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Enabling International Communication among

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RESEARCH ARTICLE

Enabling International Communication among

Brazilian Occupational Therapists: Seeking Consensus
on Occupational Terminology
Lilian Magalhaes1* & Sandra Maria Galheigo2
1

Occupational Therapy, University of Western Ontario, London, Ontario, Canada

Occupational Therapy Program, Faculty of Medicine, University of So Paulo, Brazil

Abstract
The purpose of this study was to examine how key occupational therapy terminologies are used by Brazilian occupational therapists. A nominal group approach combined with a Delphi technique involving 31 Brazilian occupational therapists was applied. A sociolinguistic approach was adopted since it broadens our understanding of the
social and cultural determinants of terminology consolidation. Brazilian occupational therapists were found to
adopt the term activity more often than human action or doing. Even less often were praxis and occupation applied.
No consensus was reached regarding which of the terms is most preferred.
While Brazilian occupational therapists have been developing their profession from international standards, it is
still embedded in local demands and policies. Additionally, the political context must be considered when building
an international dialogue between members of a professional body. Such a dialogue could engage professionals
from different countries in meaningful exchanges about their practices. These exchanges may lead to the development of solid professional communities that can contribute meaningfully to social change. Copyright 2010 John
Wiley & Sons, Ltd.
Received 25 October 2009; Revised 22 January 2010; Accepted 1 February 2010

Keywords
occupational therapy terminology; professional communication
*Correspondence
Lilian Magalhaes, Occupational Therapy, University of Western Ontario, London, Ontario, Canada.

Email: lmagalha@uwo.ca

Published online 18 June 2010 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/oti.292

Introduction and review of

related literature
Concerns about the lack of common international terminologies have been recently voiced in both the occupational therapy (OT) and the occupational science
literature (Nelson and Jonsson, 1999). The focus of this
debate has been on the word occupation and on the
diversity of its usage by professionals and nonprofessionals alike in English-speaking and nonOccup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

English-speaking countries. At the Occupational

Therapy European Congress in 1996, Nelson and
Jonsson (1999) expressed their concerns about the lack
of consensus regarding OT terminology across international borders. They invite us to consider:
Please note that several northern European languages use the Greek word ergo to label the
profession. Indeed, the official title of occupational therapy has been changed to a form of
113

Enabling International Communication among Brazilian Occupational Therapists

ergo from other linguistic roots in several of

these countries. For example, therapists in
Germany have commonly used the term ergotherapie to label their profession, although legally
the name did not change from the former term
(a rather long title!) until 1999. The move to ergo
has not been universal, however. (Nelson and
Jonsson, 1999, pp. 4445)
They stressed the linguistic implications for OT theorization both within and between countries. Supported by the World Federation of Occupational
Therapists (WFOT), they conducted their investigation
during the 1998 WFOT Congress by addressing the
differences in the various perspectives on occupation of
the Congress attendees.
An enormous diversity was revealed among the
attendees regarding concepts such as occupation and
OT. Moreover, they identified three main global problems with occupation-based words: confusion with
work-oriented disciplines, the connotation of busy work
and the limited understanding on the parts of both the
public and the policy makers.
These results confirm the experience of OTs in
Brazil. In response to the post-war initiatives of the
International Rehabilitation Movement and the United
Nations, OT undergraduate programmes were brought
to Brazil in the 1950s. With these programmes came the
term occupation, which was translated from English
to Portuguese as ocupao. During the past 50 years,
Brazilian OTs adopted activity (atividade, in Portuguese) but kept the major professional references to the
expressions occupational therapy and occupational therapist, which are literally translated in Portuguese as
terapia ocupacional and terapeuta ocupacional.
From 1980 onwards, Brazilian OTs have focused on
developing a working vocabulary of professional terminology, either by creating new concepts or by redefining old ones. Consequently, concepts such as praxis
(prxis), human action (ao humana), doing (fazer
humano) and everyday life/quotidian (cotidiano, vida
cotidiana) have become more common. In fact, activity
has been recently freshly examined. This new perspective has emphasized that activity may be emancipatory,
thus the importance of considering it within a broader
framework. In simple terms: human beings can liberate
themselves through work with their hands and their
will power (Magalhaes, 1989). Further, it has been
repeatedly acknowledged that human activity operates
114

