Occupational therapy and Paulo Freire: a scoping review

Abstract

Introduction

Paulo Freire's theoretical references and methodological propositions are spread over different study areas, including occupational therapy.

Objective

To understand how the Freirean framework has been used in academic publications on occupational therapy, gathering and analyzing this literature to identify thematic axes and gaps.

Method

A scoping review conducted through an open-period search until April 2020 for all academic articles that explicitly referenced at least one work by Paulo Freire. Data from the retrieved articles were gathered, synthesized, and organized on a Microsoft Excel® spreadsheet and then analyzed from significant thematic axes.

Results

The search identified 56 articles published between 1993 and April 2020. Freire's work has been used in occupational therapy academic publications, with emphasis on the book “Pedagogy of the Oppressed” and the concepts of Dialogue/dialogics and Critical and political consciousness/conscientization. Three thematic axes were defined and discussed: 33 (58.9%) studies used Paulo Freire as a theoretical-methodological framework for thinking/practicing occupational therapy, 10 (17.8%) used Freire as a framework to assist with research in the area, and 13 (23.2%) used Freire's contributions in analyses and propositions involving the education of occupational therapists.

Conclusions

Paulo Freire contributes to occupational therapy in different ways, favoring a praxis for social transformation; however, in most cases, the Freirean propositions are not the center of reflexive development efforts.

Keywords:
Social Change; Social Problems; Conscientization; Social Oppression; Occupational Therapy

Resumo

Introdução

O referencial teórico e o aporte metodológico trazidos pelas obras de Paulo Freire vêm se espraiando por distintas áreas, inclusive na terapia ocupacional.

Objetivo

Apreender como o referencial freireano vem sendo utilizado em publicações acadêmicas da terapia ocupacional, reunindo e analisando essa literatura, para identificar eixos temáticos e lacunas presentes.

Método

Revisão de escopo, com levantamento de publicações nas bases de dados CINAHL, Scopus e Web of Science, focalizando artigos acadêmicos que referenciam explicitamente Paulo Freire, num período que, sem recorte inicial, foi até abril de 2020, tendo sido incluídos todos os artigos que referenciavam pelo menos uma obra do autor. Uma planilha desenvolvida no programa Microsoft Excel® reuniu os dados gerais dos artigos, cujos conteúdos foram agrupados, sintetizados e analisados a partir de conjuntos temáticos significativos.

Resultados

Foram identificados 56 artigos, publicados entre 1993 e abril de 2020. A obra de Freire vem sendo utilizada em publicações acadêmicas da terapia ocupacional, destacando-se o livro “Pedagogia do Oprimido” e as categorias Diálogo/Dialógica e Conscientização/Consciência crítica/política. Foram definidos e discutidos três conjuntos temáticos: 33 (58,9%) artigos que utilizam o referencial freireano para o pensar/fazer da terapia ocupacional; 10 (17,8%) em que ele parametriza a pesquisa na área; 13 (23,2%) cujas análises e proposições envolvendo a formação de terapeutas ocupacionais tomam-no como aporte.

Conclusão

Paulo Freire informa de diversas maneiras a terapia ocupacional, em prol de uma práxis para a transformação social, embora, em boa parte das vezes, as formulações freireanas não sejam o centro dos esforços de elaboração reflexiva.

Palavras-chave:
Mudança Social; Problemas Sociais; Conscientização; Opressão Social; Terapia Ocupacional

Introduction

Paulo Reglus Neves Freire was born in Recife, state of Pernambuco, northeastern Brazil on 19 September 1921. According to Gadotti (1996), since adolescence, Freire engaged in processes of education for young and adult workers and, later on, in the 1950s, he began to think about and propose non-traditional and differentiated pedagogical methods for these individuals that combined pedagogy, politics, dialogue, consciousness and problematization, taking the concept of education as the practice of freedom as a central axis. In other words, his interest was in education that “[...] aims at liberation, at the radical transformation of reality to improve it and make it more humane, and allows men and women to be recognized as subjects, and not as objects, of their history” (Gadotti, 1996, p. 81), overcoming their condition of oppressed.

During his career trajectory, Freire was involved in several popular education projects, beginning in 1960 in the context of a country where 50% of the population was illiterate. Based on his political and pedagogical conceptions, his first experiences occurred in the municipality of Angicos, state of Rio Grande do Norte, Brazil, in 1963, when he taught 300 laborers how to read and write through culture circles¹.

Given the great repercussions of this literacy and cultural movement, Paulo Freire was appointed coordinator of the National Literacy Program, linked to the Brazilian Ministry of Education, in 1964; there were plans to create 20,000 culture circles that would include two million illiterate people across the country in that same year. However, these plans were interrupted by the conservative forces of the military coup d'état (1964), which felt threatened by the revolutionary character of Freire's propositions; he was accused of subverting the established order, arrested, and exiled (Gadotti, 1996; Nosella, 2007).

