How has the philosophy of pragmatism been addressed in occupational therapy and occupational science? Protocol for a scoping review

Como a filosofia do pragmatismo tem sido utilizada na terapia ocupacional e na ciência ocupacional? Protocolo para uma revisão de escopo

Abstract

Introduction  The Philosophy of Pragmatism has been recognized for its importance in the initial development of occupational therapy in the early twentieth century in the United States. This perspective has regained attention as an approach that is fruitful for understanding contemporary challenges in the field. Despite this renewed interest, there are no review studies that examine the affordances of pragmatism in the occupational therapy and occupational science peer-review literature.

Objective  To present the scoping review protocol.

Method  The protocol was developed guided by the Joanna Briggs Institute methodology.

Results  This protocol presents a comprehensive plan to conduct the scoping review. The study aim is to identify the state of knowledge about how the philosophy of pragmatism has been addressed in occupational therapy and occupational science in peer-reviewed literature in the past ten years, specifying subquestions. The inclusion criteria encompasses English, Spanish and Portuguese peer-reviewed literature (conceptual and research studies), with any population and in any physical, geographic, field of practice, and cultural context. The protocol presents the collaborative team strategy for searching databases (PsycINFO, Scopus, Web of Science, MedLine, and Embase) and for selection of papers. Data extraction will include key information from the papers presented in an evidence table. The use of pragmatism in theoretical and methodological aspects will be extracted from the papers, and thematically analyzed.

Conclusion  We inform the research community about our intentions to understand the repercussions of pragmatism in occupational therapy and occupational science by making publicly available the comprehensive plan for conducting the study.

Keywords:  Occupational Therapy; Science; Activities of Daily Living; Philosophy; Research Design; Review Literature as Topic

Resumo

Introdução  A Filosofia do Pragmatismo foi reconhecida por sua importância no desenvolvimento inicial da terapia ocupacional no início do século XX nos Estados Unidos. Essa perspectiva voltou a ter visibilidade como uma abordagem frutífera diante dos desafios contemporâneos. Apesar desse interesse renovado, não há estudos de revisão sobre sua utilização na literatura revisada por pares na terapia ocupacional e na ciência ocupacional.

Objetivo  Apresentar o protocolo para revisão de escopo.

Método  O protocolo foi guiado pela metodologia do Joanna Briggs Institute.

Resultados  Este protocolo apresenta um plano abrangente para conduzir a revisão de escopo. O objetivo do estudo é identificar o estado do conhecimento sobre a filosofia do pragmatismo na terapia ocupacional e na ciência ocupacional na literatura revisada por pares nos últimos dez anos, especificando subquestões. Os critérios de inclusão abrangem literatura revisada por pares em inglês, espanhol e português (estudos conceituais e de pesquisa), com qualquer população e em qualquer contexto físico, geográfico, campo de prática e cultural. O protocolo apresenta a estratégia colaborativa de equipe para busca em bases de dados (PsycINFO, Scopus, Web of Science, MedLine e Embase) e seleção de artigos. A extração de dados incluirá informações dos documentos apresentados em uma tabela de evidências. Conceitos de pragmatismo e tendências para pesquisas futuras serão extraídos dos artigos e analisados tematicamente.

Conclusão  Informamos à comunidade de pesquisa sobre nossas intenções de compreender as repercussões do pragmatismo na terapia ocupacional e na ciência ocupacional, disponibilizando publicamente o plano abrangente para a realização do estudo.

Palavras-chave:  Terapia Ocupacional; Ciência; Atividades Cotidianas; Filosofia; Projetos de Pesquisa; Literatura de Revisão como Assunto

Introduction

Pragmatism is the first philosophical movement that arose specifically in the United States of America (Hookway, 2019; De Waal, 2001). In the first two thirds of the 19th century, Western European philosophies were “imported” to other parts of the world, as predominant approaches for understanding the nature of human behavior (Goodman, 2020). In the last third of the nineteenth century, and after the Civil War, the way of understanding society changed radically, opening space to the idea that beliefs constantly change. Philosophies originating from classical European society did not respond to the challenges of a new society, imbued with distinct and particular beliefs. Pragmatism emerged from the meeting of some European philosophical traditions, particularly ones that seek to overcome dichotomies between human experience and nature, with the particular conditions of the experience of building North American society (McDermid, 2006; Nunes, 2008).

