Empowering marginalised groups through co-operative inquiry: Illustrated by a practical example.

Background: Cooperative inquiry gives a voice to marginalised groups and breaks down power imbalances which makes it suitable for researching practical issues at community level. Objectives: The objective of this article is to illustrate how cooperative inquiry can be utilised to empower members of marginalised communities in facilitating social change. Method: The study setting is in Paarl, Western Cape, South Africa. A cooperative inquiry methodology was used. The inquiry group consisted of wheelchair users (9), their care givers (8), taxi drivers (7) and stakeholders (4). Data collection comprised 16 sessions, alternating between action and reflection. Inductive thematic analysis of data of all the phases was done to ensure that cooperative inquiry gives voice to marginalised communities. Results: The four themes that is, practical arrangements, understanding process, purpose, bonding and a cohesive group were identified. The themes showed progress from logistics, through individual understanding, to the group becoming one, and working together. Each of these phases is important in the development of a cooperative inquiry. Conclusion: Cooperative inquiry methodology can bring people together in a positive way to facilitate social change, and developing practical solutions to challenges. Contribution: Making use of a cooperative inquiry methodology to bring social change, minibus taxi services can be made accessible for wheelchair users. Concepts of social justice and decolonisation were imbued in the methodology.

A qualitative exploration of community mobility experiences of wheelchair users.

Background: Freedom of movement, which is dependent on community mobility, is a key contributor to good quality of life and important in the establishment of a person's community identity. Objective: To describe the community mobility experiences of wheelchair users who lived in a socio-economically challenged setting. Method: The study setting was Paarl, a peri-urban area of the Western Cape province of South Africa. This article reports findings from phase 1 (a reflection on past community mobility and minibus taxi use experiences) of cycle 1 of a co-operative inquiry. Nine adult wheelchair users, eight caregivers, six minibus taxi drivers, and four community stakeholders participated. Data were collected during a focus group discussion and analysed using inductive thematic analysis. Results: Four themes, 'Knowledge, attitudes, and actions', 'Natural, manmade and mechanical environmental barriers', 'Health and safety concerns' and 'Poor community participation and quality of life' were identified. The themes showed how difficult an everyday activity like moving around in the community were for wheelchair users, and how that limited their community involvement. Conclusions: Wheelchair users living in a low-income peri-urban area struggled to participate in community activities meaningful to them because various barriers hampered community wheelchair mobility and minibus taxi use. Contribution: The findings regarding community mobility struggles and specifically minibus taxi access guided specific recommendations and the further phases and cycles of the co-operative inquiry. The purpose of the co-operative inquiry was to allow co-researchers to find their voice and develop solutions to minibus taxi access for wheelchair users.

Support factors contributing to successful start-up businesses by young entrepreneurs in South Africa.

BACKGROUND: Unemployment and restricted work opportunities for youth are enduring social challenges that affect health, well-being, and quality of life, especially in low- to middle-income countries. When considering the advantages associated with work as a determinant of health, unemployment is understood to contribute to occupational injustice. However, self-employment, hailed the solution to youth unemployment, is often necessity-driven, precarious in nature and restricted by the low success rate of business start-ups. OBJECTIVE: Research was undertaken to explore factors perceived to contribute to the success of start-up businesses in an informal settlement in the Western Cape of South Africa. The importance of support in the success of business start-ups will be the focus of this article. METHODS: A collective case study, using narrative interviewing and - analysis, was undertaken in South Africa. Two narrative interviews were conducted with each of the five participants who were youth entrepreneurs and founders of start-up businesses. Data analysis comprised the use of narrative analysis and paradigmatic type narrative analysis. RESULTS: Three themes captured factors deemed to have contributed to the success of start-up businesses. The vital role of support systems and networks in business success was demonstrated. CONCLUSIONS: Support systems included family, friends, role models, mentors, team members and business partners. Identification, utilization, and ongoing development of support structures available in the social networks of young entrepreneurs were perceived to have contributed to the success of start-ups.

Scoping review of women with disabilities' livelihood occupation experiences: An equity perspective.