During exile, in the midst of the painful experience of being distant from his family and his country, Freire broadened his struggle for the liberation of the oppressed and began to understand it beyond national limits, and his formulations started to assume global dimensions in this process. This and the exile led him to live and carry out work in Chile, the United States of America, Switzerland, and Guinea-Bissau, among other countries, disseminating, debating, elaborating, and sharing his ideas and intentionalities (Gadotti, 1996). “In the 1960s, Freire's message, which was launched in the northeast region of Brazil, spread throughout the country; in the 1970s, his name and pedagogical method were expanded worldwide” (Nosella, 2007, p. 180).

Gadotti (1996) divides Freire's experience and elaborations into two phases: a Latin American phase, from 1960 to 1970, of the author of Pedagogy of the Oppressed (written in 1968), and a second phase named Paulo Freire, citizen of the world, from 1980 to 1990, during which he co-authored books and shared experiences around the world.

Paulo Freire returned to Brazil definitively in 1980, where he continued to develop his work, always engaged with the values he propagated, contributing to the continuous renewal of national and universal pedagogical thinking. Freire died in São Paulo, Brazil on 2 May 1997, leaving a legacy of propositions for the search and struggle for a fairer world (Nosella, 2007).

Paulo Freire's legacy and influence are still being disseminated, and have reached and spread across different fields of knowledge (Gadotti, 1996), including occupational therapy (Toldrá, 1986; Barros, 2004; Magalhães, 2012; Gontijo & Santiago, 2018, 2020; Farias & Lopes, 2020).

Gontijo & Santiago (2018),in a survey of Brazilian scientific production that combined occupational therapy and Paulo Freire's pedagogy, identified works between 2000 and 2016 with a progressive increase in citations. Those authors concluded that references to this author would result from the search for more critical bases to understand the profession, the processes of professional education, as well as occupational-therapeutic interventions in various fields of practice, but highlighting this in the subarea of social occupational therapy.

The analysis of this presence showed different levels of comprehension of Freire's work, characterizing a dynamic approaching process that is contextualized amid the historicity in which occupational therapy reflects on itself, its relationship with the participants of the interventions, and its intervention role in and with the world (Gontijo & Santiago, 2018, p. 145).

Farias & Lopes (2020),when reflecting on the use of the Freirean framework in occupational therapy, and especially in social occupational therapy, discuss the bases for thinking/doing a professional action guided by education as a practice of freedom, having ethical-political commitment, criticality of problematization, democratization, and technical-scientific rigor as key points.

Those authors turn to possible paths that interest professionals in the area from Paulo Freire’s legacy, both in practical and theoretical terms, operating Freirean formulations to denounce inequalities and announce a fairer world, with dialogics, freedom, conscientization, and transposition of extreme situations. These propositions are in line with the ideas developed by Barros (2004), bringing Paulo Freire's centrality to resort to categories such as consciousness and dialogue, as well as to understand the inseparability between technical and political action in the profession and the idea of transforming action in reality.

Thus, references and contributions² developed by Paulo Freire have been used to inform different areas of knowledge that converge in the fight against oppression and in search of alternatives to the social contradictions that challenge the everyday life of individuals marked by relations of domination and exploitation, and occupational therapy is among them.

In this context, this literature review aimed to expand the scope and enhance the character of this academic presence in occupational therapy using international databases as a reference.

Method

A scoping review, which is the most appropriate methodology for surveying and mapping the academic production of a given area of knowledge (Arksey & O’Malley, 2005), was conducted on occupational therapy and its correlation with the contributions of Paulo Freire's work. Complementarily, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) (Moher et al., 2009; Tricco et al., 2018) was used.

Identifying the research question

The research question that led the review was: How has the Freirean framework been used in occupational therapy productions?

Identifying relevant studies

Initially, to this end, between March and April 2020, a search for studies on the theme was carried out on CINAHL, Scopus, and Web of Science, which are the academic databases that index most of the scientific journals in the field of occupational therapy, using the descriptors “occupational therap*” for title, abstract and key words³, and “Paulo Freire”, “Freire, P.”, and “Freire, Paulo”⁴ for full text.

Selection of studies

No parameters for year or language of publication were stipulated in the survey, and all articles that referenced at least one work by Paulo Freire were included in the review.

Mapping the data

As proposed by Levac et al. (2010), the selected studies were organized using a Microsoft Excel® spreadsheet according to the following categories: title, abstract, key words, language, journal, year of publication, type of article, author(s), author institutional affiliation and country, works by Paulo Freire referenced, and number of times these works were cited in the article.

