Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review

Objective To explore ways in which occupational justice and social inclusion are conceptualised, defined and operationalised in highly stigmatised and chronic conditions of mental illness and HIV. Design This scoping review protocol followed Arksey and O’Malley’s (2005) Scoping Review Framework. Data sources and eligibility The following databases were searched for the period January 1997 to January 2019: Medline via PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX and grey literature. Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV. Study appraisal and synthesis We undertook a three-part article screening process. Screening and data extraction were undertaken independently by two researchers. Arksey’s framework and thematic analysis informed the collation and synthesis of included papers. Results From 3352 records, we reviewed 139 full articles and retained 27 for this scoping review. Definitions of social inclusion and occupational justice in the domains of mental illness and HIV were heterogeneous and lacked definitional clarity. The two concepts were conceptualised as either processes or personal experiences, with key features of community participation, respect for human rights and establishment and maintenance of healthy relationships. Conceptual commonalities between social inclusion and occupational justice were premised on social justice. Conclusions To address lack of clarity, we propose further and concurrent exploration of these concepts, specifically with reference to persons with comorbid mental health disorders such as substance use disorders and HIV living in low-income countries. This should reflect contextual realities influencing community participation, respect for human rights and meaningful occupational participation. From this broadened understanding, quantitative measures should be applied to improve the standardisation of measurements for occupational justice and social inclusion in policy, research and practice.

The global burden of disease from HIV remains substantially high with about 37.9 million people living with HIV by World Health Organisation estimates of 2018. However, in the last two decades, the world has seen a combination of a significantly decreased mortality and a small decrease in incidence leading to an increase in the number of people living with HIV from 8·74 million (1990) to 36·82 million (2017). 1 Nevertheless, in some key populations, this decline is being impacted by the rising and ever complex relationship between mental illness and HIV. 2 3 The prevalence of common mental disorders has been shown to be significantly higher among people living with HIV despite being on ART and is further impounded by stigma. 4 People with chronic and usually stigmatised conditions such as mental illnesses, physical disabilities and HIV, face barriers to full participation in their communities. 5 Poverty, lack of education, lack of suitable housing, and unemployment are some of the social and economic barriers to accessing adequate and sustained healthcare faced by this group. 6 These barriers may similarly be experienced by people who face discrimination based on their class, race or gender identity or sexuality and thus, when persons with mental illness also share these characteristics they may be severely stigmatised or discriminated against. 7 8 Social inclusion and occupational justice as concepts are relevant to direct research and practice toward the moral imperative to address exclusions and injustices experienced by stigmatised groups 9 . Focus on these outcomes ensure that health and social well-being are addressed beyond the medical management of the disease. Health-related quality of life as a holistic construct for promoting continuum of care and health and well-being beyond viral suppression in HIV, 10 11 including social inclusion and occupational justice. These concepts direct the health and social care community to foreground social justice issues of people with mental illness and HIV as part of marginalized groups at risk of being deprived of respect, rights and opportunities to achieve optimal health-related quality of life.
Social inclusion and occupational justice are potentially key in informing the promotion of human-rights based, sustainable person and community-centred interventions that promote recovery for persons with chronic, and stigmatised conditions. 12 13 In order to aid integration, and operationalisation of occupational justice and social inclusion in practice, we need to understand how the concepts are conceptualised and applied in population groups affected by chronic and stigmatised conditions. Synthesised summaries of research evidence can inform primary research and implementation science , 14 therefore we selected a scoping review design to advance this field. 15 This was a particularly appropriate method for this area due to the diverse disciplinary location of existing literature. 16 17 This scoping review aimed to explore and appraise the definitions, current utilisation, and relationships between the concepts of social inclusion and occupational justice in mental illness and HIV literature.

Methods
This scoping review followed our published study protocol 15 , developed using Arksey and O`Malley`s Scoping Review framework, 17 as well as guidelines for scoping review protocols in occupational therapy . 14 18 In this paper, a scoping review is taken to be a form of knowledge synthesis that addresses an exploratory research question rather than the highly focused question in a systematic review. 16 17 For reporting, we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. 19 We followed an iterative process to develop and refine the research question. 17 Based on the subject area terminology, literature, and our understanding of current practice trends in managing conditions that are chronic, and stigmatised, we asked the following question: How are occupational justice and social inclusion conceptualised, defined, and operationalised, and how are these concepts related in the highly stigmatised chronic conditions of mental illness and HIV?
The objectives of our scoping review were:  To identify articles that define or conceptualise occupational justice and social inclusion related to mental illness or HIV.
 To describe how these are operationalised or utilised.
 To identify and describe relationships between occupational justice and social inclusion.
 To determine potential areas for further development, integration, and application of these concepts.

Search Strategy
With the aid of a subject librarian, we identified appropriate databases using a journal indexing system. We searched twelve databases in January 2018: PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, and SocINDEX, Grey literature Report, Web of Science Conference Proceedings, and Open Grey.
We used PubMed as the free platform for accessing articles indexed on Medline database. The selected databases captured a comprehensive sample of literature from a variety of disciplines including social work, psychiatry, nursing and occupational therapy.
The first and last authors (CN & RG) worked with the librarian, through an iterative process, to develop an inclusive list of search terms and applicable filtering methods including Boolean phrases and MESH terms for each database. 15 Primary search terms related to the primary concepts of occupational justice and social inclusion while secondary search terms encompassed the broader terms of mental health, occupational therapy, mental illness, HIV, and rehabilitation. For the purposes of search strategy development, we restricted our search to literature published between January 1997 and 31 January 2019 a period which has seen the emergence and rapid growth in literature on occupational justice. 20 We conducted a preliminary search on PubMed and this enabled refinement of our search strategy to maximise sensitivity and specificity. We adapted the PubMed search strategy (Appendix 1 -provided as an online supplementary appendix) accordingly for other databases.

Study selection
The first author (CN) reviewed the titles identified in the search for eligibility. The aim was to identify articles that i) indicated a research focus on mental illness, or HIV, or both and ii) titles that included the key terms of occupational justice, social inclusion or both. Article types included primary studies, reviews, opinion papers and other theoretical papers without primary data. Articles were not eliminated where there was uncertainty with the title until it was examined more in-depth by looking at the abstract. Two independent reviewers, the first and third authors (CN & EM), reviewed titles and abstracts of preliminarily selected articles using predetermined inclusion and exclusion criteria detailed in our protocol. 15 These same reviewers each further screened full-text articles to determine if they met the inclusion/exclusion criteria.
At this stage, articles were included if their explicit focus was on social inclusion or occupational justice in mental illness and or HIV; there was definitional part for the concepts and reported some operationalisation of the two concepts. Discrepancies were resolved by consensus or by seeking adjudication from the second author (LL). The Cohen's κ statistic to determine inter-rater agreement was calculated for the title and abstract review and the full article review stage, giving more than 90% agreement between reviewers with Cohen's κ statistic of 0.78 and 0.83 respectively.

Data Extraction
A common extraction table was designed, guided by the study objectives, to extract standard bibliometric information study characteristic and main findings. The first five articles were reviewed by both the first and third authors, with the remaining articles divided between the two authors. We then checked for accuracy and completeness against each other's work.
Discrepancies were resolved by revisiting the article, discussing, and reaching consensus.

Data Synthesis
Data were synthesised descriptively to give a structured summary of the dataset and to capture the characteristics of the studies included and the definitional range of social inclusion and occupational justice. Study grouping followed the publication trends over time and study designs used. Descriptive statistics were calculated using Microsoft Excel 2016 for frequencies.
We used deductive thematic analysis to organise the extracted definitions and related concepts for occupational justice and social inclusion.