Magalhaes and Galheigo

from a personal to social, political, and cultural contexts (Francisco, 1988; Castro et al., 2001; Galheigo,
2003; Barros et al., 2007).
Despite these developments, Brazilian OTs have
been apart from the major international debate on this
issue and have not pursued systematic comparative
studies on OT terminology either in Portuguese or in
other languages.
Among the studies focusing on these issues, there are
numerous discussions about the application of terminology or, more specifically, the lack of consistency
across language systems and the relationship between
language, culture and power. Some were conducted by
occupational scientists who focused on the conceptualization of OT terms such as discussed in the series
of Occupational Terminology Interactive Dialogue published by the Journal of Occupational Science (Townsend,
2000; Dunn and Hocking, 2001; Wilcock and Jakobsen,
2001; Lentin, 2004a, 2004b, 2005). This publication has
had annual contributions from various scholars and has
contributed to the analysis of terms such as act, action,
active, agency, doing, praxis and various definitions of
occupation.
Some articles focused on the need for consistent terminology in health policies (Christiansen et al., 1995),
research, electronic records and comparison of data
(Schwammle, 1996; Brewin, 2002) across different
language systems similar to the North American,
Australian, and European OTs who have worked on
developing a common set of consensual professional
terminology (Townsend, 1998; Youngstrom, 2002;
Steward, 2004; Craik, 2005; Creek, 2006; Paley et al.,
2006; Sinclair, 2006). This development was also
evident with the European Network of Occupational
Therapy in Higher Education (ENOTHE, 2003) in its
Protocol for the Translation of the Consensus Definitions in Occupational Therapy Project.
Another common theme was the view that professional language may help health care providers maintain oppressive relationships over their clients.
Accordingly, some authors have argued that by developing a language that functions as a common ground
for clients, public policy developers and health care
professionals, a shift in the prevailing power relationships at both client and organizational levels could be
realized. According to Townsend (1998, p. 46): Deliberate use of language, then, is a method of enabling
those with little power to take action in changing mainstream thinking . . . In essence, professional language
Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

Magalhaes and Galheigo

Enabling International Communication among Brazilian Occupational Therapists

forms the text around which professional power is

organized.
Following the same theme but more focused on cultural issues are those who stressed the need for an alternative way of conceptualizing OT and its various forms
of health care intervention from a cultural standpoint.
Accordingly, Iwama states (2006, pp. 45),
Most of our current models of occupation and
OT have been raised and informed by people
who share common experiences and common
views of truth, situated in the western world
particularly urban North America. . . . What
happens to these ideas, theoretical frameworks
and emergent intervention designs when they
cross cultural boundaries of meaning?
Thus, it seems imperative that OTs work critically
together towards developing a more inclusive and
diverse set of terminologies for their profession.
In Brazil, this debate has arisen mainly at national
conferences and in academic settings. However, it has
been at best intermittent and sometimes only subtle.
Even in scientific articles, appropriate terminology and
clear concepts have been lacking. After reviewing the
literature on concepts such as activity, occupation,
praxis and everyday life/quotidian, between 1990 and
2006, Canto and Galheigo identified 26 articles in two
Brazilian OT peer-reviewed periodicals the Revista de
Terapia Ocupacional da Universidade de So Paulo and
the Cadernos de Terapia Ocupacional da Universidade
Federal de So Carlos. Of these, four articles presented
conceptual analyses of professional terminology
(Machado, 1991; Prado 1991; Toyoda and Akashi,
1993; Galheigo, 2003). All the articles employed activity
as a keyword; some used qualifiers such as human, ludic
(playful), daily living, leisure or everyday life. To date,
Toyoda and Akashi (1993) provide the only article in
Portuguese that focuses on how OTs view activity and
occupation. According to these authors, within the
Brazilian context (more specifically, in the state of So
Paulo), activity is predominantly used and understood
by OTs as meaning action (in the sense of doing). The
word occupation presents a similar meaning, being
identified with action, expression and production.
Thus, there is a need to address the international use
of terminologies for both speakers and non-speakers of
English since both may provide important insights into
the particularities of each language and social customs.
Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