Grouping, synthesizing and presenting results

After the initial reading of the retrieved articles included in the review, a numerical analysis of the extension and nature of the studies was conducted using percentages, tables, and graphs with information such as number of publications over time, journals in which this framework was most present, occurrence of authors and countries of institutional affiliation, types of studies, most cited texts and number of citations in the body text, and most used Freirean categories.

Subsequently, after a comprehensive reading of the texts in full, syntheses of the contents addressed in the articles were prepared, and some axes of analysis emerged, enabling a thematic division of the articles into three groups: Paulo Freire as a theoretical-methodological framework for thinking/practicing occupational therapy; Freire as a framework to assist with research in occupational therapy; and Freire's contributions to the education of occupational therapists.

Data analysis

The developed syntheses were treated using a set of techniques applied to contents that carry linguistic and iconic meanings and other semiotic codes, weaving their relationship with sociological structures - a process that Bardin (1977) named content analysis. Thus, the gathered data were analyzed in an attempt to comprehend, infer, or speculate their meanings aiming to go beyond a superficial reading to “[...] understand the messages beyond what they show at first glance” (Bardin, 1977, p. 29).

Results

The search strategies found 198 publications. After removing studies in duplicate, books, book chapters, and editorials, and keeping a focus on collecting academic articles, 93 publications were selected. After revising the bibliographic references and abstracts, studies that did not include works by Paulo Freire in their references (many of them showed publications by other authors with the same surname) and those whose abstracts did not focus on occupational therapy, such as articles addressing integrative practices, health education, among others, 56 studies were ultimately included in the scoping review. Subsequently, these 56 included works were read in full. Figure 1 presents a flow chart depicting the search, inclusion and exclusion of articles.

Figure 1
Flow chart of the selection process using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) model (Moher et al., 2009; Tricco et al., 2018).

Overview of the collected literature

The first identified article evidencing the use of Paulo Freire's framework dates from 1993. It is titled Occupational therapy guidelines for client-centered practice: Impact study findings, written by Jenny Blain and Elisabeth Townsend, and published in the Canadian Journal of Occupational Therapy. Freire was cited once, as part of a group of authors, when Blain and Townsend mentioned the concept of social action.

As shown in Figure 2, the number of publications by year ranged from zero to four between 1993 and 2017, with a significant increase in 2018 (8) and 2019 (7). It should be noted that 2020 is underreported, as the search lasted until April that year.

Figure 2
Number of publications by year (1993-2020). Source: CINAHL, Scopus, and Web of Science (April 2020).

The Canadian Journal of Occupational Therapy presented the largest number of articles (n=10), followed by the Brazilian Journal of Occupational Therapy (n=6) and the Occupational Therapy in Health Care (n=6). In addition, it is worth noting that 11 articles were identified in journals with a single publication, as is shown in detail in Table 1.

Table 1
Distribution of published articles between 1993 and 2020 by journal.

Journal	Number of articles	%
Canadian Journal of Occupational Therapy	10	17.8%
Brazilian Journal of Occupational Therapy	6	10.7%
Occupational Therapy in Health Care	6	10.7%
American Journal of Occupational Therapy	4	7.1%
Australian Occupational Therapy Journal	4	7.1%
British Journal of Occupational Therapy	4	7.1%
Journal of Occupational Science	3	5.3%
Occupational Therapy International	3	5.3%
Scandinavian Journal of Occupational Therapy	3	5.3%
Interface: Communication, Health, Education	2	3.5%
Others	11	19.6%
Total	56	100%

• Note. Source: CINAHL, Scopus, and Web of Science (April 2020).

Of the 109 authors identified, the majority (n=90; 82.6%) published only one article on the theme of the present review, and 19 authors (17.4%) published two or more studies (see Table 2), with emphasis on Elizabeth Townsend with nine published articles – five of which were published between 1996 and 1998 – followed by Roseli Esquerdo Lopes with five works, and Patrícia Leme de Oliveira Borba and Nick Pollard with four publications each.

Table 2
Authors by continent and country of institutional affiliation.

Continent	n	%	Country	n	%
Americas	81	74.30%	Brazil	41	37.6%
			USA	21	19.2%
			Canada	17	15.6%
			Colombia	2	1.8%
Europe	19	17.40%	UK	10	9.1%
			Spain	2	1.8%
			Sweden	1	0.9%
			Ireland	1	0.9%
			Malta	1	0.9%
			Germany	1	0.9%
			Estonia	1	0.9%
			Netherlands	1	0.9%
			Georgia	1	0.9%
Oceania	8	7.30%	Australia	8	7.3%
Africa	1	0.90%	Tunisia	1	0.9%

• Note. Source: CINAHL, Scopus, and Web of Science (April 2020).