BACKGROUND: Globally, persons with disabilities are faced with unemployment and reduced income opportunities. Barriers to employment tend to be severe for women with disabilities who occupy marginalized positions in labor markets. 'Livelihood occupations' are conceptualized for this review to denote everyday activities that are done for subsistence and survival, and to broaden presentations of activities normally termed 'work', 'employment', 'job' or 'productivity' that people do to earn money and non-monetary gain. OBJECTIVE: This scoping review, undertaken as part of a broader interpretive phenomenological analysis of livelihood occupations of women with disabilities, maps research on the subject of livelihood occupations for women with disabilities. METHODS: The Arksey and O'Malley framework and PRISMA extension for scoping reviews were utilized to guide the five stage scoping strategy used to screen and select sources. Data from selected sources were synthesized using deductive qualitative content analysis to fit experiential components into equity categories determined a-priori from the Equitable Total Rewards model, to determine if these experiences connote equity or lack thereof. RESULTS: Nineteen sources, mainly from high income countries, are identified. Aspects of benefit and career inequity were largely evident in the experiences of the women across all sources. CONCLUSION: There is considerable lack of research on experiences of livelihood occupations in low and middle income countries contexts justifying further research. Women with disabilities report experiencing inability to realize career goals and occupational choice.

Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review.

OBJECTIVE: To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace. DESIGN: The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework. DATA SOURCES AND ELIGIBILITY: Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included. STUDY APPRAISAL AND SYNTHESIS: Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work. RESULTS: The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace. CONCLUSIONS: There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.

Out-of-home life spaces valued by urban older adults with limited income.

Background: Access to, and occupational performance in, out-of-home-life-spaces is linked to health, wellbeing and quality of life for older adults. There is little evidence of how this relates to older adults with limited resources in an African urban context. Objectives: To describe the out-of-home-life-spaces accessed and valued by older adults with limited resources, living in an urban South African setting. Method: An exploratory concurrent mixed methods study saw 84 rehabilitation clinicians conduct 393 face-to-face interviews with older adults. Clinicians produced reflective field notes and participated in focus groups. Quantitative data were analysed using descriptive statistics with SPSS Version X. Qualitative data were analysed through inductive content analysis. Results: Older adults walked, used mini-bus taxis or private vehicles to get to places of worship, medical facilities, shops, family and friends and special interest gatherings on a weekly or monthly frequency. Lack of funds was the main barrier. Older adults aspired to travel, go on holiday and to visit out-of-town family homes. Conclusion: Exploring the daily lived experience of older, urban South Africans with limited resources brought to light the value they attribute to participation in activities that contribute to the wellbeing of their families and communities. Such activities are found in a variety of life spaces. Contribution: Results could inform policy makers and service providers in their planning of community mobility, transportation services and health care, for older adults with limited resources.

Structural and cross-cultural validity of the Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

BACKGROUND: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire has been translated and cross-culturally adapted to Afrikaans for the Western Cape, within the public health service context of South Africa. The aim of this study was to evaluate structural validity, internal consistency, and cross-cultural validity/measurement invariance of this new translation to increase applicability and clinical utility in a public health service context. METHODS: During this cross-sectional study, exploratory factor analysis (EFA) was conducted with parallel analysis and oblimin rotation. Confirmatory factor analysis (CFA) and multiple group confirmatory factor analysis (MGCFA) to assess cross-cultural validity/measurement invariance, was employed to test model fit with X2 goodness-of-fit statistic, root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR) and comparative fit index (CFI). Internal consistency was calculated using Cronbach's alpha. RESULTS: 109 women and 110 men (n = 219) completed the Afrikaans for the Western Cape and the South African English DASH questionnaire, used during the analysis. Unidimensionality of the Afrikaans for the Western Cape DASH questionnaire was not supported in the 218 questionnaires eligible for inclusion in the analysis [X2 (df) = 1799.10 (405); p value = < 0.01; RMSEA (90% CI) = 0.126 (0.120-0.132); SRMR = 0.09 and CFI = 0.984]. EFA revealed a two-factor structure with Eigenvalues exceeding one explaining 55% and 7% of the variance. The two-factor structure of the Afrikaans for the Western Cape DASH questionnaire was supported during CFA. Cronbach's alpha revealed good internal consistency of both factors [factor 1 = 0.97 (0.96, 0.97) and factor 2 = 0.92 (0.90, 0.94)]. MGCFA conducted between 218 Afrikaans for the Western Cape DASH and 219 South African English DASH questionnaires (N = 437) revealed that the data supports configural, metric and scalar invariance models during initial model fit assessment. Subsequent hypotheses testing comparing the nested models revealed that scalar invariance holds. CONCLUSION: The Afrikaans for the Western Cape DASH questionnaire revealed a two-factor structure with good internal consistency across the two factors and demonstrated measurement invariance with the South African English DASH questionnaire.

