Occupational therapy graduates’ conceptualisations of occupational justice in community service practice in South Africa: a uwc case study

Abstract

The purpose of this qualitative study was to identify ways in which the University of the Western Cape (UWC) occupational therapy (OT) curriculum could be developed to prepare its graduates to advance occupational justice in community service practice. The background to the study is the development of occupational therapy practice and education within a policy context of health reform that gave momentum to the shift in emphasis from a bio-medical to a more socio-political approach to health in South Africa. Underpinning this study was the assumption that OT education informs professional practice and that uncovering new graduates’ practice experiences can inform the development of the UWC OT curriculum. The aim of the studyn was to examine how UWC OT graduates conceptualised occupational justice and how it manifested in their daily practice of community service in three provinces in South Africa. The study is framed within the theories of occupational justice and critical curriculum theory, in particular, critical pedagogy. A literature review pertaining to the application of occupational justice in OT practice and education is presented. This includes the background values that inform the practice of occupational justice, the application of occupational justice as it relates to OT practice and the relationship between OT education and occupational justice. The research design that was adopted is that of a single, interpretive case study. Through purposive sampling seven occupational therapy graduates from UWC who graduated in 2009, and who practiced in under-resourced, rural community service settings in 2010, were selected to participate in the study. The methods of data collection that were utilised were participant observation, a reflective journal, semi-structured paired or dyadic interviews and document review. The findings revealed that occupational justice held considerable value for the participants. They conceptualised occupational justice as enhanced health and well-being, and broader social change as an outcome of the facilitation of occupational enablement. The nature of their community service practice settings, however, posed several challenges for the participants. From the perspective of the participants, the dominance of the medical model, lack of resources and system of bureaucracy appeared to be the biggest challenges they encountered. While the participants’ education was geared towards equipping them to provide appropriate services as indicated by local needs, the health system was not ready tob accommodate their practice. Consequently, the participants appeared to encounter hegemony in practice. In encountering hegemony, however, they displayed an attitude of defeatism, leaving them with feelings of guilt, despondency and powerlessness. They lacked the skills to respond to power dynamics and to interact with people in positions of power. The main conclusion drawn from the study findings is that for OT graduates to impact the contexts in which they practice in South Africa, OT education must ensure that students develop competence to deal with the complexities of community service practice. This implies that transformational learning as pedagogical practice is of the essence, as it frames student preparation not just as learning but as a process of critical reflexivity that equips them to respond to power dynamics and intervene in matters related to occupational justice as active agents of change. The role and practice of occupational justice are subjects of debate in the context of OT education as they are for the profession broadly. This study contributed to this conversation through its examination of UWC OT graduates’ actual practice and the transmission of occupational justice-promoting practice through UWC OT education. The study highlighted that it is imperative that OT curricula in South Africa provide opportunities for students to engage in critical reflection on ways in which indigenous knowledge and a local understanding of occupational justice, as it relates to collective agency and critical consciousness, can be made more explicit in everyday practices. To this end, recommendations for the development of the UWC OT curriculum are made in respect of curriculum structure, content and approach; interdisciplinary education and practice, support for community service graduates and occupational therapy continued professional development.