As it is shown in Table 2, regarding institutional affiliation, most of the 109 authors are concentrated in four countries in the Americas (74.3%), with emphasis on Brazil (37.6%), followed by the United States of America (19.2%) and Canada (15.6%). Oceania (7.3%) and Africa (0.9%) presented the lowest percentages in this context, and no authors affiliated with institutions in Asia were identified.

Because most journals are established in English-speaking countries, it was identified that 83.9% (47) of the articles are written in English only, 8.9% (5) in Portuguese, 7.1% (3) have versions in Portuguese and English, and only 1.7% (1) are written in Spanish and English.

The publications were classified into three main types: research articles, essays (which address various themes), and experience reports. Research articles (25-44.6%) comprised most of the publications, demonstrating a strong occupational therapy production in the scope of research using the Freirean framework, followed by a significant number of essays (20-35.7%), and a smaller number of experience reports (11-19.6%).

Fourteen different works by Paulo Freire were referenced in 72 citations, with Pedagogy of the Oppressed (Freire, 2016) being the most referenced (37 citations), representing more than half (51.3%) of all references to Freire's contributions in articles published in the occupational therapy area, mostly in English (33), as is shown in Table 3.

Table 3
Distribution of Paulo Freire's works and the number of times each was cited and the language of the revised publications.

Title	Type	Nº of citations	Language	%
Pedagogy of the Oppressed	Book	37	33 english; 4 portuguese	51.3%
The Politics of Education	Book	9	english	12.5%
Education as the Practice of Freedom	Book	5	4 english; 1 portuguese	6.9%
Pedagogy of Freedom	Book	4	portuguese	5.5%
Cultural Action for Freedom	Book	3	1 english; 2 portuguese	4.1%
Education for Critical Consciousness	Book	3	english	4.1%
Educação e Mudança (Education and Change)	Book	2	portuguese	2.7%
Extension or Communication	Book	2	1 english; 1 portuguese	2.7%
Professora, sim; Tia, não (Call me Teacher, not Aunt)	Book	2	portuguese	2.7%
Pedagogy of Hope	Book	1	english	1.3%
Educadores de Rua (Street educators)	Book	1	portuguese	1.3%
We can Reinvent the World	Chapter	1	english	1.3%
We Make the Road by Walking	Book	1	english	1.3%
What is the “Dialogical Method” of Teaching?	Article	1	english	1.3%
Total		72		100%

• Note. Source: CINAHL, Scopus, and Web of Science (April 2020).

It is worth mentioning that 47 (83.9%) of the 56 studies analyzed refer to a single work by Paulo Freire, and Pedagogy of the Oppressed is the only work referenced in 51.7% (29) of the articles, which suggests that this is the central work that supports the concepts and reflections of authors in the scope of occupational therapy.

The use of only one of Paulo Freire's work is also reflected in the number of citations⁵ throughout the articles. Most of the analyzed articles (34-60.7%) show only one citation of the work used in the body text.

Regarding Freire's works, the following concepts were identified as the most present in the investigated articles. In total, 33 Freirean conceptual elaborations were listed, with Dialogue/dialogics being the most used (16 citations), followed by Critical and political consciousness/conscientization (14 citations), and Praxis/action + Reflection, Social transformation/change and Participant research/action research, with nine citations each.

Uses of Paulo Freire’s works

Turning to the most commonly used conceptual and/or theoretical-methodological elaborations by Paulo Freire, the articles were divided into three groups: 33 (58.9%) studies used Paulo Freire as a theoretical-methodological framework for thinking/practicing occupational therapy, with a focus on practice; 10 (17.8%) used Freire as a framework to assist with research in occupational therapy; and 13 (23.2%) used Freire's contributions in analyses and propositions involving the education of occupational therapists.

1. a

   Paulo Freire as a theoretical-methodological framework for thinking/practicing occupational therapy

This group comprises publications that used the Freirean framework to propose and discuss aspects involved in thinking/practicing that seek to inform occupational therapy practice. 33 (58.9%) of the articles analyzed were allocated to this group⁶.

Therefore, these articles bring aspects common to professional practice with different populations, such as, for instance, the studies by Blain & Townsend (1993), Townsend (1996a; 1996b; 1997a; 1997b) and Townsend et al. (2003), which address issues of the limited involvement of professionals with respect to what would configure the empowerment of assisted subjects because of institutional structural barriers and psycho-biomedical and individualized practices prevalent in health services. At the same time, they discuss the power of occupational therapy practices for these actions, aiming at a dialogue for denunciation, through a language of possibility and hope.

