Lived experiences of occupational therapy students from under—represented backgrounds in professional educational programs: A scoping review

Lived experiences of occupational therapy students from under—represented backgrounds in professional educational programs: A scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lived experiences of occupational therapy students from under—represented backgrounds in professional educational programs: A scoping review Alesia Ford, Diane Smith, Tamara Wanklyn, Danielle Hitch This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8359272/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The aim of this scoping review is to describe the experiences of occupational therapy students from diverse backgrounds during professional education. The objective is to identify common facilitators, barriers, or strategies that impact their safety and inclusion in professional education and ultimately the workforce, and to highlight any gaps in the literature. Introduction: Occupational therapy lacks diversity in its workforce, which is predominantly White and female in many countries. Increased workforce diversity is a priority for the occupational therapy profession to enhance the provision of culturally competent care and address health inequity and access barriers. Therefore, recruiting and retaining occupational therapy students from diverse backgrounds in a safe and inclusive academic environment is important for the entire profession. Methods : A scoping review of sources exploring the lived experiences of occupational therapy students from one or more diverse backgrounds was undertaken. The sources used qualitative or mixed methods approaches and were published in English since 2014. Databases searched via the EBSCOHost platform included Medline, CINAHL, AMED, Pubmed, SocINDEX, ERIC, and CENTRAL via Cochrane. Citation searching was conducted on included papers using the Connected Papers platform. Articles were screened by two independent researchers by title and abstract, and then by full text, before relevant data were extracted. Results: Thematic analysis identified evidence relating to barriers and facilitators in the systemic and organizational context; departmental and peer supports; and the students' lived experiences of professional programs. Strategies suggested to address these barriers include purposeful mentoring, increased knowledge of the student’s culture, and increased accessibility. Conclusion: There has been an increase in the amount of research published regarding diversifying student populations. The experiences of diverse occupational therapy students during professional education are influenced by multiple individual, group, organizational, and systemic factors. More research is needed to evaluate the effectiveness of these strategies. Cultural Studies Diversity occupational therapy professional education equity inclusion intersectionality Figures Figure 1 Figure 2 Introduction The demographics of the occupational therapy workforce in many countries often fail to reflect the population they serve [ 1 ]. These communities are diverse and intersectional, encompassing individuals of different genders, sexes, ages, socioeconomic statuses, cultural backgrounds, religions, sexual orientations, neurodiversity, and living locations, as well as people with and without disabilities [ 2 ]. In contrast, occupational therapists typically identify as White, middle-class, and female [ 1 , 3 , 4 ]. In this paper, the terms “diverse" and “diversity” are used to represent the wide variety of different human characteristics within human populations, such as race, ethnicity, gender, sexual orientation, age, socioeconomic status, religion, physical and mental abilities, and cultural background. Groups which differ from majority characteristics (in this case, White, middle-class, and female) are often characterized “under-represented,” “marginalized,” and “vulnerable.” [ 5 ] Limited diversity within healthcare professional workforces can lead to a lack of cultural humility when interacting with diverse communities [ 5 ]. A lack of diversity in the workforce may reduce incentives and opportunities for people from these groups to join the profession, particularly when the visibility of individuals from these groups is low, and few role models exist [ 6 ]. This is not only an equity issue, but it may also be influencing the demographic composition of student cohorts entering higher education to study occupational therapy [ 6 ]. Increasing opportunities for students from diverse groups to enter and remain in the profession may enhance recruitment and retention [ 7 ]. The experiences of people from diverse groups can be both positively and negatively influenced by the safety and inclusivity of the educational environment and support available [ 6 ]. Safe environments include those perceived as welcoming and enabling of positive and inclusive interactions that promote social and emotional learning [ 8 ]. Some research has been conducted to explore the educational environment in occupational therapy courses around the world. Previous research into the experiences of diverse occupational therapy students is generally single case studies of specific groups, for example, occupational therapists in Canada who were trained overseas [ 9 ], allied health students moving to study in a regional university [ 10 ], and new graduate occupational therapists commencing work in rural Australia [ 11 ]. A recent scoping review exploring the intersectional experiences of minoritized occupational therapy practitioners and students found that practitioners and students alike often tolerate hostile and unfair environments, recommending that the profession focus on and improve efforts to address these issues [ 12 ]. This scoping review synthesized information about the articles, such as the country, group investigated, and whether the authors identified as members of these groups, and developed four themes from the literature [ 12 ]. However, the experiences of students and practitioners were evaluated together, though the needs of these two groups may differ when addressing any challenges identified and warrant separate evaluation. The review also did not synthesize literature regarding barriers, facilitators, and implications for the higher education sector, and did not include studies about other minoritized groups, such as students from rural backgrounds or those from low socio-economic backgrounds. Exploring occupational therapy students’ experiences in educational settings reported in the literature will provide a profile of their level of inclusion in higher education contexts and will allow for the examination of what strategies should be implemented to improve the support available to these students. Occupational therapy students may belong to multiple diverse groups; therefore, this review was conducted using an intersectional lens to examine issues experienced by students. Intersectionality is a framework that can be used to understand how different factors or identities overlap, compound, or intersect to create a profile of discrimination and privilege that may influence someone’s life experiences [ 13 ]. Intersectionality is a relatively recent concept in the occupational therapy literature and has most often been applied to service users rather than students or clinicians [ 14 ]. However, adopting an intersectional perspective is crucial to developing a more nuanced and person-centred understanding of the needs of diverse occupational therapy students and the implications for the broader profession. A recent scoping review of experiences of diversity for occupational therapy practitioners and students found that both groups are exposed to and must tolerate hostile and unfair educational and employment environments, leading the authors to recommend that the profession prioritize efforts to address these issues [ 12 ]. The aim of this scoping review was to analyze current knowledge gaps and identify potential strategies for increasing diversity in the occupational therapy student population, specifically. The primary objective was to identify common facilitators, barriers, or strategies that impact safety and inclusion in the workforce. Therefore, the research question for this review is “What does the literature say about the lived and living experiences of occupational therapists from diverse backgrounds during professional education using an intersectional lens?” Sub questions include: (1) What are the common facilitators and barriers to safety and inclusion to support diverse occupational therapists through professional education? (2) What strategies are suggested to support the safety and inclusion of occupational therapists through professional education? and (3) From an intersectional perspective, how do the experiences of occupational therapy students from under-represented and diverse backgrounds compare? Methods The review was conducted per the Joanna Briggs Institute (JBI) methodology for scoping reviews [ 15 ]. A scoping review was the most appropriate approach due to the relatively sparse literature available on the topic and the need to understand future directions for education, research, practice, and policy [ 16 ]. The scope of the review was intentionally broad, incorporating data on the experiences of people from various and/or intersecting diverse groups to examine the experiences of occupational therapy students from multiple perspectives. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used to structure all reporting [ 16 ]. The review was registered in the Open Science Framework registry on 14/11/2024 ( https://doi.org/10.17605/OSF.IO/3CWYF ) [ 17 ] This review was part of a broader review that included diverse occupational therapists at all stages of their professional career (i.e., from professional education to practice). During the review process, it became evident that the context and experiences of students were distinct enough from those of practitioners, and the sources related to these two groups were analyzed separately. The findings of sources, including both students and practitioners, were included in both reviews, reporting only those relevant to the chosen group. The scoping review related to diverse occupational therapists in practice is published separately. Inclusion Criteria Participants Sources appropriate for this scoping review included articles that focused on occupational therapy students from diverse backgrounds from any area of practice or geographical location. All sources addressed the concept of the lived and living experiences of occupational therapy students, including the exploration of perceptions, attitudes, beliefs, subjective data, narratives, or any other approach to understanding personal experience. Studies were also included if they contained a mixed sample of practitioners and students, and if specific findings related to student participants were reported. Types of Sources Included sources reported on the experiences of students from any population group characterised as diverse, marginalized, under-represented, or vulnerable. These groups included those who identify as: disabled, male, non-binary, LGBTIQ+, culturally and linguistically diverse, living rurally or remotely, Indigenous or First Nations people, people of color, adults over 65 years, and/or of lower socio-economic status. Qualitative studies were located, including, but not limited to, phenomenological, grounded theory, ethnographic, descriptive, action research, and feminist research designs. Mixed methods studies were also included, where qualitative approaches were the primary methodology. Search Strategy A search strategy involved locating published studies relevant to the review question, which began on November 14, 2024, and was periodically updated until the final review on June 30, 2025. The first step was to complete a limited search of MEDLINE (via the EBSCOhost platform) to identify key articles on the topic. (see protocol for details [ 17 ]). In the second step, keywords contained in the titles and abstracts of relevant articles, along with index terms, provided the basis for developing a full search strategy for MEDLINE (EBSCO) (See Supplementary Materials II). The search strategy, including identified keywords and index terms, was adapted for each database and/or information source. The third step involved citation searching of all included sources of evidence, which was conducted using the Connected Papers platform [ 18 ]. A university librarian was repeatedly consulted to review and provide feedback on the search strategy to ensure its scope was feasible and comprehensive [ 19 ]. Initially, the search strategy focused on the experiences of transitions between education and practice; however, this was found to limit the search of literature relevant to the research question, so the scope was broadened for any stage of a professional career, and eventually split into an article relevant to students and another relevant to practitioners. Studies published in languages other than English were not included due to the language profile of the review team and resource limitations. Studies published since 2014 were included to encompass developments in multiple healthcare systems internationally and university occupational therapy programs in the last decade. Evidence Screening and Selection Following the search, all identified citations were uploaded into the Covidence platform [ 20 ], and duplicates were automatically removed. Titles and abstracts were screened by two independent reviewers within the team (AF, DS, TW) for assessment against the inclusion criteria for the review. Potentially relevant sources for inclusion were retrieved in full, with a copy text imported into Covidence [ 20 ]. Two independent reviewers then assessed the full text in detail against the inclusion criteria. Reasons for the exclusion of sources at this stage were recorded and are reported here. (see Fig. 1 ). Disagreements between reviewers at each stage of the selection process, typically less than 10% of sources, were resolved through discussion with a third reviewer. The search and screening results are presented in a PRISMA flow diagram (see Fig. 1 ) [ 15 ]. Data Charting Process Data were extracted from included sources by all authors independently (AF, DS, TW, DH) using the data extraction tool developed by the reviewer (see Supplementary Materials III). The data extraction table was developed based on examples from other reviews and recommendations. [ 21 ]. A draft data extraction form was piloted with all review team members independently extracting data for a subset of the articles, then comparing their results to ensure the form captured relevant data for the review question. Extracted data included details about the participants, concept, context, study location, study methods, and key findings relevant to the review questions. Any disagreements about extraction arising between reviewers were resolved through collaborative discussion by the entire review team. Data Analysis and Presentation Critical appraisal of the articles was not conducted, consistent with scoping review methodology. Study characteristics (e.g., population, publication year, etc.) were described numerically and narratively. Descriptive thematic analysis was then conducted across studies, synthesizing literature related to the research questions. These data were reported narratively, with supporting tables and charts. Themes were developed through analysis of recurring issues that emerged in the literature that were identified and agreed upon by the authors. Results The initial titles search identified 1394 articles from databases and 85 additional sources from citation searching. After applying the inclusion criteria and removing duplicates, 1020 articles were subjected to further screening, and 165 studies were selected for full-text review (see Fig. 1 ). Insert Fig. 1 here The final number of studies included in this scoping review was 24. Eighteen articles focused on the experiences of professional education of diverse occupational therapy students, with six further including both occupational therapy students and practitioners. Figure 2 illustrates the number of publications per year, showing a general upward trend. Of the 24 publications, the majority of the studies originated in Canada (n = 9, 37.5%), followed by the United States (n = 7, 29.2%), Australia (n = 3, 12.5%), United Kingdom (n = 3, 12.5%) and South Africa (n = 2, 8.3%). Insert Fig. 2 here Themes Thematic analysis of the sources identified evidence relating to barriers and facilitators in the systemic and organizational context; departmental and peer supports; and the students' lived experiences of professional programs (Table 1 ). Table 1 Study Characteristics Author/Year, Country, Journal Aim Methodology/Data Collection Participants Limitations Aldridge et al. (2023). Canada Journal of Occupational Therapy Education, 7 (4). This study explores Black OT students' lived experiences with systemic racism during their academic program A phenomenological research design was used for this study. Fifteen one-to-one semi-structured interviews and five focus groups were conducted. Participants included fifteen Black OT students attending school in the United States. Interviews were conducted via Zoom due to safety concerns regarding the global COVID-19 pandemic. These interviews may have felt impersonal and may have skewed body language, facial expressions, and the natural flow of conversation. Connectivity issues may also have affected these interviews. The methodology is somewhat flawed as the data are self-reported and filtered through the participant’s point of view. The final limitation includes researcher bias. Benitez et al. (2022). United States Journal of Occupational Therapy Education The purpose was to identify and understand the perspectives of international students and alumni on their transition to graduate-level occupational therapy education and daily life in the United States. A qualitative research design was used for this study. Eleven individual interviews and one joint interview with two individuals were conducted. Data were analyzed through group-based methods. Participants included thirteen international students currently enrolled in post-professional occupational therapy programs in the United States, as well as alumni. The results presented were from a single university and may not accurately represent the views or experiences of all international students. This study includes perspectives of international students from the Philippines, Ireland, India, South Korea, Singapore, Venezuela, Canada, China, South Africa, and Taiwan, and lacks perspectives of students from other parts of the world. Bevan, J. (2014) United Kingdom Disability & Society To describe a small-scale study of the experiences of disabled occupational therapists, recounting their journey and having a first-hand account of the reality of being a disabled health professional. The study utilized an ethnographic approach to data collection. Individual, unstructured, ethnographic interviews were used. A thematic analysis was employed, involving the reading and annotation of transcripts, as well as working within and between accounts, to identify themes. 1 = diagnosed with Parkinson’s disease when she was 43 years old. 1 = born with cerebral palsy, which affects her left side. 1 = dyslexia. 1 = has a hearing impairment that was diagnosed when she was three; she also has rheumatoid arthritis. 1=(the researcher) was told I had ‘grown out’ of childhood epilepsy aged 10, but was re-diagnosed 5 years after qualification as an occupational therapist when it was triggered by a virus. This study only examined the retrospective experiences of a small number of members of the Disability Forum and the findings are therefore not generalizable to all disabled occupational therapists, but may be transferrable to some, as well as to other disabled health professionals or students. The study suggested that barriers still exist to the acceptance of disabled people as professional colleagues. Ching, E. & Ammon. A. (2020). United States Diversity & Equality in Health and Care This research study explored the lived experiences of a recent graduate of color and a faculty of color in a mentoring relationship. A phenomenological approach utilizing semi-structured interviews was used for this study. Two participants: one student of color who recently graduated and one faculty of color. Small sample size Easterbrook, et al. (2015). Canada Disability & Society This study explored the experiences of students in Health and Human Service programs with disabilities. A qualitative study, employing a phenomenological design, was used for this study. Semi-structured and structured interviews were conducted to explore the barriers, challenges, and facilitators experienced by HHS students with disabilities. Participants were Twelve students with disabilities in HHS programs: (medicine, n = 1; nursing, n = 2; occupational therapy, n = 1; physical therapy, n = 1; social work, n = 2; teacher education, n = 5) Small exploratory study in which students may not be representative of all students with visible and non-visible disabilities. Edelist et al. (2024). Canada Medical Education This study examined how the Health and Human Services education creates meanings of disability, accommodations, and professional competence, to investigate how students with disabilities continue to experience barriers. This study used a phenomenological design with interpretive analysis. 14 individual and seven group interviews were conducted. Thirty-five HHS students with disabilities The study's structure resulted in some HHS professions being disproportionately represented in the data, and the view may not be reflective of students with disabilities from other professions. Ford, et al. (2021). United States American Journal of Occupational Therapy The purpose of this study was to explore the perceived challenges to and facilitators of the recruitment and retention of OTPs and students of color. A qualitative approach with an interpretive, constructionist design was used to examine perceptions of facilitators and barriers experienced by OTPs and students of color. Data were collected online from three focus groups and four interviews. 5 occupational therapy practitioners and students of color in the United States. This study had a small sample size, and its findings may not be representative of the views of all practitioners and students of color. Participant recruitment was limited through social media, word of mouth, and at the in-person conference. Gross, E. et al. (2023). Canada International Journal of Inclusive Education This study aimed to understand the barriers experienced by students with disabilities in Canadian education during practice placement, and the means that might facilitate support and accommodations, from the perspectives of students with disabilities. This study employed a mixed-methods, quantitative and qualitative design, comprising 82 survey responses and 11 semi-structured interviews. 82 survey participants from health and human services and occupational therapy programs in Canada. Of the 82, 11 were interviewed. Study limitations included a small qualitative sample size. Hendricks, F., & Toth-Cohen, S. (2018). South Africa Occupational Therapy International This study examined the personal narratives of Black OT students attending the Occupational Therapy International 3 first OTASA National Student Leadership Camp, which was designed to foster authentic leadership development. Pilot study. Structured interviews were conducted Twelve occupational therapy students from six university OT programs in South Africa This small pilot study may not be representative of the experiences of Black student leaders in OT. Jarus, T. et al. (2023). Canada Medical Education This study examines the recurrent forms of social relations that underlie the participation of individuals with disabilities across health professions within the current context of health education and practice. A phenomenological design, utilizing grounded theory and semi-structured interviews, was employed to explore ‘what disability is like’ in the roles of health professional students and practitioners. Fifty-six individuals with disabilities: health practitioners (n = 29) and students (n = 27) from 5 professions : medicine (n = 6), nursing (n = 15), occupational therapy (n = 13), physical therapy (n = 7), and social work (n = 15). Study participants came from only two Canadian provinces and may not capture experiences common in other jurisdictions Lalor, A. F. et al. (2019). Australia British Journal of Occupational Therapy This study aimed to understand international students’ perceptions of the purpose of practice placements and the attributes that contribute to successful practice education. A qualitative design utilizing a semi-structured interview format was used to gain a rich understanding of occupational therapy International Students’ experiences, views, and perceptions of undertaking practice placements Seven International Students from countries located in the Asia-Pacific region spoke English as a second language. The sample of international occupational therapy students may not be representative of all International Students from Asian countries. Law, et. al. (2022). United Kingdom Scandinavian Journal of Occupational Therapy The study primarily aims to explore the opportunities and challenges experienced by a student group in practice education. It also aims to examine how the students can be supported to facilitate a high-quality learning experience. A phenomenological approach was used to uncover the first-hand experiences of practice education from a group of international students enrolling in pre-registration OT programs in the UK. In-depth, in-person interviews were conducted with 6 students. 6 international students enrolled in pre-registration OT programs in the UK This study had a small sample size. Some participants of this study had limitations in their oral proficiency in English and may have struggled to express certain thoughts or opinions during the interviews Lim, et al. (2016). Australia Australian Occupational Therapy Journal This study aimed to explore and describe the experiences of international students from Asian backgrounds studying occupational therapy in Australia. A phenomenological approach was used to understand the experiences of participants. In-depth interviews were conducted with 8 international occupational therapy students from Asian countries studying in Australia. Data were analyzed using hermeneutic methods. Participants were recruited from two occupational therapy programs at the University of Sydney. 2 = Male 6 = Female 3 = Hong Kong 2 = Malaysia 3 = Singapore 7 = Chinese 1 = Muslim Malay This is a small exploratory study, where participants may not be representative of all occupational therapy students from Asian countries in Australia. The sample was primarily composed of Chinese females. The first author was a peer who may have affected the results. Lindsay et al. (2023). Canada Disability and Rehabilitation , The objective of this review was to explore the experiences and impact of workplace discrimination and ableism among healthcare providers and trainees with disabilities. Systematic searches of seven databases from 2000 to January 2022 were conducted. Five reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality. Forty-eight studies met the inclusion criteria, representing 13 participants from six countries over 21 years. The sample sizes of the included studies ranged from 2 to 11,859. 