Retained studies' characteristics
As described in Figure 1, we screened (n=3352) titles and after reviewing (n=139) full articles, (n=27) were included in this scoping review. Of the (n=27) sources included for final review, (n=23) were published between 2009-2018, with the majority of these (n=6) published in 2012 (Table 1). Most publications were by authors in the mental health field and from high income countries, with 68% of the primary studies being conducted in Europe [21][22][23][24][25][26][27][28][29][30][31][32][33] , and 9% in Australia. 34 35 No primary studies were conducted in North America, Africa, or Asia. More than a third of the studies (n=10) utilised a qualitative research design 22-25 28-30 32 34 36 37 , five (16%) utilised a quantitative research design 21 26 27 33 35 and only one study utilised a mixed methods design. 31 Six (19%) were review papers and the remainder (n=5) were opinion 38 39 , lectureship 40 , commentary 41 and theoretical analysis papers. 42 The two concepts were predominantly explored around mental illness (n=26) with less focus on HIV (n=1). The majority (n=21) of the published research investigated social inclusion as it related to mental health conditions, and all the occupational justice papers were focussed on mental illness. Only one paper was included which discussed social inclusion in relation to people living with HIV. 43              To examine the impact of community participation on their recovery and social inclusion and how service users' experiences informed joint planning between mental health services and the learning community to promote social inclusion.
Social inclusion as the process of enabling citizenship through fuller community participation.
Occupational justice defined as the process of lobbying for the occupational needs of individuals and communities as part of a fair, inclusive, and empowering society; as a community reintegration issue.

Social inclusion: concepts and definitions
Social inclusion was defined with high variability, with only two studies using the same definition by defining social inclusion as a subjective sense of belonging and active citizenship that enhances social integration. 28 30 Conceptualisations and definitions used ambiguous words such as community, participation and integration to define social inclusion.. Some studies defined social inclusion in terms of paid work and participation in community events, 26 27 others focussed on social acceptance and absence of stigma, 28 30 33 44 while still others saw it as a political discourse. 29 Stain et al. 35 tried to capture these varieties, and defined social inclusion as "the participation of a person in society, evidenced by an individual having the opportunities, resources and abilities to build and maintain relationships, engage in education and employment, and participate in community events and organisations" (p.880).
The variations revealed notable thematic areas that emerged from the analysis of the definitions, namely community participation; human rights; and relational (relating to relations, and notions of acceptance and belonging).

Community participation
The most prominent shared features of the definitions of social inclusion in mental illness and HIV research focussed on it being a process and an experience centred on community participation. However, the terms 'community participation' and 'community' were used in many ways without clear description. These varied interpretations of community participation included reference to people with HIV or mental illness as: individuals with opportunities to participate in key activities in their communities like paid employment 26 27 35 45 ; being integrated into the community 25 29 33 ; having a sense of belonging within the community 21 28 30 39 ; and exercising active citizenship. 27 43 46 Human rights Social inclusion was also defined and conceptualised as a human rights issue. 27  as the right to engage in productive occupations, with full access to work and or educational activities within the community despite one's health concerns. 46

Relational
Social inclusion was further conceptualised and defined as a subjective experience 21 28 30 31 33 35 where those who are socially included should experience belonging in establishing, maintaining and experiencing positive relationships. While a number of authors 21 28 30 31 33 35 talked about relationships as being a key component, this was not defined or discussed in depth, instead it was emphasised that for social inclusion to be a reality, an individual should experience positive social relationships with their significant others, family, friends and acquaintances. 21 28 30 31 33 35 Social inclusion was also conceptualised as experiencing social support and positive support networks. 33

Diversity in definitions reflected in measurement tools
The diversity in definitions and features was also present in instruments used. Most quantitative studies included a social inclusion measure, including: Social Inclusion Questionnaire, 31 Social Relationships Scale and Social Inclusion Scale, 21 Social Inclusion Interview Schedule, 33 and Social Inclusion Questionnaire User Experience. 26 Social inclusion was also portrayed in some definitions as a subjective personal concept where it is the individual with mental illness or person living with HIV, who subjectively experiences inclusion and should have a choice on what determines their experience of such inclusion. 22 28 30 32 39 It is their perception of the quality of their relationships, their acceptability to others, and how integrated they are, which was emphasised.
In summary, social inclusion was conceptualised as processes and experiences of empowered and equitable community participation for all, in which there is respect for human rights and healthy relational well-being is promoted.

Conceptualising and defining occupational justice
In the last two decades, only six research papers on mental illness used the concept of occupational justice and provided a definition. 23 24 34 38 40 42 (Table 1) Five different definitions were found (Table 1). As with social inclusion, occupational justice was defined with great variability, with it being referred to as both a process and as an experience. 23 24 34 38 40 42 Two major themes emerged pointing to social justice in which occupational justice was framed as an occupational rights issue and as a matter of community participation.  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60   F  o  r  p  e  e  r  r  e  v  i  e  w  o  n  l  y 23

Occupational rights
Occupational justice as experiencing or enjoying one's occupational rights 23 24 34 38 40 42 emerged as key to conceptualizing and defining occupational justice for persons with mental illness. Where occupational rights were taken to mean people's rights to participate in a range of meaningful and contextual occupations enabling them to flourish, fulfil their potential and experience life satisfaction in ways consistent with their contexts. Townsend (2012) defined occupational justice as the enjoyment of 'occupational rights' by all people to engage in occupations and feel socially included in their desired occupations, thereby contributing positively to their own well-being and to that of their communities. 40 Occupational justice was also highlighted as an advocacy process of lobbying for the occupational rights and needs of individuals and communities as part of an equitable, inclusive, and empowering society. 24

Community participation
The process of promoting occupational justice was viewed as related to promoting social inclusion and community participation through advancing participation. 34 In another paper community participation was emphasised, with occupational justice defined as situations when people are seen as having the opportunity to choose to participate in the community. 23 The core emphasis in the definitions was the acknowledgement of occupational justice as a means of actioning community participation and social justice. 23 34 However, in all the definitions there was an overuse of the term occupation. While occupation was framed as purposeful everyday activities people engage in, it carries diverse meanings outside occupational science and occupational therapy. This rendered many of the definitions and arguments cyclical in nature.

Commonalities between social inclusion and occupational justice
** Insert Figure 2: Commonalities between occupational justice and social inclusion definitions -

associated terms
Although not clearly articulated, all the papers which discussed the two concepts together seemed to infer that occupational justice was an important ingredient of social inclusion. 23 24 34 40 Notwithstanding the considerable variability in definitions and conceptualisations of the two concepts, some commonalities were identified ( Figure 2). Both social inclusion and occupational justice seek to promote equitable access to opportunities for engagement and to seek for fairness and justice in individual's community participation. 23 24 34 40 Hamer et al. provided the closest account of the relationship between the concepts positing that social inclusion was enhanced through occupational justice. 34 Here they argued that recognition of people's right to inclusive participation in everyday occupations (occupational justice) enhanced the extent to which the person became confident about and were able to exercise their rights and participate by choice in the ordinary activities as citizens (social inclusion). 34 Both concepts were centred on key thematic areas of human rights, equality, inclusivity, and community participation.
Significantly, both social inclusion and occupational justice had a social justice focus, emphasizing the right to inclusive participation in a community and individuals exercising choice of participation as part of their citizenry beyond their health conditions. Occupational justice specifies that the participation in meaningful occupations is central, while social inclusion highlights community participation in general. Both concepts also highlight the need to address discriminatory practices, by doing away with stigma. 33 34 Hamer and colleagues highlight that social inclusion is the process of experiencing inclusive participation in the community as a citizen, while occupational justice promotes social inclusion through participation in meaningful and valued activities. 34