Supported by Paulo Freire, these authors point out that professional work to empower subjects is fundamental to a fairer society and should to be carried out through activities aimed at a liberating and conscientizing education, highlighting the potential of occupation for personal and social transformation, as well as professional responsibility in relation to acting in favour of these issues, taking actions more horizontal and inclusive towards the subjects they work with. To this end, parameters that rethink the professional language (Magalhães & Galheigo, 2010; Townsend, 1998; Phelan, 2011) and its epistemic bases from praxis are needed, that is, practice in dialectical relationship with reflection, the thinking/doing; only this way is it possible to develop strategies that are committed to social change and that do not reproduce processes of discrimination and exclusion (Kinsella & Whiteford, 2009).

In this sense, Freire appears strongly as a critical theorist for practical and reflective elaborations that focus on social transformation, change or justice in the world (Shaw et al., 2009; McCorquodale & Kinsella, 2015; Pollard, 2018; Malfitano et al., 2014). Townsend (2012) and Rudman (2018) advocate a critical perspective in the profession, stressing the importance of confronting the social structures of power, and begin to recognize the occupational therapist as an agent who performs technical work that is linked to ethical and political issues, and should thus have cultural sensitivity and political awareness so as not to risk reducing social problems to merely technical aspects (Galheigo, 2011; Godoy-Vieira et al., 2018; Quiroga & Reyes, 2019).

The existence of possible and potent connections between occupational therapy and Freire's educational perspectives is recognized, emphasizing that these can foster critical thinking that assists with professional practice with groups that experience exclusion and oppression whether in socioeconomic, physical or mental aspects, especially in community, territorial and extra-clinical services that require a practice that acts more broadly on the subjects' realities, aiming at social emancipation (VanLeit, 1998; Frank, 1996; Padilla, 2002; Neufeld & Kniepmann, 2001; Lopes et al., 2011a, 2011b; Fransen et al., 2015; Maia et al., 2016; Gontijo et al., 2016; Boland & Cunningham, 2018). This can be exemplified by the purpose of the work developed with socially vulnerable youth in Brazil in a Public School and a Youth Center, described by Lopes et al. (2013, p.939), who propose that “[...] it is necessary to seek resources that expand the social support networks for these young people, creating spaces of belonging and possibilities for critical consciousness”.

The dialogical approach is reiterated many times in the studies assessed as a structuring axis of the intervention that promotes the active participation of subjects, the construction of bonds, and the valorization of everyday experiences (Arblaster et al., 2019; Silva et al., 2018; Serpa et al., 2018).

1. b

   Freire as a framework to assist with research in occupational therapy

This group was composed of 10 (17.8%) articles⁷ that use the Freirean framework to support research alternatives in occupational therapy.

When proposing research paths for occupational therapists, Wright (1998) relies on Freire to discuss action research characterized as participant research, emphasizing the involvement of participants in the production of dialogues for critical awareness. These are the bases on which Participatory Action Research (PAR) is configured (Taylor et al., 2004; Wilding & Whiteford, 2007), which is an aid to develop occupational therapy practices, since it enables a comprehensive understanding of the demands and needs of subjects who become active in the processes. In this way, participant research conducted with traditionally oppressed individuals and social groups is based on the concepts of dialogue, consciousness and empowerment, proposing the development of strategies for mutual reflection between the investigated and investigators, in order to work together so that subjects can be educated to improve their living conditions and face the structures of oppression.

Participant research would be a form of joint action in favour of social cooperation, emancipation and justice, going beyond “simple” data collection (Wilding & Whiteford, 2008). It would seek to overcome positivist models of science, guided by an egalitarian and committed approach between the researcher/occupational therapist and participant, in which both apprehend the knowledge produced (Blakeney & Marshall, 2009; Zubriski et al., 2020), adhering to the research’s social role (Bryant et al., 2019). Other research strategies are also mentioned in the studies in this group, such as ethnography (Pastore & Sato, 2018), which would foster powerful relational and dialogic processes for research that can encompass different ways of life, problematics and issues that permeate societies. Dialogue is also mentioned as a method to be used in research, considering that it produces socio-political discourses that generate reflection, awareness and transformations (Farias & Rudman, 2019; Farias et al., 2019).

1. c

   Freire's contributions in analyses and propositions involving the education of occupational therapists

The 13 (23,2%) articles included in this group⁸ refer to Paulo Freire to make analyses and propositions that involve either the initial or continued professional education of occupational therapists.

