Exploring opportunities and barriers experienced by occupational therapists in facilitating community participation for persons with intellectual disabilities in Malta

Abstract

Background: Community participation is an important aspect of quality of life for persons with intellectual disabilities, since it supports inclusion, autonomy, meaningful engagement and active citizenship. Occupational therapists play an important role in facilitating participation by supporting individuals to engage in meaningful occupations within their communities. However, limited local research exists on the opportunities and barriers experienced by occupational therapists in Malta when supporting persons with intellectual disabilities to participate in community life. Aims: This study aimed to explore the opportunities and barriers that Maltese occupational therapists encounter when supporting persons with intellectual disabilities in achieving community participation. It also aimed to identify the strategies used by occupational therapists to overcome barriers, facilitate meaningful participation, and highlight service gaps and recommendations for future practice. Method: A qualitative research design was adopted for this study. Participants were recruited through purposive sampling and included seven occupational therapists working with persons with intellectual disabilities within Mental Health Services and a Maltese National Agency providing disability services. Data was gathered through semi-structured interviews, which were conducted online using Zoom. The interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s thematic analysis. Findings: Five main themes were identified: ‘Conceptualising Community Participation’, ‘Opportunities to Community Participation’, ‘Barriers to Community Participation’, ‘Occupational Therapy Strategies Used to Facilitate Community Participation’, and ‘Service Gaps and Recommendations for Future Practice’. Participants described community participation as more than physical presence, emphasising meaningful engagement, autonomy, choice and belonging. Opportunities included existing community services, increasing awareness, and the role of occupational therapists in promoting independence and inclusion. However, several barriers were identified, including low confidence, self-stigma, overprotective family dynamics, societal stigma, transport difficulties, employment challenges, limited resources and gaps in service provision. Occupational therapists used person-centred and strengths-based approaches, context-based interventions, coaching, graded exposure and multidisciplinary collaboration to support participation. Discussion/Conclusion: The findings highlight that community participation for persons with intellectual disabilities is influenced by the interaction of personal, environmental, familial, societal and systemic factors. Occupational therapists in Malta have an important role in enabling participation by building skills, adapting environments, supporting families, and advocating for more inclusive opportunities.