Furthermore, there is a need for a universal language

framework, which could bring professional coherence,
facilitate the international transferability of publications and ensure the empowerment of the international
OT community through the establishment of a common
dialogue (Craik, 2005). Using a sociolinguistic approach
(Dias, 2000; Krieger, 2000;), this study explores the
views of Brazilian OTs on key OT terminology
and examines the essence of the professional OT
language where certain words have acquired specific
connotations.

Method
A nominal group approach combined with a Delphi
technique was used to address an expert panel of
Brazilian OTs in a two-stage process (Fretheim et al.
2006). Ethics approval for this study was provided
by the Research Ethics Board at the University of
Western Ontario and the University of Sao Paulo.
As Figure 1 shows, the first assessment, which used
the nominal group approach, was conducted during a
workshop in So Paulo, Brazil (August 2007). The goal
of this meeting, which included 10 panellists, was to
elicit the specific issues and/or themes for the second
round of discussions (adapted Delphi round). The 10
panellists were invited on the basis of their leadership
among professionals in the state of Sao Paulo. The
nominal group activities were taped, transcribed in full
and then revised where necessary when compared to
the original recording. The transcribers were fully
informed about their ethical responsibilities and the
need for complete confidentiality concerning the
content of the recordings. The second assessment,
which used an adaptation of the Delphi technique, consisted of an online questionnaire survey that was
answered anonymously by 31 professionals from different Brazilian regions. These respondents were purposively selected and invited on the basis of their having
at least 5 years experience in clinical practice, some
familiarity with research activity and/or a background
in teaching, researching or writing about OT theoretical
foundations. The professionals who participated in the
nominal group were also invited to the Delphi round.
The Delphi round participants responded to 19
questions drawn from the nominal group narratives.
Each question had four possible responses ranging
from I totally agree to I have no opinion about that, plus
space for comments. With the participants consent, all
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Enabling International Communication among Brazilian Occupational Therapists

Magalhaes and Galheigo

Figure 1 Research design

activities were conducted in Portuguese. Both the

nominal group discussions and the online questionnaires (Delphi round) were in Portuguese. The NVivo
software was used to code, store and manage all text,
and a critical discourse analysis was conducted at each
stage (Nogueira, 2008). After transcription, the data
collected were analysed as a narrative. The responses
were carefully read and coded line by line by the first
116

author. After being reviewed and recoded where

necessary by the second author, the final consolidated
coding was grouped into categories and further analysed by theme (Ballinger, 2004; Cohen and Crabtree,
2008).
A reflective journal was kept by each author to
reduce the potential for personal bias, which was
avoided by the systematic debriefing experiences and
Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

Magalhaes and Galheigo

Enabling International Communication among Brazilian Occupational Therapists

issues raised during the research process (Graneheim

and Lundman, 2003).

Findings
In total, 31 professionals participated in the study. In
Figure 2, we summarize the demographics, bearing
in mind the need to protect the anonymity of the
respondents.
This article focuses on the findings regarding the use
of terms such as activity, occupation and praxis, which
comprise the first seven statements the respondents had
to analyse. The other two parts of the Delphi round will
be described elsewhere.
The findings are presented in Figure 3, along with
the percentage of agreement or disagreement they
present. The participants views regarding professional
terminology may be summarized in two main themes
and related subthemes as follows:
(1) The conceptual debate over the use of professional
language.
(1.1) Intelligibility, difficulties and ambiguities in
the use of occupation
(1.2) Occupation and intentionality
(1.3) Occupation, praxis and activity
(1.4) Act, task, activity and occupation
(2) The diverse perspectives on the production of
knowledge in OT.