Discussion
We explored and appraised the definitions, current utilisation, and relationships between social inclusion and occupational justice in literature on mental illness or HIV. We identified and critically appraised 27 articles that presented variety of definitions. Most studies were on mental illness and conducted in high-income countries. Despite the great variability, key thematic concepts used to define social inclusion and occupational justice included community participation, human rights, and relationships. The two concepts are theoretically related with a social justice focus. There is also emphasis on the multidimensional nature of the concepts framed as both a process and a personal experience. The main source of these definitions being qualitative studies using service user's experiences and experts opinions.
While definitions of social inclusion vary, our scoping review findings confirm that the definitions are still in line with the original concept, that of poverty reduction with a focus on reducing stigma and discrimination. 32 33 43 Social inclusion emerged from European societies, in response to a welfare crisis and desire to fight disadvantage. 47 We propose that this focus The most striking observation was the lack of clarity in the definition of social inclusion, which is still evident, despite its existing for almost five decades. Efforts to be all inclusive, multidimensional, person-centred and contextual can explain the variations and, thus, ambiguity in the definitions. 47 48 However, this lack of definitional clarity could hamper its universal concept utilisation, measurement, and further exploration with a common goal. 49 50 This lack of a single, universal understanding has positive and negative implications for research and application of the concept in clinical practice. Without a universally agreed upon definition, comparisons between studies and practice remains difficult. 50 This was echoed in the variety of social inclusion measures applied in the quantitative studies. 21  It is possible to have multiple, but mutual interpretations that could be understood as complementary or even contesting, in line with contextual realities.
Embracing plural definitions may be especially important in low and middle-income countries, where such research needs further growth. 47 For example different activities purported to enhance social inclusion, like paid employment, have different meanings and impact across regions and would influence how it is conceptualised as part of social inclusion. We found a preference towards paid employment as a key determinant of community participation in social inclusion. 28  Some of the social inclusion definitions had an individual focus, for example the individual had to be actively participating at the expense of the collective found in communal societies. 26 27 31 Given that the studies were mainly from high-income regions, there remains some missing voices in informing the definitions, given the largely communal orientation found in indigenous communities in low and middle-income settings. The challenge in some of the reviewed definitions was to try to focus on the individual and the impact of disease, yet the social justice agenda may better be approached from a population level with a focus on broader social determinants of health which has been the case in many countries addressing developmental and intellectual disabilities. 53 Defining social inclusion from the perspective of people who experience poverty, unemployment, social inequality and forms of violence affecting collectives rather than individuals can strengthen the concept of social inclusion and promote its utilisation in such contexts.
Though the concept of occupational justice has been present in the literature for about three decades, 20 we found limited evidence of its conceptualisation and application in mental health and no studies in HIV. 23 24 34 38 40 42 The studies found were also from high-income countries, despite the global-justice theoretical orientation of the concept. 23 24 34 We found key features that could guide occupational justice utilisation and further theorisation: community participation by having one's occupational rights upheld, occupational needs met, empowerment and equity in occupational participation. To some extent, the lack of diversity in regions informing the concept offers an opportunity to strengthen the concept by adding insights from contexts with potential for different realities, experiences and viewpoints, such as Africa. Also some authors conceptualised occupational justice as participation in occupation(s) in an equitable manner 34 , they took participation as synonymous with justice, without spelling the nature of the occupation and position of the person accessing the occupations. These have great potential in influencing how the accessed occupation impacts health, well-being and feeling of social inclusion.
Despite the definitional lack of clarity, social inclusion and occupational justice are related concepts that can be used together to frame research and practice. The commonality between the concepts is the need to promote equitable access to opportunities for community participation with fairness and equity. 23 24 34 40 The relationship between the concepts could be further developed using diverse communities to build evidence on how engagement in meaningful everyday activities underlie inclusive communities for people with mental illness and living with HIV. Focus on occupational justice presents a perspective on the nuances of We therefore propose an expansion of the relationship between the conceptualisation of the two concepts, using most affected population groups, such as people with comorbid mental health disorders like substance use disorders and HIV in low-income contexts. This population group is known to have unmet broader health and social care needs hinged to the double stigma associated with substance abuse and HIV. 54 That expansion should reflect the contextual realities influencing community participation, respect of human rights, and having healthy relationships, actioned through engagement in meaningful occupations. Measures with a broader scope and cross-cultural validation like the Social and Community Opportunities Profile (SCOPE), 55 56 can be instrumental in developing standardized measures.

Ethics and dissemination
Since the scoping review methodology consists of reviewing and collecting data from publicly available literature, this scoping review did not require ethics approval. Dissemination of findings is ongoing through peer-reviewed journals; seminars and conferences; targeting clinicians, academics, researchers, service users and policy makers.

Patient and public involvement:
Patient and public involvement (PPI) representatives were not directly involved in the design of this scoping review protocol. However, experiences of the first author in working with adults afflicted with HIV and mental health disorders in Zimbabwe informed the need to explore issues faced by this population beyond biomedical care. We also built our research question from insights being generated in his doctoral studies exploring occupational perspectives on social inclusion among young adults dually afflicted with substance use disorders and HIV.
Social inclusion speaks to life beyond medical management which was not being given sufficient attention and hence the need to conduct a scoping review.

Conclusion
To our knowledge, this scoping review is the first to appraise the concepts of occupational justice and social inclusion in populations afflicted by mental illness and HIV. Our findings have the potential to initiate critical conversations in the field and expand understanding and utilisation of occupational justice and social inclusion to critique and enhance global mental health. We have also presented commonalities which will give us a better theoretical foundation to inform further research, practice, and training, especially from underrepresented societies.

Author Contributions:
All authors have made substantive intellectual contributions to the conduct and write-up of this review. CN and RG conceptualised the review approach and provided general guidance to the research team. Then CN and EM were involved in systematic and independent screening and data extraction. CN provided primary input at all stages, developed all draft documents and had overall responsibility for the review. LL, RG and RH gave substantial review and critique through the review process and manuscript. All the authors reviewed and commented on the drafts of the manuscript and they all read and approved the final manuscript.

Now combine Sets, 1 AND 2 AND 3 AND 4 or Sets 1 AND 2 AND 3 AND 5
Limit to last 20 years Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.

Rationale 3
Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.
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Objectives 4
Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.

Protocol and registration 5
Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.

Yes ref 15
Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.

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Information sources* 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.

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Search 8 Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated.
Selection of sources of evidence † 9 State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.

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Data charting process ‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.
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Data items 11
List and define all variables for which data were sought and any assumptions and simplifications made.
Page 9. Table  1 Critical appraisal of individual sources of evidence §

12
If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).
Click here to enter text. Describe the methods of handling and summarizing the data that were charted. Page 8

Selection of sources of evidence 14
Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.
Page 8. Figure 1 Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations.
Page 8-14. Table 1 Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12).
Click here to enter text.

Results of individual sources of evidence 17
For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives. Table 1 Synthesis of results 18 Summarize and/or present the charting results as they relate to the review questions and objectives. Page 14-18

Summary of evidence 19
Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.

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Limitations 20 Discuss the limitations of the scoping review process. Page 2

Conclusions 21
Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.

Funding 22
Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.
Page 22 JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O'Malley (6) and Levac and colleagues (7) and the JBI guidance (4,5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document).  Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV.
Study appraisal and synthesis. We undertook a three-part article screening process.
Screening and data extraction were undertaken independently by two researchers. Arksey's framework and thematic analysis informed the collation and synthesis of included papers.

