Early career occupational therapists’ perceptions of occupational justice in practice in Singapore

Abstract

Introduction:

Occupational justice addresses social, political and economic factors influencing occupational participation as a human right. Implementing occupational justice is challenging due to institutional, personal, environmental and cultural barriers, and may be further complicated in non-Western contexts. Early career occupational therapists often struggle to apply these principles while transitioning from education to practice, despite their desire to advocate for justice-focused practices.

Methods:

This qualitative descriptive study, grounded in social constructivism, explored the experiences of early career occupational therapists applying occupational justice in Singapore. Using snowball sampling of 2020 and 2021 graduates, participants engaged in one-time semi-structured interviews, which were transcribed verbatim and thematically analysed.

Findings:

Of 140 potential participants, 10 responded and completed the study. Four themes were developed: (1) Feeling uncertain about occupational justice, (2) Perceived relevance in the Singaporean context, (3) Early career challenges and (4) Aspiration to be agents of change.

Conclusion:

Early career occupational therapists expressed uncertainty in applying occupational justice concepts, often confusing them with occupation-centred practice. Despite recognising individual influences, they felt ill-prepared to tackle systemic barriers and advocate for broader social change. However, participants were aware and willing to support occupational justice ideals, suggesting a need for more guidance to integrate individual therapeutic goals with societal advocacy.

Introduction

Occupational justice is a foundational concept within occupational therapy, emphasising the rights of people to engage in meaningful occupations that contribute to their health, well-being, and quality of life (Hocking et al., 2022; World Federation of Occupational Therapists, 2019). This concept broadens the scope of occupational therapy beyond individual-centred practice to include advocacy for societal changes that promote equitable access to occupations. The term encapsulates the belief that opportunities for participation in occupation are a fundamental human right and should be accessible to all people, regardless of their background or circumstances (Bailliard et al., 2020). Occupational therapists are increasingly focusing on promoting justice, diversity, equity and inclusion within their practice, addressing barriers at individual, institutional, cultural, political and interpersonal levels (Smith, 2023).

Despite the importance of occupational justice concepts, implementing them in practice is challenging due to their complexity and the influence of various contextual factors, including institutional, personal, environmental and cultural nuances (Bailliard et al., 2020; Whiteford et al., 2020). Moreover, there is a recognised necessity for a critical examination of the suitability of occupational justice principles in non-Western cultures, emphasising the complexities inherent in applying these concepts (Sy et al., 2021).

For early career occupational therapists, translating occupational justice concepts into practice presents additional hurdles. While occupational therapy education provides a theoretical foundation in occupational justice, the transition period from student to practitioner can be overwhelming as they navigate the complexities of settling into the workplace while grappling with their junior position within the health system (Moir et al., 2021; Turpin et al., 2021). Nonetheless, these early career professionals, influenced by recent education, may possess a contemporary grasp of occupational justice concepts. Consequently, they have the potential to advocate for and incorporate these principles into existing services, thereby fostering a practice that prioritises justice. However, the extent to which this occurs remains uncertain.

Literature review

Occupational justice, integral to occupational therapy’s domain (Bailliard et al., 2020; Hocking et al., 2022), encompasses four key rights: meaning and enrichment in occupations, participation for health and social inclusion, decision-making power and equal privileges (Townsend and Wilcock, 2004). These concepts closely align with occupation-centred practice, highlighting the significance of meaningful engagement in activities as essential for well-being (Fisher, 2013; Ford et al., 2022; Nilsson and Townsend, 2014).

Efforts to promote justice-oriented practice are gaining momentum, yet translating these principles into everyday practice is not straightforward (Bailliard et al., 2020; Durocher et al., 2016; Whiteford et al., 2020). Despite the significance of occupation to health and well-being, many people encounter obstacles in accessing health-promoting occupations, leading to instances of occupational injustice (Hammell, 2020; Kearns Murphy and Shiel, 2019). For instance, individuals with mental illness may experience occupational deprivation during hospitalisation, losing access to personal belongings, social connections, and meaningful engagement, in addition to facing barriers to participation upon discharge (Kearns Murphy and Shiel, 2019).