(2.1) Relationship between language and power

(2.2) Technical language versus lay language
Seeking consensus
Usually, for both the Delphi and the nominal group,
there is a previously established threshold for the reaching of a consensus. For this study, it was established that
a full consensus comprised a 75% agreement and that
a moderate consensus ranged between 50% and 70%.
In our findings, a full consensus was only reached in
two aspects:
(a) The word occupation holds several difficulties in
Portuguese and needs to be better conceptualized
when applied to OTs (80%; Figure 3).
(b) More research is needed to gain a better understanding of a potential gradation in meaning for
terms such as act, task, activity and occupation
(75.9 %; Figure 3).
Terminology usage, intelligibility,
difficulties and ambiguities in use of
occupation
Among the research participants, there was a consensus
that occupation presents countless difficulties when
applied to Portuguese-speaking OTs. They confirmed
that the meaning of this word needed to be reviewed to

Figure 2 Percentage of respondents by gender, type and length of time of professional experience and place of work by Brazilian regions

Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

117

Enabling International Communication among Brazilian Occupational Therapists

1.

2.

The expressions used by OTs are not always

clear and objectives. Sometimes we take words
from other fields, the translated words are not
always well adapted, the applied expressions are
not well defined and there may be differences
amongst the various regions of the country, that
are not acknowledged by the professionals.
The word occupation holds several difficulties in
Portuguese. OTs need to articulate its meaning
to avoid ambiguities.

Magalhaes and Galheigo

56.7
3.3
36.7
3.3

80
0
20
0

3.

Occupation and praxis are synonymous.

10.3
3.4
58.6
27.3

4.

Occupation encompasses every human activity

including breathing, stumbling and dreaming.

3.4
3.4
31
62.1

5.

Occupation only happens if it is intentional and

connected to a specific project. All other
activities are either reflex or physiological and
cannot be part of the therapeutic process.

28.6
3.6
42.9
25

6.

The use of the word occupation by OTs is

beneficial because it holds a broader meaning.

44.8
6.9
31
17.2

7.

There is some progression among the terms act,

task, activity and occupation, which should be
better studied by OTs.

75.9
6.9
13.8
3.4

Legend:
I fully agree

No opinion on the subject

I partially agree

I fully disagree

Figure 3 Percentage of respondents in regard to statements concerning professional terminology

avoid ambiguities and that a better understanding of it

would be welcomed. However, some professionals suggested that ambiguity is unavoidable and that OTs
should accept the fact that they work in an imprecise
and subjective area. Some participants addressed the
need to widen the technical debate, even considering
118

the common sense in order to dialogue with people in

general, away from the professional area. There was a
moderate degree of consensus on the fact that occupation (ocupao) has many meanings in Portuguese and
that its polysemy, i.e. plurality of meanings, may indeed
be beneficial. However, the participants pointed out
Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

Magalhaes and Galheigo

Enabling International Communication among Brazilian Occupational Therapists

that some Brazilian OTs reject occupation a priori, and

thus reveal some prejudice against its usage.

doing something worthwhile. According to the Delphi

round:

I believe that occupational therapists need to

understand that the concept occupation may be
sustained by different theoretical frameworks. It
is necessary to make the sources clear, instead of
refusing the term a priori. I notice some prejudice of many Brazilian occupational therapists in
regard to occupation, leading to many conceptual misapprehensions. (Delphi round)

Activities should only be regarded as being

an occupation when they involve the processes
of idealization, realization, objectivation and
subjectivation, creation, production and
transformation.

