Exploring occupational therapy interventions in homeless settings in Tshwane

Abstract

Background: In South Africa, the national lockdown was both a challenge and an opportunity to address health-related issues of homelessness. While initial emergency responses in Tshwane focused on basic needs and medical intervention, the need for more holistic intervention became evident. Aim: To understand the experiences and perceptions, benefits and facilitators, and barriers and challenges of university-driven occupational therapy interventions with people experiencing homelessness in Tshwane during the various coronavirus disease 2019 lockdown levels and beyond to March 2023. Setting: Research was conducted in various homeless settings, such as temporary shelters, transitional- or permanent housing facilities or drop-in centres, where occupational therapy intervention was implemented. Methods: An explorative, descriptive qualitative design was used, with focus group discussions and semi-structured interviews conducted with people experiencing homelessness and homeless practitioners. These were audio recorded, transcribed and thematically analysed. Student-written occupational therapy planning and feedback documents were analysed through reflexive thematic analysis and interpreted using the Capability Approach. Results: Inputs and conversion factors positively influencing intervention outcomes included a supportive environment, client-centred care, therapeutic activities in small groups, ensuring positive volition, and understanding the real-life experiences of participants. Challenges included unsupportive environments, language barriers, poor attitudes and motivation, and lack of continuity of occupational therapy intervention. Conclusion: Occupational therapy intervention in homeless settings is valuable, as it considers personal, social and environmental aspects affecting a person’s functioning. Contribution: Applying the unique contribution of occupational therapy intervention in homeless settings will improve overall health- and social service delivery.