Further challenges include the difficulty for therapists in identifying and implementing justice-oriented interventions within their practice settings (Bailliard et al., 2020). Employing reasoning informed by occupational justice concepts empowers occupational therapists to consider the health outcomes influenced by social determinants. Nevertheless, this reasoning approach also presents challenges as therapists navigate complex social, political and cultural contexts to effectively address occupational injustices (Albuquerque and Farias, 2022).

Additionally, ethical dilemmas emerge from the need to balance client priorities with the operational constraints of healthcare systems, alongside systemic limitations such as imposed practices, ineffective processes, resource scarcities and service gaps (Durocher et al., 2016; McArdle et al., 2023). Furthermore, the prevalence of risk-averse methodologies hinders the adoption of justice-oriented, occupation-centred interventions, while the dominance of medically oriented perspectives and payment systems adds further barriers (Whiteford et al., 2020).

Implementing occupational justice perspectives is also influenced by unclear concepts and definitions, and its primarily ‘Western’ viewpoint (Bailliard et al., 2020; Sy et al., 2021). In an earlier study in Singapore, occupational therapists recognised this issue, viewing occupational justice as more relevant to ‘Western’ contexts and potentially overlooking local injustices (Lim and Stapleton, 2016). While some occupational therapists question its applicability in certain contexts (Durocher et al., 2016; Sy et al., 2021), research confirms that occupational justice influences occupational therapy practice (Malfitano et al., 2019). However, further exploration is needed to understand how to effectively translate occupational justice concepts into practice.

Efforts have been made in the education of occupational therapists globally to enhance students’ understanding of occupational rights, social responsibility and the impact of systemic injustices on healthcare inequities (Irvine-Brown et al., 2020). Curricula revisions, including those in Singapore, aim to equip students with the necessary skills to work with diverse populations, engage in advocacy and address occupational injustices at individual, community and societal levels (World Federation of Occupational Therapists, 2016). In Singapore, for instance, occupational justice is integrated into the final-year module of the 4-year occupational therapy undergraduate programme. Students are given the task of identifying a population experiencing occupational injustice. They delve into the structural and contextual factors influencing this injustice, using the Framework of Occupational Justice (Stadnyk et al., 2010). Additionally, they are required to propose a service design aimed at mitigating some of the identified injustices. The intention of this module is to support students to link the theory of occupational justice with practice in the local context.

Despite the university preparation, given the challenges faced by experienced occupational therapists, early career therapists may find it particularly difficult to navigate the complexities of translating occupational justice principles into practice. It is a common experience among early career therapists to grapple with feelings of anxiety, ambiguity, and reduced self-confidence during the transition from graduation to practice (Moir et al., 2021; Turpin et al., 2021). Early career occupational therapists also often encounter barriers such as an uncertain understanding of the role of occupational therapy, challenges in collaborating with colleagues, alongside the systemic obstacles such as the dominance of the medical model, resource limitations, and intricate administrative rules (Hess-April et al., 2016).

While early career occupational therapists may possess fresh theoretical knowledge about occupational justice, their experiences in applying these concepts in practice are not well understood. Hence, the aim of the research is to investigate the experiences of early career occupational therapists integrating occupational justice concepts and perspectives into their practice in Singapore.

Methods

The Consolidated Criteria for Reporting Qualitative Studies was used to frame these methods (Tong et al., 2007).

Study design

This study adopted a qualitative descriptive, social constructivist perspective to examine the experiences of early career occupational therapists in applying occupational justice concepts in clinical practice in Singapore (Stanley, 2023).

Research team and reflexivity

The research team comprised an academic researcher, a faculty member in occupational therapy with practical experience in clinical, educational and policy roles, and a clinician researcher, an experienced occupational therapist and manager. Both had played key roles in developing and teaching the Occupational Justice and Disability Studies module since its inception in 2020. The research team acknowledged the potential for bias stemming from their closeness to the subject matter. However, this closeness also offered a tool for genuine understanding, providing depth to the reported findings and contributing to a comprehensive understanding of the experiences (Stanley, 2023).