The problem for some professionals, therefore, was

not with the language but with the concept. They
argued that due to their educational constraints,
OTs tended to oversimplify the concepts and had
difficulties with the etymologic and philosophical
conceptualizations.
The term occupation resonates better with the
Professional title, adding value to it. (Delphi
round)
The participants therefore called for a better articulation of the meanings, concepts and values inherent in
the complexity of ocupao.
Occupation can be seen as busy work or something alienating . . . in this way that expression is
troublesome (nominal group).
Furthermore, they stressed the importance of reaching an understanding of the theoretical frameworks
that sustain the various meanings of the concepts.
[The use of occupation] may also be to our disadvantage since it can have meanings that
are detached from our therapeutic objectives.
(Delphi round)

In contrast, others believed that the issue is more

complex and that it is impossible to declare that occupation is always intentional. These participants based
their arguments on the fact that an occupation may be
the result of alienation or of some external imposition
or personal obligation. An occupation may also be the
result of something being done out of a basic human
need or to satisfy another persons existential emptiness. Others said that occupation also includes subconscious and subjective motivations:
Occupation infers a specific form of activity that
requires intentionality, commitment and conscious involvement. It should also include the
subconscious and subjective motivations behind
the act of becoming occupied. (Delphi round)
Meaningfulness was a consensual point with reference to having an occupation. Some participants also
thought that, beyond being meaningful, an occupation
should promote personal, professional and social transformation and should contribute to humanizing and
improving the quality of peoples lives. Having an occupation, then, should be akin to a persons vocational
abilities, gifts or talents and/or to that persons life
ambitions.
The activities undertaken, therefore, should not
only be meaningful in themselves, but also they
should have a meaning within the life context of
a particular person. (Delphi round)

Concepts of occupation and role

of intentionality

Occupation, praxis and activity

When the debate focused on the scope of the concepts

surrounding occupation and the role of intentionality
within those concepts, the opinions became blurred.
Some participants felt that occupation is always intentional and involves a high degree of commitment
and consciousness. For them, occupation implies a
conscious and volitional act and to be employed in

As already mentioned, OTs in Brazil use the word activity more frequently than other terms. Sometimes they
use human action and doing and, less often, praxis and
occupation. Accordingly, when the participants were
asked if they preferred to use occupation instead of
activity, no consensus could be reached (44.8%). Some
therapists stated that they considered occupation to be

Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

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Enabling International Communication among Brazilian Occupational Therapists

more comprehensive than activity, and others stated

exactly the opposite.
Some therapists felt that occupation circumscribed
better what OTs as professionals intend to emphasize.
They foresaw advantages in its usage because the word
made it possible to (a) analyse the complexity of the
relationship within the personal/occupational context
and (b) observe what is meaningful for the clientele.
Supporters of this perspective identified the advantages
of occupation when referring to their profession to
others since it also encompasses household activities,
work and leisure. They argued that activity may be as
restricting as task. They say that the International Classification of Functioning, Disability and Health (ICF),
for example, presents a restrictive dimension of activity
by only referring to concrete tasks, such as feeding,
dressing and walking.
However, some participants highlighted the fact that
activity is preferable since it accurately expresses the
words original connotation: the state of being active.
On the other hand, one participant felt that the concept
of activity is more generic.
Many professionals stated that it would be helpful if
OTs could reach a common understanding of the true
meaning of occupation and be able to transmit it to
others clearly. Hence, any ambiguity, which could manifest itself as a problem for professional development,
could be avoided, e.g. in differentiating between occupation and praxis. There was moderate agreement that
the terms were correlated but not synonymous. Thus,
some considered occupation to be a general or broad
concept free from any theoretical framework or stream
of thought.
Alternatively, some participants stated that the
concept of praxis was most commonly used under the
framework of dialectical materialism. Thus, it has
been associated with the transformation of social reality
and involved both intentionality and consciousness.
According to this view, praxis implies that the process
of doing is associated with the consciousness of doing,
as much as with choice and desire and the development
of mental, emotional and/or social capacities. Therefore, to these participants, praxis meant a contextualized, intentional action seeking to transform the
relationship between people and concrete life situations. Hence, praxis is a human occupation in its ideal
form, or, in other words, it is an occupation providing
individuals with identification and contributing to both
their personal development and their social inclusion.
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Magalhaes and Galheigo