Article Summary
Strengths and limitations of this study  The methodology as provided by the scoping review design, facilitated comprehensive mapping of the literature, and presented a foundation for further exploration utilisation of the concepts to inform policy, research and practice.  We used a rigorous strategy to explore research foci, definitions and utilisations of the concepts of social inclusion and occupational justice in mental illness and HIV.  Data synthesis was limited to work published in English originally or with available English translated copies.  We focused on mental illness, which is made up of several different conditions and could have introduced generalisation bias. However, most of the included studies were also not condition specific, fitting our primary aim for conceptual review.  Focus was limited to conceptual and theoretical aspects of the concepts more than interventions and outcomes of interventions. The global burden of disease from HIV remains substantially high with approximately 37.9 million people living with HIV 1 However, in the last two decades, the world has seen a combination of a significantly decreased mortality and a small decrease in incidence leading to an increase in the number of people living with HIV from 8·74 million (1990) to 36·9 million (2017). 2 This increase in the number of people living with HIV and decreased mortality rates are largely a result of the scaling up of HIV treatments. 1 3 However, what remains as a concern are persisting gaps in the treatment continuum towards the UNAIDS 90-90-90 target. Among those living with HIV who knew their status globally, 17% were still not on life-saving antiretroviral therapy UNAIDS Global AIDS update 2019. 1 Moreover, only 53% of those on treatment were virally suppressed. 1 3 One reason for these discrepancies, mainly seen in key populations, is the rising and ever complex relationship between mental illness and HIV. 4 5 Secondary to both biological and psychosocial factors, people living with HIV are at an increased risk of experiencing poor mental health 6 7 which negatively impacts on their healthseeking behaviours, adherence to antiretroviral treatments 8 and quality of life. 9 The prevalence of common mental disorders is also significantly higher among people living with HIV, irrespective of their being on ART, and is further impounded by stigma. 10 There is also a known bidirectional relationship between HIV and mental health, worsened by associated health and social inequalities. This often leaves people with severe mental illnesses at an increased risk for HIV infection. 11 12 Individuals with chronic and usually stigmatised conditions such as mental illnesses, physical disabilities and HIV, face barriers to full participation in their communities. 13 Poverty, lack of access to education, lack of suitable housing, and unemployment are some of the social and economic barriers to accessing adequate and sustained healthcare faced by this group. 14 These barriers may similarly be experienced by people who face discrimination based on their class, race or gender identity or sexuality and thus, when persons with mental illness also share these characteristics they may be severely stigmatised or discriminated against. 15 16 To sustain the aforementioned progress in the management of people with HIV and its comorbidities such as mental illness, there is a renewed call to take a community-led, equality and social justice approach 3 12 with concepts like occupational justice and social inclusion holding promise to inform this agenda. Occupational justice is an advanced form of social justice, concerned with equity and fairness for individuals, groups and communities access to resources and opportunities that supports their engagement in diverse, healthy, and meaningful occupations. 17 18 On the other hand, social inclusion entails multi-dimensional processes or states where prevailing contextual conditions enable full and active participation in all aspects of everyday life. 19 20 This can include civic, social, economic, and political activities, as well as participation in decision making processes irrespective of personal characteristic differences. 19 20 Social inclusion and occupational justice form aspects of social justice are therefore relevant to direct research and practice as we address exclusions and injustices experienced by stigmatised groups 21 . Focus on these social justice outcomes ensures that health and social well-being are addressed beyond the clinical management of the disease. Health-related quality of life that includes social inclusion and occupational justice will be a holistic construct for promoting continuum of care and health and well-being beyond viral suppression in HIV. 22 23 These concepts direct the health and social care communities to view individuals with mental illness and HIV as being part of marginalized groups at risk of being deprived of respect, rights and opportunities to achieve optimal health-related quality of life.
Social inclusion and occupational justice are potentially key concepts that can inform the promotion of human-rights based, sustainable, person and community-centred interventions that promote recovery for persons with chronic, and stigmatised conditions. 24 25 In order to aid integration, and operationalisation of occupational justice and social inclusion in practice, we need to understand how the concepts are conceptualised and applied in population groups affected by chronic and stigmatised conditions. Synthesised summaries of research evidence can inform primary research and implementation science, 26 therefore we selected a scoping review design to help advance this field. 27 This was a particularly appropriate method for this area due to the diverse disciplinary locations of the existing literature. 28 29 This scoping review aimed to explore and appraise the definitions, current utilisation, and relationships between the concepts of social inclusion and occupational justice in mental illness and HIV literature.

Methods
This scoping review followed our published study protocol 27 , developed using Arksey and O'Malley's Scoping Review framework, 29 as well as guidelines for scoping review protocols in occupational therapy. 26 30 In this paper, a scoping review is taken to be a form of knowledge synthesis that addresses an exploratory research question rather than the highly focused question in a systematic review. 28 29 For reporting, we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. 31 We followed an iterative process to develop and refine the research question. 29 Based on the subject area terminology, literature, and our understanding of current practice trends in managing conditions that are chronic, and stigmatised, we asked the following question: How are occupational justice and social inclusion conceptualised, defined, and operationalised, and how are these concepts related in the highly stigmatised chronic conditions of mental illness and HIV?
The objectives of our scoping review were:  To identify articles that define or conceptualise occupational justice and social inclusion related to mental illness or HIV.
 To describe how these are operationalised or utilised.
 To identify and describe relationships between occupational justice and social inclusion.
 To determine potential areas for further development, integration, and application of these concepts.

Search Strategy
With the aid of a subject librarian, we identified appropriate databases using a journal indexing system. We searched twelve databases in January2019: i) PubMed; ii) Scopus; iii) Academic Search Premier; iv) the Cumulative Index to Nursing and Allied Health Literature (CINAHL); v) Africa-Wide Information; vi) Humanities International Complete; vii) Web of Science; viii) PsychInfo; ix) SocINDEX; x) Grey Literature Report; xi) Web of Science Conference Proceedings; and, xii) Open Grey. We used PubMed as the free platform for accessing articles indexed on Medline database. The selected databases captured a comprehensive sample of literature from a variety of disciplines including social work, psychiatry, nursing and occupational therapy.
The first and last authors (CN & RG) worked with the librarian, through an iterative process, to develop an inclusive list of search terms and applicable filtering methods including Boolean phrases and MESH terms for each database. 27 We developed a general search strategy with primary search terms related to the primary concepts of occupational justice and social inclusion while secondary search terms encompassed the broader terms of mental health, occupational therapy, mental illness, HIV, and rehabilitation (Table 1). For the purposes of search strategy development, we restricted our search to literature published between January 1997 and January 2019, a period which has seen the emergence and rapid growth in literature on occupational justice. 32 We conducted a preliminary search on PubMed and this enabled refinement of our search strategy to maximise sensitivity and specificity. We adapted the PubMed search strategy (Appendix 1 -provided as an online supplementary appendix) accordingly for other databases.

Study selection
The first author (CN) reviewed the titles identified in the search for eligibility. The aim was to identify articles that i) indicated a research focus on mental illness, or HIV, or both and ii) titles that included the key terms of occupational justice, social inclusion or both. Article types included primary studies, reviews, opinion papers and other theoretical papers without primary data. Articles were not eliminated where there was uncertainty with the title until it was examined more in-depth by looking at the abstract. Two independent reviewers, the first and third authors (CN & EM), reviewed titles and abstracts of preliminarily selected articles using predetermined inclusion and exclusion criteria (Table 2), detailed in our protocol. 27 These same reviewers each further screened full-text articles to determine if they met the inclusion/exclusion criteria. At this stage, articles were included if their explicit focus was on social inclusion or occupational justice in mental illness and or HIV; concepts were defined and reported some operationalisation of the two concepts. Discrepancies were resolved by consensus or by seeking adjudication from the second author (LL). The Cohen's κ statistic to

Data Extraction
Guided by the study objectives, a common extraction table was designed, to extract standard bibliometric information study characteristic and main findings. The first five articles were reviewed by both the first and third authors, with the remaining articles divided between the two authors. We then checked for accuracy and completeness against each other's work.
Discrepancies were resolved by revisiting the article, discussing, and reaching consensus.

Data Synthesis
Data were synthesised descriptively to give a structured summary of the dataset and to capture the characteristics of the studies included and the definitional range of social inclusion and occupational justice. Study grouping followed the publication trends over time and study designs used. Descriptive statistics were calculated using Microsoft Excel 2016 for frequencies.
We used deductive thematic analysis to organise the extracted definitions and related concepts for occupational justice and social inclusion.

Patient and public involvement:
Patient and public involvement (PPI) representatives were not directly involved in the design of this scoping review protocol. However, experiences of the first author in working with adults afflicted with HIV and mental health disorders in Zimbabwe informed the need to explore issues faced by this population beyond biomedical care. We also built our research question from insights being generated in his doctoral studies exploring occupational perspectives on social inclusion among young adults dually afflicted with substance use disorders and HIV.
Social inclusion speaks to life beyond medical management which was not being given sufficient attention and hence the need to conduct a scoping review.
Social inclusion as the process of enabling citizenship through fuller community participation.
Occupational justice defined as the process of lobbying for the occupational needs of individuals and communities as part of a fair, inclusive, and empowering society; as a community reintegration issue.