Acknowledging potential bias due to their involvement with the module and some existing relationships with participants, the team proactively addressed this by involving three occupational therapy student researchers in their final-year honours project, who led the interviews. To mitigate bias further, the researchers engaged in regular reflective discussions within the team to scrutinise their biases. They also continually assessed their relationships with participants, considering power dynamics and trust levels, making detailed field notes to capture and discuss any insights (Patton, 2015).

Ethical considerations

Ethical approval was granted by the Institutional Review Board of (Project #2022046). Written informed consent was gathered prior to data collection.

Participant selection and recruitment

Following the principles of qualitative description (Stanley, 2023), the participants in this study were purposefully invited from all graduates who completed the Occupational Justice and Disability Studies module in 2020 (60 therapists) and 2021 (80 therapists) and had working experience of at least 6 months in any field of practice.

A recruitment poster and email message were distributed to the two graduated cohorts of occupational therapists via their university alumni emails and existing messaging platform groups. In addition, participants who responded were encouraged to share the recruitment message with their classmates, further expanding the reach of the study’s recruitment efforts. This deliberate selection strategy and purposive snowball sampling aimed to include participants who could provide information-rich insights, thereby maximising the understanding of the phenomenon being investigated (Patton, 2015).

Setting and data collection

The data collection process involved conducting one-time semi-structured interviews with one, two or three participants at a time to accommodate the schedules of both the student researchers and participants. The interview guide was piloted by the student researchers with two final-year occupational therapy students who were currently undertaking the occupational justice module and described their previous placement experiences. Minor changes were made for clarity based on their feedback. Individual interviews offered the opportunity for in-depth exploration of individual experiences, perspectives and emotions, while having more than one participant facilitated interaction, diverse perspectives and collective insights. These interviews were conducted and recorded using the online platform Zoom over a 3-month period. In managing data from these different collection methods, the researchers identified recurring themes or divergent viewpoints to ensure comprehensive analysis (Clarke and Braun, 2022; Patton, 2015).

The semi-structured interviews were facilitated in English by two to three student researchers following training and using an interview guide (Appendix 1). The aim of the interviews was to explore the participants’ educational experiences and their current perspectives on occupational justice in their graduate roles. A total of six interviews were conducted (10 total participants), with each session lasting between 45 minutes to 1 hour.

Interviews were transcribed verbatim, and cross-checking was performed by the student researchers to ensure transcription accuracy. The student researchers also maintained field notes to document any significant observations during the interviews, such as participants’ body language and non-verbal cues that could be used to enhance data interpretation (Patton, 2015). Data saturation was achieved when no new themes or insights emerged during the interviews, indicating that the data collected sufficiently represented the participants’ experiences. The research team conducted iterative analyses throughout the process, allowing them to determine that additional interviews would yield redundant information rather than novel perspectives (Patton, 2015).

Data analysis

Thematic analysis was conducted following the guidelines of Clarke and Braun (2022). First, three student researchers independently read and conducted the first open coding stage using the qualitative data analysis software, Quirkos (2024). This inductive process involved staying close to the participants’ words at low levels of abstraction. Inductive analysis was selected as it allowed researchers to uncover patterns and themes directly from participants’ perspectives. This approach provided deeper insights into how these concepts are implemented in practice, without imposing existing theories.

Together, the research team reviewed their open codes and proceeded to identify categories and consolidate them into a smaller number of preliminary themes. The codes were subsequently reviewed and refined through collaborative discussions with the entire research team, aiming to ensure coding reliability. The research team engaged in an iterative analytical process of writing and discussion aimed to refine the themes to a higher conceptual level while preserving the richness of the data (Clarke and Braun, 2022; Stanley, 2023).

Trustworthiness

In addition to addressing potential biases by involving three student researchers to conduct interviews, the team engaged in regular reflective discussions. Detailed field notes were used to capture and discuss insights, while interviews underwent cross-checking for accuracy. Codes were refined through collaborative discussions with the entire team to ensure reliability. To further enhance trustworthiness, preliminary findings were shared with participants for member checking, resulting in no objections (Patton, 2015).

Findings

Out of 140 potential participants recruited through email invitations, messaging and snowball sampling, 10 people responded and all completed the study (Table 1). The participants were all female professionals working in acute and community sectors, serving diverse populations including pediatrics, individuals with physical and mental health conditions, and older adults. Four themes were developed from the analysis: (1) Feeling uncertain about occupational justice, (2) Perceived relevance in the Singaporean context, (3) Early career challenges and (4) Aspiration to be agents of change. Table 2 outlines the coding tree illustrating the themes, categories and codes.