For those who support this view, an occupation may

also be alienating; praxis, from the dialectic perspective,
may not.
Despite the fact that the majority of the participants
associated praxis with dialectical materialism, one participant pointed out that it is not a consensual term
since praxis in Aristotles time was related to poiesis, or
the act of creation, and praxis according to Marxist
theory is related to economic and political transformations. Also, a small group emphasized the shortcomings
of praxis. Their argument was based on the fact that
under dialectical materialism, praxis excludes a persons subconscious experience, while occupation may
not. Participants also referred to the fact that praxis is
a highly sophisticated term that would be hard for lay
people to grasp, while occupation would be easier.
Act, task, activity and occupation
Most of the participants agreed on the need for a better
conceptualization of act, task, activity and occupation
(75.9%). However, many stressed the fact that these
terms were neither hierarchical nor had any graduation
of meaning. Some thought that they should be applied
generally; that is, be used not only within the OT
cosmos but also elsewhere. Despite the strong group
interest in discussing these terms further, some individuals indicated that it would be difficult to define
where one term started and the other finished. As one
participant asserted:
Act is action itself; task is the accomplishment of
a necessary or obligatory activity; activity may be
a task for one person and leisure, work or occupation for another; and occupation are the activities that people undertake in their daily lives.
(Delphi round)
The participants also said that while a graduated perspective of these terms may be advantageous, caution
should be exercised in order not to fracture the meaning
of such a complex subject.
The interconnection between language
and power
In their discussions about the professional meaning of
a word as opposed to its lay meaning, the participants
acknowledged the political determinants of language
and its intrinsic relationship to power. On the one
Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

Magalhaes and Galheigo

Enabling International Communication among Brazilian Occupational Therapists

hand, they challenged the idea of professional terminology being imposed from abroad, while, on the other,
they were concerned about the risks of linguistic elitism
on the part of professionals who could unwittingly
prevent clients from being fully engaged in the healing
process.

Discussion
Language is crucial for professional communication. As
Hagedorn (1995, p. 13) argues:
Words are important; they are the tools of scientific and academic communication. They also
carry the subtleties of thought and the overlays
of emotion, values or attitudes which the user,
intentionally or otherwise, conveys. Precision in
language is necessary, and it is essential for a
profession to have an agreed vocabulary, avoiding the use of jargon.
Reporting from the Anglo-Saxon experience, Hagedorn (1995, pp.1314) asserts that occupation and
activity are frequently used interchangeably within
the profession and argues that outsiders may understand terms in different ways, which may cause
misinterpretations.
The International Society for Occupational Science
(ISOS) in its website describes occupation broadly as
the various everyday activities people do as individuals,
in families and with communities to occupy time and
bring meaning and purpose to life. Occupations include
things people need to, want to and are expected to do
(ISOS, 2009). Nevertheless, as one participant warned,
it is important to avoid oversimplification of professional terms. Thus, theoretical frameworks should
sustain the various meanings of concepts. This was the
stance taken by Francisco (1988) when she sought to
identify and discuss different OT frameworks in Brazil,
explaining activity as it applied to each one. Consequently, she identified the positivist view of activity as
being a form of exercise, the psychoanalytical approach
wherein an activity is viewed as an expression of the self,
and the dialectic perspective according to which an
activity is conceived as praxis. In order to avoid oversimplification, we must recognize that some of these
concepts work as categories for major theories, as does
the concept of praxis. As Wilcock and Jakobsen (2001,
p. 28) observe:
Occup. Ther. Int. 17 (2010) 113124 2010 John Wiley & Sons, Ltd.