The use and value of play: Perspectives from the continent of Africa - a scoping review.

BACKGROUND: Published play knowledge predominantly originates outside Africa. This review was undertaken to summarize sources on play originating from the continent of Africa. OBJECTIVE: To locate and summarize sources on the use and value of play in human development and learning from the African continent. MATERIAL AND METHOD: Following the PRISMA Extension - Scoping Reviews guidelines, the initial search yielded 17,004 sources. Title and abstract screening identified 263 sources which were evaluated for eligibility namely; sources originating from the African continent, in any language, focussing on play as occupation. RESULTS: A total of 127 sources were included; 76 qualitative, 28 quantitative and 23 mixed design sources; 100 from Southern Africa. Nine themes emerged: Who plays, why, where and how individuals play, intentional use of play, play and adult-related work skills, what is used in play, time/duration of play and barriers to play. CONCLUSIONS: Play was used effectively in human development and learning. Withholding play as a form of discipline, emphasized how adults and children valued play. Adults still loved playing. Safety concerns contributed to the reasons play occurred indoors more than outdoors, despite outdoor play being preferred. SIGNIFICANCE: The review provides a reference for play as an occupation which may promote learning and development.

The health equity characteristics of research exploring the unmet community mobility needs of older adults: a scoping review.

BACKGROUND: Unmet community mobility needs of older adults, published since the announcement of the UN sustainable development goals was synthesised to describe the health equity characteristics of research identifying unmet community mobility needs of older adults. METHODS: Searches were conducted in March and April 2020, 2275 articles were screened and 100 identified for data extraction. RESULTS: Findings showed underrepresentation of articles considering rural settings [9%] and originating in the global South [14%]. Gender, disability, education, and transport / driving were identified as key health equity characteristics and only 10 articles provided detail on all four of these. External factors inhibiting community mobility included built environments, service availability, and societal attitudes. Internal factors included finances, fear and apprehension, and functional limitations. CONCLUSIONS: The need for standardised reporting of participant characteristics in the community mobility of older adults was highlighted. These characteristics are required by research consumers to judge equity dimensions, and the extent to which findings represent minority or marginalised groups. 15 after the UN pledge to reduce inequalities, peer reviewed primary research does not reflect a global drive to end discrimination, exclusion and reduce the inequalities and vulnerabilities that leave people behind.

Working in the time of COVID-19: Rehabilitation clinicians' reflections of working in Gauteng's public healthcare during the pandemic.

Background: When the coronavirus disease 2019 (COVID-19) pandemic manifested in South Africa, rehabilitation services were seriously affected. The consequences of these were wide-ranging: affecting service users, their families and caregivers, rehabilitation practices and practitioners as well as the integrity and sustainability of rehabilitation systems. Objectives: This study aimed to explore the nature and consequences of disruption caused by the pandemic, based on the experience of rehabilitation clinicians who were working in public healthcare facilities in Gauteng. Methods: This was a phenomenology study that used critical reflection method. Trained and experienced in reflecting on barriers and enablers that affect their practices, a multidisciplinary group of rehabilitation clinicians captured their experience of working during the time of COVID-19. Data construction extended over 6 months during 2020. An inductive thematic analysis was performed using Taguette: an open-source qualitative data analysis tool. Results: The main themes captured the disorder and confusion with its resultant impact on rehabilitation services and those offering these services that came about at the beginning of the pandemic. The importance of teamwork and leadership in rehabilitation also emerged as themes. Other themes related to having to approach work differently, working beyond professional scopes of practice and pandemic fatigue. Conclusion: The COVID-19 pandemic disrupted the way rehabilitation was being performed, creating an opportunity to reconceptualise, strengthen and improve rehabilitation services offered at public healthcare. The presence of effective leadership with clear communication, dependable multidisciplinary teams and clinicians with robust personal resources were strategies that supported rehabilitation clinicians whilst working during COVID-19.