Pragmatism is recognized as having originated with The metaphysical club, a group related to Harvard University that met between 1871 and 1879 in Cambridge, Massachusetts (Shook, 2020; De Waal, 2001). Important thinkers, such as Oliver Wendell Holmes Jr., William James, Charles Peirce, Nicholas St. John Green, John Fiske and Francis Ellingwood Abbot, were part of this initial group (Menand, 2002). Other important American pragmatists that followed this group were John Dewey, George Mead and Jane Addams. The influence of the empiricism of John Stuart Mill, and Charles Darwin's theory of evolution, were decisive in their discussions (Goodman, 2020; Shook, 2020). The name of the movement came from Peirce, but it was popularized by James, in one of his most famous lectures in 1898, called “Philosophical Conceptions and Practical Result” (Menand, 2002).

For Peirce, the philosopher's work would be focused on analyzing questions related to possible experiences, and not making philosophical speculations around what does not constitute a fact in shared reality. Thus, pragmatism would be much more a practical method than a philosophical school, with a focus on seeking conceptual clarity from the effects that concepts produce and the empirical consequences of concepts. Peirce sought to develop a “[…] comprehensive conception of the world and our relationship to it” (De Waal, 2001, p. 2-3), based on the deliberate engagement of investigation to understand the practical consequences of the investigated concepts or phenomena. The focus of pragmatism is unique in that it rests on the future - on the unfolding consequences - rather than on the past.

Pragmatism recognizes that investigation starts from the desire to eliminate the discomfort of doubt, but the investigation proposal does not start from a belief (even if we always have an initial belief), but from action, from the willingness to act and improve knowledge about the consequences of the practice. The discovered effects are always considered provisional truths, and recognized when publicly shared and agreed by the members of a given community who are interested in the issue. In the case of science, knowledge is not considered to be a certainty in itself, but rather probable hypotheses that we accept due to their consequences. James and Peirce held that beliefs are true if they have satisfying effects and contribute to forms of adaptation. In the case of John Dewey, beliefs are understood as instruments that are useful to the extent that they help us lead a better life (Menand, 2002; De Waal, 2001). However, a transversal idea is that knowledge is not immobile, it changes as society advances and other beliefs and values are necessary to respond to new problems (Dewey, 1955; James, 1892, 1974).

Strongly critical of Cartesianism and any metaphysics that seeks to dichotomize nature and the social and cultural world, body and mind, theory and practice, Dewey makes this explicit and considers that experience and nature coexist harmoniously (Dewey, 1991). Nature, by revealing itself empirically, enriches and directs the development of experience; and experience, embracing objectivity and subjectivity as a whole, allows investigation processes to be triggered by the instabilities and contingencies inherent to it (Dewey, 1991). For Dewey, pragmatism is a method to pursue results of an empirical investigation - called instrumentalism - when a situation is indeterminate and demands resolution, and must be guided as scientifically as possible. Another pragmatist philosopher, Jane Addams, further delineates pragmatism as an epistemology in which ethical concepts are defined by their consequences in enriching the experience and designating valuable goods (Addams, 2002; Racine et al., 2017). Dewey and Adams apply these ideas to pedagogy and social democracy, respectively (Morrison, 2016).

One of the greatest expressions of this holistic perspective took shape in Jane Addams' Hull House. There, her proposals for social transformation enabled dialogues between theory and practice (Knight, 2005). These ideas would have had a strong influence on the first generation of occupational therapists, such as Susan Tracy and Eleonor Slagle. Tracy, inspired by the work of John Dewey, applied the principles of meaningful learning in the rehabilitation process of amputees. Slagle developed an application of the Dewey and Addams habit concepts for the design of Habit Training - recognized as the first occupational therapy technique (Morrison, 2017). Adolph Meyer, the important social psychiatrist who worked with Slagle, also borrowed heavily from aspects of pragmatism, however, unlike Slagle and Tracy, he did not explicitly cite pragmatists in his texts (Breines, 1986; Ikiugu, 2001; Reed, 2017).

Since the 1980s, the influence of pragmatism in occupational therapy has been rescued and made visible by Breines' research (Breines, 1986, 1987, 1989, 1990, 2002). In Breines' work, in addition to a historical discussion of pragmatism, we also find suggestions on how pragmatism can contribute to professional training (Breines, 1987, 1989, 2002). Other important scholars in the renaissance of pragmatism in occupational therapy and the growing output in occupational science are Moses Ikiugu, Virginia Dickie and Malcolm Cutchin. Ikiugu has been working with propositions of pragmatism directly for practice and research in occupational therapy, especially drawing on propositions of instrumentalism. In collaboration with Schultz, he proposed that pragmatism could be introduced in occupational therapy curricula, arguing that it could strengthen professional identity (Ikiugu & Schultz, 2006). In partnership with Ranelle Nissen, Ikiugu wrote a chapter in the book Philosophy and occupational therapy, organized by Steven Taff, discussing the implications of two concepts from pragmatism (instrumentalism and transactionalism) for occupational therapy practice (Ikiugu & Nissen, 2021).