Questioning the theory-practice dichotomy, Steward (1996) points out the importance of the relationship between these two dimensions in the education of occupational therapy students and highlights, based on Freire, the need for a practical reflective approach that values the experience of these subjects in the educational process, guided by action + reflection. The assumption is that this praxis would contribute to overcoming processes resulting from banking education – a concept coined by Freire (2016) where, in education, students are passive and merely knowledge recipients – positioning students as active subjects in the processes (Bonello, 2001).

Several of these works use Freire's elaborations to discuss education practices linked to the Scholarship of Practice, a proposition based on Participant research/action research described as having arisen at the University of Illinois at Chicago (UIC), and whose aim was to strengthen the links between practice, research and theory with the commitment of investigations that would respond to the practices together with the demands of different populations, being also a space for educating occupational therapists. Again, the presence of participant research, subjects (in this case, the professionals) that would be educated from concrete work that maximizes involvement, and dialogue as a foundation to respond to individual and community demands, consolidate strategies for critical consciousness (Kielhofner, 2005; Suarez-Balcazar et al., 2005a, 2005b, 2015). Involvement is an important element in the discussions, considering that occupational therapists in training need to experience themselves, the world, and being with others, as pointed out by Borba et al. (2018) based on Freire.

In these terms, reflections are directed towards the construction of a social commitment by the occupational therapist in training so that they do not maintain the status quo or reinforce stereotypes of vulnerable populations, turning their actions towards social change, especially in community work, which should not be mistaken for benevolence or charity work (Hansen, 2013).

These studies also reaffirm dialogue as an important axis along the course of professional education, as a pedagogical proposal to guide the curricula (Barba et al., 2012) in view of the need for higher education institutions to contribute to social capital and prepare professionals to be active members of in the communities where they live (McGrath et al., 2014). Occupational therapists should be educated to understand personal histories located in the complexity of the broadest contradictions, and thus act on them (Walsh, 2016), emphasizing the need to incorporate knowledge and pedagogical practices that are critical to the process at different levels of occupational therapy education (Malfitano et al., 2018; Walsh & Pollard, 2019).

Discussion

First, the centrality of Pedagogy of the Oppressed highlights its importance in the field. In the preface to the 60th edition of this book released by the Brazilian publisher Paz & Terra, Beisiegel (2016) states that this text is regarded as one of the most prominent works in Freire's literary production. Pedagogy of the Oppressed was completed in Portuguese during Freire's exile in Chile in 1968, although it would not be published until 1970, when it was released in English; by 1974, it had been translated into Spanish, Italian, German, Dutch, Swedish and Portuguese. Santana & Souza (2019), in a bibliometric analysis comprising the period between 1968 and 2017 (the year of the 50th anniversary of the book), found that it had been published in 57 languages, 200 editions, and amassed more than a thousand citations per year in academic publications, demonstrating its worldwide dissemination and apprehension. Moreover, the internationalized movement of this work, which was identified here, can be explained by its first publication in English and by Freire's trajectory as an intellectual and political exile in several countries.

The centrality of Pedagogy of the Oppressed is also evidenced by the fact that this is the only work cited, even when only once, in more than half of the articles (37).

On the other hand, these facts show limitations concerning the use of Freire’s work and evidence that, in many articles, there is only a superficial understanding of the Freirean framework, insofar as they do not work with concepts and elaborations developed and matured by Freire throughout his vast production.

Added to this, citations of Freire sometimes come together with other authors, not elucidating how his framework is thought of in the elaboration in question, as for example, in excerpts on social transformation, social action, critical awareness, power, hope, etc. The interpretation of Freire to work with these categories is not exposed, which suggests a more punctual/isolated use to solve a theoretical aspect.

The reading of Freire restricted to a single work, or any limited understanding of the works/categories, is an aspect harshly criticized by the author himself, who calls these readers Freirean tourists (Freire, 2001b).

In short, many educators who use my work superficially as a means of pedagogically solving their technical problems are, to some extent, Freirean tourists. They almost become Freirean fundamentalists, and then the world becomes fixed, eliminating the possibility of history being a possibility (Freire, 2001b, p.61).

Freire points out that this aspect is contradictory, considering that the path to a progressive praxis presupposes the consolidation of frameworks combined with a (re)invention according to the realities and historicity.

This limitation also appears in Garzon et al. (2018), who analyzed the theoretical and methodological application of Paulo Freire's liberating critical pedagogy in the scientific production on nursing, and concluded that there is an isolated/partial use of the Freirean categories in research, which would represent a weakness that simplifies Paulo Freire's theoretical-methodological framework, thus indicating the need for greater investments in the area.

Dialogue/dialogics and Critical and political consciousness/conscientization were the categories informing occupational therapy most frequent found, corroborating the studies by Gontijo & Santiago in the national production on occupational therapy and by Garzon et al. (2018) in nursing.