Scoping review exploring vocational rehabilitation interventions for mental health service users with chronic mental illness in low-income to upper-middle-income countries.

OBJECTIVE: To synthesise research published on vocational rehabilitation (VR) interventions offered in institutions, by occupational therapists, to mental health service users (MHSUs) with chronic mental illness, in low-income to upper-middle-income countries (L-UMIC). DESIGN: This scoping review used Arksey and O'Malley's methodological framework, the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews and Joanna Briggs scoping review guidelines. DATA SOURCES: We searched PsycInfo, EBSCOhost, HINARI, Google Scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley online library between 15 July and 31 August 2021. ELIGIBILITY CRITERIA: Sources, published in English between 2011 and 2021, on institution-based VR in occupational therapy for MHSUs who had chronic mental illness in L-UMIC were included. We included primary studies of any design. DATA EXTRACTION AND SYNTHESIS: Three reviewers used Mendeley to manage identified references, Rayyan for abstract and full-text screening and Microsoft Excel for data extraction. Data were sifted and sorted by key categories and themes. RESULTS: 895 sources were identified, and their title and abstracts reviewed. 207 sources were included for full-text screening. 12 articles from 4 countries (South Africa, India, Brazil and Kenya) were finally included. Types of VR intervention included supported employment, case management and prevocational skills training. Client centeredness, support and empowerment were the key VR principles identified. Teaching of illness self-management, job analysis and matching, job coaching, trial placement, and vocational guidance and counselling were the main intervention strategies reported. CONCLUSIONS: VR intervention in institutions for MHSUs in L-UMIC revealed the multidimensional uniqueness of individual MHSU's vocational ability, needs and contexts. The interventions allowed client-centred approaches that offer support and empowerment beyond the boundaries of the institutions. Occupational therapists offering VR need to expand their interventions beyond their institutions to contexts where MHSUs are working or intending to work.

A systematic review of work-related interventions for breast cancer survivors: Potential contribution of occupational therapists.

BACKGROUND: A high number of breast cancer survivors need to resume work. Therefore, interventions aimed at effective work-related transitions are important. OBJECTIVE: A systematic review to determine what occupational therapy interventions are effective in work-related transitions of breast cancer survivors. METHODS: Multiple databases were searched for studies on work-related interventions within the scope of occupational therapy. Studies were included if 70% or more study participants were working age (> 18 years) breast cancer survivors, and work-related transition outcome measures were used. RESULTS: The search yielded 2 872 articles, of which 12 met the inclusion criteria. When classified according to the International Classification of Function Framework, quantitative sources focussed on Body Structures and Functions component and Multicomponents (consists of the Body Structures and Functions Component and the Activities Component) showed positive effects on improving the work-related transitions of BC survivors, however, the effects were statistically insignificant and the strength of evidence was moderate. Participants in a qualitative source reported that after they underwent a physical exercise programme their work performance improved. A Multicomponents intervention study showed statistically significant improvements on self-reported work-related outcomes of BC survivors. Low evidence was found for implementing a vocational rehabilitation case management programme targeting the Activities component, which showed positive effects in reducing the sick leave days of BC survivors, but the effects were statistically insignificant. No evidence was found for programmes focussed on restoring the Participation component. CONCLUSION: The evidence included in this systematic review were insufficient to recommend occupational therapy interventions that are effective (showing statistically significant improvements) for work-related transitions of BC cancer survivors.