Social inclusion: concepts and definitions
Social inclusion was defined with high variability, with only two studies using the same definition by defining social inclusion as a subjective sense of belonging and active citizenship that enhances social integration. 40 42 Conceptualisations and definitions used ambiguous words such as 'community,' 'participation,' and 'integration' to define social inclusion.. Some studies defined social inclusion in terms of paid work and participation in community events, 38 39 others focussed on social acceptance and absence of stigma, 40 42 45 56 while still others saw it as a political discourse. 41 Stain et al. 47 tried to capture these varieties, and defined social inclusion as "the participation of a person in society, evidenced by an individual having the opportunities, resources and abilities to build and maintain relationships, engage in education and employment, and participate in community events and organisations" (p.880).
Notable thematic areas emerged from the analysis of the definitions, namely community participation; human rights; and social relations that enhances a sense of acceptance and belonging.

Community participation
The most prominent shared features of the definitions of social inclusion in mental illness and HIV research focussed on it being a process and an experience centred on community participation. However, the terms 'community participation' and 'community' were used in many ways without clear descriptions. These varied interpretations of community participation included reference to people with HIV or mental illness were wide ranging and included individuals with opportunities to participate in key activities in their communities like paid employment 38 39 47 57 ; being integrated into the community 37 41 45 ; having a sense of belonging within the community 33 40 42 51 ; and exercising active citizenship. 39 55 58 Human rights Social inclusion was also defined and conceptualised as a human rights issue, 39

Social relations
Social inclusion was further conceptualised and defined as a subjective experience 33

Diversity in definitions reflected in measurement tools
The diversity in definitions and features was also present in the measurement tool used.
Quantitative their acceptability to others, and how integrated they are, which was emphasised.
In summary, social inclusion was conceptualised as processes and experiences of empowered and equitable community participation for all, in which there is respect for human rights and healthy social relations and well-being are promoted.

Conceptualising and defining occupational justice
In the last two decades, only six research papers on mental illness used the concept of occupational justice and provided a definition. 35 36 46 50 52 54 (Table 3) Five different definitions were found ( Table 3). As with social inclusion, occupational justice was defined with great variability, with it being referred to as both a process and as an experience. 35

Occupational rights
A key concept of occupational justice for individuals with mental illness was experiencing or enjoying one's occupational rights. 35

Community participation
The process of promoting occupational justice was viewed as related to promoting social inclusion and community participation through advancing participation. 46 In another paper community participation was emphasised, with occupational justice defined as situations when people are seen as having the opportunity to choose to participate in the community. 35 The core emphasis in the definitions was the acknowledgement of occupational justice as a means of actioning community participation and social justice. 35 46 However, in all the definitions there was an overuse of the term 'occupation' which forms part of the term we are working to define. While 'occupation' was framed as purposeful everyday activities people engage in, it carries diverse meanings outside occupational science and occupational therapy. This rendered many of the definitions and arguments cyclical in nature.

** Insert Figure 2: Commonalities between occupational justice and social inclusion definitionsassociated terms
Although not clearly articulated, all the papers which discussed the two concepts together seemed to infer that occupational justice was an important ingredient of social inclusion. 35 36 46 52 Notwithstanding the considerable variability in definitions and conceptualisations of the two concepts, some commonalities were identified (Figure 2). Both social inclusion and occupational justice seek to promote equitable access to opportunities for engagement and to seek for fairness and justice in an individual's community participation. 35 36 46 52 Hamer et al. provided the closest account of the relationship between the concepts positing that social inclusion was enhanced through occupational justice. 46 Here they argued that recognition of people's right to inclusive participation in everyday occupations (occupational justice) enhanced the extent to which the person became confident about and was able to exercise their rights and participate by choice in the ordinary activities as citizens (social inclusion). 46 Both concepts were centred on key thematic areas of human rights, equality, inclusivity, and community participation.
Significantly, both social inclusion and occupational justice had a social justice focus, emphasizing the right to inclusive participation in a community and individuals exercising choice of participation as part of their citizenry beyond their health conditions. Occupational justice specifies that the participation in meaningful occupations is central, while social inclusion highlights community participation. Both concepts also highlight the need to address discriminatory practices, by doing away with stigma. 45 46 Hamer and colleagues highlight that social inclusion is the process of experiencing inclusive participation in the community as a citizen, while occupational justice promotes social inclusion through participation in meaningful and valued activities. 46

Discussion
We explored and appraised the definitions, current utilisation, and relationships between social and other stigmatised groups. 21 There is also emphasis on the multidimensional nature of the concepts framed as both a process and a personal experience, also allowing a broader horizon of their application, from policy to practice. The main source of these definitions were qualitative studies using service user's experiences and experts opinions.
While definitions of social inclusion vary, our scoping review findings confirm that the definitions are still in line with the concept of poverty reduction and a focus on reducing stigma and discrimination. 44 45 55 Social inclusion emerged from European societies, in response to a welfare crisis and desire to fight disadvantage. 59 We propose that this focus on welfare and fighting disadvantage should remain and should be taken up in the mental health and HIV fields, with poverty reduction, justice, and equality as pillars of social inclusion. This would be even more effective if poverty reduction was prioritised as a specific focus of social inclusion when informing mental health and HIV policies, particularly in sub-Saharan Africa, where these problems are more prevalent and driven by poverty. 3 The most striking observation was the lack of clarity in the definition of social inclusion, which is still evident, despite its existence in the literature for almost five decades. 59 Efforts to be all inclusive, multidimensional, person-centred and contextual can explain the variations and, thus, ambiguity in the definitions. 59 60 However, this lack of definitional clarity could hamper its universal concept utilisation, measurement, and further exploration with a common goal. 61 62 This lack of a single, universal understanding has positive and negative implications for research and application of the concept in clinical practice. Without a universally agreed upon definition, comparisons between studies and practice remains difficult. 62 This was echoed in the variety of social inclusion measures applied in the quantitative studies. 33 64 65 can be instrumental in developing standardized measures.
In contrast, the variations in defining the concepts reflects diversity and the importance of contexts, rather than a singular adoption of a "universal" idea. Given the diversities in   Though the concept of occupational justice has been present in the literature for about three decades, 32 we found limited evidence of its conceptualisation and application in mental health and no studies in HIV. 35 36 46 50 52 54 Despite the global-justice theoretical orientation of the concept, the studies found were also exclusively from high-income countries,. 35 36 46 We found key features that could guide occupational justice utilisation and further theorisation in HIV and mental health: community participation by having one's occupational rights upheld, occupational needs met, empowerment and equity in occupational participation. To some extent, the lack of diversity in regions informing the concept offers an opportunity to strengthen it by adding insights from regional contexts with potential for different realities, experiences and viewpoints, such as Africa where HIV and mental illness are prevalent and intertwined. 68 Also some authors conceptualised occupational justice as participation in occupation(s) in an equitable manner 46  Despite the definitional lack of clarity, social inclusion and occupational justice are related concepts that can be used together to frame research and practice and inform policy in HIV and mental health. The commonality between the concepts is the need to promote equitable access to opportunities for community participation with fairness and equity for people with HIV and those suffering from mental illness. 35 36 46 52 The relationship between the concepts could be further developed using diverse communities to build evidence on how engagement in meaningful everyday activities underlie inclusive communities for people with mental illness and those living with HIV. This focus on occupational justice perspective presents an opportunity to routinely explore the nuances of everyday occupational participation and what that may mean for the process and experiences of social inclusion of those involved.
We therefore propose an expansion of the relationship between the conceptualisation of the two concepts, using most affected population groups, such as people with comorbid mental health disorders like substance use disorders and HIV in low-income contexts. This population group is known to have unmet broader health and social care needs hinged to the double stigma associated with substance abuse and HIV. 69 That expansion should reflect the contextual realities influencing community participation, respect of human rights, and having healthy relationships, actioned through engagement in meaningful occupations. These contextually refined concepts of social inclusion and occupational justice should then be used together to inform policy, research and practice, for a just and inclusive society for those with stigmatised conditions like HIV and mental illnesses. The occupational justice and socially inclusive approach from policy through to practice, will ensure health and social well-being outcomes are addressed beyond the medical management of mental illness and or HIV. Health-related quality of life as a holistic construct for promoting continuum of care and health and well-being beyond viral suppression in HIV, 22 23 will also be made practical with a social justice lens.