Other current applications of pragmatism can be found in occupational science literature on transactionalism (Dickie et al., 2006; Cutchin & Dickie, 2012). Pragmatism has been called one of the possible philosophical foundations for understanding occupation as a complex and non-individualized social phenomenon - especially under Dewey's conception of occupation as a transaction. Dickie and Cutchin helped rethink the way occupational science has understood the relationship between the environment and the person. The transactional point of view is a strong foundation perspective in today's occupational science literature. This line of research culminated in the publication of an edited collection by Cutchin and Dickie on Transactional perspectives on occupation, which has inspired many occupational scientists since its publication in 2012.

In contemporary times, pragmatism is often considered more a cluster of ideas developed by several 20th century and contemporary philosophers, rather than a single school of philosophy (De Waal, 2001). Although the influence of several philosophers from the beginning of pragmatism in the United States, such as James, Mead, Peirce and Addams, is historically known in occupational therapy and occupational science (Breines, 1986; Gordon, 2002; Hooper & Wood, 2002; Ikiugu, 2001; Ikiugu & Schultz, 2006; Morrison, 2016, 2021, 2022), John Dewey’s propositions have been particularly impactful stand out for both disciplines (Ikiugu, 2007; Cutchin et al., 2008; Kirby, 2015; Lee Bunting, 2016; Madsen et al., 2021).

Dewey's pragmatism has been applied to studies related to many contemporary and complex problems, such as climate change, social inequality, human rights (Buchan & Simpson, 2020; Maivorsdotter & Andersson, 2020). As occupational therapy and occupational science can have wide applications in diverse fields of knowledge and practice, understanding how pragmatism has been addressed in both disciplines, can offer visibility to the paths taken so far, map different areas that have been inspired by pragmatism, and shed light on contemporary trends. There is currently no review study that has accounted for the applications of pragmatism in these two disciplines, from a general perspective.

To map the scope of a given topic that has not yet been explored in general, scoping reviews have been widely used (Peters et al., 2022). Scoping review methodology was firstly developed by Arksey & O’Malley (2005), but this methodology has been updated, with the most recent guidelines being published by the Joanna Briggs Institute (JBI) (Peters et al., 2022). Although scoping reviews do not necessarily require that the review protocol be registered or published (Tricco et al., 2018), such methodological practice has increasingly been used to improve the reliability and rigor of the review and to publically share interest on the topic with the research community (Peters et al., 2022). In addition, methodological papers on scoping reviews have tended to include protocol guidelines adapted from the Preferred Reporting Items for Systematic Reviews and the Meta-Analysis Protocol Checklist - PRISMA, named PRISMA-ScR (Tricco et al., 2018). In Occupational Therapy and Occupational Science, scoping review protocols have been increasingly published, informing the academic community about review research interests in various topics (Bell & Hallett, 2021; Jesus et al., 2021; Nhunzvi et al., 2020; Snyder et al., 2021; Turner et al., 2022; Villas et al., 2020).

In order to provide a broader picture of the repercussions of pragmatism in occupational therapy and occupational science in peer-review literature, especially emphasizing the work of John Dewey, this scoping review aims to identify and present the available evidence in terms of how pragmatism has been used in literature and in which areas of practice and research. We choose a ten-year framework (2013-2022) of peer reviewed literature, as the focus of this review is not to capture the renaissance of pragmatism, but to provide a broader picture of the current repercussions of pragmatism in the field.

Study Aim and Subquestions

The review question is: “What is the state of knowledge about how the philosophy of pragmatism has been addressed in occupational therapy and occupational science in peer-reviewed literature in the past ten years?” The question was developed initially by two team members, and iteratively refined during team meetings, taking into account the results of testing search strings and databases.

Some specific questions guiding the study include:

1. How pragmatism has been used in professional literature?

2. Which areas of practice and research in occupational therapy and occupational science are addressed by pragmatism in the literature?

Inclusion criteria

The inclusion criteria detail the elements that the studies to be included must contain in terms of concept, context, population, and types of evidence sources related to objective and questions of the review (Peters et al., 2022).