It is known that these concepts are central to Freire's most used book, Pedagogy of the Oppressed, as stated by Santana & Souza (2019), who point out that authors who quote excerpts from this book most often quote the words dialogue and consciousness, as also observed in this review.

It is worth noting that these are not isolated categories as shown in some articles, but they are part of a consolidated and broad framework. Dialogue, for instance, cannot be understood only as a method, but as a theoretical-methodological proposition that implies the assumption of a conception of education, of the world, and of the human being, which are fundamental aspects proposed by Freire in several books he authored and co-authored.

According to Farias & Lopes (2020, p. 1350), it is important to apprehend the Freirean categories without losing the notion that they are dynamic and that “[...] there is a dialectic in all their formulations, conceptions, denunciations, and annunciations (within one category, a variety of others are announced)”, a complex field be explored by occupational therapists.

This complex dialectical relationship occurs, for example, as Dialogics is the essence of education as the practice of freedom, understanding it as a moment where humans meet to reflect on their reality as they make it and remake it, so that they can transform it. This is the basis for the conscientization process, as something that goes beyond “being aware”, in which they seek the necessary movement for an emancipated insertion into the historical process as subjects of decision and commitment – a progressive process of creative praxis (Freire, 2016, 2005; Shor & Freire, 1987).

Therefore, in this elaboration, dialogue or conscientization are not categories that are able to inform occupational therapy individually, requiring an understanding of the principles that structure such a proposal, and this also occurs with other categories, such as empowerment, praxis, transformation, etc.

It is interesting to note the emphasis given to the conceptual elaborations involving Participant research/action research, which are debated by Freire in his propositions on a way of doing/thinking research based on the dialogics of liberating and conscientizing education. In other words, this presupposes a pedagogical and joint research action in which investigators and the investigated “[...] are both subjects of the educational process” (Freire, 1987, p. 56).

Such assumptions have been informing the praxis of occupational therapists interestingly, within what seems to be potent for a praxis that combines research interested in the direct transformation of reality – with social commitment, even if, at times, the aforementioned use of isolated categories occurs, without even finding that it is a category inspired by the author.

The concepts of Praxis/action and reflection and Social transformation/change also stand out, with praxis being a term used by Freire to explain the dialectical unity between action and reflection. “Praxis, however, is the reflection and action of men [and women] on their world to transform it, without which it is impossible to resolve the oppressor-oppressed contradiction” (Freire, 1987, p. 21), and thus it is the central axis for social transformation processes, as it proposes a liberating radicalization. This standing out is an important exercise for occupational therapists in thinking about the action of concrete change, without losing sight of the reflexive dimension.

Social transformation/change is an important category that appears in the articles, characterizing the search for a more critical perspective in the scope of occupational therapy. In Freire’s (1987, 2001b) work, social transformation presupposes a fairer reality in which subjects can be more, fulfilling their vocation for humanization, being a process of change permeated by awareness and positioning of subjects to move towards social, collective and structural transformation.

Although in a limited way regarding a more consolidated understanding of the frameworks, the articles dialogue with this perspective of transformation aiming at a more critical thinking/doing, which means being more collective, social, extra-clinical, community, non-biomedical, etc. In other words, they are praxes/reflections/actions that go beyond individualized/institutionalized analyses of the issues in question, weaving an understanding of the subjects and structures of oppression that move between the individual and the collective.

It is interesting to note that the search for this occupational therapy within a critical perspective and for social transformation, even though it requires greater depth, expands contributions to occupational therapy both in direct practice and in research and professional education.

Based on the reading of social occupational therapy, it seems that there is an occupational therapy that, based on Freire's framework, would seek to engender possibilities for individual and social emancipation (Barros et al., 2007). To this end, based on Freire (Shor & Freire, 1986), it is necessary to think of an intervention that involves individual “empowerment”, in which the subject of the intervention starts to have a critical and problematizing perception of society, recognizing themself as an agent, as well as social “empowerment”, since social transformation depends on the contractual power of the social class, which results from the struggle of the oppressed classes - for obtaining political power in the historical process.

Freire speaks of the need to exercise a methodical curiosity - central to more critical and radical approaches (Freire, 1996; 2001a) - which occupational therapists also need to use to develop more systematically a thinking/doing for social transformation that does not stagnate in simplified reproduction, restricting itself to a sectarian verbalism (Freire, 1987).

It was possible to recognize contributions along this path in the reviewed articles, describing systematization exercises based on models of empowerment, liberating approaches to education, or on the theoretical-methodological framework of education as the practice of freedom; however, the approach is still much more descriptive than actually propositional/analytical.