Conclusion
To our knowledge, this scoping review is the first to appraise the concepts of occupational justice and social inclusion in populations afflicted by mental illness and HIV. Our findings have the potential to initiate critical conversations in the field and expand understanding and utilisation of occupational justice and social inclusion to critique and enhance global mental health. We have also presented commonalities which will give us a better theoretical foundation to inform further research, practice, and training, especially from underrepresented societies.

Author Contributions:
All authors have made substantive intellectual contributions to the conduct and write-up of this review. CN and RG conceptualised the review approach and provided general guidance to the research team. Then CN and EM were involved in systematic and independent screening and data extraction. CN provided primary input at all stages, developed all draft documents and had overall responsibility for the review. LL, RG and RH gave substantial review and critique through the review process and manuscript. All the authors reviewed and commented on the drafts of the manuscript and they all read and approved the final manuscript.

Acknowledgements:
We would like to thank Mary Shelton -UCT librarian for assistance in developing our search strategy. This article also benefited from writing soft skills and reviews by Dr Helen Jack through African Mental Health Research Initiative (AMARI).

Now combine Sets, 1 AND 2 AND 3 AND 4 or Sets 1 AND 2 AND 3 AND 5
Limit to last 20 years

Rationale 3
Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.

Page 6
Objectives 4 Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.

Protocol and registration 5
Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.

Yes ref 27
Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.

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Information sources* 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed. State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.

Page 7
Data charting process ‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.
Page 8

Data items 11
List and define all variables for which data were sought and any assumptions and simplifications made.
Page 11. Table 3 Critical appraisal of individual sources of evidence §

12
If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).
Click here to enter text.

Selection of sources of evidence 14
Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.
Page 9. Figure 1 Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations.
Page 11-22. Table 3 Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12).
Click here to enter text.

Results of individual sources of evidence 17
For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.

Summary of evidence 19
Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.

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Limitations 20 Discuss the limitations of the scoping review process. Page 2

Conclusions 21
Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.

Funding 22
Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.
Page 31 JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O'Malley (6) and Levac and colleagues (7) and the JBI guidance (4,5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document).  Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV.
Study appraisal and synthesis. We undertook a three-part article screening process.
Screening and data extraction were undertaken independently by two researchers. Arksey's framework and thematic analysis informed the collation and synthesis of included papers.   1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  also not condition specific, fitting our primary aim for conceptual review.  Focus was limited to conceptual and theoretical aspects of the concepts more than interventions and outcomes of interventions.  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  The global burden of disease from HIV remains substantially high with approximately 37.9 million people living with HIV 1 However, in the last two decades, the world has seen a combination of a significantly decreased mortality and a small decrease in incidence leading to an increase in the number of people living with HIV from 8·74 million (1990) to 36·9 million (2017). 2 This increase in the number of people living with HIV and decreased mortality rates are largely a result of the scaling up of HIV treatments. 1 3 However, what remains as a concern are persisting gaps in the treatment continuum towards the UNAIDS 90-90-90 target. Among those living with HIV who knew their status globally, 17% were still not on life-saving antiretroviral therapy UNAIDS Global AIDS update 2019. 1 Moreover, only 53% of those on treatment were virally suppressed. 1 3 One reason for these discrepancies, mainly seen in key populations, is the rising and ever complex relationship between mental illness and HIV. 4 5 Secondary to both biological and psychosocial factors, people living with HIV are at an increased risk of experiencing poor mental health 6 7 which negatively impacts on their healthseeking behaviours, adherence to antiretroviral treatments 8 and quality of life. 9 The prevalence of common mental disorders is also significantly higher among people living with HIV, irrespective of their being on ART, and is further impounded by stigma. 10 There is also a known bidirectional relationship between HIV and mental health, worsened by associated health and social inequalities. This often leaves people with severe mental illnesses at an increased risk for HIV infection. 11 12 Individuals with chronic and usually stigmatised conditions such as mental illnesses, physical disabilities and HIV, face barriers to full participation in their communities. 13 Poverty, lack of access to education, lack of suitable housing, and unemployment are some of the social and economic barriers to accessing adequate and sustained healthcare faced by this group. 14 These barriers may similarly be experienced by people who face discrimination based on their class, race or gender identity or sexuality and thus, when persons with mental illness also share these characteristics they may be severely stigmatised or discriminated against. 15 16 To sustain the aforementioned progress in the management of people with HIV and its comorbidities such as mental illness, there is a renewed call to take a community-led, equality and social justice approach 3 12 with concepts like occupational justice and social inclusion holding promise to inform this agenda. Occupational justice is an advanced form of social justice, concerned with equity and fairness for individuals, groups and communities access to resources and opportunities that supports their engagement in diverse, healthy, and meaningful occupations. 17 18 On the other hand, social inclusion entails multi-dimensional processes or states where prevailing contextual conditions enable full and active participation in all aspects of everyday life. 19 20 This can include civic, social, economic, and political activities, as well as participation in decision making processes irrespective of personal characteristic differences. 19 20 Social inclusion and occupational justice form aspects of social justice are therefore relevant to direct research and practice as we address exclusions and injustices experienced by stigmatised groups 21 . Focus on these social justice outcomes ensures that health and social well-being are addressed beyond the clinical management of the disease. Health-related quality of life that includes social inclusion and occupational justice will be a holistic construct for promoting continuum of care and health and well-being beyond viral suppression in HIV. 22 23 These concepts direct the health and social care communities to view individuals with mental illness and HIV as being part of marginalized groups at risk of being deprived of respect, rights and opportunities to achieve optimal health-related quality of life.

Results
Social inclusion and occupational justice are potentially key concepts that can inform the promotion of human-rights based, sustainable, person and community-centred interventions that promote recovery for persons with chronic, and stigmatised conditions. 24 25 In order to aid integration, and operationalisation of occupational justice and social inclusion in practice, we need to understand how the concepts are conceptualised and applied in population groups affected by chronic and stigmatised conditions. Synthesised summaries of research evidence can inform primary research and implementation science, 26 therefore we selected a scoping review design to help advance this field. 27 This was a particularly appropriate method for this area due to the diverse disciplinary locations of the existing literature. 28 29 This scoping review aimed to explore and appraise the definitions, current utilisation, and relationships between the concepts of social inclusion and occupational justice in mental illness and HIV literature.

Methods
This scoping review followed our published study protocol 27 , developed using Arksey and O'Malley's Scoping Review framework, 29 as well as guidelines for scoping review protocols in occupational therapy. 26 30 In this paper, a scoping review is taken to be a form of knowledge synthesis that addresses an exploratory research question rather than the highly focused question in a systematic review. 28 29 For reporting, we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. 31 We followed an iterative process to develop and refine the research question. 29 Based on the subject area terminology, literature, and our understanding of current practice trends in managing conditions that are chronic, and stigmatised, we asked the following question: How are occupational justice and social inclusion conceptualised, defined, and operationalised, and how are these concepts related in the highly stigmatised chronic conditions of mental illness and HIV?
The objectives of our scoping review were:  To identify articles that define or conceptualise occupational justice and social inclusion related to mental illness and or HIV.
 To describe how these are operationalised or utilised.
 To identify and describe relationships between occupational justice and social inclusion.
 To determine potential areas for further development, integration, and application of these concepts.