20 in the US 14 in the UK 8 in Canada 3 in Australia 2 in Ireland 1 in New Zealand Types of disabilities included non-visible disabilities, dyslexia, learning disabilities, physical disabilities, mental health disabilities, and sensory disabilities. Studies were from six countries, which have different customs and policies for the recruitment and treatment of people with disabilities in the workplace. Therefore, it was difficult to make comparisons. Many studies did not specify a distinct disability, but were heterogeneous, and the sample sizes were small. Luong, et al. (2023) US Journal of Occupational Therapy Education This study explored how occupational therapy students’ perceptions of racism and ethnic discrimination impacted their educational experiences. Students completed an anonymous web-based survey that included a demographic questionnaire, the Brief Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV), and open-ended survey questions. Mean +/- standard deviation was computed for quantitative variables and frequency for ordinal variables. The normality of quantitative variables was assessed using the Shapiro-Wilk test and box plots. Pearson correlation analysis was performed on the participants’ responses to the Brief PEDQ-CV. Data were analyzed using SPSS V. 28. All analyses were performed at an alpha level of .05. Participants included 226 students aged 18–60 years old enrolled in occupational therapy entry-level, post-professional, or assistant programs throughout the United States The students in the study may not represent the general student population outside of OT or OTA programs; therefore, they cannot be generalized to other student populations. The 20-minute length of the survey may have been a limitation. Also, data were not collected through an interview that would have allowed participants to provide clarification and elaborate meanings of their responses. Not all students were minoritized. Otuniga & Chichaya (2025). UK Irish Journal of Occupational Therapy This study aims to explore the experiences of Black students enrolled in pre-registration occupational therapy programs at a university in the U.K. A qualitative phenomenological study design was used for this study. Semi-structured interviews were conducted. Thematic analysis resulted in four themes. Seven Black occupational therapy students were selected using purposive sampling. Conducting interviews via Microsoft Teams may have felt detached for the participants and distorted the conversation’s organic flow, body language, and facial reactions. UK literature is scarce, focused on Black OT students, so literature was drawn from other countries. Penman et al. (2021). Australia Journal of International Students International students report higher sociocultural and academic stress when settling into a new university compared with their local counterparts. Three disciplines in the health professions collaborated to create a transition program addressing international student health and well-being in Australia. Commencing students and senior student mentors participated in a four-session program of activities to reflect on their current study/work practices and learn self-management strategies. Participants developed plans for coping with cultural, language, academic, and social barriers, and assisted in improving physical and mental health and well-being. Of the 26 participants who attended sessions, 15 participated in in-depth interviews. Postgrad dietetics course = 1 Postgrad nursing course = 7 Undergrad nursing course = 2 Undergrad OT course = 5 Mainland China = 8 Hong Kong = 3 Malaysia = 2 Taiwan = 1 Philippines1 Female = 12 Male = 3 A small number of international students who volunteered to participate limits generalizability. No comparison group. Pride, et al. (2024). Canada Diaspora, Indigenous, and Minority Education To explore the education experiences of health professionals from marginalized groups in Canada. The authors drew on a subset of data from a larger qualitative study examining experiences of health professionals who self-identify as disabled, working-class origin, racialized, ethnic minority, and/or minority sexual/gender identity (LGBTQ+). Thematic analysis was conducted. Transcripts were coded using ATLAS.ti software to facilitate team coding. Interpretative thematic analysis moved iteratively between compiling coded data and re-reading full transcripts, moving back to theory, then returning to the transcripts and coded data. Participants include 35 participants from medicine, nursing, and occupational therapy. Nurses = 9 Physicians = 12 OTs = 14 Racialized = 17 Ethnic minority = 12 LGBTQ + = 11 Working-class origins = 10 Disabled = 7 Only 7 of 35 participants were men, disproportionately in medicine. Nuances that are profession-specific may have been missed. Heterogeneity of the sample is a challenge for theoretical saturation. Pride, et al. (2025). Canada Cadernos Brasileiros de Terapia Ocupacional This manuscript explores the retrospective educational experiences of Indigenous occupational therapists. This study was collaborative in nature with Indigenous occupational therapists across the country, using both Indigenous and Western methods of inquiry. Stage 1 used individual storytelling sessions (n = 13) to hear about participants' everyday experiences. Stage 2 consisted of an in-person sharing circle gathering (n = 8) to build relationships and community, and to refine data from Stage 1 Data were compiled and uploaded into Atlas Ti8 for the development of themes. Preliminary themes were presented at a sharing circle. Using purposive and snowball sampling. 8 = first nation 5 = Métis 8 = 0–4 years of practice 1 = 5–9 years of practice 4 = 10 + years of practice 4 = Eastern Canada 5 = Central Canada 4 = Western Canada Small sample size Most participants had less than 4 years of practice Stories are not necessarily comparable or generalizable. Ramirez & Kiraly-Alvarez (2023). US Journal of Occupational Therapy Education The purpose of this study was to identify the supports and barriers to inclusion in occupational therapy (OT) education from the experiences of OT students from historically marginalized groups and the perspectives of OT faculty/staff. The authors used a convergent mixed methods design for the study, which consisted of an online survey and semi-structured interviews. The authors used descriptive statistics to analyze quantitative data from the survey. Responses were collected and exported into Microsoft Excel to analyze frequencies, percentages, and measures of central tendency to summarize demographic data and responses. In addition, the authors used rank and frequency distribution to understand the supports and barriers. A phenomenological thematic analysis was used to analyze qualitative responses from surveys and interviews. Using a purposeful, convenience, and snowball sampling technique, 131 students and 35 faculty/staff completed the survey, while 20 students and 11 faculty completed interviews. Sample size limits external validity. Use of a convenience sample may have resulted in self-selection bias and response bias. First author identifies as a member of a historically marginalized group. Razek, L. & Zafran, H. (2022). Canada McGill Journal of Global Health This study explored admissions processes related to the inclusion of equity groups within McGill University’s Occupational Therapy program and identified recommendations specific to Black applicants. Data were collected from a survey of current students and program graduates. Data analysis, applying a critical intersectional lens, was contextualized in dialogue with five key individuals at McGill and a review of the literature. Data analysis applied a critical intersectional lens, was contextualized in a dialogue with five key individuals and a review of the literature. 73 survey respondents 21–24 = 30.14% White/Caucasian = 46% Black = 3% East or Southeast Asian = 27% Indigenous = 3% Other = 13% Female = 64.38% Male = 35.62% Linguistic minorities = 13.7% Visible minorities = 28.77% LGBTQ + = 35.62% Disabled = 31.51% Only 2 students identified as Black, highlighting the overall low number of Black OT students and graduates. Questionnaires needed to be bilingual for students whose first language was French. Perspectives of prospective applicants who chose not to apply or failed the application process were not captured. Salvant, S., et al. (2021). US American Journal of Occupational Therapy To discuss the influence of systemic racism on the profession of occupational therapy. In June and July of 2020, the AOTA hosted a series of listening sessions, entitled “Be Heard-We’re Listening,” to provide a platform for BIPOC persons to discuss lived experiences. Common topics, experiences, and recommendations for action were transferred to an Excel spreadsheet and categorized and summarized to determine emerging themes. 4 sessions between June 18-July 23, 2020, with approximately 200 participants per session. Possible selection and response bias. The use of Zoom, which was not accessible to all in 2020. Themes are open to interpretation. Serrano-Diaz et al. (2025). US American Journal of Occupational Therapy To investigate the inclusion and belonging experiences of minoritized occupational therapy practitioners and students internationally. A scoping review explored articles published between January 2010 and July 2022 using six journal databases. An updated search was completed using Litmaps and Google Scholar to check for articles published between August 2022 and May 2024. Using NVivo, the authors inductively led the code development, conceptually clustering aspects of the articles and enriching the themes until all included studies had been coded. Authors also provided feedback on the order and clustering of themes. Thirty-one studies across 17 journals highlighted four distinct minoritized groups (some study criteria included multiple identities): culturally and linguistically diverse people ( n = 16), people with disabilities ( n = 8), LGBTQ + individuals ( n = 8), First Nations people ( n = 2). Only articles in English were included. Findings should be treated as preliminary and applied with careful consideration of the unique social, institutional, and population contexts. Many of the findings come from experiences of marginalization within the OT profession in Westernized, industrialized, and settler-colonial nation-states. Certain minoritized groups are missing (e.g., transgender, gender-diverse, intersex, or asexual or aromantic people, members of the Deaf community, specific cultural groups). van Rensburg & Kapp (2014) South Africa South African Journal of Occupational Therapy This article describes and analyzes the learning journey of Zinhle, a first-generation university student from an impoverished rural village who studied occupational therapy at a relatively elite South African university. Qualitative longitudinal analysis was used in a single case study to analyze four interviews conducted with Zinhle over her undergraduate years. Each semi-structured interview was spaced a year apart to allow Zinhle to reflect on her experiences of the previous academic year. Data were analyzed inductively by the two researchers. Thematic content analysis was used to analyze the transcribed interviews. 1 participant, a first-generation university student from an impoverished rural village who studied occupational therapy at a relatively elite South African university. Generalizations cannot be made from a single case study. Table 2 Lived Experiences, Barriers and Facilitators Author Lived Experiences Barriers to safety, inclusion, and/or justice. Facilitators, strategies or resources for safety, inclusion and/or justice. Aldridge et al. (2023). Canada Journal of Occupational Therapy Education, 7 (4). Students identified that they were impacted by systemic racism in the academic and clinical settings. Participants reported that their sense of Belonging was affected by the lack of Black representation in their OT programs. Students identified increased anxiety around the lack of Black representation. Students reported feeling burdened for having to initiate change as the “diversity person.” Participants initiated change at their institution in their own ways by starting chapters for the Coalition of Occupational Therapy Advocates for Diversity (COTAD), opening forums and workshops to spark conversation surrounding diversity, imploring their institutions to make statements about high-profile Black murders, and working with professors to develop more culturally sensitive materials. Benitez et al. (2022). United States Journal of Occupational Therapy Education Participants’ lived experiences included the challenges inside and outside of the classroom, including differences in pedagogical methods, English language proficiency, barriers identified in daily life, and transitioning into the workforce. Participants also experienced a need for a support system away from home and the need to give back to their home country. Identified barriers included changes in every aspect of daily life, and how each experience is new, different, and extraordinarily complex. These barriers affect their overall well-being. The creation of a support system: a home away from home Giving back to the home country: improving occupational therapy education, practice, and research Bevan, J. (2014) United Kingdom Disability & Society Participants experienced negative attitudes from clients/patients and colleagues. Also discussed were negative attitudes toward the university application and interview. Also experienced were inaccessible environments in the educational setting. Experiences with organizational barriers included bureaucratic policies, guidelines, or structures of an organization that made it difficult for the participants to directly or indirectly access information. Some experienced that being diagnosed with a disability gave them a “reason” for some of their difficulties. Environmental barriers included steps or stairs, absence of hearing loops or accessible information. The participants did not see environments as a barrier, they were used to adapting and saw no reason why they should not do ‘anything I wouldn’t do anyway’. The environment was seen as a barrier by others, not them. Organizational barriers indicated a general lack of knowledge relating to funding sources for equipment, adaptations, and support. A firm commitment is required by the profession to: removing disabling barriers in education, practice, and research; recognizing and endorsing initiatives like the Disability Forum (in their own right as well as part of a national diversity network); and reviewing their guidelines on an ongoing basis. A positive, inclusive approach towards disabled occupational therapists may inspire greater diversity within the profession, challenging its stereotypical image and helping to ensure it develops to meet the needs of current and future registrants and service users alike. Ching, E. & Ammon. A. (2020). United States Diversity & Equality in Health and Care Participants expressed feelings of imposter syndrome that impacted their mental health and increased stress and anxiety within the classroom. This study identified a lack of representation as a barrier to success and inclusion in academic settings. Facilitators of a positive mentor/mentee relationship included similar racial, cultural, and class backgrounds The findings of this study focus on the need for quality mentorship, spaces, and opportunities to dialogue about race and racism, and institutional structural support for the recruitment, retention, and success of both students and faculty of color in academia Mental health resources are provided by the university. Easterbrook, et al. (2015). Canada Disability & Society Students with disabilities had to legitimize their ability to perform the roles of student and future practitioner. Students found there were often complexities around the disclosure of disability. Faculty can foster a learning environment that is supportive of students’ differing levels of comfort concerning telling others about their disabilities and needed accommodations. Working with students to create personalized accommodations can motivate students to advocate for their needs. Edelist et al. (2024). Canada Medical Education Students reported they feared having their competence questioned based on the disclosure of their disability. Students also feared accommodation requests being denied. The dominant medical model of disability in Health and Human Service education creates institutional barriers that require students to constantly (re)construct their ‘professional’ identity in relation to their ‘patient’ identity. Suggestions for strategies included reworking competency standards to critically examine taken-for-granted competency and licensing standards, particularly the assumption that disability is a problem for practice. Strategies suggested training to shift ableist ideas about what it means to be a competent practitioner. Ford, et al. (2021). United States American Journal of Occupational Therapy Participants described feelings of being an outsider within the educational and professional setting. They also described a lack of support from faculty, peers, and clinical instructors. Participants reported feelings of self-doubt and tokenization within the education setting. Students identified non-welcoming settings, racist faculty, and systematic barriers such as financial support as barriers to success. Purposive recruitment targeting diverse institutions, along with holistic admission and diversity-driven missions. Creation of formal mentoring programs via diversity caucuses. Cultural awareness/bias training for faculty/Clinical instructors, along with inclusive curricula highlighting diverse OTPs. Gross, E. et al. (2023). Canada International Journal of Inclusive Education Students reported attitudinal barriers when seeking placement accommodations. A requirement to disclose in order to request accommodations raised fears of having people determine whether students were capable of practicing. Students identified a lack of knowledge and awareness of supports regarding placement accommodations. Students were unaware of their university’s procedures for seeking placement accommodations. Additionally, students expressed concern about academic educators’ lack of awareness of the existence of, or the options for, placement accommodations. Collaboration across Health and Human Service programs is needed to develop clear and effective placement accommodation procedures. Those who support disabled students in placement should receive education on supporting students with disabilities and legal obligations of accommodation. Students may benefit from advocacy and disclosure skill education. support from placement educators and an understanding of what the students’ limitations are and how to support them’ to successfully complete a placement. Hendricks, F., & Toth-Cohen, S. (2018). South Africa Occupational Therapy International An individual’s positive psychological state of development is characterized by (1) confidence, (2) being optimistic about succeeding, (3) perseverance toward goals and, when necessary, redirecting paths toward goals (i.e., showing hope) in order to succeed, and (4) when beset by problems and adversity, sustaining and bouncing back and even beyond (i.e., resilience) to attain success. Within the historical context of a contested description of being “Born Frees” (i.e., born into Democratic South Africa), students face significant challenges from the macro environment in terms of socioeconomic-political struggles, requiring positive psychological capital. Use of personal storytelling in OT leadership camps/ curricula, to facilitate leadership growth in self-knowledge, self-awareness, and other elements of mindful leadership. Leadership development models that recognize life purpose, values and morality. Jarus, T. et al. (2023). Canada Medical Education Although protected by legislation and policies that support their access to the health professions, participants experience challenges to their sense of legitimacy and belonging as health providers. Educational and workplace demands negatively impacted social relations among colleagues and peers. In the educational setting, for example, student participants have experienced their peers as viewing their disability and accommodations as an unfair source of advantage in a highly competitive environment. Challenges to legitimacy and the physical inaccessibility of many practice and education settings alienates students with disabilities. For example, educational settings that are not accessible put the responsibility on disabled students to do the extra planning to engage in learning activities, thus giving the impression that they are less valued. Participants described supportive relationships with colleagues, employers, instructors and others in health education and practice as respectful; collaborative; trusting; kind and warm; rigorous, but fair and welcoming; sensitive to needs; open; encouraging; and friendly. Lalor, A. F. et al. (2019). Australia British Journal of Occupational Therapy International students identified that supportive supervisors and a welcoming environment helped to define a successful clinical placement. Placements that facilitated open communication between students and staff members helped students’ transition to practice placement. International students also expressed how practice education assisted in their understanding of the Australian hospital system, which was different from their home country. Students valued practice placements that demonstrated a welcoming environment by promoting a student-friendly culture. Increased cultural sensitivity/training for clinical supervisors. Students identified supportive supervisors were those who were approachable, listened, provided emotional support, and were flexible with their approach as a supervisor. The provision of a detailed orientation to the practice placement, including the physical site, available facilities (for example, tea and coffee, bathrooms, parking), and the service delivery framework. Law, et. al. (2022). United Kingdom Scandinavian Journal of Occupational Therapy Students reported that the ability to learn how to work in multidisciplinary teams led to personal/professional growth International students identified negative experiences when faculty assumed their experiences were similar to local students. Students identified language limitations and cultural differences, creating reduced confidence and inclusion. Students reported self-directed learning demands were different than prior didactic styles, creating exclusion and difficulty with curricula. Inadequate university support beyond liaison tutors; need for cultural orientation Facilitators included the willingness of peers to share cultural expectations. System-level policies: Proactive disability planning, clear accountability, team-based competency focus. Lim, et al. (2016). Australia Australian Occupational Therapy Journal Participants described three interlinked and ongoing themes that were essential to the experience of being an occupational therapy student in Australia for these students: (1) Discovering and engaging with occupational therapy; (2) Fitting into my new role; and (3) Anticipating my role at home. Participants experienced the continuing discovery of a profession about which they initially knew little about. They encountered difficulties but adapted themselves to fit in and succeed as occupational therapy students in Australia. Although they continued to see themselves as different from domestic students, these changes influenced how they saw themselves fitting back within their home cultures; while the theoretical aspects of occupational therapy were seen as compatible with participants’ home cultures, application was seen as problematic due to the differences in structure and institutional culture of the healthcare systems The poor understanding of occupational therapy reported in their home countries is likely to reflect its low profile and may also be exacerbated by language issues. For example, the literal translation of ‘occupational therapy’ in Asian languages can be misleading or unfamiliar. None of the students reported feeling that they had reached an optimal state of competence and mastery, and the occupational identity of international occupational therapy students included being different and separate from domestic students. The findings in the second theme, ‘fitting into my new role’, indicated that cultural and language issues are major barriers in both adjusting to the university environment and achieving academic success. Participants identified some aspects of occupational therapy theory and practice that corresponded with Western rather than Asian worldviews, Students were concerned that they would retain their sense of themselves as different when they initially returned to their home cultures and that it would take effort to fit back in and master a sense of belonging. Students adapted, despite the difficulties, by changing their behaviors and sometimes even their attitudes, described as both necessary and deliberate. Improved integration with domestic students would benefit students by improving both English language skills and understanding of and comfort with Australian culture. It would also benefit domestic students who maintain close interactions with international students to exhibit greater cultural sensitivity, attitudes, and behaviors that foster international awareness, openness, curiosity, and cooperativeness. Educators can consider providing structured opportunities in coursework and assessment for international students to relate their learning to practice in their home countries. Lindsay et al. (2023). Canada Disability and Rehabilitation , Key trends related to student and practitioner experiences of workplace ableism included: rates and types of workplace ableism, which occurred at the institutional and individual level; and the impact of workplace ableism. Barriers included disability discrimination, hostile work environments, retaliation against a person for participating in activities protected by the statute, stereotyping, and bullying. Institutional ableism included inaccessible environments and physical barriers, a lack of support, and an unsupportive work environment. In health professions, these included difficulty disclosing due to fear of stigma, the impact on health and well-being, and the impact on job and career Having more knowledge about people with disabilities could help to reduce stereotypes while improving positive attitudes, empathy, and social inclusion. More support at an institutional and senior leadership level is needed to enhance the inclusion of people with disabilities and