This review will address peer-reviewed literature, in English, Spanish and Portuguese, bringing in the title, abstract, keywords, and/or findings and discussion sections, the descriptors: the root words “occupational scien*” (science, scientist, scientists) or “occupational therap*” (therapy, therapist, therapists) and “pragmatis*” (pragmatism, pragmatist) or the root words “dewey*” (Dewey, deweyan) or “transaction*” (transaction, transactional, transactionalism). The root word “transaction*” was included as a descriptor after finding, during testing search strings, transactional perspectives on more recent relevant papers, not linked explicitly to pragmatism.

We will consider studies with any population and in any physical, geographic, field of practice, and cultural context; published between 2013 and 2022. A ten-year period was chosen because previous tests to delimit the scope of this review indicated the existence of studies more focused on situating pragmatism in the history of the profession and others focused on presenting pragmatism in its possibilities; considering that it is a philosophical perspective already introduced in the field, our objective was to focus on the current repercussions of pragmatism in the field. Conceptual¹ and research studies (quantitative, qualitative and mixed-methods) will be included. Other types of academic publications, such as all types of literature review; and also non-publicated or non-peer-reviewed academic materials and non-indexed electronic resources will be excluded. Another exclusion criteria encompasses studies that bring descriptors not linked to the philosophy of pragmatism. Some examples are: pragmatism or instrumentalism as synonyms of practical or pragmatic, transactional linked to transition or sex/gender transition; transactional linked to the psychology theory.

Method

This scoping review will be guided by the JBI methodology for scoping reviews (Peters et al., 2022). The protocol was registered with the Open Science Framework (OSF) under the DOI 10.17605/OSF.IO/Z2BSH.

Between September and December 2022, the research team developed tests in four databases for refining the review general and specific questions. In January 2023, we developed the search strategy in partnership with the librarian from the Federal University of São Carlos. The database results were imported to a screening software - Covidence. In this protocol, we also report on the not-yet-completed aspects of our methodology.

Search strategy

To identify the articles that meet the inclusion criteria, we carried out a search strategy in collaboration with team members, who are co-authors of this protocol. The team consisted of five researchers. The researcher 1 has extensive experience in scoping review studies, and is also a scholar interested in pragmatism. The researcher 2 has some experience in scoping review studies. Researcher 1, researcher 2 and researcher 3 have collaborated directly in developing an appropriate search strategy for this study. Meanwhile, researcher 2 and researcher 4 and researcher 5 collaborated with their expertise in Pragmatism, Occupational Therapy and Occupational Science. The researcher 3 coordinated the process of this protocol elaboration. A librarian from the Federal University of São Carlos collaborated on the process of running search pilot tests and reviewed this protocol.

The team chose databases contending publications from the Health field, including the areas of Occupational Therapy and Occupational Science, in addition to the areas of Rehabilitation, an interface field that could contain studies of interest. Three researchers completed several tests in three databases - PsycINFO, Scopus (Elsevier), Web of Science (Clarivate Analytics) - to refine the definition of the search terms. It was possible to identify the root words of terms, such as pragmatis*, which allowed inclusion of both pragmatism and pragmatist; and also to identify the relevance of the root word transaction*, considering that more recent publications rarely refer directly to Dewey's pragmatism, but to the transactional perspective of occupation, rooted in his work. The final search was performed in PsycINFO, Scopus (Elsevier), Web of Science (Clarivate Analytics), MedLine (EBSCOhost), Embase databases; with slight modifications to the search terms according to each database's layout. Table 1 presents the final search terms and strategy.

Table 1
Final search strategy.

Search Strategy
any field: “occupational scien*” OR “occupational therap*” AND any field: “pragmatis*” OR “dewey*” OR “transaction*”

Source of evidence selection

Our initial search in the five databases was uploaded into Covidence in April 2023 (1070 articles). After the removal of duplicates, researcher 2 and researcher 3 independently screened the 299 studies by reading the title and abstract. The inter-rater reliability at the title and abstract reading stage was 89% (34 conflicting articles). Discrepancies were discussed with researcher 5. The 81 articles selected at this stage are currently being read in full (this phase is in progress) by researchers 2, 3, 4 and 5, and disagreements will be resolved in a meeting with all team members. We will map the reason for exclusion for all excluded papers in this stage. Details about the review process will be recorded and reported using the flowchart of PRISMA-Sc (Tricco et al., 2018).