Table 1.

Participants’ demographics.

Participant	Gender	Cohort	Length of clinical experience	Clinical setting
Participant 1	Female	2016	1 year 2 months	Acute
Participant 2	Female	2017	6 months	Acute
Participant 3	Female	2017	10 months	Community
Participant 4	Female	2017	10 months	Community
Participant 5	Female	2016	1 year 10 months	Acute
Participant 6	Female	2017	11 months	Community
Participant 7	Female	2016	2 years	Acute
Participant 8	Female	2016	1 year 11 months	Acute
Participant 9	Female	2017	10 months	Community
Participant 10	Female	2016	2 years 1 month	Acute

Table 2.

Coding tree of findings.

Theme	Categories	Codes
Feeling uncertain about occupational justice	Implicit presence in work ethos and values	• It’s ingrained in us already • May not use the terminology
	Confusion between occupational justice and occupation-centred practice	• Similar to how we see occupational engagement, participation and identity • Uncertain if our understanding of occupational justice is right
	Non-health related cases exemplified occupational justice	• It was especially visible for migrant workers • Textbook examples seen in the real world
Perceived relevance in the Singaporean context	Inspired during university education	• How we can make a difference as a novice • Seeing the potential for change
	Framework to guide application	• The issues became visible to us • Seeing the influence of culture
	Low resources limited the applicability of occupational justice	• Resources limit our options for advocating for occupational justice • Occupational justice is idealistic and not achievable in our reality
Early career challenges	Optimism versus scepticism	• Maybe we can start looking towards trying to change it from the inside out • But OJ (occupational justice) in itself is very idealistic
	Insecurities of clinical competence	• Managing on my own • Everything is new to me • Not knowing if I am doing it right
	Position in the healthcare system	• Needing to understand the system better • Feeling small
	Workload pressures	• I have a lot to do already • Occupational justice is an additional task to think about
	Don’t want to push boundaries	• Needing to fit in to get registered • Can’t challenge the system right now
Aspiration to be agents of change	Perseverance and faith in own capacity	• It starts with you • Control of my own sessions
	Practical strategies	• Supportive colleagues and role models • Opportunities for reflection • Ongoing education of occupational justice concepts • Raising awareness among junior and senior staff members

Feeling uncertain about occupational justice

All participants expressed a sense of occupational justice being ingrained within the profession, highlighting its implicit presence in their work ethos and values. However, although it was recognised by participants, there was uncertainty in how they translated these ideas into their practice.

This concept [occupational justice], even though we don’t use the term. . . in work, it’s in us already because we are taught to think that way. . .But, whether we are fighting for it in the right way that we are taught or whether we are doing it in a good enough way. . .[however] I’m acting based on what I think is right. Participant 6

There was also notable confusion surrounding the terminology and conceptualisation of occupational justice, with participants often describing it synonymously with occupation-centred practice. Participants’ reflections suggested a discrepancy between their intuitive understanding of occupational justice, rooted in notions of meaningful occupation and client engagement, and the more nuanced theoretical frameworks found in occupational justice literature.

I think our idea of occupational justice is very similar to how we see. . .occupational engagement, participation and identity. I think these are the more familiar terms that we are using in documentation and in our therapy sessions. We do try our best to facilitate meaningful occupations, but I don’t know whether or not it fits into the type of occupational justice and injustice in the literature. Participant 10

Participants recounted experiences where they found it easier to connect with occupational justice concepts, particularly when researching or engaging in work beyond the established healthcare settings. For instance, participants found that discussing migrant worker populations affected by COVID-19 restrictions in Singapore improved their understanding and awareness of occupational injustices.

I think at the time we were learning [about occupational justice at university], it was especially true for the migrant worker population due to Covid and how they were really, really very restricted in terms of where they can go, and how it was essentially like a prison for them. Participant 2

***

It [occupational justice concepts] was more relevant, for me, . . .because after I graduated I was working with the migrant worker support coalition at the peak of Covid, so it really was a good time to be able to apply [the ideas]. . . like it was right after my graduation so you could really see how it could apply to this community. Participant 1

Perceived relevance in the Singaporean context

Participants reflected on their experiences studying occupational justice concepts during their university education and expressed how they were inspired by the perspectives and could see the relevance to their future practice in Singapore.

