title: Expanding client-centred thinking to include social determinants: a practical scenario based on the occupation of breastfeeding.
abstract: BACKGROUND
  Client-centred thinking in occupational therapy underemphasizes the influence of social determinants and societal-level factors on occupation across the life course. When client-centred thinking focuses solely on the local or immediate contexts of individuals, therapists may not fully recognize or understand how social determinants can create barriers to occupational participation and performance.
  
  
  OBJECTIVE
  This article critically examines gaps in traditional thinking concerning client-centredness and demonstrates how the complex interplay between social determinants and societal-level factors may lead to occupational injustices.
  
  
  METHODS
  A practical example from a recent study on breastfeeding and accompanying scenario is used to examine limitations in current client-centred reasoning. The Life Course Health Development framework, a theoretical framework examining contexts of health disparities, is applied to illustrate the opportunity to expand thinking about client-centredness.
  
  
  RESULTS
  The Life Course Health Development framework may be a useful addition to client-centred thinking about social determinants of occupation.
  
  
  CONCLUSIONS
  Expanding client-centred thinking to include awareness, understanding, and respect for social determinants of occupation may enhance therapist-client interactions and outcomes of the occupational therapy process, and address gaps in current thinking that may contribute to occupational injustices.
authors.affiliation: University of Washington, Rehabilitation Medicine , 1959 NE Pacific Street, Box 356490, Seattle, WA 98195-6490 , USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Pitonyak
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Mroz
authors.forename: Donald
authors.initials: D
authors.lastname: Fogelberg
mesh_terms: D001942:Breast Feeding; D054625:Healthcare Disparities; D006801:Humans; D009788:Occupational Therapy; D018802:Patient-Centered Care / Q000379:methods*; D064890:Social Determinants of Health
keywords: critical thinking; occupational justice; social determinants; theoretical development