-urban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focused services are more commonly discussed. Understanding intentions expressed in publications about non-urban services design may identify assumptions/limitations to current approaches and contribute to improved future services.
Methods: Each of 117 publications identified in a scoping review were read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes. The first author re-interrogated the publications and coded data to identify relevant examples to support the identified themes. Results: Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes i) Extension of urban practice and ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focused on developing non-urban communities, and promoting justice.
Conclusion: The hegemonic paradigm links occupational therapy services with neoliberal notions of individualism, private provision of care, and efficiency/market value, rather than the occupational therapy values for justice. The profession must consider our role in perpetuating injustice for non-urban people and consider if and how more contextually tailored counter hegemonic place-based paradigms can be developed from and with regional, rural, and remote practice. Key Points for Occupational Therapy:•Rural communities and geography may be blamed for challenges experienced by urban providers in meeting needs•Rural people often must compromise service frequency, costs, and modality to support urban service models •A new place-based therapy paradigm requires development from regional, rural, and remote practice