Search Strategy
With the aid of a subject librarian, we identified appropriate databases using a journal indexing system. We searched twelve databases in January2019: i) PubMed; ii) Scopus; iii) Academic Search Premier; iv) the Cumulative Index to Nursing and Allied Health Literature (CINAHL); v) Africa-Wide Information; vi) Humanities International Complete; vii) Web of Science; viii) PsychInfo; ix) SocINDEX; x) Grey Literature Report; xi) Web of Science Conference Proceedings; and, xii) Open Grey. We used PubMed as the free platform for accessing articles indexed on Medline database. The selected databases captured a comprehensive sample of literature from a variety of disciplines including social work, psychiatry, nursing and occupational therapy.
The first and last authors (CN & RG) worked with the librarian, through an iterative process, to develop an inclusive list of search terms and applicable filtering methods including Boolean phrases and MESH terms for each database. 27 We developed a general search strategy with primary search terms related to the primary concepts of occupational justice and social  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60   F  o  r  p  e  e  r  r  e  v  i  e  w  o  n  l  y   7 inclusion while secondary search terms encompassed the broader terms of mental health, occupational therapy, mental illness, HIV, and rehabilitation (Table 1). For the purposes of search strategy development, we restricted our search to literature published between January 1997 and January 2019, a period which has seen the emergence and rapid growth in literature on occupational justice. 32 We conducted a preliminary search on PubMed and this enabled refinement of our search strategy to maximise sensitivity and specificity. We adapted the PubMed search strategy (Appendix 1 -provided as an online supplementary appendix) accordingly for other databases.

AND Social inclusion
Social exclusion OR Social isolation OR social integration

Study selection
The first author (CN) reviewed the titles identified in the search for eligibility. The aim was to identify articles that i) indicated a research focus on mental illness, or HIV, or both and ii) titles that included the key terms of occupational justice, social inclusion or both. Article types included primary studies, reviews, opinion papers and other theoretical papers without primary data. Articles were not eliminated where there was uncertainty with the title until it was examined more in-depth by looking at the abstract. Two independent reviewers, the first and third authors (CN & EM), reviewed titles and abstracts of preliminarily selected articles using predetermined inclusion and exclusion criteria (Table 2), detailed in our protocol. 27 These same reviewers each further screened full-text articles to determine if they met the inclusion/exclusion criteria. At this stage, articles were included if their explicit focus was on  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59

Data Extraction
Guided by the study objectives, a common extraction table was designed, to extract standard bibliometric information study characteristic and main findings. The first five articles were reviewed by both the first and third authors, with the remaining articles divided between the two authors. We then checked for accuracy and completeness against each other's work.

Data Synthesis
Data were synthesised descriptively to give a structured summary of the dataset and to capture the characteristics of the studies included and the definitional range of social inclusion and occupational justice. Study grouping followed the publication trends over time and study designs used. Descriptive statistics were calculated using Microsoft Excel 2016 for frequencies.
We used deductive thematic analysis to organise the extracted definitions and related concepts for occupational justice and social inclusion.

Patient and public involvement:
Patient and public involvement (PPI) representatives were not directly involved in the design of this scoping review protocol. However, experiences of the first author in working with adults afflicted with HIV and mental health disorders in Zimbabwe informed the need to explore issues faced by this population beyond biomedical care. We also built our research question from insights being generated in his doctoral studies exploring occupational perspectives on social inclusion among young adults dually afflicted with substance use disorders and HIV.
Social inclusion speaks to life beyond medical management which was not being given sufficient attention and hence the need to conduct a scoping review.
Social inclusion as the process of enabling citizenship through fuller community participation.

Social inclusion: concepts and definitions
Social inclusion was defined with high variability, with only two studies using the same definition by defining social inclusion as a subjective sense of belonging and active citizenship that enhances social integration. 40 42 Conceptualisations and definitions used ambiguous words such as 'community,' 'participation,' and 'integration' to define social inclusion.. Some studies defined social inclusion in terms of paid work and participation in community events, 38 39 others focussed on social acceptance and absence of stigma, 40 42 45 56 while still others saw it as a political discourse. 41 Stain et al. 47 tried to capture these varieties, and defined social inclusion as "the participation of a person in society, evidenced by an individual having the opportunities, resources and abilities to build and maintain relationships, engage in education and employment, and participate in community events and organisations" (p.880).
Notable thematic areas emerged from the analysis of the definitions, namely community participation; human rights; and social relations that enhances a sense of acceptance and belonging.

Community participation
The most prominent shared features of the definitions of social inclusion in mental illness and HIV research focussed on it being a process and an experience centred on community participation. However, the terms 'community participation' and 'community' were used in many ways without clear descriptions. These varied interpretations of community participation included reference to people with HIV or mental illness were wide ranging and included individuals with opportunities to participate in key activities in their communities like paid employment 38 39 47 57 ; being integrated into the community 37 41 45 ; having a sense of belonging within the community 33 40 42 51 ; and exercising active citizenship. 39 55 58 Human rights Social inclusion was also defined and conceptualised as a human rights issue, 39 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59

Social relations
Social inclusion was further conceptualised and defined as a subjective experience 33 40 42 43 45 47 where those who are socially included should experience positive relationships. While a number of authors 33 40 42 43 45 47 talked about relationships as being a key component, this was not defined or discussed in depth. Instead it was emphasised that for social inclusion to be a reality, an individual should experience positive social relationships with their significant others, family, friends and acquaintances. 33 40 42 43 45 47 Social inclusion was also conceptualised as experiencing social support and having positive support networks. 45

Diversity in definitions reflected in measurement tools
The diversity in definitions and features was also present in the measurement tool used.
Quantitative studies included one of the following social inclusion measures: i) Social  34 40 42 44 51 It is their perception of the quality of their relationships, their acceptability to others, and how integrated they are, which was emphasised.
In summary, social inclusion was conceptualised as processes and experiences of empowered and equitable community participation for all, in which there is respect for human rights and healthy social relations and well-being are promoted.

Occupational rights
A key concept of occupational justice for individuals with mental illness was experiencing or enjoying one's occupational rights. 35  occupations, thereby contributing positively to their own well-being and to that of their communities. 52 Occupational justice was also highlighted as an advocacy process where individuals could lobby for the occupational rights and needs of individuals and communities as part of an equitable, inclusive, and empowering society. 36

Community participation
The process of promoting occupational justice was viewed as related to promoting social inclusion and community participation through advancing participation. 46 In another paper community participation was emphasised, with occupational justice defined as situations when people are seen as having the opportunity to choose to participate in the community. 35 The core emphasis in the definitions was the acknowledgement of occupational justice as a means of actioning community participation and social justice. 35 46 However, in all the definitions there was an overuse of the term 'occupation' which forms part of the term we are working to define. While 'occupation' was framed as purposeful everyday activities people engage in, it carries diverse meanings outside occupational science and occupational therapy. This rendered many of the definitions and arguments cyclical in nature.

Commonalities between social inclusion and occupational justice
** Insert Figure 2: Commonalities between occupational justice and social inclusion definitions -

associated terms
Although not clearly articulated, all the papers which discussed the two concepts together seemed to infer that occupational justice was an important ingredient of social inclusion. 35 36 46 52 Notwithstanding the considerable variability in definitions and conceptualisations of the two concepts, some commonalities were identified (Figure 2). Both social inclusion and  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60   F  o  r  p  e  e  r  r  e  v  i  e  w  o  n  l  y   26   occupational justice seek to promote equitable access to opportunities for engagement and to seek for fairness and justice in an individual's community participation. 35 36 46 52 Hamer et al. provided the closest account of the relationship between the concepts positing that social inclusion was enhanced through occupational justice. 46 Here they argued that recognition of people's right to inclusive participation in everyday occupations (occupational justice) enhanced the extent to which the person became confident about and was able to exercise their rights and participate by choice in the ordinary activities as citizens (social inclusion). 46 Both concepts were centred on key thematic areas of human rights, equality, inclusivity, and community participation.
Significantly, both social inclusion and occupational justice had a social justice focus, emphasizing the right to inclusive participation in a community and individuals exercising choice of participation as part of their citizenry beyond their health conditions. Occupational justice specifies that the participation in meaningful occupations is central, while social inclusion highlights community participation. Both concepts also highlight the need to address discriminatory practices, by doing away with stigma. 45 46 Hamer and colleagues highlight that social inclusion is the process of experiencing inclusive participation in the community as a citizen, while occupational justice promotes social inclusion through participation in meaningful and valued activities. 46