After the [occupational justice] module I was actually quite inspired. The [professor] also went through a lot of concepts like how we can make change despite. . . having a very small role [as a student or new graduate], but we can still make changes [to people’s lives]. Participant 9

The Framework of Occupational Justice (Stadnyk et al., 2010), taught to students during their university education, was cited by participants as a crucial tool for understanding multifaceted issues and linking the concepts to the local context in Singapore. Participants explained that it helped them recognise potential occupational injustices in their graduate practice, raising awareness of prevalent local challenges.

The framework [of occupational justice] guides us in trying to identify what are the issues. So, you start to see how many issues there are. . . I think that’s the eye-opening part. Participant 4

***

There are the different kinds of [injustice] and based on the type of [injustice]. . ., it will affect what is the root cause and how you can go about approaching the problem. . . [For example] are we imposing occupations on that person because of some structural factors?. . .[Is] it like something that is solvable [at a] societal perspective? Participant 1

In addition, participants described the Framework of Occupational Justice as something that helped them reflect on cultural norms in Singapore. For example, some participants highlighted the reliance on family or hired support for older people, which tended to restrict individuals from participating in occupations that could promote health and quality of life.

I feel like a lot of Singaporean elderly. . .have that idea that, “Oh my family will get me a helper and. . .the helper can just help me.” So, Singapore culture is like that. So, I feel that is also a main [contributing factor to] occupational injustice. Participant 6

***

I think for a lot of family members, even when [the patient] is not injured, they don’t see the point of us trying to encourage patient to participate [in occupations]. They will just say “Oh, nevermind lah, the helper can help.” But deep down when we speak to the patients, we know that they. . . really don’t like to be helped or assisted. Participant 10

Participants also described how resource limitations, such as equipment for activities of daily living, staffing, funding and community services were issues contributing to occupational injustices as without these, clients were not able to engage in meaningful occupations.

There’s also not enough equipment, like geriatric chairs available in the room for the patients to sit out of bed, whether or not the nurses are comfortable with transferring patients, or whether a hoist is available to hoist the patient out. Participant 10

Early career challenges

Participants were inspired by and optimistic about applying occupational justice concepts in their practice but felt uncertain and somewhat sceptical about how to use these concepts to drive change due to their novice status in the healthcare system. Many participants shared that occupational justice is an aspirational state and achieving it fully in their current context was difficult. While they were eager to promote occupational justice, they faced early career challenges, struggling with insecurities regarding their clinical skills and their understanding of their role within the healthcare system.

What I can see [is you have to] kind of wiggle your way through the existing infrastructure and work with what we can at the moment. I think once [I have] a better idea about what’s going on, both within the profession, as well as the structural setup of the hospitals and Singapore’s health care, then maybe we can start looking towards trying to change it from the inside out. Participant 2

***

But OJ [occupational justice] in itself is very idealistic. It’s something you want to work towards. But in reality, it is something that you can never achieve. Participant 4

***

I think it’s very difficult at the start [as a new graduate] because there’s a lot of insecurities about whether you’re even managing things correctly on your own and there’s the workload, and then there’s a lot of things. Everything is new to you. Participant 9

Participants also highlighted the tendency to prioritise existing process task demands over occupational justice considerations due to workload pressures and organisational structures. Concerns about job security and the fear of repercussions if they voiced different ideas further deterred participants from advocating for occupational justice principles in their workplaces.

As much as I learnt about occupational justice [at university], as a budding therapist I feel like I have to do a lot [already]. Participant 5

***

What do you want me to say? Like to my boss? I mean I haven’t gotten my confirmation yet you know. I’m scared that you know I won’t get my confirmation. . ., then I cannot even become a therapist! So, I don’t want to push the boundaries. Participant 4

Aspiration to be agents of change

The participants expressed a desire to become agents of change in their graduate practice, emphasising the pivotal role they could play in fostering occupational justice. They viewed themselves as crucial conduits for integrating occupational justice principles into the workplace, highlighting the importance of perseverance and faith in their capacity as occupational therapists.

