The lived experiences of Black occupational therapy students at a UK university

This paper focuses on the lived experiences of Black occupational therapy students. Therefore, we start by contextualising the terms used in this paper such as; being Black or Blackness, racism and anti-Black racism before addressing the research question. Blackness, as both an identity and a social construct, is deeply rooted in historical and cultural contexts that have evolved over centuries (Moore and Simango, 2021). It has been shaped by the legacy of colonialism, slavery and systemic oppression, serving as a framework for marginalisation and exclusion (Moore and Simango, 2021; Ahmed-Landeryou, 2023). Equally, Blackness, as a social construct, embodies a powerful legacy of resilience, creativity and cultural pride for those who identify as Black (McPherson, 2017). The concept of Blackness is not only a marker of racial identity (Mapedzahama and Kwansah-Aidoo, 2017), but also a tool through which power, privilege and discrimination are negotiated in society. The terms “Blackness” and “Black,” as used in this article, refer to a collective group of people of African and Caribbean descent, sharing phenotypic similarities, such as dark skin colour, despite diverse sociocultural and political backgrounds.

This paper adopts a definition that considers racism to be a system that perpetuates unfair inequalities in power, resources or opportunities across racial groups. In this paper, anti-Black racism is more specifically centred as the main challenge threatening the safety, survival and flourishing of Black people (Wilcox et al, 2024). These can be attitudes, beliefs, behaviours, practices and actions that strip Black people of their humanity, reducing them to mere objects and denying their inherent worth. This systemic devaluation of Blackness seeks to erase Black contributions and experiences, perpetuating a legacy of oppression (Udah, 2023). Anti-Black racism extends beyond generalised racism, specifically targeting individuals who are Black or perceived as Black. This form of oppression is perpetuated not only by white individuals but also by members of other racial and ethnic groups (Landor and McNeil Smith, 2019).

In the UK, evidence shows that racism is embedded within several dimensions from the workplace, education and health care (Fella and Ruzza, 2012). These ingrained racial issues arise from perceptions, especially those of the white population, that immigration of ethnic minorities poses a threat to British culture and values. However, it is worth noting the significant contributions made by ethnic minoritised populations, especially from Black people and most notably the Empire Windrush which used Caribbean migrants to help rebuild Britain and its national health service (NHS) (McDowell, 2018). Additionally, NHS statistics show that about 26% of the health-care workforce is made up of Black and ethnic minority staff (NHS, 2023). Despite their contributions, Black health and social care workers face significant racism (Hackett et al., 2020).

The occupational therapy profession prides itself in promoting justice, equality and inclusion (WFOT, 2019; Johnson et al., 2022; Wilson et al., 2020). However, there is a scarcity of literature discussing, let alone interrogating issues related to racism, coloniality, power imbalances and privilege within the profession (Emery-Whittington, 2021; Ahmed-Landeryou, 2023). White middle-class women have traditionally and presently dominated the profession (Wasmuth et al., 2023; Salvant et al., 2021; Wilcock and Townsend, 2009). This results in limited perspectives upon which both theory and practice are built and has been linked to perpetuating colonial values and white supremacy within the profession (Ramugondo, 2018; Sterman et al, 2022; Ahmed-Landeryou, 2023).

The racial disparity within the occupational therapy profession in the UK is huge, with only 4% of the over 44,000 registered occupational therapists identifying as Black and 84% identifying as white (HCPC, 2024). The royal college of occupational therapists (RCOT) acknowledges the need to increase diversity within the occupational therapy profession in the UK (RCOT, 2024). The goal of increasing representation of Black occupational therapists requires increased recruitment and training of Black students. The national attrition rate of students from pre-registration occupational therapy programmes in the UK ranges between 6% and 10% (RCOT, 2017). Anecdotal evidence shows that there is an over-representation of Black students and male students among those who drop out of their studies. This attrition could be linked to experiences of not identifying with the profession as a Black student and feelings of not belonging (Welch, 2022). There is need to explore the unique experiences of Black occupational therapy students in the UK.

Additionally, studies by Atwal et al. (2021) and Beagan et al. (2022) illuminated the absence of belonging by exploring the disappointing reality of racism experienced by Black occupational therapists. These examples show how the occupational therapy profession in the UK has consistently failed to establish an inclusive and supportive atmosphere for occupational therapists from minoritised ethnic backgrounds. This absence of belonging negatively affects the safety, survival and flourishing of Black students and occupational therapists resulting in occupational alienation (Wilcock and Townsend, 2009).