Conclusion

Synthesizing the results discussed with the intention of answering our research question, we point out that authors in the occupational therapy area have used Paulo Freire's framework in elaborations involving education, research, and practice.

Overall, Freire's concepts and proposals can support a critical professional approach intended to engender vulnerable populations and social transformation movements in the dialectical relationship between micro- and macro-social aspects.

The need for efforts to a more comprehensive understanding of this framework that goes beyond the superficial reading restricted to a single work is also highlighted.

However, within the scope of this review, it can be seen that Paulo Freire's framework has been informing occupational therapy in different ways, in doing/thinking interventions with subjects, in research alternatives, and in professional education proposals. Although most of the time Freire's theoretical-methodological framework and concepts are not the center of reflexive elaboration efforts, what all these ways of understanding and applying his constructions have in common is the search for an occupational therapy praxis (action + reflection) that is technical, political, critical, and committed to social transformation.

Finally, a limitation to this study lies in the fact that its reflections were constructed from articles gathered through a search of three databases that are relevant to the academic environment, but restricted in terms of professional interest. In addition, only scientific articles were assessed, and books, book chapters, editorials, and other productions were not included in the scoping review. Therefore, other studies that seek to expand this review are encouraged, as is research aimed at understanding the use of the Freirean framework in the practice of professionals who are assisting with different services, that is, to understand how Freire's concepts are transformed into actions in a variety of occupational therapy practices.

• 1
  Culture circle is a strategy formulated by Freire for an awareness-raising education practice. Using dialogue in a circle and exercises with words, including the written word, the aim is for the collaborating subjects to problematize the world, unveiling its contradictions and, with awareness of and reflection on these contradictions and themselves, produce/think ways to overcome structures of dominance, and become beings in and with the world, in a process of praxis, humanization and emancipation (Fiori, 1987).
• 2
  Freire (2001a, 2013) recognizes his elaborations as a dialectical-ethical-critical-political understanding of education. This comprehension is understood here as a set of theoretical references and methodological contributions, within the dialectics between reflection and action, that inform in a way to gather the reality (the world, human beings, and power relations), but also in ways of doing and acting on this reality (the concrete actions to move towards problems). In addition, these references and contributions announce what we call categories (Minayo, 2001), such as dialogue, conscientization, political consciousness, praxis and others, which combine concepts characterized by certain Freirean principles.
• 3
  The Cumulative Index to Nursing and Allied Health Literature (CINAHL) cannot be searched by title, abstract and key words simultaneously, and does not present the category key words. Thus, the search was conducted in each of these categories separately, first for title, then for abstract, and finally for theme (instead of key words).
• 4
  The descriptors “Freire, P.” and “Freire, Paulo” were included because these are the spellings that appear in the references to his works.
• 5
  This analysis was performed considering the citation parameters, for example, Freire (year) or (FREIRE, year).
• 6
  Blain & Townsend (1993); Frank (1996); Townsend (1996a, 1996b, 1997a, 1997b, 1998); VanLeit, (1998); Neufeld & Kniepmann, (2001); Padilla, (2002); Townsend et al. (2003); Shaw et al. (2009); Kinsella & Whiteford, (2009); Magalhães & Galheigo, (2010); Lopes et al. (2011a, 2011b); Phelan, (2011); Galheigo, (2011); Townsend, (2012); Lopes et al. (2013); McCorquodale & Kinsella, (2015); Fransen et al. (2015); Maia et al. (2016); Gontijo et al. (2016); Godoy-Vieira et al. (2018); Rudman (2018); Pollard, (2018); Silva et al. (2018); Serpa et al. (2018); Arblaster et al. (2019); Boland & Cunningham (2018); Quiroga & Reyes, (2019); Malfitano et al. (2014).
• 7
  Wright (1998); Taylor et al. (2004); Wilding & Whiteford (2007, 2008); Blakeney & Marshall (2009); Pastore & Sato (2018); Farias & Rudman (2019); Bryant et al. (2019); Farias et al. (2019); Zubriski et al. (2020).
• 8
  Steward (1996); Bonello (2001); Kielhofner (2005); Suarez-Balcazar et al. (2005a, 2005b); Barba et al. (2012); Hansen (2013); McGrath et al. (2014); Suarez-Balcazar et al. (2015); Walsh (2016); Malfitano et al. (2018); Borba et al. (2018); Walsh & Pollard (2019).

• Funding Source

  National Council for Scientific and Technological Development (CNPq). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

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Edited by

Section editor

Profa. Dra. Marta Carvalho Almeida

Publication Dates

• Publication in this collection
  24 Jan 2022
• Date of issue
  2022

History

• Received
  16 Feb 2021
• Accepted
  20 Aug 2021