particularly engage managers and coworkers to be less discriminatory. Luong, et al. (2023) US Journal of Occupational Therapy Education Students experienced racism or ethnic discrimination in settings, such as external educational opportunities (e.g., school applications), program curriculum, on campus, and in fieldwork. Fieldwork was the most reported setting where students experienced racism or ethnic discrimination Barriers included racism and ethnic discrimination in their educational setting. Though students reported having experienced racism or ethnic discrimination within the classroom and fieldwork settings, classroom conversations and content related to topics on diversity, equity, and inclusion (DEI) and anti-racism were limited. OT programs are encouraged to increase these conversations and implement supportive resources for students who have experienced racism and ethnic discrimination. Recommendations include: a) acquire additional education in DEI-related subjects; b) continue to incorporate more conversations related to topics of DEI, racism, and ethnic discrimination in the classroom and fieldwork settings; c) provide simulated or real-life hands-on opportunities and experiences to work with people of color within the community; d) teach students how to appropriately behave and respond to racism and ethnic discriminatory situations; e) create program curriculums that focus on DEI and anti-racism content; f) host support groups with diverse people to encourage mentorship between students, practitioners, and community members; and g) diversify course content to include images, perspectives, and stories of people of color. Otuniga & Chichaya (2025). UK Irish Journal of Occupational Therapy Four themes include lived experiences of: bitter-sweet experiences, harsh realities on placement, need for intentionality when planning the course, and need for creating safe spaces during practice placement. Barriers were described as: 1) horrible peer support from white students, 2) lack of Black representation, 3) difficulty reporting racial issues, 4) being the only black person on placement, 5) lack of educator professionalism, and 6) hesitancy to report racial issues. Facilitators included: 1) Positive black peer support system, 2) supportive lecturers. Recommendations for educator training, Black educator representation, and a better racial support system. Penman et al. (2021). Australia Journal of International Students International students report experiencing higher sociocultural and academic stress when settling into a new university compared with their local counterparts. Specifically, following thematic analysis, four themes emerged from the text, highlighting the impact of the program on the participants. These were facilitating adjustment, establishing relationships, gaining new skills and knowledge, and transforming beliefs and behavior. International students reported high levels of loneliness and anxiety, saying that they really struggled to fit into university life and also into the Australian way of life more generally. Despite having been accepted by the university into their courses, they expressed strong feelings of self-doubt in their ability to complete them. They described how their feelings were also barriers to their full participation in university life, both academically and socially. Students indicated that finding a safe place was crucial for relationship building and adjustment. Programs need to provide an environment that is beneficial in terms of encouraging positive behaviors and participation, reducing academic pressure, and increasing confidence in communication and interactions with students and staff. Another dimension of this theme is the mentee-mentor relationship that emerged, which can contribute to social and peer learning and the creation of a safe environment. Program activities can facilitate the development of a sense of community through the sharing of culture, ways of learning, relationships, and food. Pride, et al. (2024). Canada Diaspora, Indigenous, and Minority Education Lived experiences included: 1) Isolation; 2) Normative curricula; 3) Marginalization by classmates and instructors; 4) Exclusionary social and cultural capital; and 5) Coping strategies. Together, they represented routine institutional processes in health professions education – particularly access and admissions, formal and informal curricula, and socialization into professional identities – that are implicated in the reproduction of oppressive systems. For participants, a sense of not fully belonging was conveyed by seeing few people like themselves in their educational programs, particularly in teaching and leadership roles. Participants described how content relating to marginalized groups was rarely included in curricula, and when it was, it included and/or reproduced negative, harmful stereotypes. Participants described how clinical instructors “were always super hard on minority students. And it was blatant, it was in your face, kind of thing.” This included grilling them, demanding extra work, asking obscure questions, and being quick to suggest remedial work. In addition to isolation, marginalization by classmates and instructors, as well as gaps and stereotypes presented in the curriculum, participants felt excluded in educational contexts when they lacked the social and cultural capital valued in their programs. Each participant had their own ways of coping with exclusion and marginalization during their education, such as self-care, substance use, immersion in study, and activism. Some focused on advocacy, some focused on keeping their heads down till they graduated. Two key things that mitigated harm while helping create a sense of belonging and respect were mentoring and community. A clear need was expressed for the program to turn the lens inward, toward changing long-standing institutional underpinnings and undermining the exclusionary processes that render some learners as “expected” and “normative” while others are constructed as misfits. Although this requires an overhaul of health professions education, it is an essential step toward creating spaces for people, knowledges, ways of knowing, values, and resources that have traditionally been subjugated. Pride, et al. (2025). Canada Cadernos Brasileiros de Terapia Ocupacional Indigenous occupational therapists experienced imposed isolation, lack of support, exclusion, a devaluing of merit and skill, and ‘jagged worldviews colliding’ in their programs. Imposed isolation resulted in feelings of being ‘othered’ and illuminated who the ‘expected’ OT student is in these spaces. Loneliness, often due to being imposed isolation, deeply impacted these participants’ sense of belonging in their educational programs. Most participants noted a serious lack of support in their respective programs. Affirmative action or ‘equity’ processes have at times resulted in backlash, largely due to myths relating to being underqualified or getting an unfair advantage. This backlash is displayed through devaluing and questioning the merit and skills of Indigenous learners, a doubt that can be internalized, further undermining any sense of belonging. The occupational therapy profession needs to move towards decolonial Indigenization, which requires divesting of colonial privilege and ideologies towards something dynamic and new. Also recommended was a deep consideration of the value of, and need for, multiple perspectives, and drawing on the expertise and experiences of Indigenous students, occupational therapists, researchers, and educators is needed. Ramirez & Kiraly-Alvarez (2023). US Journal of Occupational Therapy Education Lived experiences include a lack of awareness of OT as a profession and the lack of representation of OT practitioners from historically marginalized groups act as barriers to exploring OT as a potential career. Themes include 1) Barriers and facilitators exist while exploring OT as a potential career; 2) Pros and cons in the OT admission process for students from historically marginalized groups; 3) Students from historically marginalized groups experience varying degrees of exclusion and a limited sense of belonging with their OT programs; 4) Many OT programs have good intentions to promote diversity and inclusion through various efforts; 5) Some OT program efforts may be counterproductive, and more actions must be taken to further promote inclusion and address barriers to inclusion. According to participants, the lack of knowledge or guidance on how to apply to OT schools was deemed a barrier to the admissions process. Lack of social support and mentorship to navigate the various components of the complex application process may prevent students from historically marginalized groups from applying to OT school. Limited financial resources to complete the application process and limited financial support from OT programs prevented students from applying to certain programs, therefore limiting the opportunities for admissions. Students reported experiencing various degrees of discrimination and exclusion by both faculty and peers, from microaggressions and culturally insensitive behaviors to overt racism. Other students reported that although they do not experience explicit exclusivity from their peers or faculty, they still feel less included due to their inability to relate to their peers’ values and experiences. Participants identified that opportunities to observe OT practitioners greatly influenced the desire to ultimately choose to pursue OT as a career. Therefore, it is imperative to continue to work on enhancing the awareness and knowledge of the OT profession and creating more opportunities for observing OT practitioners in action. This can be done through various outreach, pipeline, and mentoring programs beginning during primary school education. Students who had social supports (e.g., family, friends, and peers) were more likely to overcome barriers and had more opportunities to engage in higher education. Availability of scholarships and clear information about financial aid may support students who experience financial barriers. Participants suggested that there should be more opportunities to provide faculty feedback in an anonymous way. Most participants reported that when OT faculty and administration were more open-minded to change and feedback from students, it helped foster more feelings of inclusion and belonging. Participants also suggested that when conflicts do arise, there should be more emphasis on the follow-through to ensure the conflict is resolved. Barriers Barriers experienced in the professional education experience of diverse students included subthemes related to the effects of systemic or organizational context, lack of department or student support, and the students’ feelings or reactions. Systemic or Organizational Context Sources consistently reported that diverse students felt a lack of support from the educational system, including experiences of stigma and marginalization, bias, racism [ 22 – 24 ], and system inequities [ 25 , 26 ]. Examples identified included admission criteria biased toward upper-class White students, for example, opportunity for leadership or other health care experiences, such as serving as a rehabilitation technician [ 27 ], and a lack of financial support [ 22 ]. Other systemic or organizational barriers included ableism [ 28 , 29 ] and inaccessible environments, such as classrooms and labs with equipment that could not be adapted, and fieldwork sites with inaccessible clinical spaces [ 30 , 31 ]. Department or Peer Student Support Sources also highlighted a lack of department and peer student support as a significant barrier to success for diverse students. This sometimes involved having to take on the role of the “diversity person” in class or in the department [ 26 , 32 ]. Despite this, students felt that there were limited Diversity, Equity, and Inclusion (DEI) conversations in the program, a normative curriculum that focused on issues related to middle to upper middle-class persons [ 26 ], language barriers [ 33 – 36 ], and a lack of awareness of marginalized groups [ 33 ]. Students reported feeling isolated [ 37 ], experiencing negative attitudes from peers [ 26 , 38 ], a lack of support from faculty, students, and the educational system [ 12 , 22 , 26 , 28 , 29 , 38 , 39 ], and vulnerability to authority [ 30 ]. Citing admission criteria that were biased toward upper-class White colleagues [ 27 , 40 ], diverse students often felt unsupported by their peers, and an increased need to legitimize their ability and competence [ 22 , 26 , 28 – 31 , 36 , 41 ]. Student Feelings or Reactions Students consistently reported feeling anxious due to a lack of faculty representation of their identity cultures, which fostered a sense of not belonging or being an “outsider” [ 12 , 22 – 26 , 31 , 32 , 34 , 38 ]. Students said they often felt self-doubt or experienced imposter syndrome regarding their ability to be successful in the occupational therapy program [ 33 , 46 ] and experienced racialized trauma [ 23 – 26 , 31 ]. Facilitators Diverse students also identified facilitators to success they experienced within professional educational settings, which were also related to systemic or organizational contexts and departmental or peer support. In addition, the students’ own feelings and reactions were perceived as potential facilitators. Systemic or Organizational Context Included sources showed that improving organizational processes can facilitate recruitment and retention success for diverse students. Holistic admission practices increased recruitment of diverse students through consideration of lived experiences from under-represented groups and elimination of in-person interviews [ 27 ]. Students reported both academic and practice success with support from school resources such as access to mental health providers, writing workshops, small classes, and workshops on stress management [ 36 , 42 ]. Creation of spaces to discuss diversity and inclusion by diverse faculty was also identified as beneficial to students [ 42 ], as was the importance of having legislation in place to allow diverse students to access the academic and fieldwork settings [ 31 ]. Department or Peer Student Support Studies consistently identified departmental and peer student support (both within and beyond their educational institutions) as facilitators of success for diverse students. Students identified that having mentorship opportunities with mentors of the same cultural background and/or lived experience promoted open dialogue, provided a sense of relief and community, and fostered inclusion [ 24 , 26 , 43 , 44 ]. Several studies also demonstrated that support from outside the educational organization reduced feelings of isolation. Examples included connections with national and international professional organizations (e.g., Coalition of Occupational Therapy Advocates for Diversity (COTAD), National Board of Certification for Occupational Therapists (NBCOT), social media, diverse student support groups, and the broader community [ 22 , 26 , 43 ]. Student Feelings and Reactions Students consistently reported creating their own coping strategies to deal with feelings of marginalization and exclusion. Examples of coping strategies included self-care practices, creating a community outside of the educational setting, activism, and changing values to fit in with peers [ 26 , 33 , 34 ]. Those who used activism as a coping strategy often led spaces for conversations around diversity, as well as creating chapters of national and international organizations for diverse occupational therapy groups [ 32 ]. Students identified that having previous experiences in settings with limited diversity was beneficial to anticipating and adapting to similar situations they may experience as a student [ 33 ]. They also reported that sharing their lived experience with clients and clinical instructors enhanced practice and increased their ability to relate to and build rapport with clients during fieldwork placements [ 30 , 31 ]. Strategies to Address Student Safety and Inclusion Systemic or Organizational Context Several suggested strategies to address these barriers from a systemic or organizational context were proposed in the literature. Creation of culturally sensitive materials and clear accommodation processes for admission and to support students’ study was recommended to increase feelings of belonging [ 12 , 44 ]. Suggestions were also made for the development of safe spaces and support services that address racism and other “isms” such as ableism, and sexism [ 23 , 42 ] Increasing DEI conversations for administration, faculty, and students, including awareness training and listening sessions, was recommended to increase understanding, inclusion, and advocacy for systemic and organizational support of diverse students [ 12 , 22 , 24 , 25 , 31 , 33 , 37 , 44 ]. Department or Peer Support Accessing support from national and international professional organizations (e.g., Coalition of Occupational Therapy Advocates for Diversity (COTAD), Black Caucus) that support diversity were recommended to enhance belonging, as well as purposive recruitment of diverse department faculty and students [ 22 , 31 , 32 ]. Intentional support of diverse students at orientation [ 45 ], creation of support services to address safety and inclusion for under-represented student populations [ 23 ], activities that integrate diverse students [ 35 ], and alumni mentorship programs [ 42 , 44 ] were also identified as strategies to address isolation. Within the professional education program, reworking of competencies and transparent, competency standards helped address feelings of incompetence and assumptions about competence for diverse students by faculty, peers, clinical supervisors, and the students themselves [ 29 , 30 , 33 ]. Reworking of the curriculum to include extended or modified programs was also recommended to increase success in the program for students who may not be able to afford a full-time program [ 36 ]. Use of critical reflexivity and listening sessions was suggested to increase knowledge of faculty and students about issues faced by diverse students [ 23 , 24 , 26 , 30 ]. Finally, advocacy by faculty and peers was suggested to address policy inequities experienced by students (and ultimately practitioners) [ 28 , 31 , 44 ]. Discussion This scoping review aimed to explore the experiences of occupational therapy students from diverse backgrounds, including the barriers and facilitators to inclusion, the strategies recommended to support equity, and to compare experiences between groups using an intersectional lens. The findings indicate persistent systemic and organizational barriers to inclusion exist, with facilitators and strategies to counteract these barriers also reported, including mentorship and inclusive admissions practices. The findings indicate there are ongoing equity issues within occupational therapy education that require systemic and organization-level action to address, with multiple recommendations for interventions required to improve inclusion, safety, and justice within occupational therapy professional education. This review describes the complex and intersectional factors that contribute to the lived experience of diverse occupational therapy students during their professional education. Research in this area has consistently identified barriers embedded throughout programs and processes, while also highlighting facilitators and opportunities for positive change. However, the extent to which these facilitators and strategies are currently used to address identified barriers is unclear. Common Facilitators and Barriers to Safety and Inclusion The included sources demonstrate that the barriers experienced by diverse occupational therapy students are deeply embedded within systemic, organizational, and educational structures. These experiences are symptomatic of how the profession itself is structured, given the ongoing dominance of White, Western, and ableist norms [ 46 ], which overshadow the social and structural determinants of health and occupation in favour of individualised explanations of “problems.” Their experiences produced significant emotional labor related to the need to perform ‘invisible work’ to create their own belonging [ 6 ], which negatively affected belonging and academic persistence. For occupational therapy, these findings underscore the need to move beyond individualized explanations of student “preparedness” toward systemic reform that embodies principles of occupational justice. Despite these challenges, the review also highlighted several key facilitators that support safety, inclusion, and success. Holistic admissions processes that consider the students' full backgrounds, clear accommodation pathways, and access to appropriate institutional supports (e.g., mental health services, small group learning, writing support) were identified as meaningful organizational enablers here and in other studies [ 47 , 48 ]. Students also drew on their own strengths, including self-advocacy, collective activism, and creating supportive peer communities, to counteract feelings of exclusion. They are also more able to navigate complex cultural contexts in education and practice [ 34 ], countering the deficit narrative and problematizing that often accompanies discussion of their place in the profession. These facilitators illustrate the importance of intentionally designing and supporting structures that recognize lived experience as a valued knowledge source and diversity as a source of strength and capability. Strategies to Support the Safety and Inclusion of Occupational Therapy Students Studies explored entry into and experiences within occupational therapy professional programs. While the focus most commonly was on the experiences of students during their professional education, there were several studies exploring the practices leading to the entry of students into these programs, and how these procedures impacted certain groups. Four articles either reported the experiences of students during the entry process or interviewed students about their recommendations for the admissions process [ 22 , 24 , 27 , 31 , 40 ]. One of the common factors mentioned was the financial requirements for entering occupational therapy. Students were concerned about the costs of the program, and required greater information initially about the tuition to make an informed decision before applying [ 27 , 40 ]. Students also reported concerns regarding the costs associated with applying to professional programs, creating a barrier before they had even applied [ 27 ]. In the United States, tuition costs continue to be the greatest barrier to entering occupational therapy programs [ 49 ]. While most of the studies reporting on the admissions process were conducted in the United States [ 22 , 24 , 40 ], one study suggests this may be a more global issue, with greater international research required, and action needed to address this inequity where it exists [ 27 ]. One of the common recommendations for increasing accessibility to occupational therapy was employing an admissions process that considered more than just academic results. Factors, such as life experiences, used in the admissions process, suggest that holistic admissions would lead to greater equity in the recruitment process [ 22 , 24 , 27 ]. Also recommended is that the admissions process should not require the identification of information about one’s identity that could impact decisions regarding admissions, even if inadvertently, and that the admissions process should signal inclusivity [ 27 ]. It is evident that the admissions process is part of the problem, with greater accessibility and inclusivity required. However, the subjectivity with which admissions processes are applied, particularly regarding the qualitative information that applicants provide, needs to be managed with clear criteria, thus reducing the risk of biasing the selection process [ 50 ]. Greater support and inclusive practices are required, with greater research and clear recommendations needed regarding the most inclusive and fair way of ensuring that greater equity is achieved in the entry process and reducing barriers for diverse students. While some articles provided recommendations regarding entry into professional programs, most articles explored the experiences of students once they had entered, reporting common facilitators and barriers to safety and inclusion in the course. Consistent barriers were identified, including a lack of support from the program, the need to “prove oneself” in class or on fieldwork, stigma, marginalization, bias, racism, and inequities. Students also consistently reported feeling a lack of belonging and support, and reported that their peers lacked an awareness of the experiences and challenges they face because of their identity. Often, the students felt pressure to be the “diversity” person in class [ 23 , 25 , 31 , 32 ]. These reactions often caused the student to experience self-doubt and imposter syndrome [ 26 , 32 ]. These experiences indicate that students from diverse backgrounds have a markedly negative and more challenging experience at university, which is unsafe and unjust. While professional bodies in the UK, Canada, the US, and Australia indicate the importance of inclusion within the profession, there is clearly a disconnect between intentions and reality [ 22 , 24 , 25 , 26 , 31 , 36 , 40 ]. The environment created within a professional program influences who might apply. If students believe they will have a positive experience and can see themselves reflected within the student cohort and faculty, and profession, they may be more likely to apply, leading to greater diversity in educational programs and the profession [ 24 , 26 , 36 , 40 ]. While some of these program-level issues create barriers to safety and may hinder entry, these challenges were often due to wider system-level issues impacting students’ experiences. There were multiple systems-level opportunities identified that could improve the experiences of students at an individual level. Some examples included reflecting diversity in curriculum content [ 31 , 34 , 45 ], employing diverse staff [ 22 , 23 ], and making content and systems universally accessible to reduce the burden on students with specific needs [ 28 , 31 , 39 ]. Universal design principles have been mentioned as imperative in university education, because if accessibility is addressed for some, it can improve the experience for all [ 28 , 31 , 39 ]. Creating systems-level change has the potential to improve the educational experience for all students, creating a more inclusive and accessible environment that benefits everyone [ 28 , 31 , 39 ]. The key role played by faculty was also emphasized in the included sources, which advocated for intentional recruitment of diverse academics. Strategies suggested in the literature included recruiting diverse faculty, creating safe spaces for students, and increasing awareness for faculty and peers about issues faced by diverse students [ 28 , 31 , 39 ]. A large study across multiple courses and disciplines [ 51 ] highlighted a significant but indirect impact on