Evidence shows that health-care professionals and students from marginalised groups bring community cultural richness as well as unconventional pieces of knowledge and expertise that not only prove useful in dealing with a diverse variety of service users but are also essential in reforming organisations and societal frameworks (Beagan et al., 2022; Yosso, 2005). Ford et al. (2021) reported an alarming 100% of participants feeling like outsiders within their profession and occupational therapy education course in the USA. This points to students and qualified occupational therapists continued experience of limited opportunities for professional development, prejudice and repetitive encounters with racial unfairness in both clinical and academic environments (Atwal et al., 2021; Ford et al., 2021).

Based on this evidence it could be argued that it is pointless to recruit and promote a diverse workforce if there is no radical effort being made to minimise exclusion, racism and marginalisation (Beagan and Chacala, 2012; Beagan et al., 2022; Johnson et al., 2022). The review of background literature led to the question: What are the lived experiences of Black occupational therapy students within the universities where the researchers are based? Therefore, the aim of this study was to explore the lived experience of Black pre-registration occupational therapy students at a UK university, to give them an opportunity to share their experiences and the power to suggest recommendations for improvement.

This paper was a result of a scholarly collaboration between two Black authors. The authors embrace Blackness as an affirmation of identity and strength, rooted in the triumph over systemic oppression and the celebration of collective achievements. The first author was a post-graduate occupational therapy student and the second author is an experienced researcher who supervised the research project at the same university. The first author acknowledges that some of the participants in this study were her peers and she had insight into some of their experiences prior to the study. This means there are possibilities of the participants having felt social pressure when answering questions during interviews with the first author. In addition, the first author acknowledges her own experiences which led to the development of the research questions could have been different from those of the participants. Therefore, there were possibilities of a risk of bias when interpreting the findings. The second author acknowledges the biases that could be associated with the power of being an academic and not having a lived experience as a Black student at the same institution.

The lived experiences of the authors as Black people living in the UK influenced the choice of using interpretivism and critical theory as theoretical frameworks underpinning this study. To avoid personal views and beliefs influencing the findings from the study, both authors used bracketing to set aside their personal views and approached data collection and data analysis with an open mind. Furthermore, to minimise interpretive bias, researchers used reflective journaling throughout the research process, thereby maintaining objectivity and ensuring personal biases did not infiltrate the study findings.

A combination of interpretivist epistemology and a critical theory lens was adopted in this study (Capper, 2018; Byrne, 2001). The primary concern for interpretivist epistemology is to understand and sympathise with people’s lived experiences often without necessarily addressing inequities in the real world or promoting change (Capper, 2018). Therefore, to complement the interpretivist epistemology, critical theory was also adopted. Critical theory focuses on exposing underlying power dynamics and systems of oppression and working towards creating a more just and equitable society (Geuss, 1981). Interpretivism and critical theory were therefore adopted in this study to explore the lived experience of Black occupational therapy students and identify possible action points to address the challenges that they face.

A qualitative phenomenological study design was used for this study. Qualitative research aligns with the research’s question, aim and objectives and focuses on the lived experiences of Black occupational therapy students at a UK university. A phenomenological approach allows researchers to investigate lived experiences or “truths” to understand and give them meaning, particularly in certain areas of daily life that are commonly taken without consideration (Byrne, 2001). Using a phenomenological approach offered a more holistic approach and a suitable method for discovering how the participants make sense of and attach meaning to their experiences (Byrne, 2001).

However, a disadvantage inherent in qualitative phenomenological research is that the results may not be transferable because of usually small sample size. Nevertheless, a bigger sample size does not imply that there is more robust research quality. Therefore, in qualitative studies, the richness of the data is more important than the sample size.

Ethical approval was obtained from Coventry University Ethics with ID: P163018. Semi-structured interviews were used to obtain narratives from participants. The study sample included seven Black occupational therapy students from a UK university. Purposive sampling was initially used to select the study sample. Eventually, snowball sampling ensued as other participants referred the researcher to their peers who met the inclusion criteria. An online poster was developed by the first author and posted on the university online platform by the second author to recruit participants. Potential participants then contacted the research through email or text.