Someone said to me “It starts with you.” Maybe the organisation cannot bring about occupational justice to the patient, but it always starts with you. So how you do your sessions, how you plan your sessions, how you set goals, through the whole occupational therapy process. . . I feel I can help to integrate the occupational justice concepts into the workplace. So don’t lose faith that you cannot bring occupational justice to your patients, because we are the best candidate to bring it to them, occupational therapists. Participant 6

Participants emphasised the need for practical strategies to integrate occupational justice principles into their professional roles amid early career uncertainties. They identified supportive colleagues, role models and opportunities for reflection as valuable resources for navigating challenges and advocating for change within their organisations.

I am privileged in that my colleagues are very open and nice and very helpful to want to discuss [occupational justice ideas]. Participant 4

***

The senior staff can have more impact in making changes in that department. So, if they are aware of the terms [associated with occupational justice] and what kind of benefits it can bring and add value to our therapy sessions, I think that will help. Participant 10

Participants also highlighted the importance of exposure and ongoing education of occupational justice concepts, calling for greater awareness among both junior and senior staff members. Leveraging digital platforms and media channels was suggested to promote understanding and engagement with occupational justice principles among diverse audiences.

I think number one is that I think people don’t know about [occupational justice]. I think a new batch of students, I did see their presentation and they did talk about it a little bit, but I think number one is the exposure. To not just the junior staff, but also the senior staff. Participant 10

***

There needs to be some regular education and discussion of how these concepts are very prevalent in our daily life. If not, these are things that we will gradually forget as we grow in our work. Participant 1

***

I think those videos, they do generate buzz about occupational justice. I think it’s probably through media, most people consume content on Instagram, or TikTok or something. Participant 8

Discussion and implications

This study explored the experiences of early career occupational therapists and how they considered and integrated occupational justice concepts into their practice. The findings highlight the challenges these practitioners encountered when addressing occupational justice concerns during their early careers but also the role they felt they had in promoting these important perspectives in their practice.

Participants expressed uncertainty about their understanding and application of occupational justice concepts and often used or described occupation-centred practice as if it were synonymous with occupational justice. While both occupation-centred practice and occupational justice perspectives share a focus on meaningful engagement in occupations, they differ in their primary focus and scope (Bailliard et al., 2020). Occupation-centred practice primarily focuses on the individual client (or group) and their personal experience of engagement in meaningful occupations. The goal is to enhance the client’s ability to perform and enjoy occupations through tailored therapeutic interventions, which may include changes to the performance context, choice of occupations or how the occupation is done (Fisher, 2013). In contrast, occupational justice addresses the broader social, economic and political factors that affect peoples’ access to occupational opportunities. Its goal is to identify and dismantle systemic barriers, promoting equitable participation for all. Recognising that these perspectives are not mutually exclusive but complementary is crucial for advancing occupational therapy practice (Bailliard et al., 2020; Gallagher et al., 2023; Olivares-Aising, 2018). This finding highlights the need for enhanced education and training in occupational justice to enable practitioners to integrate both perspectives effectively in their work.

The early career occupational therapists in this study primarily framed their roles and expectations around individual client care, emphasising therapeutic relationships and occupation-centred practice. While they recognised cultural influences on clients’ occupations using the Framework of Occupational Justice (Stadnyk et al., 2010), they felt ill-equipped to engage with broader societal issues or advocate for systemic change. Notably, some participants found it easier to relate to occupational justice concepts when addressing the needs of marginalised groups, such as migrant workers affected by COVID-19 restrictions (Wong et al., 2022). This tendency to focus on individual-level practice, often conflating it with occupational justice, is understandable given the challenges faced during the transition into practice, including anxiety, role ambiguity and reduced self-confidence in clinical skills (Moir et al., 2021; Turpin et al., 2021).

