Includes abstract. / Includes bibliographical references (leaves 69-75). / Spirituality has been a topic of debate in occupational therapy. However, incorporating spirituality into occupational therapy practice has remained a challenge due to its subjective nature. Limited exploration has been done on how clinical reasoning may assist occupational therapists in this regard within mental health practice, especially within the African context. In this study, the clinical reasoning process used by occupational therapists in determining whether their clients’ spiritual occupations were health seeking behaviours or manifestations of a psychiatric illness are described. Five occupational therapists within mental health practice were interviewed and transcribed data were analysed using Nvivo and Stake (2006)’s cross case analysis worksheets. Member checking, peer reviews, research journal, data triangulation and visual presentation of data were used to enhance research rigor.Three themes emerged from the study: Clinical Reasoning: Complex, dynamic and multi-layered; Multiple resources: People as key; and Rewarding and challenging experience.

Bibliography: leaves 124-131. / The objective of this research was to determine the enabling factors that employed individuals with rheumatoid arthritis encounter in the open labour market, and strategies they use to keep their jobs. One hundred individuals with rheumatoid arthritis between the ages of 18 and 65 years and employed in the South African open labour market participated in the study. Participants were recruited from two tertiary hospitals and two private practices in the Western Cape. Participants completed a questionnaire and afterwards six volunteers were selected for a one-hour semi-structured interview.

Bibliography: leaves 96-102. / In the context of reduced resoursces available for healthcare delivery, costing of services has become an important focus. As occupational therapy services do not fit neatly into the medical model of healthcare, funding of such services is at risk when costs are rationalised. This study aimed to determine the costs of the Somerset Hospital occupational therapy service and thereby assist other occupational therapists to undertake similar studies to inform health service managers of the funding requirements of such services and promote the expansion of occupational therapy services.

Over the last decade, industrialised countries have experienced a significant increase in the cost of sickness, disability and employment injury benefits. Concurrently, an increase has been noticed in the need for work rehabilitation due to reasons such as disability as a result of an aging work-force, and work-related stress. Occupational therapists play a crucial role in providing work practice services, but little is known about the type of services they provide or the settings in which they are offered. The aim of this study was to describe the practice profile of occupational therapists delivering services within the field of work practice in South Africa to determine whether the work-related needs of the South African population are being met and to inform future planning of services. Methods: A descriptive cross-sectional study was undertaken. A self-administered survey was distributed to occupational therapists in the field of work practice within South Africa. Convenience and snowball sampling were used to target as many participants as possible. A survey based on the literature was developed and underwent pilot testing. Content and face validity was determined by a panel of experts who participated in a focus group. Instrument utility was established with occupational therapists who did not work in this field. Frequencies and proportions were determined for categorical data. Chi-square tests of association were undertaken to determine whether there were any significant associations between identified variables. A p-value of < 0.05 was considered significant. Open-ended questions were post coded.

Bibliography : leaf 105.

In this qualitative study, in-depth interviews with three young men with tetraplegia, who have resumed living in their pre-injury environments on the Cape Flats, were used to uncover the meanings they attach to their everyday occupations. The aim of the study was to gain a deeper understanding of the nature and meaning of their occupations. Themes which emerged from an inductive analysis of the data: "It's a boring life", "Feeling trapped" and "Struggling to find a way", indicated that the most prevalent experience of occupation, was its limited and monotonous repertoire. Contextual barriers served to restrict opportunities for meaningful occupation. However, tentative meaning making through occupational strategies was evident. Occupations supporting meaningful relationships were highly valued in the absence of physical capacity. The contribution of occupation to re-defining self identity following a major life disruption, was discovered in relation to the themes. The findings have implications for clinical practice aimed at enabling occupation and for policy development.