The researchers screened potential participants according to the set inclusion and exclusion criteria targeting students of Black ethnicity and enrolled in either a BSc or MSc pre-registration occupational therapy programme at the university. Participation in the study was voluntary and participants were provided with information about the study and were allowed and ask questions and receive answers before providing written consent to participate in the study. Consent was obtained for both participating in the study and being recorded. The right to withdrawal and the structure of the interview were discussed before beginning the interviews. There was no foreseeable harm in participating in the study, as a safeguarding measure, the participants were provided with contact details for the student well-being services should they have felt the need for debriefing afterwards. None of the participants expressed experiencing distress during the study. The first author who was a post-graduate student at the time conducted all the interviews, thereby creating a safe space allowing participants to freely express themselves in conversation with a fellow Black student (NIHR, 2022).

Interviews were conducted using Microsoft Teams at a date and time convenient for the participants, all interviews took place as scheduled and the interviews ranged from 45 to 60 min in length. Firstly, the interview questions explored the challenges experienced by Black students in teaching and learning at the university, with a focus on identifying factors that impacted their teaching and learning. Furthermore, the interview questions explored the challenges experienced by Black occupational therapy students when on placement in health and social care settings. Finally, the interview questions explored recommendations that participants had for improving the experiences of Black occupational therapy students enrolled at the university. Interviews were recorded and transcribed verbatim by Microsoft Teams transcriber followed by proofreading to address any transcription mistakes before thematic analysis was conducted to generate the themes.

The six stages of thematic analysis, namely, familiarisation with data, generating codes, searching for themes, reviewing the themes and defining themes were followed. Four themes were generated from this study and were named: bitter-sweet experiences, harsh realities on placement, need for intentionality when planning the course and need for creating safe spaces during practice placement. Table 1 presents the main themes; the associated sub-themes; and some direct quotes from the participants linked to the main themes.

This theme speaks to interview questions exploring the experiences of Black students within the university with peers and lecturers. Participants recognised that there was a lack of representation of Black students on the course. Participant 5 explained the negative effects of being the only Black person in their group; “I felt very uncomfortable, very uncomfortable. I just wanted to. I wanted to drop out”. Similarly, Participant 6 reported how being the only Black person in the class made them feel and affected their learning; “I’m the only Black person like it wasn’t, I wasn’t able to just be me and it wasn’t a conducive learning environment for me. For me there and I really, really did not want to study”.

Many participants testified the class being divided, as white peers would self-segregate from their Black and Asian peers because of discomfort, social dynamics and cultural differences. Some participants reported micro-aggressive behaviours from white peers when it came to group work. For example, Participant 2 said; “When it comes to the white peers in the University, I don’t feel they are that inclusive. Very antisocial. From my own perspective, even when you come to work in groups, you can see, I mean, it’s obvious. Subconsciously, some people are racist”.

Furthermore, some students chose to not report racial issues in the class because they perceived that the lecturers might not understand the experiences of Black students as they were also white. The participants wanted to avoid possible trouble considering the absence of a concrete support system in place to support and enable them to speak out. Participant 3 encapsulated this sentiment stating: “They’re all white people. Like, most of them, majority of them are white women and I don’t know how comfortable I would feel going to them about racial issues”.

These experiences diminished their confidence to authentically be themselves in class, as they were anxious about how they were viewed, ultimately impacting their course satisfaction. Participants expressed an understanding that white peers may have limited experiences of working with people from Black and minoritised ethnic communities. Despite this, they expressed feelings of sadness, not belonging and a yearning for connection in an unfamiliar environment.

Participants who were in the same class with at least another Black student reported the positive sweet experiences of having other Black peers on the course. These participants expressed feeling confident, settled, comfortable, like they belonged and were supported by Black peers on the course and expressed a desire to continue with the course. Participant 2 reported having another Black person they could talk to was their coping mechanism for getting through the course stating: “my coping mechanism was being able to have another Black student that I can relate to”.

Some participants had positive learning experiences with their non-Black peers on the course. Participant 3 reported that peers in their class from other ethnic groups and white peers listened when Black students shared ideas in class leading them to feel comfortable; “There’s like small group of like ethnic minorities in my group and the other two Black women in my group, we are we are strong characters. We speak up in the lesson. You know they often lead conversations, and you know I didn’t I never felt kind of like inferior”. This reflected the positive experiences in a situation where three Black students were in the same class. The majority of participants reported feeling supported by the lecturers within the university when it came to support on assignments and in general. Participant 7 reported: “The tutors can be very supportive”. Similarly, Participant 6 said about lecturers; “They’ve been very supportive, and they’ve helped me”.