Data extraction

Key information (title, year, database, journal) from the included articles will be recorded using the Covidence software system. The team will extract information related to the geographic location/country and research design of each article (method, participants, aim, main results). The extracted data will be organized in a shared online spreadsheet. There will be a spreadsheet testing stage with data extraction from 10 articles, carried out by two independent researchers, followed by a meeting of the research team to discuss the need for adjustment and reliability verification.

The final extraction stage will be carried out by four researchers, article by article, extracting both characterization data and data related to the use of pragmatism - the focus of the study. For information about the use of pragmatism, fragments of qualitative data will be extracted in which the theoretical and/or methodological aspects are detailed/explained, as well as fragments that explain the justifications and reasons for this use. Analysis of this data, will be mapped and organized using the qualitative data analysis software ATLAS.ti. Table 2 presents the data extraction information.

Table 2
Data extraction information.

Source of evidence (citation)
Year
Journal
Country
Objectives
Method
Participants	Age and Sex/Gender
Practice/Research Area
Key Points
Use of Pragmatism	Fragments of qualitative data detailing purposes of the use

It should be noted that, if there are articles by researchers developing this review, they will not be responsible for extracting the data and this fact will be reported in the final considerations of the review. All divergent extraction decisions will be dealt with in meetings of the research team.

Data Analysis and Presentation

The findings will summarize the current state of knowledge about how the philosophy of pragmatism has been addressed in occupational therapy and occupational science in peer-reviewed literature in the past ten years.

The data summarized by Covidence will be presented in tables. Descriptive analysis will be used to collate, summarize, and present information (global location/country, research design, practice of area and/or research) in a table of evidence.

An initial deductive analysis will examine the use of pragmatism. An inductive and iterative thematic analysis will identify patterns and themes in the data, drawing on thematic analysis and iterative dialogue and analysis among team members (Davies, 2011). This process will be supported by ATLAS.ti software. Independent analysis will be completed by researcher 3 and researcher 4, followed by discussions with researcher 2. Researcher 1 and researcher 5 will cross-check and critically discuss the emergent themes. The analysis will be finalized upon reaching consensus. The qualitative results will be presented in prose, seeking to highlight the emerging themes.

Conflict of interest

One of the researchers involved in this review is an author with many academic productions around the topic of this review, which could increase the visibility of their work. This researcher will not participate in some phases (search phase; and evidence selection and data extraction of his own papers). This researcher will support the data analysis process, but all results directly related to his articles will be discussed in team meetings.

We inform you that there is no other conflict of interest.

Possible bias

To avoid possible bias, any co-author of studies that will be included in the review will not participate in decisions about screening and data extraction. However, the co-author may participate in the synthesis of the study, given the expertise on the subject. Any results directly linked to this co-author's studies will be explicitly addressed in the study's final considerations.

Implications and Conclusion

This protocol aims to inform the research community about the authors' intentions to study the use of theories of pragmatism in occupational therapy and occupational science in the peer review literature over the past ten years. This review may be useful for researchers to understand the possibilities of using the philosophy of pragmatism in research, especially considering the support of occupational practices that date back to the origins of the profession and that have been resurfacing with strength in occupational science in order to overcome individualistic perspectives and dichotomies between subject and context, culture and nature.

In this paper, we aim to make publicly available information about our comprehensive plan for conducting a scoping review. Scoping reviews involve an iterative process, which may lead to protocol deviations. In case of changes to our proposed protocol, the authors will detail any such deviations in the final manuscript, in order to adhere to the quality standards of transparency and rigor.

• 1
  “The term conceptual refers to articles that discuss practical, applied, or reflective or philosophical, theoretical, or conceptual propositions.” (Araújo et al., 2022, p. 2)
• How to cite:
  Souza, N. P., Marcolino, T. Q., Correia, R. L., Kinsella, E. A., & Morrison, R. (2024). How has the philosophy of pragmatism been addressed in occupational therapy and occupational science? Protocol for a scoping review. Cadernos Brasileiros de Terapia Ocupacional, 32, e3720. https://doi.org/10.1590/2526-8910.ctoAR286237202
• Funding Source
  This work was carried out with the support of the State of São Paulo Research Foundation (FAPESP), funding 21/14571-6.

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Edited by

• Section editor
  Profa. Dra. Ana Paula Serrata Malfitano

Publication Dates

• Publication in this collection
  13 Sept 2024
• Date of issue
  2024

History

• Received
  21 Dec 2023
• Reviewed
  22 Jan 2024
• Accepted
  03 July 2024