Includes abstract. / Includes bibliographical references. / Disability impacts one’s life and many South African people with disabilities remain socially excluded as they are denied access to employment. This research study was conducted to understand the experiences of a group of people with disabilities who were engaged in an employment assisted programme (EAP) as a means of accessing the open labour market. The Literature Review provided a rich theoretical base by giving an overview of the concepts underpinning disability related issues within the social context of employment in the open labour market. A qualitative research approach was followed using individual descriptive case studies as the research design. Five unemployed young people with disabilities, who engaged an EAP, participated in the research study. Semi-structured interviews contributed to the rich information regarding their experiences relating to engaging in the EAP. Informed consent was obtained to ensure voluntary participation by the participants. Data was analysed using thematic content analysis. Four themes relating to each of the corresponding objectives emerged from the findings. The themes were: Theme One: Vehicle of progression This theme highlights the expectations held by the participants as they entered and engaged the EAP. Theme Two: Belonging in the world of work This theme captures the process of engagement in the EAP. It encapsulates the collective experiences which reflect coping factors, benefits and challenges encountered in the EAP. Theme Three: Active participation begins with me This theme reveals action taken by participants’ to promote personal progress relating to expectations and challenges presented in the EAP. Theme Four: Advancing Quality of life The final theme provides an awareness of personal change within participants as a result of their journey through the EAP.

Street trading forms a large subsection of South Africa's informal economic activity, creating opportunity for self-employment and sustaining livelihoods (Mitullah, 2003; Skinner, 2008). Yet, street traders face various barriers including societal marginalization and pervasive poverty, threatening their well-being. The scarcity of occupational therapy literature around informal economy occupations limits the profession's understanding about what engagement in such occupations entails. While available literature around work in the informal economy emphasises economic contributions to development, there is limited evidence that informal business owners effectively escape vulnerability. From an occupational perspective, little is known about how these occupations are experienced and their implications for well-being. This study will inform contextually relevant conceptions of participation in the informal economy occupation of street trade, providing necessary knowledge for social and political practices of occupational therapy. The study aimed to describe women street traders' experiences of street trading and, how they perceived these related to their well-being. The objectives were to identify personal and external factors that promoted or hindered their well-being whilst engaged in street trading. An ethnographic inquiry was carried out with four women street traders identified through purposive recruitment. It involved semi-structured and photo elicitation interviews, and participant observation. Interviews were audio recorded and transcribed for inductive and thematic cross case analysis and field notes were made following interviews and participant observation. One theme and three categories emerged in the findings. The theme, 'Togetherness: steering against the current towards a better life", revealed the impact of interpersonal connectedness as participants attempted to steer towards valued lives against various barriers. The first category, 'Taking the helm', described the women's actions to determine valued livelihoods. 'Facing tough conditions' detailed the personal and external barriers they encountered while attempting to direct their lives towards positive outcomes through street trading. The third category, 'We're in the same boat' demonstrated the significance and the positive and negative impact of interpersonal connectedness for street traders. Conclusively, the study revealed how the contextually situated nature of this occupation translated to nuanced and fluid experiences of wellbeing in street trading, where well-being was deeply tied to valued social connectedness and significance of collective well-being.

Bibliography: leaves 237-245.

The absence of culturally appropriate assessment tools for the measurement of cognition and activities of daily living in an older black African population living in South Africa was the reason for embarking on the study. The purpose of the study was to develop culturally appropriate screening tools for dementia in a South African, Xhosa speaking urban black population. The aim of the study was to determine a correlation between the scores on a six item cognitive test ( 6CIT) (Brooke and Bullock 1999), and a modified Bristol Activities of Daily Living Scale (BADL) (Bucks, Ashworth, Wilcock and Siegfried 1996), in order to assess the usefulness of the cognitive test as a screening tool for dementia in black older women. A random sample of women (N=92) was drawn in an urban area (Khayelitsha) near to Cape Town, South Africa. Data were gathered with the use of three instruments. Background information was obtained from the subjects. The 6CIT was administered to the subjects. The BADL, an informant-based scale, was administered to the primary carers. The instruments were modified for local use and translated into Xhosa, the home language of the majority of residents in Khayelitsha. The results of the study showed a correlation between the scores on the two measurement instruments (r =.49745) at a 95% confidence interval. The instruments were found to be culturally appropriate for the black African older population. However, low education was a confounding factor for the cognitive test and cut-off scores, used in previous studies to detect the possible presence of early dementia, were found to be too low for this population. The modified BADL scale showed that none of the subjects were fully dependent on their carers for the performance of activities of daily living. Recommendations are that the instruments, 6CIT and modified BADL, which have been shown to be easily administered by community health workers be further validated and translated into other black South African languages. Easy to administer screening tools for dementia should be developed for detection of the disease in the population so that provision is made by health authorities and occupational therapists for treatment plans to minimise the detrimental effects of the disease on the individuals, their families and communities.