The majority of participants reported that the university has a lot of work to do in making the course inclusive for Black students. Participants proposed an established student support facility specifically for Black students needing support on the course, serving as a platform to empower students to voice their concerns. Participant 2 highlighted the university need to be more intentional in planning the course by advocating for; “Increased student participation from all ethnicities in the planning”. Including cultural humility in the occupational therapy curriculum could help both students and lecturers to develop skills for being inclusive when working within multiracial contexts.

Participants stated that the lecturers did not attempt to mix the students to come out of their comfort zones and as a result students stayed in: “Cliques” (Participant 5). Participants recommended that lecturers could implement strategies to integrate students from diverse backgrounds. This could involve creating opportunities for mixed-group activities and discussions, which could help to challenge implicit biases and foster a more inclusive learning environment. Moreover, participants conveyed the necessity for more representation among lecturers, emphasising the need for role models as well as a point of contact as none of the participants had been taught by a Black lecturer at the time of the study.

This theme speaks to interview questions exploring the experiences of Black students on placement. One participant reported experiencing racism from white educators despite overworking themselves and producing evidence of their learning, which led to inadequate support and a failed placement. Participant 7 said: “I actually have a failed placement and it was just pure racism. Pure racism. Pure disrespect. Pure evil”. The lack of Black representation negatively affected some participants on placement. Six participants stated they were the only Black person in their team in most of their placements, if not all of them and did not have a support system as a result. Participant 5 stated; “Everyone else was not Black, so you don’t have anybody you could speak to. I’ve cried. I’ve cried on placements”. All participants reported that their placement experience either was or would have been enhanced by a more diverse racial composition within the team. The following statement reflects the experiences of the students: “I would say the more diverse placement is, the more I think the more facilitating it is” (Participant 1).

Four participants reported that educators lacked professionalism when talking about patients of ethnic minorities and different religions. These participants admitted that stereotyping and racial biased behaviour towards patients and themselves only happened in a team that was mostly white women. Participant 3 reported feeling uncomfortable with the conversations that they had to distance themselves from the team impacting the quality of their placement experience: “What you’re saying isn’t OK and I don’t feel comfortable, and I don’t feel relaxed or safe here. So yeah, I go to my car, I have my lunch”. Participant 7 highlighted a sense of caution and felt uneasy with the idea of Black person entering a team with white people: “If you enter any team and it’s pure white and there’s nobody from different background in the place like Birmingham or London which are usually diverse just know it is a red flag. It’s a big red flag”.

Reporting racial concerns to the university or placement educators was avoided by the majority of participants because they did not know how and if the university will support them, if their concerns would be taken seriously and did not want to cause any issues with their educators that might impact their grade. Participant 3 summarised their experiences: “I’m just trying to get through placement. For starters, and I didn’t want to, you know, ruffle any feathers, or cause any issues”. Two participants reported to the university about racial issues on placements and one retracted their report. Other participants reported not wanting to report racial issues because they did not know if they were experiencing racism or some other form of discrimination. Participant 4 summarised these sentiments: “most of the times I felt like it’s all in my head and I just cannot differentiate whether they’re doing certain things because of my race”.

Some participants reported that they felt their white educators lacked cultural awareness when conducting assessments with Black patients. This made participants more motivated and optimistic about qualifying to be able to bring awareness. Five participants highlighted that they felt acute hospital placements as dangerous and toxic for Black students: “But NHS as a whole is very. Anti-Black it’s a dangerous place for Black people to be. Very, very dangerous place”. Participant 7 corroborated this sentiment also adding they felt community placements as better because of diversity reporting; “I think acute experience is quite toxic”. Furthermore, when asked about coping strategies for the challenges they faced as Black students on placement, participants described developing resilience and a determined attitude. However, they also acknowledged the toll that prolonged exposure to racism, both on placement and in their daily lives, had taken on their mental health. For example, Participant 5 said; “I decided to forget about my mental health and just get on with what I had to do. It’s not the right way”.

Not all participants had a negative experience on all placements. For some participants they experienced supportive educators, and some had positive interactions with patients. All participants highlighted that their main positive outcome of placement besides passing placement was when they: “got to work with a lot of Black and ethnic minority patients” (Participant 5).

The participants noted that placement practice educators lacked adequate training when working with Black students and proposed the need for educators to undergo diversity and racial bias training to improve the experiences of Black occupational therapy students. Furthermore, participants emphasised the importance of having Black or ethnically diverse representation among educators, believing it would contribute to a better placement experience for Black students. Participant 7 stated; “having a Black supervisor that makes a big difference”.