student success and progression to graduation from alignment between student and faculty racial and ethnic composition. While systems-level change is required, mentorship was one of the strategies commonly mentioned in the literature. Increasing the DEI capacity of non-diverse faculty is also recommended, and several approaches to its achievement have been explored in the literature [ 52 , 53 ]. Diverse occupational therapy faculty also provide role models and representation and occupy positions of influence and leadership [ 54 ]. Faculty diversity and equity capability are, therefore, core infrastructure for building a just and inclusive occupational therapy workforce. Intersectionality and Diverse Occupational Therapy Students While many studies explored the experiences of students from different identity groups, most included sources did not specifically discuss the experiences of diverse students using an intersectional lens. The concept of intersectionality is emerging as a critical perspective in occupational therapy and has a growing presence in practice, education, and research [ 55 ]. Research commonly explored the experiences of students who identified with a specific identity group, for example, students with disabilities [ 29 , 30 ] or people of color [ 42 ]. The research aims were commonly focused on a specific group, and there was little exploration of the impact that intersecting identities may have had on students’ experiences. This has the potential to miss the complexity of people’s experiences that could exist when examining the experiences with these groups. It also limits the ability to analyze findings between different groups, with limited demographic information provided about the samples included. Pooley and Beagan assert that occupational therapy needs to take intersectionality more seriously if the profession wants to meaningfully address systemic inequities [ 56 ]. Within the literature, there were different terms used for ‘diverse’ that added complexity to the search strategy and data analysis. Some common terms used included marginalized, minoritized, under-represented, and diverse. The use of minoritized and marginalized reflects the systemic power dynamics and the exclusion and disadvantage experienced by certain groups [ 57 , 58 ]. Alternatively, under-represented was also commonly used, and reflects the small number of people from certain groups, but does not reflect the disadvantage experienced by some groups. It also puts the onus on the individuals, rather than on the system or those in positions of power, to address injustice, with instances of inequity [ 59 ]. The use of ‘diverse’ is also complex. Using ‘diverse’ risks highlights difference without acknowledging the oppression and discrimination experienced by many groups, and risks certain people being seen as other [ 60 ]. The use of varied terms added to the complexity of this more holistic perspective. There is, therefore, an urgent need to embed intersectionality into everyday practice, education, and research, rather than treating diversity categories separately or superficially. The urgency for this shift in perspective partly comes from the compounding and amplifying effects of intersectionality on safety and inclusion for occupational therapy students and requires a considered selection of language that should acknowledge the disadvantage and oppression commonly experienced by certain groups. Many of the experiences identified in the included sources (e.g., having to “prove” competence, lack of belonging) were consistent across multiple marginalized student groups (e.g., race, ethnicity, ability, gender). This confirms a core concept within intersectionality by highlighting how the interactions between different identities within the same person can introduce a complexity that may be hidden when groups are considered in isolation [ 61 ]. Occupational therapy already possesses a holistic perspective on human health and wellbeing, which could inform better engagement with the needs of students as individuals rather than as part of a particular group. Limitations Although results from this scoping review were consistent in the identification of facilitators, barriers, and solutions, it is not without limitations. One of the limitations of this review was that sources in languages other than English were not reviewed, as the research team was English-speaking only and there was insufficient resourcing to locate and translate texts in other languages, limiting the transferability of findings to certain parts of the world. Additionally, care was taken to incorporate terms that reflected as many diverse groups as possible in the search strategy, and the search strategy was reviewed on multiple occasions by a librarian. However, it is possible that certain groups may have been inadvertently missed, which may have impacted the articles that were located and limited the comprehensibility of the search. In addition, some members of the research team did not identify as being a member of any of the diverse groups included in this study, and although the researchers had discussions as a team and worked collaboratively, reviewing each other’s work, this may have influenced the interpretation of the findings. Most articles were not located by using the traditional database keyword search strategy and were instead located using citation searching through Connected Papers that accessed articles not indexed in the traditional databases. This suggests that articles covering diversity, equity, and inclusion topics may not be published in traditional journals, and strategies used to search for articles on these topics should consider this, incorporating additional steps to locate these articles. Publications practices should also incorporate articles on these topics to improve dissemination. Implications For Occupational Therapy Education and Policy Multiple implications for occupational therapy education and policy were identified. These implications have been divided into systemic or organizational, course, and individual levels. Systemic or Organizational Level Implications To achieve greater diversity in student cohorts, purposeful recruitment strategies are required, with greater support provided in the application process for those who require it. Greater information about the costs associated with study needs to be provided up front, and more inclusive admissions processes are required, providing people with choice about what they choose to disclose about their identity, with holistic admissions mentioned as one strategy to support greater diversity and inclusivity [ 22 , 24 , 27 , 31 , 40 ]. Once students have entered the university system, there needs to be easily accessible accommodations and support provided [ 28 , 31 , 39 ]. Staff require training on providing safe and inclusive environments. There needs to be educational frameworks developed that accommodate, highlight, and support people from diverse backgrounds [ 31 , 34 , 45 ]. Supportive communities within educational institutions need to be established. Students also need to be made aware of and encouraged to make connections with professional organisations focused on issues of diversity to support inclusion [ 22 , 32 ]. Program Level Implications Strategies are required to reduce isolation and support inclusion. Suggestions to foster inclusion were to facilitate opportunities for mentoring with mentors from similar diverse backgrounds. Increased representation within curricula was also suggested [ 22 , 42 ]. Students suggested that opportunities should be provided to raise the awareness of diverse students’ experiences [ 23 , 31 ]. It was also suggested that within occupational therapy, competencies need to be changed to address incorrect assumptions about the competence of diverse students [ 29 , 30 ]. Individual Level Implications Some approaches that students found useful included finding opportunities to share their lived experiences with peers and mentors [ 22 , 41 ]. They also suggested employing self-care strategies, which, for some, were seen as an act of resistance [ 34 ]. Though individual strategies may support withstanding the system as it is currently, there was emphasis on the importance of creating change at a program and system level. Conclusion This scoping review explored how the literature represents the lived experiences of diverse occupational therapy students during their professional education. Recent literature continues to show systemic, organizational, and departmental barriers to student success, resulting in discrimination and reduced feelings of not belonging. Facilitators include mentorship, revised admission criteria, and increased awareness by faculty, peers, and clinical instructors of issues experienced by diverse students. Research is becoming more prevalent but still limited. Future research should examine how interventions at the program level can improve the experiences of diverse students and how to strengthen inclusive student recruitment practices, ultimately improving the experiences of future clinicians and the clients we serve. Declarations Acknowledgements We respectfully acknowledge the Traditional Custodians of the lands on which we live and work. In Australia, we pay respects to the Aboriginal and Torres Strait Islander peoples, the original inhabitants and caretakers of this country. We recognise their enduring connection to the land, waters, and culture, and we honour their Elders past and present. We also acknowledge the Indigenous peoples of other lands where this work may be read and utilised. We recognise their traditional knowledge, wisdom, and practices that have been maintained for generations. We are committed to fostering respectful and collaborative relationships with Indigenous communities and to supporting the sovereignty and self-determination of all Indigenous peoples. This scoping review aims to contribute to a broader understanding of occupational therapy practices globally, and we are mindful of the diverse cultural contexts in which this knowledge will be applied. Funding No funding was received to conduct this review. Alesia Ford is an occupational therapist of color, with a commitment to social justice, equity, inclusion and cultural humility. She is passionate about diversifying the field of occupational therapy. Diane Smith: As a white, heterosexual, cisgender, able-bodied, upper-middle class individual, my work as a PhD occupational therapy researcher has been primarily focused on issues of disability rights and access and, more recently, the intersectional effects of disparity faced by populations receiving occupational therapy and other healthcare services. My lens reflects this social and occupational justice focus in all of my roles as a professor and researcher. Tamara Wanklyn : I live and work on Wadawurrung country in the regional Australian town of Geelong and grew up in Naarm, Melbourne. I have worked as an occupational therapist for 14 years, in Australia, England, and Canada. Identifying as female, cis-gender, heterosexual, Australian of Anglo-Celtic heritage, neurotypical, highly educated, middle class, and without disability, I recognise the multiple elements of my identity that afford me privilege, and I strive to advocate for and promote the creation of more inclusive healthcare environments and practices. Danielle Hitch is an occupational therapist and health economist, with a commitment to social justice and inclusion. She lives with disability and was the first person in her family to complete secondary school. Author contributions All authors contributed to the scoping review protocol manuscript. All authors contributed to the search strategy design, data analysis plan, and writing and/or editing the scoping review protocol. Conflicts of interest There were no conflicts of interest in the development of this paper. 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09:45:09","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":232892,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8359272/v1/31ffe4622d7013ac7b2fbfd0.html"},{"id":98435656,"identity":"104d44ec-5419-4187-951a-53b12724fca1","added_by":"auto","created_at":"2025-12-17 16:54:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":332404,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA Diagram\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSource. Figure format from Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., . . . Straus, S. E. (2018). PRISMA\u003c/p\u003e\n\u003cp\u003eExtension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169, 467–473. https://doi.org/10.7326/M18-0850\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8359272/v1/8d506313aa4a2afa67a2a3bb.png"},{"id":98298740,"identity":"07eb7c7c-55e9-4edb-98f5-d5ed48df07f8","added_by":"auto","created_at":"2025-12-16 09:45:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72156,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8359272/v1/ce56347560bf6de6297a8cb4.png"},{"id":98775445,"identity":"9be4813c-b81e-47f5-b36c-bc02278e0634","added_by":"auto","created_at":"2025-12-22 12:20:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2544848,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8359272/v1/32ceacc4-d2cb-430a-9da2-cc962a201954.pdf"},{"id":98298741,"identity":"68adffbc-35ee-43ea-83e7-6e568b9142b2","added_by":"auto","created_at":"2025-12-16 09:45:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14963,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementarydocumentII.docx","url":"https://assets-eu.researchsquare.com/files/rs-8359272/v1/69e68f8cb14317b77f202145.docx"},{"id":98434108,"identity":"ea11dbb5-eaa1-4395-82db-7f8b3bb7df59","added_by":"auto","created_at":"2025-12-17 16:51:31","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16500,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryDocumentIII.docx","url":"https://assets-eu.researchsquare.com/files/rs-8359272/v1/20785266e4950a4fb98972df.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eLived experiences of occupational therapy students from under—represented backgrounds in professional educational programs: A scoping review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe demographics of the occupational therapy workforce in many countries often fail to reflect the population they serve [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These communities are diverse and intersectional, encompassing individuals of different genders, sexes, ages, socioeconomic statuses, cultural backgrounds, religions, sexual orientations, neurodiversity, and living locations, as well as people with and without disabilities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In contrast, occupational therapists typically identify as White, middle-class, and female [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this paper, the terms \u0026ldquo;diverse\" and \u0026ldquo;diversity\u0026rdquo; are used to represent the wide variety of different human characteristics within human populations, such as race, ethnicity, gender, sexual orientation, age, socioeconomic status, religion, physical and mental abilities, and cultural background. Groups which differ from majority characteristics (in this case, White, middle-class, and female) are often characterized \u0026ldquo;under-represented,\u0026rdquo; \u0026ldquo;marginalized,\u0026rdquo; and \u0026ldquo;vulnerable.\u0026rdquo; [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eLimited diversity within healthcare professional workforces can lead to a lack of cultural humility when interacting with diverse communities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A lack of diversity in the workforce may reduce incentives and opportunities for people from these groups to join the profession, particularly when the visibility of individuals from these groups is low, and few role models exist [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This is not only an equity issue, but it may also be influencing the demographic composition of student cohorts entering higher education to study occupational therapy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Increasing opportunities for students from diverse groups to enter and remain in the profession may enhance recruitment and retention [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe experiences of people from diverse groups can be both positively and negatively influenced by the safety and inclusivity of the educational environment and support available [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Safe environments include those perceived as welcoming and enabling of positive and inclusive interactions that promote social and emotional learning [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Some research has been conducted to explore the educational environment in occupational therapy courses around the world. Previous research into the experiences of diverse occupational therapy students is generally single case studies of specific groups, for example, occupational therapists in Canada who were trained overseas [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], allied health students moving to study in a regional university [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and new graduate occupational therapists commencing work in rural Australia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA recent scoping review exploring the intersectional experiences of minoritized occupational therapy practitioners and students found that practitioners and students alike often tolerate hostile and unfair environments, recommending that the profession focus on and improve efforts to address these issues [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This scoping review synthesized information about the articles, such as the country, group investigated, and whether the authors identified as members of these groups, and developed four themes from the literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the experiences of students and practitioners were evaluated together, though the needs of these two groups may differ when addressing any challenges identified and warrant separate evaluation. The review also did not synthesize literature regarding barriers, facilitators, and implications for the higher education sector, and did not include studies about other minoritized groups, such as students from rural backgrounds or those from low socio-economic backgrounds. Exploring occupational therapy students\u0026rsquo; experiences in educational settings reported in the literature will provide a profile of their level of inclusion in higher education contexts and will allow for the examination of what strategies should be implemented to improve the support available to these students.\u003c/p\u003e \u003cp\u003eOccupational therapy students may belong to multiple diverse groups; therefore, this review was conducted using an intersectional lens to examine issues experienced by students. Intersectionality is a framework that can be used to understand how different factors or identities overlap, compound, or intersect to create a profile of discrimination and privilege that may influence someone\u0026rsquo;s life experiences [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Intersectionality is a relatively recent concept in the occupational therapy literature and has most often been applied to service users rather than students or clinicians [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, adopting an intersectional perspective is crucial to developing a more nuanced and person-centred understanding of the needs of diverse occupational therapy students and the implications for the broader profession.\u003c/p\u003e \u003cp\u003eA recent scoping review of experiences of diversity for occupational therapy practitioners and students found that both groups are exposed to and must tolerate hostile and unfair educational and employment environments, leading the authors to recommend that the profession prioritize efforts to address these issues [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The aim of this scoping review was to analyze current knowledge gaps and identify potential strategies for increasing diversity in the occupational therapy student population, specifically. The primary objective was to identify common facilitators, barriers, or strategies that impact safety and inclusion in the workforce.\u003c/p\u003e \u003cp\u003eTherefore, the research question for this review is \u0026ldquo;What does the literature say about the lived and living experiences of occupational therapists from diverse backgrounds during professional education using an intersectional lens?\u0026rdquo; Sub questions include: (1) What are the common facilitators and barriers to safety and inclusion to support diverse occupational therapists through professional education? (2) What strategies are suggested to support the safety and inclusion of occupational therapists through professional education? and (3) From an intersectional perspective, how do the experiences of occupational therapy students from under-represented and diverse backgrounds compare?\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe review was conducted per the Joanna Briggs Institute (JBI) methodology for scoping reviews [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A scoping review was the most appropriate approach due to the relatively sparse literature available on the topic and the need to understand future directions for education, research, practice, and policy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The scope of the review was intentionally broad, incorporating data on the experiences of people from various and/or intersecting diverse groups to examine the experiences of occupational therapy students from multiple perspectives. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used to structure all reporting [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The review was registered in the Open Science Framework registry on 14/11/2024 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17605/OSF.IO/3CWYF\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/3CWYF\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e This review was part of a broader review that included diverse occupational therapists at all stages of their professional career (i.e., from professional education to practice). During the review process, it became evident that the context and experiences of students were distinct enough from those of practitioners, and the sources related to these two groups were analyzed separately. The findings of sources, including both students and practitioners, were included in both reviews, reporting only those relevant to the chosen group. The scoping review related to diverse occupational therapists in practice is published separately.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e Sources appropriate for this scoping review included articles that focused on occupational therapy students from diverse backgrounds from any area of practice or geographical location. All sources addressed the concept of the lived and living experiences of occupational therapy students, including the exploration of perceptions, attitudes, beliefs, subjective data, narratives, or any other approach to understanding personal experience. Studies were also included if they contained a mixed sample of practitioners and students, and if specific findings related to student participants were reported.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eTypes of Sources\u003c/h3\u003e\n\u003cp\u003eIncluded sources reported on the experiences of students from any population group characterised as diverse, marginalized, under-represented, or vulnerable. These groups included those who identify as: disabled, male, non-binary, LGBTIQ+, culturally and linguistically diverse, living rurally or remotely, Indigenous or First Nations people, people of color, adults over 65 years, and/or of lower socio-economic status.\u003c/p\u003e \u003cp\u003eQualitative studies were located, including, but not limited to, phenomenological, grounded theory, ethnographic, descriptive, action research, and feminist research designs. Mixed methods studies were also included, where qualitative approaches were the primary methodology.\u003c/p\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eA search strategy involved locating published studies relevant to the review question, which began on November 14, 2024, and was periodically updated until the final review on June 30, 2025. The first step was to complete a limited search of MEDLINE (via the EBSCOhost platform) to identify key articles on the topic. (see protocol for details [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]). In the second step, keywords contained in the titles and abstracts of relevant articles, along with index terms, provided the basis for developing a full search strategy for MEDLINE (EBSCO) (See Supplementary Materials II). The search strategy, including identified keywords and index terms, was adapted for each database and/or information source. The third step involved citation searching of all included sources of evidence, which was conducted using the Connected Papers platform [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A university librarian was repeatedly consulted to review and provide feedback on the search strategy to ensure its scope was feasible and comprehensive [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Initially, the search strategy focused on the experiences of transitions between education and practice; however, this was found to limit the search of literature relevant to the research question, so the scope was broadened for any stage of a professional career, and eventually split into an article relevant to students and another relevant to practitioners.\u003c/p\u003e \u003cp\u003eStudies published in languages other than English were not included due to the language profile of the review team and resource limitations. Studies published since 2014 were included to encompass developments in multiple healthcare systems internationally and university occupational therapy programs in the last decade.\u003c/p\u003e\n\u003ch3\u003eEvidence Screening and Selection\u003c/h3\u003e\n\u003cp\u003eFollowing the search, all identified citations were uploaded into the Covidence platform [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and duplicates were automatically removed. Titles and abstracts were screened by two independent reviewers within the team (AF, DS, TW) for assessment against the inclusion criteria for the review. Potentially relevant sources for inclusion were retrieved in full, with a copy text imported into Covidence [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Two independent reviewers then assessed the full text in detail against the inclusion criteria. Reasons for the exclusion of sources at this stage were recorded and are reported here. (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Disagreements between reviewers at each stage of the selection process, typically less than 10% of sources, were resolved through discussion with a third reviewer. The search and screening results are presented in a PRISMA flow diagram (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Charting Process\u003c/h2\u003e \u003cp\u003eData were extracted from included sources by all authors independently (AF, DS, TW, DH) using the data extraction tool developed by the reviewer (see Supplementary Materials III). The data extraction table was developed based on examples from other reviews and recommendations. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A draft data extraction form was piloted with all review team members independently extracting data for a subset of the articles, then comparing their results to ensure the form captured relevant data for the review question. Extracted data included details about the participants, concept, context, study location, study methods, and key findings relevant to the review questions. Any disagreements about extraction arising between reviewers were resolved through collaborative discussion by the entire review team.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Analysis and Presentation\u003c/h3\u003e\n\u003cp\u003eCritical appraisal of the articles was not conducted, consistent with scoping review methodology. Study characteristics (e.g., population, publication year, etc.) were described numerically and narratively. Descriptive thematic analysis was then conducted across studies, synthesizing literature related to the research questions. These data were reported narratively, with supporting tables and charts. Themes were developed through analysis of recurring issues that emerged in the literature that were identified and agreed upon by the authors.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe initial titles search identified 1394 articles from databases and 85 additional sources from citation searching. After applying the inclusion criteria and removing duplicates, 1020 articles were subjected to further screening, and 165 studies were selected for full-text review (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eInsert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e\u003c/p\u003e \u003cp\u003e The final number of studies included in this scoping review was 24. Eighteen articles focused on the experiences of professional education of diverse occupational therapy students, with six further including both occupational therapy students and practitioners. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the number of publications per year, showing a general upward trend. Of the 24 publications, the majority of the studies originated in Canada (n\u0026thinsp;=\u0026thinsp;9, 37.5%), followed by the United States (n\u0026thinsp;=\u0026thinsp;7, 29.2%), Australia (n\u0026thinsp;=\u0026thinsp;3, 12.5%), United Kingdom (n\u0026thinsp;=\u0026thinsp;3, 12.5%) and South Africa (n\u0026thinsp;=\u0026thinsp;2, 8.3%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eInsert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThemes\u003c/h2\u003e \u003cp\u003eThematic analysis of the sources identified evidence relating to barriers and facilitators in the systemic and organizational context; departmental and peer supports; and the students' lived experiences of professional programs (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor/Year, Country, Journal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAim\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMethodology/Data Collection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAldridge et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education, 7\u003c/em\u003e (4).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study explores Black OT students' lived experiences with systemic racism during their academic program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA phenomenological research design was used for this study.\u003c/p\u003e \u003cp\u003eFifteen one-to-one semi-structured interviews and five focus groups were conducted.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants included fifteen Black OT students attending school in the United States.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInterviews were conducted via Zoom due to safety concerns regarding the global COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eThese interviews may have felt impersonal and may have skewed body language, facial expressions, and the natural flow of conversation.\u003c/p\u003e \u003cp\u003eConnectivity issues may also have affected these interviews.\u003c/p\u003e \u003cp\u003eThe methodology is somewhat flawed as the data are self-reported and filtered through the participant\u0026rsquo;s point of view.\u003c/p\u003e \u003cp\u003eThe final limitation includes researcher bias.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenitez et al. (2022).\u003c/p\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe purpose was to identify and understand the perspectives of international students and alumni on their transition to graduate-level occupational therapy education and daily life in the United States.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative research design was used for this study.\u003c/p\u003e \u003cp\u003eEleven individual interviews and one joint interview with two individuals were conducted.\u003c/p\u003e \u003cp\u003eData were analyzed through group-based methods.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants included thirteen international students currently enrolled in post-professional occupational therapy programs in the United States, as well as alumni.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe results presented were from a single university and may not accurately represent the views or experiences of all international students.\u003c/p\u003e \u003cp\u003eThis study includes perspectives of international students from the Philippines, Ireland, India, South Korea, Singapore, Venezuela, Canada, China, South Africa, and Taiwan, and lacks perspectives of students from other parts of the world.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBevan, J. (2014)\u003c/p\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003cp\u003e\u003cem\u003eDisability \u0026amp; Society\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo describe a small-scale study of the experiences of disabled occupational therapists, recounting their journey and having a first-hand account of the reality of being a disabled health professional.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe study utilized an ethnographic approach to data collection. Individual, unstructured, ethnographic interviews were used.\u003c/p\u003e \u003cp\u003eA thematic analysis was employed, involving the reading and annotation of transcripts, as well as working within and between accounts, to identify themes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;diagnosed with Parkinson\u0026rsquo;s disease when she was 43 years old.\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;born with cerebral palsy, which affects her left side.\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;dyslexia.\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;has a hearing impairment that was diagnosed when she was three; she\u003c/p\u003e \u003cp\u003ealso has rheumatoid arthritis.\u003c/p\u003e \u003cp\u003e1=(the researcher) was told I had \u0026lsquo;grown out\u0026rsquo; of childhood epilepsy aged 10, but was re-diagnosed 5 years after qualification as an occupational therapist when it was triggered by a virus.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThis study only examined the retrospective experiences of a small number of members of the Disability Forum and the findings are therefore not generalizable to all disabled occupational therapists, but may be transferrable to some, as well as to other disabled health professionals or students. The study suggested that barriers still exist to the acceptance of disabled people as professional colleagues.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChing, E. \u0026amp; Ammon. A. (2020).\u003c/p\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003cp\u003e\u003cem\u003eDiversity \u0026amp; Equality in Health and Care\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis research study explored the lived experiences of a recent graduate of color and a faculty of color in a mentoring relationship.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA phenomenological approach utilizing semi-structured interviews was used for this study.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTwo participants: one student of color who recently graduated and one faculty of color.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmall sample size\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEasterbrook, et al. (2015).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eDisability \u0026amp; Society\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study explored the experiences of students in Health and Human Service programs with disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative study, employing a phenomenological design, was used for this study.\u003c/p\u003e \u003cp\u003eSemi-structured and structured interviews were conducted to explore the barriers, challenges, and facilitators experienced by HHS students with disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants were Twelve students with disabilities in HHS programs: (medicine, n\u0026thinsp;=\u0026thinsp;1; nursing, n\u0026thinsp;=\u0026thinsp;2; occupational therapy, n\u0026thinsp;=\u0026thinsp;1; physical therapy, n\u0026thinsp;=\u0026thinsp;1; social work, n\u0026thinsp;=\u0026thinsp;2; teacher education, n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmall exploratory study in which students may not be representative of all students with visible and non-visible disabilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEdelist et al. (2024).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eMedical Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study examined how the Health and Human Services education creates meanings of disability, accommodations, and professional competence, to investigate how students with disabilities continue to experience barriers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis study used a phenomenological design with interpretive analysis.\u003c/p\u003e \u003cp\u003e14 individual and seven group interviews were conducted.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThirty-five HHS students with disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study's structure resulted in some HHS professions being disproportionately represented in the data, and the view may not be reflective of students with disabilities from other professions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFord, et al. (2021).\u003c/p\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003cp\u003e\u003cem\u003eAmerican Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe purpose of this study was to explore the perceived challenges to and facilitators of the recruitment and retention of OTPs and students of color.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative approach with an interpretive, constructionist design was used to examine perceptions of facilitators and barriers experienced by OTPs and students of color.\u003c/p\u003e \u003cp\u003eData were collected online from three focus groups and four interviews.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 occupational therapy practitioners and students of color in the United States.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThis study had a small sample size, and its findings may not be representative of the views of all practitioners and students of color. Participant recruitment was limited through social media, word of mouth, and at the in-person conference.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGross, E. et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eInternational Journal of Inclusive Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study aimed to understand the barriers experienced by students with disabilities in Canadian education during practice placement, and the means that might facilitate support and accommodations, from the perspectives of students with disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis study employed a mixed-methods, quantitative and qualitative design, comprising 82 survey responses and 11 semi-structured interviews.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 survey participants from health and human services and occupational therapy programs in Canada.\u003c/p\u003e \u003cp\u003eOf the 82, 11 were interviewed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy limitations included a small qualitative sample size.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHendricks, F., \u0026amp; Toth-Cohen, S. (2018).\u003c/p\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003cp\u003e\u003cem\u003eOccupational Therapy International\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study examined the personal narratives of Black OT students attending the Occupational Therapy International 3 first OTASA National Student Leadership Camp, which was designed to foster authentic leadership development.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePilot study.\u003c/p\u003e \u003cp\u003eStructured interviews were conducted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTwelve occupational therapy students from six university OT programs in South Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThis small pilot study may not be representative of the experiences of Black student leaders in OT.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJarus, T. et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eMedical Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study examines the recurrent forms of social relations that underlie the participation of individuals with disabilities across health professions within the current context of health education and practice.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA phenomenological design, utilizing grounded theory and semi-structured interviews, was employed to explore \u0026lsquo;what disability is like\u0026rsquo; in the roles of health professional students and practitioners.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFifty-six individuals with disabilities: health practitioners (n\u0026thinsp;=\u0026thinsp;29) and students (n\u0026thinsp;=\u0026thinsp;27) from 5 professions : medicine (n\u0026thinsp;=\u0026thinsp;6), nursing (n\u0026thinsp;=\u0026thinsp;15), occupational therapy (n\u0026thinsp;=\u0026thinsp;13), physical therapy (n\u0026thinsp;=\u0026thinsp;7), and social work (n\u0026thinsp;=\u0026thinsp;15).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy participants came from only two Canadian provinces and may not capture experiences common in other jurisdictions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLalor, A. F. et al. (2019).\u003c/p\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003cp\u003e\u003cem\u003eBritish Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study aimed to understand international students\u0026rsquo; perceptions of the purpose of practice placements and the attributes that contribute to successful practice education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative design utilizing a semi-structured interview format was used to gain a rich understanding of occupational therapy International Students\u0026rsquo; experiences, views, and perceptions of undertaking practice placements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeven International Students from countries located in the Asia-Pacific region spoke English as a second language.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe sample of international occupational therapy students may not be representative of all International Students from Asian countries.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaw, et. al. (2022).\u003c/p\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003cp\u003e\u003cem\u003eScandinavian Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe study primarily aims to explore the opportunities and challenges experienced by a student group in practice education. It also aims to examine how the students can be supported to facilitate a high-quality learning experience.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA phenomenological approach was used to uncover the first-hand experiences of practice education from a group of international students enrolling in pre-registration OT programs in the UK.\u003c/p\u003e \u003cp\u003eIn-depth, in-person interviews were conducted with 6 students.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 international students enrolled in pre-registration OT programs in the UK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThis study had a small sample size. Some participants of this study had limitations in their oral proficiency in English and may have struggled to express certain thoughts or opinions during the interviews\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLim, et al. (2016).\u003c/p\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003cp\u003e\u003cem\u003eAustralian Occupational Therapy Journal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study aimed to explore and describe the experiences of international students from Asian backgrounds studying occupational therapy in Australia.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA phenomenological approach was used to understand the experiences of participants. In-depth interviews were conducted with 8 international occupational therapy students from Asian countries studying in Australia.\u003c/p\u003e \u003cp\u003eData were analyzed using hermeneutic methods.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants were recruited from two occupational therapy programs at the University of Sydney.\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Male\u003c/p\u003e \u003cp\u003e6\u0026thinsp;=\u0026thinsp;Female\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;Hong Kong\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Malaysia\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;Singapore\u003c/p\u003e \u003cp\u003e7\u0026thinsp;=\u0026thinsp;Chinese\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Muslim Malay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThis is a small exploratory study, where participants may not be representative of all occupational therapy students from Asian countries in Australia. The sample was primarily composed of Chinese females. The first author was a peer who may have affected the results.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLindsay et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eDisability and Rehabilitation\u003c/em\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe objective of this review was to explore the experiences and impact of workplace discrimination and ableism among healthcare providers and trainees with disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSystematic searches of seven databases from 2000 to January 2022 were conducted.\u003c/p\u003e \u003cp\u003eFive reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eForty-eight studies met the inclusion criteria, representing 13 participants from six countries over 21 years.\u003c/p\u003e \u003cp\u003eThe sample sizes of the included studies ranged from 2 to 11,859.\u003c/p\u003e \u003cp\u003e20 in the US\u003c/p\u003e \u003cp\u003e14 in the UK\u003c/p\u003e \u003cp\u003e8 in Canada\u003c/p\u003e \u003cp\u003e3 in Australia\u003c/p\u003e \u003cp\u003e2 in Ireland\u003c/p\u003e \u003cp\u003e1 in New Zealand\u003c/p\u003e \u003cp\u003eTypes of disabilities included non-visible disabilities, dyslexia, learning disabilities, physical disabilities, mental health disabilities, and sensory disabilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudies were from six countries, which have different customs and policies for the recruitment and treatment of people with disabilities in the workplace. Therefore, it was difficult to make comparisons. Many studies did not specify a distinct disability, but were heterogeneous, and the sample sizes were small.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLuong, et al. (2023)\u003c/p\u003e \u003cp\u003eUS\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study explored how occupational therapy students\u0026rsquo; perceptions of racism and ethnic discrimination impacted their educational experiences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudents completed an anonymous web-based survey that included a demographic questionnaire, the Brief Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV), and open-ended survey questions.\u003c/p\u003e \u003cp\u003eMean +/- standard deviation was computed for quantitative variables and frequency for ordinal variables. The normality of quantitative variables was assessed using the Shapiro-Wilk test and box plots. Pearson correlation analysis was performed on the participants\u0026rsquo; responses to the Brief PEDQ-CV. Data were analyzed using SPSS V. 28. All analyses were performed at an alpha level of .05.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants included 226 students aged 18\u0026ndash;60 years old enrolled in occupational therapy entry-level, post-professional, or assistant programs throughout the United States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe students in the study may not represent the general student population outside of OT or OTA programs; therefore, they cannot be generalized to other student populations. The 20-minute length of the survey may have been a limitation. Also, data were not collected through an interview that would have allowed participants to provide clarification and elaborate meanings of their responses. Not all students were minoritized.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOtuniga \u0026amp; Chichaya (2025).\u003c/p\u003e \u003cp\u003eUK\u003c/p\u003e \u003cp\u003e\u003cem\u003eIrish Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study aims to explore the experiences of Black students enrolled in pre-registration occupational therapy programs at a university in the U.K.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA qualitative phenomenological study design was used for this study.\u003c/p\u003e \u003cp\u003eSemi-structured interviews were conducted.\u003c/p\u003e \u003cp\u003eThematic analysis resulted in four themes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeven Black occupational therapy students were selected using purposive sampling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eConducting interviews via Microsoft Teams may have felt detached for the participants and distorted the conversation\u0026rsquo;s organic flow, body language, and facial reactions. UK literature is scarce, focused on Black OT students, so literature was drawn from other countries.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenman et al. (2021).\u003c/p\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of International Students\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational students report higher sociocultural and academic stress when\u0026nbsp;settling into a new university compared with their local counterparts.\u003c/p\u003e \u003cp\u003eThree\u0026nbsp;disciplines in the health professions collaborated to create a transition program\u0026nbsp;addressing international student health and well-being in Australia.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommencing\u0026nbsp;students and senior student mentors participated in a four-session program of\u0026nbsp;activities to reflect on their current study/work practices and learn self-management\u0026nbsp;strategies.\u003c/p\u003e \u003cp\u003eParticipants developed plans for coping with cultural, language,\u0026nbsp;academic, and social barriers, and assisted in improving physical and mental\u0026nbsp;health and well-being.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOf the 26 participants who attended sessions,\u0026nbsp;15 participated in in-depth interviews.\u003c/p\u003e \u003cp\u003ePostgrad dietetics course\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003ePostgrad nursing course\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003cp\u003eUndergrad nursing course\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003eUndergrad OT course\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003cp\u003eMainland China\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e \u003cp\u003eHong Kong\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003eMalaysia\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003eTaiwan\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003ePhilippines1\u003c/p\u003e \u003cp\u003eFemale\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003cp\u003eMale\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA small number of international students who volunteered to participate limits generalizability. No comparison group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePride, et al. (2024).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eDiaspora, Indigenous, and Minority Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo explore the education experiences of health professionals from marginalized groups in Canada.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe authors drew on a subset of data from a larger qualitative study examining experiences of health professionals who self-identify as disabled, working-class origin, racialized, ethnic minority, and/or minority sexual/gender identity (LGBTQ+).\u003c/p\u003e \u003cp\u003eThematic analysis was conducted. Transcripts were coded using ATLAS.ti software to facilitate team coding. Interpretative thematic analysis moved iteratively between compiling coded data and re-reading full transcripts, moving back to theory, then returning to the transcripts and coded data.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants include 35 participants from medicine, nursing, and occupational therapy.\u003c/p\u003e \u003cp\u003eNurses\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e \u003cp\u003ePhysicians\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003cp\u003eOTs\u0026thinsp;=\u0026thinsp;14\u003c/p\u003e \u003cp\u003eRacialized\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e \u003cp\u003eEthnic minority\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003cp\u003eLGBTQ\u0026thinsp;+\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003cp\u003eWorking-class origins\u0026thinsp;=\u0026thinsp;10\u003c/p\u003e \u003cp\u003eDisabled\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOnly 7 of 35 participants were men, disproportionately in medicine. Nuances that are profession-specific may have been missed. Heterogeneity of the sample is a challenge for theoretical saturation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePride, et al. (2025).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eCadernos Brasileiros de Terapia Ocupacional\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis manuscript explores the retrospective educational experiences of Indigenous occupational therapists.