Participants also reported that workload pressures and the need to prioritise work within the existing healthcare system often left little room for considering broader societal and community-level issues related to occupational justice. Additionally, personal and pragmatic concerns, such as meeting professional registration requirements, often led participants to conform to the existing healthcare system practices rather than pursuing innovative, justice-oriented approaches. Some participants provided examples of how their attempts to address occupational justice were often overshadowed by competing priorities, such as the urgent push for patient discharge. Durocher and colleagues highlighted that occupational therapists often face ethical tensions between providing quality care and following health system constraints (Durocher et al., 2016). This is partly due to the need for compliance with hospital protocols and the dominance of the medical model in their practice setting (Whiteford et al., 2020).

Despite challenges in understanding and applying occupational justice perspectives, participants demonstrated a genuine appreciation for the intrinsic connection between these concepts and their professional obligations. This marks a significant shift from Lim and Stapleton’s (2016) findings, which indicated that occupational therapists in Singapore primarily viewed occupational justice as a ‘Western’ concept, disconnected from their local practice context (Bailliard et al., 2020; Sy et al., 2021). Such perceptions are likely shaped by societal attitudes toward illness and disability, particularly the emphasis on familial support and filial piety in Singaporean culture (Foo et al., 2020). For example, cultural norms often dictate that adult children are responsible for caring for their elderly parents, potentially fostering a passive acceptance of assistance and inactivity (Lim and Stapleton, 2016).

Early career therapists typically enter the field with enthusiasm for promoting occupational justice, driven by their training, which emphasises equitable access to meaningful activities. However, this optimism often meets scepticism from established healthcare structures resistant to new approaches, which can undermine their confidence and ability to effect change. Participants expressed a strong desire to advocate for occupational justice, recognising their unique position as agents of change to uphold their client’s occupational rights (CAOT, 2012). To advance their goal, they adapted client interactions and documentation practices to highlight clients’ abilities and occupational profiles.

Our research highlights the importance of supportive environments created by management and mentors in fostering resilience and positive attitudes among novice therapists. Future studies should explore the factors influencing scepticism and optimism in early career professionals, particularly how mentorship and organisational culture affect their capacity to implement meaningful change. While the participants’ adjustments are commendable, they are unlikely to lead to a widespread shift towards occupational justice perspectives on their own (Whiteford et al., 2020). Understanding these dynamics could inform the development of better support systems for emerging practitioners, empowering them to make a significant impact.

These findings reflect broader expectations placed on early-career occupational therapists, who are often seen as advocates for occupational justice due to their fresh perspectives. However, this expectation can feel burdensome, given the stresses and uncertainties of transitioning from student to professional status (Cho et al., 2023). Participants acknowledged the need for practical strategies and ongoing education, advocating for greater awareness and engagement with occupational justice principles. They also faced challenges in persuading clients and families about the health benefits of meaningful activities, highlighting the enduring influence of societal perspectives on healthcare practices.

Notably, the growing awareness among early-career therapists regarding both occupation-centred practice and occupational justice is significant. While they may occasionally conflate the two concepts, their increasing recognition of occupational rights indicates a shift towards questioning and refining their practice (Gallagher et al., 2023). This evolution represents a crucial step in integrating individual-focused therapeutic goals with broader societal advocacy within their professional roles.

Implications for practice

Strengthening occupational justice concepts in practice requires changes at both the individual and broader system levels. At the individual level, early career therapists are encouraged to actively seek role models, alliances and mentorship from various sources, including direct supervisors, peers within and outside their organisations and professionals from diverse backgrounds (Dancza et al., 2022). Participants in this study emphasised the importance of guided reflective discussions with peers and mentors, as well as positive role models who advocate for occupational justice. These interactions help early career therapists build confidence, develop competence and establish professional connections (Moores and Fitzgerald, 2017). Additionally, this critical reflection, highlighting that hegemonic practices that may exist within their institutions, contributes to research, education, practice and policy changes aligned with occupational justice goals (Kinsella and Durocher, 2016).

Organisational-level changes can involve supporting mentorship structures that encourage discussions about occupational justice concepts. This may include more experienced therapists mentoring less-experienced colleagues and fostering a culture of openness for dialogue on these topics. Additionally, there should be open dialogue within services in how to recognise and address sociocultural barriers that clients may face, promoting a more inclusive approach to care that respects diverse backgrounds and needs. Ongoing engagement in learning opportunities and critical reflection about occupational justice concepts is recommended to support the integration of these principles into daily practice at all levels.