Praxis is, perhaps, the closest philosophical

concept to how occupation is viewed by occupational therapists. To define occupational therapy
as a praxial model of practice might be worth
considering, if this definition was linked with
mental, physical, social and spiritual health in
order to make the difference clear.
Further, as Wilcock and Jakobsen (2001) reflect, the
way in which people engage in occupations plays a
major role for Marxs concept of alienation. As such,
intentionality becomes a key concept that can help
explain praxis as a category.
In fact, our interviewees did mention this aspect, and
intentionality was at the core of the tension between the
supporters of an exclusionary concept of occupation
that led some participants to view a person as having
an occupation only if so doing was intentional. When
considered within this context, the roles of oppression
and alienation would be introduced, although the interviewees would acknowledge that an imposed occupation
is still an occupation, and that OTs should take this fact
into account. In summary, a consensual definition of a
preferable term is very unlikely at this point within the
Brazilian context according to our interviewees.
Interestingly, our findings are in consonance with
those of Ivarsson and Mllersdorf (2008). These
authors, who both have OT backgrounds, explored the
best Swedish semantic translation for the English word
occupation. They found that aktivitet is the best term
to use when referring to an occupation. The authors
highlight the fact that aktivitet holds more power,
strength and spirit when compared to the Swedish
expression syssla/syssselsttning (occupation). Similarly,
European Network of Occupational Therapy in Higher
Education (ENOTHE) experts working for the Terminology Project would warn participants of the difficulties surrounding the consensus being reached between
different European languages. As an example, they
described the distinct circumstances under which the
German language defines occupation and activity and
how impossible it is to come up with a single definition
for these terms (ENOTHE, 20042005). The same difficulties were encountered while proposing a taxonomic code for defining an occupation (Anonymous,
2005) or for the experience-based categorization of
occupation, as proposed by Jonsson (2008).
While working within a consensus-building framework, our results show that Brazilian OTs are far from
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Enabling International Communication among Brazilian Occupational Therapists

having a consensual view of key aspects of their professional language. In a way, the lack of consensus among
the Brazilian professionals interviewed reflects the
complexity of this subject. Rather than showing a division in concepts, the lack of consensus may reflect the
richness and complexity of language. Nevertheless, the
development of a democratic international dialogue
may be the path to strengthening the profession of OT
and to expanding the scope of its contribution to social
evolution across borders.

Study limitations
The findings of this study may be affected by some
limitations. First, the use of the online questionnaire,
which evolved from the nominal groups discussions,
may have restricted the debate to those aspects selected
by the first group of experts. Future research should
embrace a more participatory approach in order to
encompass a broader scope of themes to be addressed.
Second, by selecting a group of professionals with previous experience in research and/or teaching within the
Occupational Therapy Theoretical Foundations, the
results may not reflect the general views of therapists
who are not familiar with this particular debate. This
fact would suggest caution in the generalization of
these findings to other Brazilian OTs. Furthermore,
considering the diversity of the Brazilian population,
future analyses should consider the specificity of geographic, economic and cultural areas, including lay
language forms of appropriation of the technical
terminology.

Final remarks and

future directions
The findings of this study illuminate the fact that language is intrinsically related to power and social interaction. Paulo Freire, the Brazilian educator who had
enormous influence on several generations of Brazilian
OTs, states:
We have to acknowledge that language is [a]
social production; with an individual presence in
that social production . . . language is an ideological body: it is not possible to think about language without ideology and without power . . . In
a progressive perspective it is absolutely fundamental that language is also reinvented. (Paulo
Freire, 1995, p. 263)
122

Magalhaes and Galheigo

In discussing the differences between the professional

(or technical) meaning of a particular word and the lay
meaning of it, the participants seem to be asserting the
political aspect of language. As one Delphi participant
voiced:
Words do not belong to anyone, they are actually
part of social heritage and their meanings should
not be imposed.
Brazilian OTs have been crafting their profession on
the basis of international standards but also embedded
in local demands and policies. The struggle to develop
the profession is far from harmonious or consensual,
and it mirrors the social struggle surrounding the issues
of power and significance within the Brazilian society.
Although a full consensus was not reached concerning the majority of the topics studied, the combined
Delphi and nominal group techniques provided a
suitable ground for developing a dialogue among the
professionals.
The political context must be considered when trying
to build an international dialogue, and a culturally
informed approach is required for a respectful interchange of ideas. Such a dialogue may engage professionals in productive reflections on their practices. This
reflection, in turn, may lead to the development of solid
professional communities that can contribute to the
evolution of positive social change.

Acknowledgements
The authors thank Joyce Alonso Canto for her assistance during the transcriptions of the data.
We are very grateful to our colleagues who participated in the Nominal Group and to those who
responded to the online survey for the Delphi round.
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