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis study was collaborative in nature with Indigenous occupational therapists across the country, using both Indigenous and Western methods of inquiry. Stage 1 used individual storytelling sessions (n\u0026thinsp;=\u0026thinsp;13) to hear about participants' everyday experiences. Stage 2 consisted of an in-person sharing circle gathering (n\u0026thinsp;=\u0026thinsp;8) to build relationships and community, and to refine data from Stage 1\u003c/p\u003e \u003cp\u003eData were compiled and uploaded into Atlas Ti8 for the development of themes. Preliminary themes were presented at a sharing circle.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUsing purposive and snowball sampling.\u003c/p\u003e \u003cp\u003e8\u0026thinsp;=\u0026thinsp;first nation\u003c/p\u003e \u003cp\u003e5\u0026thinsp;=\u0026thinsp;M\u0026eacute;tis\u003c/p\u003e \u003cp\u003e8\u0026thinsp;=\u0026thinsp;0\u0026ndash;4 years of practice\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;5\u0026ndash;9 years of practice\u003c/p\u003e \u003cp\u003e4\u0026thinsp;=\u0026thinsp;10\u0026thinsp;+\u0026thinsp;years of practice\u003c/p\u003e \u003cp\u003e4\u0026thinsp;=\u0026thinsp;Eastern Canada\u003c/p\u003e \u003cp\u003e5\u0026thinsp;=\u0026thinsp;Central Canada\u003c/p\u003e \u003cp\u003e4\u0026thinsp;=\u0026thinsp;Western Canada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmall sample size\u003c/p\u003e \u003cp\u003eMost participants had less than 4 years of practice\u003c/p\u003e \u003cp\u003eStories are not necessarily comparable or generalizable.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamirez \u0026amp; Kiraly-Alvarez (2023).\u003c/p\u003e \u003cp\u003eUS\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe purpose of this study was to identify the supports and barriers to inclusion in occupational therapy (OT) education from the experiences of OT students from historically marginalized groups and the perspectives of OT faculty/staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe authors used a convergent mixed methods design for the study, which consisted of an online survey and semi-structured interviews.\u003c/p\u003e \u003cp\u003eThe authors used descriptive statistics to analyze quantitative data from the survey. Responses were collected and exported into Microsoft Excel to analyze frequencies, percentages, and measures of central tendency to summarize demographic data and responses. In addition, the authors used rank and frequency distribution to understand the supports and barriers. A phenomenological thematic analysis was used to analyze qualitative responses from surveys and interviews.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUsing a purposeful, convenience, and snowball sampling technique, 131 students and 35 faculty/staff completed the survey, while 20 students and 11 faculty completed interviews.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSample size limits external validity.\u003c/p\u003e \u003cp\u003eUse of a convenience sample may have resulted in self-selection bias and response bias. First author identifies as a member of a historically marginalized group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRazek, L. \u0026amp; Zafran, H. (2022).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eMcGill Journal of Global Health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study explored admissions processes related to the inclusion of equity groups within McGill University\u0026rsquo;s Occupational Therapy program and identified recommendations specific to Black applicants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eData were collected from a survey of current students and program graduates. Data analysis, applying a critical intersectional lens, was contextualized in dialogue with five key individuals at McGill and a review of the literature.\u003c/p\u003e \u003cp\u003eData analysis applied a critical intersectional lens, was contextualized in a dialogue with five key individuals and a review of the literature.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 survey respondents\u003c/p\u003e \u003cp\u003e21\u0026ndash;24\u0026thinsp;=\u0026thinsp;30.14%\u003c/p\u003e \u003cp\u003eWhite/Caucasian\u0026thinsp;=\u0026thinsp;46%\u003c/p\u003e \u003cp\u003eBlack\u0026thinsp;=\u0026thinsp;3%\u003c/p\u003e \u003cp\u003eEast or Southeast Asian\u0026thinsp;=\u0026thinsp;27%\u003c/p\u003e \u003cp\u003eIndigenous\u0026thinsp;=\u0026thinsp;3%\u003c/p\u003e \u003cp\u003eOther\u0026thinsp;=\u0026thinsp;13%\u003c/p\u003e \u003cp\u003eFemale\u0026thinsp;=\u0026thinsp;64.38%\u003c/p\u003e \u003cp\u003eMale\u0026thinsp;=\u0026thinsp;35.62%\u003c/p\u003e \u003cp\u003eLinguistic minorities\u0026thinsp;=\u0026thinsp;13.7%\u003c/p\u003e \u003cp\u003eVisible minorities\u0026thinsp;=\u0026thinsp;28.77%\u003c/p\u003e \u003cp\u003eLGBTQ\u0026thinsp;+\u0026thinsp;=\u0026thinsp;35.62%\u003c/p\u003e \u003cp\u003eDisabled\u0026thinsp;=\u0026thinsp;31.51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOnly 2 students identified as Black, highlighting the overall low number of Black OT students and graduates.\u003c/p\u003e \u003cp\u003eQuestionnaires needed to be bilingual for students whose first language was French.\u003c/p\u003e \u003cp\u003ePerspectives of prospective applicants who chose not to apply or failed the application process were not captured.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalvant, S., et al. (2021).\u003c/p\u003e \u003cp\u003eUS\u003c/p\u003e \u003cp\u003e\u003cem\u003eAmerican Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo discuss the influence of systemic racism on the profession of occupational therapy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn June and July of 2020, the AOTA hosted a series of listening sessions, entitled \u0026ldquo;Be Heard-We\u0026rsquo;re Listening,\u0026rdquo; to provide a platform for BIPOC persons to discuss lived experiences.\u003c/p\u003e \u003cp\u003eCommon topics, experiences, and recommendations for action were transferred to an Excel spreadsheet and categorized and summarized to determine emerging themes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 sessions between June 18-July 23, 2020, with approximately 200 participants per session.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePossible selection and response bias. The use of Zoom, which was not accessible to all in 2020. Themes are open to interpretation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerrano-Diaz et al. (2025).\u003c/p\u003e \u003cp\u003eUS\u003c/p\u003e \u003cp\u003e\u003cem\u003eAmerican Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo investigate the inclusion and belonging experiences of minoritized occupational therapy practitioners and students internationally.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA scoping review explored articles published between January 2010 and July 2022 using six journal databases. An updated search was completed using Litmaps and Google Scholar to check for articles published between August 2022 and May 2024.\u003c/p\u003e \u003cp\u003eUsing NVivo, the authors inductively led the code development, conceptually clustering aspects of the articles and enriching the themes until all included studies had been coded. Authors also provided feedback on the order and clustering of themes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThirty-one studies across 17 journals highlighted four distinct minoritized groups (some study criteria included multiple identities):\u003c/p\u003e \u003cp\u003eculturally and linguistically diverse people (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16),\u003c/p\u003e \u003cp\u003epeople with disabilities (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8),\u003c/p\u003e \u003cp\u003eLGBTQ\u0026thinsp;+\u0026thinsp;individuals (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8),\u003c/p\u003e \u003cp\u003eFirst Nations people (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOnly articles in English were included. Findings should be treated as preliminary and applied with careful consideration of the unique social, institutional, and population contexts. Many of the findings come from experiences of marginalization within the OT profession in Westernized, industrialized, and settler-colonial nation-states. Certain minoritized groups are missing (e.g., transgender, gender-diverse, intersex, or asexual or aromantic people, members of the Deaf community, specific cultural groups).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evan Rensburg \u0026amp; Kapp (2014)\u003c/p\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003cp\u003e\u003cem\u003eSouth African Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis article describes and analyzes the learning journey of Zinhle, a first-generation university student from an impoverished rural village who studied occupational therapy at a relatively elite South African university.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative longitudinal analysis was used in a single case study to analyze four interviews conducted with Zinhle over her undergraduate years.\u003c/p\u003e \u003cp\u003eEach semi-structured interview was spaced a year apart to allow Zinhle to reflect on her experiences of the previous academic year.\u003c/p\u003e \u003cp\u003eData were analyzed inductively by the two researchers. Thematic content analysis was used to analyze the transcribed interviews.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 participant, a first-generation university student from an impoverished rural village who studied occupational therapy at a relatively elite South African university.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGeneralizations cannot be made from a single case study.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLived Experiences, Barriers and Facilitators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLived Experiences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBarriers to safety, inclusion, and/or justice.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFacilitators, strategies or resources for safety, inclusion and/or justice.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAldridge et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education, 7\u003c/em\u003e (4).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents identified that they were impacted by systemic racism in the academic and clinical settings.\u003c/p\u003e \u003cp\u003eParticipants reported that their sense of Belonging was affected by the lack of Black representation in their OT programs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudents identified increased anxiety around the lack of Black representation. Students reported feeling burdened for having to initiate change as the \u0026ldquo;diversity person.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants initiated change at their institution in their own ways by starting chapters for the Coalition of Occupational Therapy Advocates for Diversity (COTAD), opening forums and workshops to spark conversation surrounding diversity, imploring their institutions to make statements about high-profile Black murders, and working with professors to develop more culturally sensitive materials.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenitez et al. (2022).\u003c/p\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants\u0026rsquo; lived experiences included the challenges inside and outside of the classroom, including differences in pedagogical methods, English language proficiency, barriers identified in daily life, and transitioning into the workforce. Participants also experienced a need for a support system away from home and the need to give back to their home country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIdentified barriers included changes in every aspect of daily life, and how each experience is new, different, and extraordinarily complex. These barriers affect their overall well-being.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe creation of a support system: a home away from home\u003c/p\u003e \u003cp\u003eGiving back to the home country: improving occupational therapy education, practice, and research\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBevan, J. (2014)\u003c/p\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003cp\u003e\u003cem\u003eDisability \u0026amp; Society\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants experienced negative attitudes from clients/patients and colleagues. Also discussed were negative attitudes toward the university application and interview. Also experienced were inaccessible environments in the educational setting. Experiences with organizational barriers included bureaucratic policies, guidelines, or structures of an organization that made it difficult for the participants to directly or indirectly access information.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSome experienced that being diagnosed with a disability gave them a \u0026ldquo;reason\u0026rdquo; for some of their difficulties.\u003c/p\u003e \u003cp\u003eEnvironmental barriers included steps or stairs, absence of hearing loops or accessible information. The participants did not see environments as a barrier, they were used to\u003c/p\u003e \u003cp\u003eadapting and saw no reason why they should not do \u0026lsquo;anything I wouldn\u0026rsquo;t do anyway\u0026rsquo;. The environment was seen as a barrier by others, not them. Organizational barriers indicated a general lack of knowledge relating to funding sources for equipment, adaptations, and support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA firm commitment is required by the profession to: removing disabling barriers in education, practice, and research; recognizing and endorsing initiatives like the Disability Forum (in their own right as well as part of a national diversity network); and reviewing their guidelines on an ongoing basis.\u003c/p\u003e \u003cp\u003eA positive, inclusive approach towards disabled occupational therapists may inspire greater diversity within the profession, challenging its stereotypical image and helping to ensure it develops to meet the needs of current and future registrants\u003c/p\u003e \u003cp\u003eand service users alike.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChing, E. \u0026amp; Ammon. A. (2020).\u003c/p\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003cp\u003e\u003cem\u003eDiversity \u0026amp; Equality in Health and Care\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants expressed feelings of imposter syndrome that impacted their mental health and increased stress and anxiety within the classroom.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis study identified a lack of representation as a barrier to success and inclusion in academic settings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFacilitators of a positive mentor/mentee relationship included similar racial, cultural, and class backgrounds\u003c/p\u003e \u003cp\u003eThe findings of this study focus on the need for quality mentorship, spaces, and opportunities to dialogue about race and racism, and institutional structural support for the recruitment, retention, and success of both students and faculty of color in academia\u003c/p\u003e \u003cp\u003eMental health resources are provided by the university.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEasterbrook, et al. (2015).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eDisability \u0026amp; Society\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents with disabilities had to legitimize their ability to perform the roles of student and future practitioner.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudents found there were often complexities around the disclosure of disability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFaculty can foster a learning environment that is supportive of students\u0026rsquo; differing levels of comfort concerning telling others about their disabilities and needed accommodations.\u003c/p\u003e \u003cp\u003eWorking with students to create personalized accommodations can motivate students to advocate for their needs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEdelist et al. (2024).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eMedical Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents reported they feared having their competence questioned based on the disclosure of their disability. Students also feared accommodation requests being denied.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe dominant medical model of disability in Health and Human Service education creates institutional barriers that require students to constantly (re)construct their \u0026lsquo;professional\u0026rsquo; identity in relation to their \u0026lsquo;patient\u0026rsquo; identity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSuggestions for strategies included reworking competency standards to critically examine taken-for-granted competency and licensing standards, particularly the assumption that disability is a problem for practice. Strategies suggested training to shift ableist ideas about what it means to be a competent practitioner.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFord, et al. (2021).\u003c/p\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003cp\u003e\u003cem\u003eAmerican Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants described feelings of being an outsider within the educational and professional setting. They also described a lack of support from faculty, peers, and clinical instructors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants reported feelings of self-doubt and tokenization within the education setting. Students identified non-welcoming settings, racist faculty, and systematic barriers such as financial support as barriers to success.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePurposive recruitment targeting diverse institutions, along with holistic admission and diversity-driven missions.\u003c/p\u003e \u003cp\u003eCreation of formal mentoring programs via diversity caucuses.\u003c/p\u003e \u003cp\u003eCultural awareness/bias training for faculty/Clinical instructors, along with inclusive curricula highlighting diverse OTPs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGross, E. et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eInternational Journal of Inclusive Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents reported attitudinal barriers when seeking placement accommodations. A requirement to disclose in order to request accommodations raised fears of having people determine whether students were capable of practicing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudents identified a lack of knowledge and awareness of supports regarding placement accommodations. Students were unaware of their university\u0026rsquo;s procedures for seeking placement accommodations.\u003c/p\u003e \u003cp\u003eAdditionally, students expressed concern about academic educators\u0026rsquo; lack of awareness of the existence of, or the options for, placement accommodations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCollaboration across Health and Human Service programs is needed to develop clear and effective placement accommodation procedures. Those who support disabled students in placement should receive education on supporting students with disabilities and legal obligations of accommodation.\u003c/p\u003e \u003cp\u003eStudents may benefit from advocacy and disclosure skill education.\u003c/p\u003e \u003cp\u003esupport from placement educators and an understanding of what the students\u0026rsquo; limitations are and how to support them\u0026rsquo; to successfully complete a placement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHendricks, F., \u0026amp; Toth-Cohen, S. (2018).\u003c/p\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003cp\u003e\u003cem\u003eOccupational Therapy International\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAn individual\u0026rsquo;s positive psychological state of development is characterized by (1) confidence, (2) being optimistic about succeeding, (3) perseverance toward goals and, when necessary, redirecting paths toward goals (i.e., showing hope) in order to succeed, and (4) when beset by problems and adversity, sustaining and bouncing back and even beyond (i.e., resilience) to attain success.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWithin the historical context of a contested description of being \u0026ldquo;Born Frees\u0026rdquo; (i.e., born into Democratic South Africa), students face significant challenges from the macro environment in terms of socioeconomic-political struggles, requiring positive psychological capital.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUse of personal storytelling in OT leadership camps/ curricula, to facilitate leadership growth in self-knowledge, self-awareness, and other elements of mindful leadership. Leadership development models that recognize life purpose, values and morality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJarus, T. et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eMedical Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlthough protected by legislation and policies that support their access to the health professions, participants experience challenges to their sense of legitimacy and belonging as health providers. Educational and workplace demands negatively impacted social relations among colleagues and peers. In the educational setting, for example, student participants have experienced their peers as viewing their disability and accommodations as an unfair source of advantage in a highly competitive environment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChallenges to legitimacy and\u003c/p\u003e \u003cp\u003ethe physical inaccessibility of many practice and education settings alienates students with disabilities. For example, educational settings that are not accessible put the responsibility on disabled students to do the extra planning to engage in learning activities, thus giving the impression that they are less valued.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants described supportive relationships with colleagues, employers, instructors and others in health education and practice as respectful; collaborative; trusting; kind and warm; rigorous, but fair and welcoming; sensitive to needs; open; encouraging; and friendly.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLalor, A. F. et al. (2019).\u003c/p\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003cp\u003e\u003cem\u003eBritish Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational students identified that supportive supervisors and a welcoming environment helped to define a successful clinical placement.\u003c/p\u003e \u003cp\u003ePlacements that facilitated open communication between students and staff members helped students\u0026rsquo; transition to practice placement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternational students also expressed how practice education assisted in their understanding of the Australian hospital system, which was different from their home country.\u003c/p\u003e \u003cp\u003eStudents valued practice placements that demonstrated a welcoming environment by promoting a student-friendly culture.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased cultural sensitivity/training for clinical supervisors.\u003c/p\u003e \u003cp\u003eStudents identified supportive supervisors were those who were approachable, listened, provided emotional support, and were flexible with their approach as a supervisor.\u003c/p\u003e \u003cp\u003eThe provision of a detailed orientation to the practice placement, including the physical site, available facilities (for example, tea and coffee, bathrooms, parking), and the service delivery framework.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaw, et. al. (2022).\u003c/p\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003cp\u003e\u003cem\u003eScandinavian Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents reported that the ability to learn how to work in multidisciplinary teams led to personal/professional growth\u003c/p\u003e \u003cp\u003eInternational students identified negative experiences when faculty assumed their experiences were similar to local students.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudents identified language limitations and cultural differences, creating reduced confidence and inclusion.\u003c/p\u003e \u003cp\u003eStudents reported self-directed learning demands were different than prior didactic styles, creating exclusion and difficulty with curricula.\u003c/p\u003e \u003cp\u003eInadequate university support beyond liaison tutors; need for cultural orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFacilitators included the willingness of peers to share cultural expectations.\u003c/p\u003e \u003cp\u003eSystem-level policies: Proactive disability planning, clear accountability, team-based competency focus.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLim, et al. (2016).\u003c/p\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003cp\u003e\u003cem\u003eAustralian Occupational Therapy Journal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants described three interlinked and ongoing themes that were essential to the experience of being an occupational therapy student in Australia for these students: (1) Discovering and engaging with occupational therapy; (2) Fitting into my new role; and (3) Anticipating my role at home.\u003c/p\u003e \u003cp\u003eParticipants experienced the continuing discovery of a profession about which they initially knew little about. They encountered difficulties but adapted themselves to fit in and succeed as occupational therapy students in Australia. Although they continued to see themselves as different from domestic students, these changes influenced how they saw themselves fitting back within their home cultures; while the theoretical aspects of occupational therapy were seen as compatible with participants\u0026rsquo; home cultures, application was seen as problematic due to the differences in structure and institutional culture of the healthcare systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe poor understanding of occupational therapy reported in their home countries is likely to reflect its low profile and may also be exacerbated by language issues. For example, the literal translation of \u0026lsquo;occupational therapy\u0026rsquo; in Asian languages can be misleading or unfamiliar.\u003c/p\u003e \u003cp\u003eNone of the students reported feeling that they had reached an optimal state of competence and mastery, and the occupational identity of international occupational therapy students included being different and separate from domestic students.\u003c/p\u003e \u003cp\u003eThe findings in the second theme, \u0026lsquo;fitting into my new role\u0026rsquo;, indicated that cultural and language issues are major barriers in both adjusting to the university environment and achieving academic success.