Within the wider healthcare community in Singapore, a collective effort is essential for influencing broader policy and organisational changes. This involves raising awareness and creating support structures to address cultural attitudes and structural barriers that hinder people’s access to occupational opportunities and participation. Therapists should be encouraged to engage in advocacy efforts aimed at influencing policy and institutional practices, thereby creating a supportive environment for occupational justice. Furthermore, promoting collaboration with other professionals and stakeholders can help establish a unified approach to tackling the systemic issues that impact occupational justice. Establishing platforms that highlight the importance of occupation for health and well-being – both among practitioners and within the broader healthcare system and society – is vital for achieving systemic transformation.

Limitations

We recognise certain limitations within this study that warrant consideration. Despite efforts to safeguard information confidentiality, it is possible that participants refrained from sharing certain information due to concerns about potential career repercussions. However, participants shared both positive and negative experiences, indicating that they were comfortable to share their opinions with the student researchers. In addition, the study’s small sample size consisted of 10 female participants, all of whom were locally trained and agreed to speak about occupational justice perspectives. Consequently, the findings may not fully represent the perspectives of a broader group of early-career occupational therapists. It is recommended that further research investigate the perspectives of both early-career and more experienced occupational therapists to appreciate the wider view of occupational justice in Singapore.

Conclusion

This qualitative study explored the experiences of newly graduated occupational therapists and their integration of occupational justice concepts into their practice. At an individual level, progress has been made in how early career therapists in Singapore recognise occupational justice concepts.

However, they face insecurities in advocating for their clients due to power dynamics, a lack of confidence, systemic barriers and pragmatic considerations. Despite these personal challenges and system-imposed restrictions, early career therapists navigate these obstacles by implementing strategies within their control. While this shift towards an occupational justice perspective is encouraging, broader changes are needed to fully realise the potential of occupational justice to enhance healthcare.

Key findings

• Early-career occupational therapists face challenges integrating occupational justice into practice, often conflating it with occupation-centred practice.

• Despite their desire to drive change, systemic barriers hinder them, necessitating comprehensive support.

What the study has added

The study highlights challenges early-career occupational therapists face in understanding and implementing occupational justice perspectives, emphasising the need for systemic support to facilitate meaningful integration into practice.

Appendix 1. Interview guide

Past

• • Thinking back to your last year of university, what was your main impression of your experience going through the occupational justice module?

•   ○ What was the most memorable memory/biggest takeaway from the occupational justice module?

• • What is occupational justice to you?

• • What are some examples of occupational justice you can think of?

• • Have you taken any ideas from the module into your working places?

Present

• • Have you witnessed any forms of occupational injustice in your current setting?

•   ○ Could you share with us a little about why you think you have not considered occupational justice ideas and concepts in your workplace?

•   ○ Have there been any situations in your current workplace where you felt uncomfortable with the way the patient’s situation was being handled? (In terms of their occupations/engagement). What happened/what did you think was going on? Do you feel that you could do anything about it? Please explain.

• • Why do you think these situations of occupational injustice have occurred?

•   ○ Probe: Workplace policies/settings/management structure?

• • Do you feel that occupational justice concepts are considered or used in your workplace?

•   ○ If yes, how has it been considered/used? What are the factors that you think has helped occupational justice to be considered?

•   ○ If no, what could be the reasons? What are the factors that you think has stopped occupational justice from being considered?

• • Have you considered or used any occupational justice concepts in your own daily work?

•   ○ What has helped you to apply these concepts/take action in these situations?

•   ○ What do you think has prevented you from taking action?

• • Have you had the chance to discuss with another professional about the concepts surrounding occupational justice?

•   ○ If yes: could you describe that interaction; what were your thoughts and feelings about it?

•   ○ If no: what do you think could be some reasons why you have not done this?

• • How has your supervisor helped to facilitate learning about occupational justice concepts, client autonomy and client centredness?

Future

• • If you were to recommend something in your current workplace, what do you think would help to make the concept of occupational justice easier to integrate into the workplace?

• • Is there anything else you wanted to share or offer suggestions for how we can promote occupational justice ideas in Singapore?