Furthermore, participants highlighted the need for a support department and emphasised the importance of the university taking accountability when a student was to report racial issues on placement; “Uni should take responsibility for things that happen in placement” (Participant 5). The findings show that there was hesitancy to report racism as participants were not sure if this would make any difference if the system did not appear to have safe spaces for appropriate action to be taken by either the university of organisation offering the placement. Therefore, participants recommended the creation of safe spaces where support systems and resources are easily accessible to students from ethnic minority backgrounds. This could include the need for the university to show transparency on reporting and resolution pathways if a student is to report racism.

In summary findings from this study, given the qualitative nature of the research and small sample size of seven participants, aligns with research that Black occupational therapists face exclusion and underrepresentation in professional settings (Aldridge et al., 2023). Nevertheless, this study contributes to the existing body of occupational therapy and occupational science research around occupational justice, promoting diversity and informing recommended strategies to increase inclusivity within the occupational therapy profession.

The findings corroborate with existing research that Black students and qualified healthcare workers continually face biases, racism and systemic inequities in academic and clinical environments that have not been adequately tackled (Thomas et al., 2010 Ford et al., 2021; Salvant et al., 2021; Atwal et al., 2021; Beagan et al., 2022; Aldridge et al., 2023). The results highlighted the complexity of the lived experiences among Black occupational therapy students at the university and on placement. These obstacles are factors such as a lack of financial stability, a lack of community and family support, feelings of loneliness and exclusion and a lack of guidance and support (Aldridge et al., 2023).

The results showed that some Black students did not know whether they were victims of systemic racism and as a result they did not report their concerns. This self-questioning and self-doubt could be linked to prolonged experiences of inequalities. The students did not see the point in reporting if the system was already racist in nature. This implies the need for a collective anti-racist approach which should not burden those who are oppressed with the responsibility of finding the solutions (Ahmed-Landeryou, et al., 2023).

The lack of education on the effects of racism and strategies in the occupational therapy course and on placement has resulted in the majority of Black students not having the best educational experience. Therefore, it is important to ensure that all students and occupational therapists undergo racial training. Mullen (2024) explores the significance of Black Studies within the Irish context. By analysing the intersection of race, power and knowledge production, Black Studies provides a powerful tool to challenge systemic anti-Black racism and disrupt academic complacency. This approach can create spaces for critical reflection and the dismantling of oppressive anti-Black racism structures. Therefore, incorporating knowledge from Black Studies into racial training in occupational therapy could be beneficial for both Black and non-Black students and professionals. Such training could equip Black individuals with the tools to recognise and challenge incidents of racial bias and systemic racism. Additionally, it could raise awareness among non-Black individuals about the unique challenges faced by Black people in academic and practice settings. Thus, this awareness could empower and encourage everyone to become allies in the ongoing effort to improve inclusive and equitable practice for Black colleagues, students and professionals.

This study had some limitations. Conducting interviews through Microsoft Teams may have felt detached and may potentially have distorted the conversation’s organic flow, body language and facial reactions. There is a scarcity of UK literature specifically focusing on Black occupational therapy students. As a result, some literature was drawn from elsewhere such as the USA. This could be linked to the dearth of publications from Black occupational therapy authors in the UK. Ahmed-Landeryou (2023) suggests that white occupational science authors, who are peer-reviewed by fellow white peers, keep their advantage and power of generating and disserminating publications from their world view. This implies that white peer reviewers would possibly not lean towards publishing anti-Black racism topics as it does not centre whiteness, moreover inadvertently gatekeeping Black and minoritised authors from getting published. It therefore calls for Black authors to take their position in the space of peer-reviewed publishing as the African proverb says: “Until the lion learns to write, every story will glorify the hunter”.

This research illuminated some challenging experiences and some positive experiences faced by Black occupational therapy students at a UK university. The findings highlight a critical shortage of support for Black occupational therapy students, both within the university and, more significantly, during placements. Going forwards one key strategy would be to actively involve Black students in shaping the curriculum to dismantle systemic racism and create a truly transformative learning environment (Ahmed-Landeryou, 2023). It is imperative to amplify the voices of Black students, long silenced, to forge a more equitable and just educational system. Tokenistic gestures are no longer sufficient; systemic change is essential!