\u003c/p\u003e \u003cp\u003eParticipants identified some aspects of occupational therapy theory and practice that corresponded with Western rather than Asian worldviews,\u003c/p\u003e \u003cp\u003eStudents were concerned that they would retain their sense of themselves as different when they initially returned to their home cultures and that it would take effort to fit back in and master a sense of belonging.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudents adapted, despite the difficulties, by changing their behaviors and sometimes even their attitudes, described as both necessary and deliberate.\u003c/p\u003e \u003cp\u003eImproved integration with domestic students would benefit students by improving both English language skills and understanding of and comfort with Australian culture. It would also benefit domestic students who maintain close interactions with international students to exhibit greater cultural sensitivity, attitudes, and behaviors that foster international awareness, openness, curiosity, and cooperativeness.\u003c/p\u003e \u003cp\u003eEducators can consider providing structured opportunities in coursework and assessment for international students to relate their learning to practice in their home countries.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLindsay et al. (2023).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eDisability and Rehabilitation\u003c/em\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKey trends related to student and practitioner experiences of workplace ableism included: rates and types of workplace ableism, which occurred at the institutional and individual level; and the impact of workplace ableism.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBarriers included disability discrimination, hostile work environments, retaliation against a person for participating in activities protected by the statute, stereotyping, and bullying.\u003c/p\u003e \u003cp\u003eInstitutional ableism included inaccessible environments and physical barriers, a lack of support, and an unsupportive work environment.\u003c/p\u003e \u003cp\u003eIn health professions, these included difficulty disclosing due to fear of stigma, the impact on health and well-being, and the impact on job and career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHaving more knowledge about people with disabilities could help to reduce stereotypes while improving positive attitudes, empathy, and social inclusion.\u003c/p\u003e \u003cp\u003eMore support at an institutional and senior leadership level is needed to enhance the inclusion of people with disabilities and particularly engage managers and coworkers to be less discriminatory.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLuong, et al. (2023)\u003c/p\u003e \u003cp\u003eUS\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents experienced racism or ethnic discrimination in settings, such as external educational opportunities (e.g., school applications), program curriculum, on campus, and in fieldwork. Fieldwork was the most reported setting where students experienced racism or ethnic discrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBarriers included racism and ethnic discrimination in their educational setting. Though students reported having experienced racism or ethnic discrimination within the classroom and fieldwork settings, classroom conversations and content related to topics on diversity, equity, and inclusion (DEI) and anti-racism were limited.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOT programs are encouraged to increase these conversations and implement supportive resources for students who have experienced racism and ethnic discrimination. Recommendations include: a) acquire additional education in DEI-related subjects; b) continue to incorporate more conversations related to topics of DEI, racism, and ethnic discrimination in the classroom and fieldwork settings; c) provide simulated or real-life hands-on opportunities and experiences to work with people of color within the community; d) teach students how to appropriately behave and respond to racism and ethnic discriminatory situations; e) create program curriculums that focus on DEI and anti-racism content; f) host support groups with diverse people to encourage mentorship between students, practitioners, and community members; and g) diversify course content to include images, perspectives, and stories of people of color.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOtuniga \u0026amp; Chichaya (2025).\u003c/p\u003e \u003cp\u003eUK\u003c/p\u003e \u003cp\u003e\u003cem\u003eIrish Journal of Occupational Therapy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour themes include lived experiences of: bitter-sweet experiences, harsh realities on placement, need for intentionality when planning the course, and need for creating safe spaces during practice placement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBarriers were described as: 1) horrible peer support from white students, 2) lack of Black representation, 3) difficulty reporting racial issues, 4) being the only black person on placement, 5) lack of educator professionalism, and 6) hesitancy to report racial issues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFacilitators included: 1) Positive black peer support system, 2) supportive lecturers.\u003c/p\u003e \u003cp\u003eRecommendations for educator training, Black educator representation, and a better racial support system.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenman et al. (2021).\u003c/p\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of International Students\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational students report experiencing higher sociocultural and academic stress when settling into a new university compared with their local counterparts.\u003c/p\u003e \u003cp\u003eSpecifically, following thematic analysis, four themes emerged from the text, highlighting the impact of the program on the participants. These were facilitating adjustment, establishing relationships, gaining new skills and knowledge, and transforming beliefs and behavior.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternational students reported high levels of loneliness and anxiety, saying that they really struggled to fit into university life and also into the Australian way of life more generally. Despite having been accepted by the university into their courses, they expressed strong feelings of self-doubt in their ability to complete them. They described how their feelings were also barriers to their full participation in university life, both academically and socially.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudents indicated that finding a safe place was crucial for relationship building and adjustment. Programs need to provide an environment that is beneficial in terms of encouraging positive behaviors and participation, reducing academic pressure, and increasing confidence in communication and interactions with students and staff. Another dimension of this theme is the mentee-mentor relationship that emerged, which can contribute to social and peer learning and the creation of a safe environment.\u003c/p\u003e \u003cp\u003eProgram activities can facilitate the development of a sense of community through the sharing of culture, ways of learning, relationships, and food.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePride, et al. (2024).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eDiaspora, Indigenous, and Minority Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLived experiences included: 1) Isolation; 2) Normative curricula; 3) Marginalization by classmates and instructors; 4) Exclusionary social and cultural capital; and 5) Coping strategies. Together, they represented routine institutional processes in health professions education \u0026ndash; particularly access and admissions, formal and informal curricula, and socialization into professional identities \u0026ndash; that are implicated in the reproduction of oppressive systems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFor participants, a sense of not fully belonging was conveyed by seeing few people like themselves in their educational programs, particularly in teaching and leadership roles.\u003c/p\u003e \u003cp\u003eParticipants described how content relating to marginalized groups was rarely included in curricula, and when it was, it included and/or reproduced negative, harmful stereotypes.\u003c/p\u003e \u003cp\u003eParticipants described how clinical instructors \u0026ldquo;were always super hard on minority students. And it was blatant, it was in your face, kind of thing.\u0026rdquo; This included grilling them, demanding extra work, asking obscure questions, and being quick to suggest remedial work.\u003c/p\u003e \u003cp\u003eIn addition to isolation, marginalization by classmates and instructors, as well as gaps and stereotypes presented in the curriculum, participants felt excluded in educational contexts when they lacked the social and cultural capital valued in their programs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEach participant had their own ways of coping with exclusion and marginalization during their education, such as self-care, substance use, immersion in study, and activism. Some focused on advocacy, some focused on keeping their heads down till they graduated. Two key things that mitigated harm while helping create a sense of belonging and respect were mentoring and community.\u003c/p\u003e \u003cp\u003eA clear need was expressed for the program to turn the lens inward, toward changing long-standing institutional underpinnings and undermining the exclusionary processes that render some learners as \u0026ldquo;expected\u0026rdquo; and \u0026ldquo;normative\u0026rdquo; while others are constructed as misfits. Although this requires an overhaul of health professions education, it is an essential step toward creating spaces for people, knowledges, ways of knowing, values, and resources that have traditionally been subjugated.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePride, et al. (2025).\u003c/p\u003e \u003cp\u003eCanada\u003c/p\u003e \u003cp\u003e\u003cem\u003eCadernos Brasileiros de Terapia Ocupacional\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndigenous occupational therapists experienced imposed isolation, lack of support, exclusion, a devaluing of merit and skill, and \u0026lsquo;jagged worldviews colliding\u0026rsquo; in their programs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImposed isolation resulted in feelings of being \u0026lsquo;othered\u0026rsquo; and illuminated who the \u0026lsquo;expected\u0026rsquo; OT student is in these spaces.\u003c/p\u003e \u003cp\u003eLoneliness, often due to being imposed isolation, deeply impacted these participants\u0026rsquo; sense of belonging in their educational programs.\u003c/p\u003e \u003cp\u003eMost participants noted a serious lack of support in their respective programs.\u003c/p\u003e \u003cp\u003eAffirmative action or \u0026lsquo;equity\u0026rsquo; processes have at times resulted in backlash, largely due to myths relating to being underqualified or getting an unfair advantage. This backlash is displayed through devaluing and questioning the merit and skills of Indigenous learners, a doubt that can be internalized, further undermining any sense of belonging.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe occupational therapy profession needs to move towards decolonial Indigenization, which requires divesting of colonial privilege and ideologies towards something dynamic and new.\u003c/p\u003e \u003cp\u003eAlso recommended was a deep consideration of the value of, and need for, multiple perspectives, and drawing on the expertise and experiences of Indigenous students, occupational therapists, researchers, and educators is needed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamirez \u0026amp; Kiraly-Alvarez (2023).\u003c/p\u003e \u003cp\u003eUS\u003c/p\u003e \u003cp\u003e\u003cem\u003eJournal of Occupational Therapy Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLived experiences include a lack of awareness of OT as a profession and the lack of representation of OT practitioners from historically marginalized groups act as barriers to exploring OT as a potential career. Themes include 1) Barriers and facilitators exist while exploring OT as a potential career; 2) Pros and cons in the OT admission process for students from historically marginalized groups; 3) Students from historically marginalized groups experience varying degrees of exclusion and a limited sense of belonging with their OT programs; 4) Many OT programs have good intentions to promote diversity and inclusion through various efforts; 5) Some OT program efforts may be counterproductive, and more actions must be taken to further promote inclusion and address barriers to inclusion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccording to participants, the lack of knowledge or guidance on how to apply to OT schools was deemed a barrier to the admissions process. Lack of social support and mentorship to navigate the various components of the complex application process may prevent students from historically marginalized groups from applying to OT school. Limited financial resources to complete the application process and limited financial support from OT programs prevented students from applying to certain programs, therefore limiting the opportunities for admissions.\u003c/p\u003e \u003cp\u003eStudents reported experiencing various degrees of discrimination and exclusion by both faculty and peers, from microaggressions and culturally insensitive behaviors to overt racism. Other students reported that although they do not experience explicit exclusivity from their peers or faculty, they still feel less included due to their inability to relate to their peers\u0026rsquo; values and experiences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants identified that opportunities to observe OT practitioners greatly influenced the desire to ultimately choose to pursue OT as a career. Therefore, it is imperative to continue to work on enhancing the awareness and knowledge of the OT profession and creating more opportunities for observing OT practitioners in action. This can be done through various outreach, pipeline, and mentoring programs beginning during primary school education.\u003c/p\u003e \u003cp\u003eStudents who had social supports (e.g., family, friends, and peers) were more likely to overcome barriers and had more opportunities to engage in higher education.\u003c/p\u003e \u003cp\u003eAvailability of scholarships and clear information about financial aid may support students who experience financial barriers.\u003c/p\u003e \u003cp\u003eParticipants suggested that there should be more opportunities to provide faculty feedback in an anonymous way. Most participants reported that when OT faculty and administration were more open-minded to change and feedback from students, it helped foster more feelings of inclusion and belonging. Participants also suggested that when conflicts do arise, there should be more emphasis on the follow-through to ensure the conflict is resolved.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBarriers\u003c/h2\u003e \u003cp\u003eBarriers experienced in the professional education experience of diverse students included subthemes related to the effects of systemic or organizational context, lack of department or student support, and the students\u0026rsquo; feelings or reactions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSystemic or Organizational Context\u003c/h2\u003e \u003cp\u003eSources consistently reported that diverse students felt a lack of support from the educational system, including experiences of stigma and marginalization, bias, racism [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and system inequities [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Examples identified included admission criteria biased toward upper-class White students, for example, opportunity for leadership or other health care experiences, such as serving as a rehabilitation technician [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and a lack of financial support [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Other systemic or organizational barriers included ableism [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and inaccessible environments, such as classrooms and labs with equipment that could not be adapted, and fieldwork sites with inaccessible clinical spaces [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDepartment or Peer Student Support\u003c/h2\u003e \u003cp\u003eSources also highlighted a lack of department and peer student support as a significant barrier to success for diverse students. This sometimes involved having to take on the role of the \u0026ldquo;diversity person\u0026rdquo; in class or in the department [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Despite this, students felt that there were limited Diversity, Equity, and Inclusion (DEI) conversations in the program, a normative curriculum that focused on issues related to middle to upper middle-class persons [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], language barriers [\u003cspan additionalcitationids=\"CR34 CR35\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and a lack of awareness of marginalized groups [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Students reported feeling isolated [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], experiencing negative attitudes from peers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], a lack of support from faculty, students, and the educational system [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], and vulnerability to authority [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Citing admission criteria that were biased toward upper-class White colleagues [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], diverse students often felt unsupported by their peers, and an increased need to legitimize their ability and competence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStudent Feelings or Reactions\u003c/h2\u003e \u003cp\u003eStudents consistently reported feeling anxious due to a lack of faculty representation of their identity cultures, which fostered a sense of not belonging or being an \u0026ldquo;outsider\u0026rdquo; [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24 CR25\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Students said they often felt self-doubt or experienced imposter syndrome regarding their ability to be successful in the occupational therapy program [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and experienced racialized trauma [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFacilitators\u003c/h2\u003e \u003cp\u003eDiverse students also identified facilitators to success they experienced within professional educational settings, which were also related to systemic or organizational contexts and departmental or peer support. In addition, the students\u0026rsquo; own feelings and reactions were perceived as potential facilitators.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSystemic or Organizational Context\u003c/h2\u003e \u003cp\u003eIncluded sources showed that improving organizational processes can facilitate recruitment and retention success for diverse students. Holistic admission practices increased recruitment of diverse students through consideration of lived experiences from under-represented groups and elimination of in-person interviews [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Students reported both academic and practice success with support from school resources such as access to mental health providers, writing workshops, small classes, and workshops on stress management [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Creation of spaces to discuss diversity and inclusion by diverse faculty was also identified as beneficial to students [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], as was the importance of having legislation in place to allow diverse students to access the academic and fieldwork settings [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDepartment or Peer Student Support\u003c/h2\u003e \u003cp\u003eStudies consistently identified departmental and peer student support (both within and beyond their educational institutions) as facilitators of success for diverse students. Students identified that having mentorship opportunities with mentors of the same cultural background and/or lived experience promoted open dialogue, provided a sense of relief and community, and fostered inclusion [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Several studies also demonstrated that support from outside the educational organization reduced feelings of isolation. Examples included connections with national and international professional organizations (e.g., Coalition of Occupational Therapy Advocates for Diversity (COTAD), National Board of Certification for Occupational Therapists (NBCOT), social media, diverse student support groups, and the broader community [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStudent Feelings and Reactions\u003c/h2\u003e \u003cp\u003eStudents consistently reported creating their own coping strategies to deal with feelings of marginalization and exclusion. Examples of coping strategies included self-care practices, creating a community outside of the educational setting, activism, and changing values to fit in with peers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Those who used activism as a coping strategy often led spaces for conversations around diversity, as well as creating chapters of national and international organizations for diverse occupational therapy groups [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Students identified that having previous experiences in settings with limited diversity was beneficial to anticipating and adapting to similar situations they may experience as a student [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. They also reported that sharing their lived experience with clients and clinical instructors enhanced practice and increased their ability to relate to and build rapport with clients during fieldwork placements [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrategies to Address Student Safety and Inclusion\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eSystemic or Organizational Context\u003c/h2\u003e \u003cp\u003eSeveral suggested strategies to address these barriers from a systemic or organizational context were proposed in the literature. Creation of culturally sensitive materials and clear accommodation processes for admission and to support students\u0026rsquo; study was recommended to increase feelings of belonging [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Suggestions were also made for the development of safe spaces and support services that address racism and other \u0026ldquo;isms\u0026rdquo; such as ableism, and sexism [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] Increasing DEI conversations for administration, faculty, and students, including awareness training and listening sessions, was recommended to increase understanding, inclusion, and advocacy for systemic and organizational support of diverse students [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eDepartment or Peer Support\u003c/h2\u003e \u003cp\u003eAccessing support from national and international professional organizations (e.g., Coalition of Occupational Therapy Advocates for Diversity (COTAD), Black Caucus) that support diversity were recommended to enhance belonging, as well as purposive recruitment of diverse department faculty and students [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Intentional support of diverse students at orientation [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], creation of support services to address safety and inclusion for under-represented student populations [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], activities that integrate diverse students [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and alumni mentorship programs [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] were also identified as strategies to address isolation.\u003c/p\u003e \u003cp\u003eWithin the professional education program, reworking of competencies and transparent, competency standards helped address feelings of incompetence and assumptions about competence for diverse students by faculty, peers, clinical supervisors, and the students themselves [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Reworking of the curriculum to include extended or modified programs was also recommended to increase success in the program for students who may not be able to afford a full-time program [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Use of critical reflexivity and listening sessions was suggested to increase knowledge of faculty and students about issues faced by diverse students [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Finally, advocacy by faculty and peers was suggested to address policy inequities experienced by students (and ultimately practitioners) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This scoping review aimed to explore the experiences of occupational therapy students from diverse backgrounds, including the barriers and facilitators to inclusion, the strategies recommended to support equity, and to compare experiences between groups using an intersectional lens. The findings indicate persistent systemic and organizational barriers to inclusion exist, with facilitators and strategies to counteract these barriers also reported, including mentorship and inclusive admissions practices. The findings indicate there are ongoing equity issues within occupational therapy education that require systemic and organization-level action to address, with multiple recommendations for interventions required to improve inclusion, safety, and justice within occupational therapy professional education. This review describes the complex and intersectional factors that contribute to the lived experience of diverse occupational therapy students during their professional education. Research in this area has consistently identified barriers embedded throughout programs and processes, while also highlighting facilitators and opportunities for positive change. However, the extent to which these facilitators and strategies are currently used to address identified barriers is unclear.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eCommon Facilitators and Barriers to Safety and Inclusion\u003c/h2\u003e \u003cp\u003eThe included sources demonstrate that the barriers experienced by diverse occupational therapy students are deeply embedded within systemic, organizational, and educational structures. These experiences are symptomatic of how the profession itself is structured, given the ongoing dominance of White, Western, and ableist norms [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], which overshadow the social and structural determinants of health and occupation in favour of individualised explanations of \u0026ldquo;problems.