Discussion
We explored and appraised the definitions, current utilisation, and relationships between social inclusion and occupational justice in the literature on mental illness and or HIV. We identified and critically appraised 27 articles that presented a variety of definitions. Although we primarily sought out to describe the conceptualisations and utilisations of these concepts in the duality of mental illness and HIV, we found out that literature is scant and focuses on a single diagnosis. Most studies were on mental illness and conducted in high-income countries.
Despite the great variability, key thematic concepts used to define social inclusion and occupational justice included community participation, human rights, and relationships. The two concepts are theoretically related through a social justice focus, putting the emphasis on treating people with HIV and those with mental illness in a more respectful and equitable manner. The highlighted thematic concepts are central in directing research and practice toward the moral imperative of addressing exclusions and injustices experienced by people living with HIV, those with mental illnesses and other stigmatised groups. 21 There is also emphasis on the  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  multidimensional nature of the concepts framed as both a process and a personal experience, also allowing a broader horizon of their application, from policy to practice. The main source of these definitions were qualitative studies using service user's experiences and experts opinions.
While definitions of social inclusion vary, our scoping review findings confirm that the definitions are still in line with the concept of poverty reduction and a focus on reducing stigma and discrimination. 44 45 55 Social inclusion emerged from European societies, in response to a welfare crisis and desire to fight disadvantage. 59 We propose that this focus on welfare and fighting disadvantage should remain and should be taken up in the mental health and HIV fields, with poverty reduction, justice, and equality as pillars of social inclusion. This would be even more effective if poverty reduction was prioritised as a specific focus of social inclusion when informing mental health and HIV policies, particularly in sub-Saharan Africa, where these problems are more prevalent and driven by poverty. 3 The most striking observation was the lack of clarity in the definition of social inclusion, which is still evident, despite its existence in the literature for almost five decades. 59 Efforts to be all inclusive, multidimensional, person-centred and contextual can explain the variations and, thus, ambiguity in the definitions. 59 60 However, this lack of definitional clarity could hamper its universal concept utilisation, measurement, and further exploration with a common goal. 61 62 This lack of a single, universal understanding has positive and negative implications for research and application of the concept in clinical practice. Without a universally agreed upon definition, comparisons between studies and practice remains difficult. 62 This was echoed in the variety of social inclusion measures applied in the quantitative studies. 33 64 65 can be instrumental in developing standardized measures.
In contrast, the variations in defining the concepts reflects diversity and the importance of contexts, rather than a singular adoption of a "universal" idea.  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  Some of the social inclusion definitions had an individual focus, for example the individual had to be actively participating at the expense of the collective found in communal societies. 38 39 43 Given that the studies were mainly from high-income regions, there remains some missing voices in informing the definitions, given the largely communal orientation found in indigenous communities in low and middle-income settings. The challenge in some of the reviewed definitions was to try to focus on the individual and the impact of HIV and or mental illness, yet the social justice agenda may better be approached from a population level with a focus on broader social determinants of health which has been the case in many countries addressing developmental and intellectual disabilities. 67 Defining social inclusion of people with mental ill health and HIV, also needs to be done from the perspective of people who are in low-income countries, experiencing poverty, unemployment, social inequality and forms of violence since people with these conditions are usually stigmatised. Discrimination and consequent social problems usually affect people as part of a collective rather than only as individuals. Hence a collective perspective that considers how groups of people are affected can strengthen the concept of social inclusion and promote its possible utility in low-resource practice contexts. Though the concept of occupational justice has been present in the literature for about three decades, 32 we found limited evidence of its conceptualisation and application in mental health and no studies in HIV. 35 36 46 50 52 54 Despite the global-justice theoretical orientation of the concept, the studies found were also exclusively from high-income countries,. 35 36 46 We found key features that could guide occupational justice utilisation and further theorisation in HIV and mental health: community participation by having one's occupational rights upheld, occupational needs met, empowerment and equity in occupational participation. To some extent, the lack of diversity in regions informing the concept offers an opportunity to strengthen it by adding insights from regional contexts with potential for different realities, experiences and viewpoints, such as Africa where HIV and mental illness are prevalent and intertwined. 68 Also some authors conceptualised occupational justice as participation in occupation(s) in an equitable manner 46 , they took participation as synonymous with justice, without spelling out the nature of the occupation and position of the person accessing the occupations. These have great potential in influencing how the accessed occupation impacts health, well-being and feeling of social inclusion amongst those with HIV and mental illnesses.
Despite the definitional lack of clarity, social inclusion and occupational justice are related concepts that can be used together to frame research and practice and inform policy in HIV and mental health. The commonality between the concepts is the need to promote equitable access to opportunities for community participation with fairness and equity for people with HIV and those suffering from mental illness. 35 36 46 52 The relationship between the concepts could be further developed using diverse communities to build evidence on how engagement in meaningful everyday activities underlie inclusive communities for people with mental illness and those living with HIV. This focus on occupational justice perspective presents an opportunity to routinely explore the nuances of everyday occupational participation and what that may mean for the process and experiences of social inclusion of those involved.
We therefore propose an expansion of the relationship between the conceptualisation of the two concepts, using most affected population groups, such as people with comorbid mental health disorders like substance use disorders and HIV in low-income contexts. This population group is known to have unmet broader health and social care needs hinged to the double stigma associated with substance abuse and HIV. 69 That expansion should reflect the contextual realities influencing community participation, respect of human rights, and having healthy relationships, actioned through engagement in meaningful occupations. These contextually refined concepts of social inclusion and occupational justice should then be used together to  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60   F  o  r  p  e  e  r  r  e  v  i  e  w  o  n  l  y   30 inform policy, research and practice, for a just and inclusive society for those with stigmatised conditions like HIV and mental illnesses. The occupational justice and socially inclusive approach from policy through to practice, will ensure health and social well-being outcomes are addressed beyond the medical management of mental illness and or HIV. Health-related quality of life as a holistic construct for promoting continuum of care and health and well-being beyond viral suppression in HIV, 22 23 will also be made practical with a social justice lens.

Conclusion
To our knowledge, this scoping review is the first to appraise the concepts of occupational justice and social inclusion in populations afflicted by mental illness and HIV. Our findings have the potential to initiate critical conversations in the field and expand understanding and utilisation of occupational justice and social inclusion to critique and enhance global mental health. We have also presented commonalities which will give us a better theoretical foundation to inform further research, practice, and training, especially from underrepresented societies.

Author Contributions:
All authors have made substantive intellectual contributions to the conduct and write-up of this review. CN and RG conceptualised the review approach and provided general guidance to the research team. Then CN and EM were involved in systematic and independent screening and data extraction. CN provided primary input at all stages, developed all draft documents and had overall responsibility for the review. LL, RG and RH gave substantial review and critique through the review process and manuscript. All the authors reviewed and commented on the drafts of the manuscript and they all read and approved the final manuscript.

Rationale 3
Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.

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Objectives 4 Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.

Protocol and registration 5
Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.

Yes ref 27
Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.

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Information sources* 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed. State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.

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Data charting process ‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.
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Data items 11
List and define all variables for which data were sought and any assumptions and simplifications made.
Page 11. Table 3 Critical appraisal of individual sources of evidence §

12
If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).
Click here to enter text.  13 Describe the methods of handling and summarizing the data that were charted. Page 8

Selection of sources of evidence 14
Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.
Page 9. Figure 1 Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations.
Page 11-22. Table 3 Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12).
Click here to enter text.
Results of individual sources of evidence 17 For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives. Table 3 Synthesis of results 18 Summarize and/or present the charting results as they relate to the review questions and objectives. Page 11-22

Summary of evidence 19
Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.

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Limitations 20 Discuss the limitations of the scoping review process. Page 2

Conclusions 21
Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.

Funding 22
Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.
Page 31 JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O'Malley (6) and Levac and colleagues (7) and the JBI guidance (4,5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document).  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60