The Construction of Occupational Therapists' Agency in Their Practice Context: A Case Study on French and Quebec Occupational Therapists

This study examines the construction of agency among occupational therapists (OTs) in France and Quebec (Canada), exploring how professionals negotiate their role within complex interprofessional environments. Agency can be defined as a temporally embedded and relational process of social engagement, shaped by past habits, oriented toward future possibilities, and contextualized within the present moment's contingencies (Emirbayer & Mische, 1998). Studying agency is particularly relevant in the context of occupational therapy, a profession that has historically operated on the margins of the healthcare system dominated by a biomedical model. This case study aims to understand how French and Quebec OTs construct their agency in response to challenges posed by dominant medical paradigms, organizational structures, and interprofessional hierarchies.

Drawing on interviews and interprofessional meeting observations, this research identifies key factors influencing agency in distal and proximal contexts. Distal variables encompass political, legal, and institutional aspects, particularly concerning professional groups and organizations, whereas proximal variables focus on the relational context surrounding individuals (Denis et al., 2022). The comparison between France and Quebec offers insights into how OTs from distinct health systems and professional regulations experience similar constraints but develop different strategies to practice.

The findings reveal that OTs engage in a dynamic process of agency construction by adapting to and resisting professional and managerial norms, negotiating their roles to ensure the profession’s and clients’ values are acknowledged. French OTs encounter more rigid hierarchical structures, which can limit their agency, while Quebec OTs benefit from a more collaborative model, allowing for greater role optimization and influence.

This research sheds light on how professionals enhance their agency to influence their own work, others’ work, and organizational structures, fostering valuable connections among stakeholders. These connections empower professionals to address challenges and develop sustainable solutions, ultimately improving service quality for clients and strengthening professional identities.