\u0026rdquo; Their experiences produced significant emotional labor related to the need to perform \u0026lsquo;invisible work\u0026rsquo; to create their own belonging [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which negatively affected belonging and academic persistence. For occupational therapy, these findings underscore the need to move beyond individualized explanations of student \u0026ldquo;preparedness\u0026rdquo; toward systemic reform that embodies principles of occupational justice.\u003c/p\u003e \u003cp\u003eDespite these challenges, the review also highlighted several key facilitators that support safety, inclusion, and success. Holistic admissions processes that consider the students' full backgrounds, clear accommodation pathways, and access to appropriate institutional supports (e.g., mental health services, small group learning, writing support) were identified as meaningful organizational enablers here and in other studies [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Students also drew on their own strengths, including self-advocacy, collective activism, and creating supportive peer communities, to counteract feelings of exclusion. They are also more able to navigate complex cultural contexts in education and practice [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], countering the deficit narrative and problematizing that often accompanies discussion of their place in the profession. These facilitators illustrate the importance of intentionally designing and supporting structures that recognize lived experience as a valued knowledge source and diversity as a source of strength and capability.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eStrategies to Support the Safety and Inclusion of Occupational Therapy Students\u003c/h2\u003e \u003cp\u003eStudies explored entry into and experiences within occupational therapy professional programs. While the focus most commonly was on the experiences of students during their professional education, there were several studies exploring the practices leading to the entry of students into these programs, and how these procedures impacted certain groups. Four articles either reported the experiences of students during the entry process or interviewed students about their recommendations for the admissions process [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. One of the common factors mentioned was the financial requirements for entering occupational therapy. Students were concerned about the costs of the program, and required greater information initially about the tuition to make an informed decision before applying [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Students also reported concerns regarding the costs associated with applying to professional programs, creating a barrier before they had even applied [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In the United States, tuition costs continue to be the greatest barrier to entering occupational therapy programs [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. While most of the studies reporting on the admissions process were conducted in the United States [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], one study suggests this may be a more global issue, with greater international research required, and action needed to address this inequity where it exists [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the common recommendations for increasing accessibility to occupational therapy was employing an admissions process that considered more than just academic results. Factors, such as life experiences, used in the admissions process, suggest that holistic admissions would lead to greater equity in the recruitment process [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Also recommended is that the admissions process should not require the identification of information about one\u0026rsquo;s identity that could impact decisions regarding admissions, even if inadvertently, and that the admissions process should signal inclusivity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It is evident that the admissions process is part of the problem, with greater accessibility and inclusivity required. However, the subjectivity with which admissions processes are applied, particularly regarding the qualitative information that applicants provide, needs to be managed with clear criteria, thus reducing the risk of biasing the selection process [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Greater support and inclusive practices are required, with greater research and clear recommendations needed regarding the most inclusive and fair way of ensuring that greater equity is achieved in the entry process and reducing barriers for diverse students.\u003c/p\u003e \u003cp\u003eWhile some articles provided recommendations regarding entry into professional programs, most articles explored the experiences of students once they had entered, reporting common facilitators and barriers to safety and inclusion in the course. Consistent barriers were identified, including a lack of support from the program, the need to \u0026ldquo;prove oneself\u0026rdquo; in class or on fieldwork, stigma, marginalization, bias, racism, and inequities. Students also consistently reported feeling a lack of belonging and support, and reported that their peers lacked an awareness of the experiences and challenges they face because of their identity. Often, the students felt pressure to be the \u0026ldquo;diversity\u0026rdquo; person in class [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These reactions often caused the student to experience self-doubt and imposter syndrome [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These experiences indicate that students from diverse backgrounds have a markedly negative and more challenging experience at university, which is unsafe and unjust. While professional bodies in the UK, Canada, the US, and Australia indicate the importance of inclusion within the profession, there is clearly a disconnect between intentions and reality [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The environment created within a professional program influences who might apply. If students believe they will have a positive experience and can see themselves reflected within the student cohort and faculty, and profession, they may be more likely to apply, leading to greater diversity in educational programs and the profession [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile some of these program-level issues create barriers to safety and may hinder entry, these challenges were often due to wider system-level issues impacting students\u0026rsquo; experiences. There were multiple systems-level opportunities identified that could improve the experiences of students at an individual level. Some examples included reflecting diversity in curriculum content [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], employing diverse staff [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and making content and systems universally accessible to reduce the burden on students with specific needs [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Universal design principles have been mentioned as imperative in university education, because if accessibility is addressed for some, it can improve the experience for all [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Creating systems-level change has the potential to improve the educational experience for all students, creating a more inclusive and accessible environment that benefits everyone [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe key role played by faculty was also emphasized in the included sources, which advocated for intentional recruitment of diverse academics. Strategies suggested in the literature included recruiting diverse faculty, creating safe spaces for students, and increasing awareness for faculty and peers about issues faced by diverse students [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A large study across multiple courses and disciplines [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] highlighted a significant but indirect impact on student success and progression to graduation from alignment between student and faculty racial and ethnic composition. While systems-level change is required, mentorship was one of the strategies commonly mentioned in the literature. Increasing the DEI capacity of non-diverse faculty is also recommended, and several approaches to its achievement have been explored in the literature [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Diverse occupational therapy faculty also provide role models and representation and occupy positions of influence and leadership [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Faculty diversity and equity capability are, therefore, core infrastructure for building a just and inclusive occupational therapy workforce.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eIntersectionality and Diverse Occupational Therapy Students\u003c/h2\u003e \u003cp\u003eWhile many studies explored the experiences of students from different identity groups, most included sources did not specifically discuss the experiences of diverse students using an intersectional lens. The concept of intersectionality is emerging as a critical perspective in occupational therapy and has a growing presence in practice, education, and research [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Research commonly explored the experiences of students who identified with a specific identity group, for example, students with disabilities [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] or people of color [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The research aims were commonly focused on a specific group, and there was little exploration of the impact that intersecting identities may have had on students\u0026rsquo; experiences. This has the potential to miss the complexity of people\u0026rsquo;s experiences that could exist when examining the experiences with these groups. It also limits the ability to analyze findings between different groups, with limited demographic information provided about the samples included. Pooley and Beagan assert that occupational therapy needs to take intersectionality more seriously if the profession wants to meaningfully address systemic inequities [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin the literature, there were different terms used for \u0026lsquo;diverse\u0026rsquo; that added complexity to the search strategy and data analysis. Some common terms used included marginalized, minoritized, under-represented, and diverse. The use of minoritized and marginalized reflects the systemic power dynamics and the exclusion and disadvantage experienced by certain groups [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Alternatively, under-represented was also commonly used, and reflects the small number of people from certain groups, but does not reflect the disadvantage experienced by some groups. It also puts the onus on the individuals, rather than on the system or those in positions of power, to address injustice, with instances of inequity [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. The use of \u0026lsquo;diverse\u0026rsquo; is also complex. Using \u0026lsquo;diverse\u0026rsquo; risks highlights difference without acknowledging the oppression and discrimination experienced by many groups, and risks certain people being seen as other [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. The use of varied terms added to the complexity of this more holistic perspective. There is, therefore, an urgent need to embed intersectionality into everyday practice, education, and research, rather than treating diversity categories separately or superficially.\u003c/p\u003e \u003cp\u003eThe urgency for this shift in perspective partly comes from the compounding and amplifying effects of intersectionality on safety and inclusion for occupational therapy students and requires a considered selection of language that should acknowledge the disadvantage and oppression commonly experienced by certain groups. Many of the experiences identified in the included sources (e.g., having to \u0026ldquo;prove\u0026rdquo; competence, lack of belonging) were consistent across multiple marginalized student groups (e.g., race, ethnicity, ability, gender). This confirms a core concept within intersectionality by highlighting how the interactions between different identities within the same person can introduce a complexity that may be hidden when groups are considered in isolation [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Occupational therapy already possesses a holistic perspective on human health and wellbeing, which could inform better engagement with the needs of students as individuals rather than as part of a particular group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAlthough results from this scoping review were consistent in the identification of facilitators, barriers, and solutions, it is not without limitations. One of the limitations of this review was that sources in languages other than English were not reviewed, as the research team was English-speaking only and there was insufficient resourcing to locate and translate texts in other languages, limiting the transferability of findings to certain parts of the world. Additionally, care was taken to incorporate terms that reflected as many diverse groups as possible in the search strategy, and the search strategy was reviewed on multiple occasions by a librarian. However, it is possible that certain groups may have been inadvertently missed, which may have impacted the articles that were located and limited the comprehensibility of the search. In addition, some members of the research team did not identify as being a member of any of the diverse groups included in this study, and although the researchers had discussions as a team and worked collaboratively, reviewing each other\u0026rsquo;s work, this may have influenced the interpretation of the findings. Most articles were not located by using the traditional database keyword search strategy and were instead located using citation searching through Connected Papers that accessed articles not indexed in the traditional databases. This suggests that articles covering diversity, equity, and inclusion topics may not be published in traditional journals, and strategies used to search for articles on these topics should consider this, incorporating additional steps to locate these articles. Publications practices should also incorporate articles on these topics to improve dissemination.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eImplications For Occupational Therapy Education and Policy\u003c/h2\u003e \u003cp\u003eMultiple implications for occupational therapy education and policy were identified. These implications have been divided into systemic or organizational, course, and individual levels.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSystemic or Organizational Level Implications\u003c/h2\u003e \u003cp\u003eTo achieve greater diversity in student cohorts, purposeful recruitment strategies are required, with greater support provided in the application process for those who require it. Greater information about the costs associated with study needs to be provided up front, and more inclusive admissions processes are required, providing people with choice about what they choose to disclose about their identity, with holistic admissions mentioned as one strategy to support greater diversity and inclusivity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOnce students have entered the university system, there needs to be easily accessible accommodations and support provided [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Staff require training on providing safe and inclusive environments. There needs to be educational frameworks developed that accommodate, highlight, and support people from diverse backgrounds [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Supportive communities within educational institutions need to be established. Students also need to be made aware of and encouraged to make connections with professional organisations focused on issues of diversity to support inclusion [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProgram Level Implications\u003c/h3\u003e\n\u003cp\u003eStrategies are required to reduce isolation and support inclusion. Suggestions to foster inclusion were to facilitate opportunities for mentoring with mentors from similar diverse backgrounds. Increased representation within curricula was also suggested [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Students suggested that opportunities should be provided to raise the awareness of diverse students\u0026rsquo; experiences [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It was also suggested that within occupational therapy, competencies need to be changed to address incorrect assumptions about the competence of diverse students [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eIndividual Level Implications\u003c/h2\u003e \u003cp\u003eSome approaches that students found useful included finding opportunities to share their lived experiences with peers and mentors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. They also suggested employing self-care strategies, which, for some, were seen as an act of resistance [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Though individual strategies may support withstanding the system as it is currently, there was emphasis on the importance of creating change at a program and system level.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review explored how the literature represents the lived experiences of diverse occupational therapy students during their professional education. Recent literature continues to show systemic, organizational, and departmental barriers to student success, resulting in discrimination and reduced feelings of not belonging. Facilitators include mentorship, revised admission criteria, and increased awareness by faculty, peers, and clinical instructors of issues experienced by diverse students. Research is becoming more prevalent but still limited. Future research should examine how interventions at the program level can improve the experiences of diverse students and how to strengthen inclusive student recruitment practices, ultimately improving the experiences of future clinicians and the clients we serve.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u0026nbsp;Acknowledgements\u003c/p\u003e\n\u003cp\u003eWe respectfully acknowledge the Traditional Custodians of the lands on which we live and work. In Australia, we pay respects to the Aboriginal and Torres Strait Islander peoples, the original inhabitants and caretakers of this country. We recognise their enduring connection to the land, waters, and culture, and we honour their Elders past and present.\u003c/p\u003e\n\u003cp\u003eWe also acknowledge the Indigenous peoples of other lands where this work may be read and utilised. We recognise their traditional knowledge, wisdom, and practices that have been maintained for generations. We are committed to fostering respectful and collaborative relationships with Indigenous communities and to supporting the sovereignty and self-determination of all Indigenous peoples.\u003c/p\u003e\n\u003cp\u003eThis scoping review aims to contribute to a broader understanding of occupational therapy practices globally, and we are mindful of the diverse cultural contexts in which this knowledge will be applied.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to conduct this review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlesia\u0026nbsp;Ford\u003c/strong\u003e is an occupational therapist of color, with a commitment to social justice, equity, inclusion and cultural humility. She is passionate about diversifying the field of occupational therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiane Smith:\u003c/strong\u003e As a white, heterosexual, cisgender, able-bodied, upper-middle class individual, my work as a PhD occupational therapy researcher has been primarily focused on issues of disability rights and access and, more recently, the intersectional effects of disparity faced by populations receiving occupational therapy and other healthcare services. \u0026nbsp;My lens reflects this social and occupational justice focus in all of my roles as a professor and researcher.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTamara Wanklyn\u003c/strong\u003e: I live and work on Wadawurrung country in the regional Australian town of Geelong and grew up in Naarm, Melbourne. I have worked as an occupational therapist for 14 years, in Australia, England, and Canada. Identifying as female, cis-gender, heterosexual, Australian of Anglo-Celtic heritage, neurotypical, highly educated, middle class, and without disability, I recognise the multiple elements of my identity that afford me privilege, and I strive to advocate for and promote the creation of more inclusive healthcare environments and practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDanielle Hitch\u003c/strong\u003e is an occupational therapist and health economist, with a commitment to social justice and inclusion. She lives with disability and was the first person in her family to complete secondary school.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the scoping review protocol manuscript. All authors contributed to the search strategy design, data analysis plan, and writing and/or editing the scoping review protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no conflicts of interest in the development of this paper. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAustralian Health Practitioner Regulation Agency National Boards \u003cem\u003eOccupational therapy workforce - Snapshot as at 30, 2023\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited, Nations (2021) \u003cem\u003eWorld population prospects 2022: Summary of results\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLedgerd R (2020) WFOT report: WFOT human resources project 2018 and 2020. 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Canadian Journal of Occupational Therapy, vol. 88, 5, pp. 427\u0026ndash;439\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeffernan T (2023) \u003cem\u003eThe marginalised majority in higher education: Marginalised groups and the barriers they face.\u003c/em\u003e Palgrave-Macmillian, ISBN: 978-3-031-41431-2\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSelvarajah S, Deivanayagam TA, Lasco G, Scafe S, White A, Zembe-Mkabile W, Devakumar D (2020) Categorisation and minoritisation. BMJ Global Health 5:e004508\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNwangwu NC (2023) Why we should stop saying Underrepresented Harvard Business Review, Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hbr.org/2023/04/why-we-should-stop-saying-underrepresented\u003c/span\u003e\u003cspan address=\"https://hbr.org/2023/04/why-we-should-stop-saying-underrepresented\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBell JM, Hartmann D (2007) Diversity in everyday discourse: The cultural ambiguities and consequences of Happy Talk. Am Sociol Rev 72(6):895\u0026ndash;914\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrenshaw KW (1989) Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics, University of Chicago. Legal F. 139 (1989). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scholarship.law.columbia.edu/faculty_scholarship/3007\u003c/span\u003e\u003cspan address=\"https://scholarship.law.columbia.edu/faculty_scholarship/3007\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Deakin University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diversity, occupational therapy professional education, equity, inclusion, intersectionality","lastPublishedDoi":"10.21203/rs.3.rs-8359272/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8359272/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The aim of this scoping review is to describe the experiences of occupational therapy students from diverse backgrounds during professional education. The objective is to identify common facilitators, barriers, or strategies that impact their safety and inclusion in professional education and ultimately the workforce, and to highlight any gaps in the literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Occupational therapy lacks diversity in its workforce, which is predominantly White and female in many countries. Increased workforce diversity is a priority for the occupational therapy profession to enhance the provision of culturally competent care and address health inequity and access barriers. Therefore, recruiting and retaining occupational therapy students from diverse backgrounds in a safe and inclusive academic environment is important for the entire profession.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A scoping review of sources exploring the lived experiences of occupational therapy students from one or more diverse backgrounds was undertaken. The sources used qualitative or mixed methods approaches and were published in English since 2014. Databases searched via the EBSCOHost platform included Medline, CINAHL, AMED, Pubmed, SocINDEX, ERIC, and CENTRAL via Cochrane. Citation searching was conducted on included papers using the Connected Papers platform. Articles were screened by two independent researchers by title and abstract, and then by full text, before relevant data were extracted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThematic analysis identified evidence relating to barriers and facilitators in the systemic and organizational context; departmental and peer supports; and the students' lived experiences of professional programs. Strategies suggested to address these barriers include purposeful mentoring, increased knowledge of the student’s culture, and increased accessibility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThere has been an increase in the amount of research published regarding diversifying student populations. The experiences of diverse occupational therapy students during professional education are influenced by multiple individual, group, organizational, and systemic factors. More research is needed to evaluate the effectiveness of these strategies.\u003c/p\u003e","manuscriptTitle":"Lived experiences of occupational therapy students from under—represented backgrounds in professional educational programs: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-16 09:45:03","doi":"10.21203/rs.3.rs-8359272/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b61ae242-4c39-4fd0-ab0d-116b3e0a3889","owner":[],"postedDate":"December 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59624815,"name":"Cultural Studies"}],"tags":[],"updatedAt":"2025-12-16T09:45:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-16 09:45:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8359272","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8359272","identity":"rs-8359272","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}