Work transition after hand injury: A scoping review.

STUDY DESIGN: Systematic scoping review. INTRODUCTION: Many factors are potentially associated with successful work-related transitions following hand injury. There is no current, comprehensive review of the literature to guide clinical practice. PURPOSE OF THE STUDY: To comprehensively identify the current body of research evidence supporting return to work (RTW) after hand injury and identify gaps. METHODS: A systematic search identified relevant, peer-reviewed, full text, English language primary qualitative or quantitative literature published since 2006. All authors independently determined whether studies should be included, assigned them to a hierarchy of evidence and extracted data. Decisions were defended and disagreements resolved in team meetings. Literature was summarized into key themes using common intent and constructs. RESULTS: Of 259 potentially-relevant articles, 38 were relevant. Study designs included prospective observational, cross-sectional, and retrospective (n=9 each), mixed methods (n=3), qualitative (n=4), and opinion pieces (n=4). There were no experimental studies. The most commonly-reported key themes were prognostic factors for RTW (25 papers) and assessment tools (18 papers). Remaining themes of impact of injury on the individual, patient perspectives, other stakeholder perspectives, healthcare provider education, and treatment were reported in fewer than 10 papers each. There was little commonality in how research was conducted or reported. Gaps included lack of information on effective interventions, which prognostic factors should be routinely measured, and which assessment and outcome items to routinely use in practice. CONCLUSION: Despite the impact of hand injury on capacity to RTW, there is limited evidence to inform successful work-related transitions.

Exploring the transition from student to health professional by the first cohort of locally trained occupational therapists in Ghana.

INTRODUCTION: The transition from student to occupational therapist for new graduates has been described as a period of extreme stress and anxiety; novice therapists enter a world that is new and complex upon starting clinical practice. The first locally-trained occupational therapists in Ghana worked autonomously and in a self-directed manner from their first year of practice in a country where occupational therapy had not been established. The study sought to explore the transition from student to clinician, made by the first cohort of locally trained occupational therapists in Ghana. METHODS: An interpretive phenomenology approach was used to explore participants' experiences of their transition from occupational therapy students to clinicians in Ghana. Six participants were selected using purposive, maximum variation, sampling. Data were collected by means of in-depth interviews and analysed using an iterative, inductive approach. RESULTS: Four themes emerged: Being 'new' in a new profession, introducing occupational therapy into a new environment, Personal and professional competence, and 'The future is bright'. New graduates found continued professional development activities, such as additional reading, seminars and conferences, essential for successful transition into practice. CONCLUSION: The importance of supervision and mentorship was highlighted in the study. Explicit attention to factors that support assimilation of new graduates within health care facilities were highlighted. The importance of continued professional development in development of practice competencies was foregrounded. Strategies to facilitate multi-professional work were demonstrated.

Work transitions after serious hand injury: Current occupational therapy practice in a middle-income country.

INTRODUCTION: Work-related transitions following serious hand injury can be complex for people with hand injuries and rehabilitation professionals supporting the return-to-work process. This study explored South African occupational therapy practice related to work transitions after a serious hand injury. METHODS: In this collective case study, maximum variation sampling was used to select seven occupational therapists involved in facilitating work-related transitions for people with serious hand injuries. Participants selected at least five cases that illustrated the breadth of their practice in terms of work transitions; these cases formed the focus of the semi-structured interviews. Data were analysed using inductive content analysis. Exemplar quotations were extracted to support emergent key themes. RESULTS: There was one overarching theme-Ongoing appraisal of the fit between function and inherent work demands-which comprised three stages: (1) determining and facilitating readiness to work; (2) managing the risk and trauma of returning to work, and (3) implementing reasonable accommodation. The central theme comprised six strategies that were used to optimise the transition process and achieve the best possible outcome. CONCLUSION: The study highlighted the importance of work-related transitions that are context-driven, flexible, and involve multiple stakeholders. The occupational therapists demonstrated how they drew on their knowledge of local contexts to solve problems and generate effective individual strategies over the rehabilitation period. The findings may be applicable to other low- or middle-income countries where the return-to-work process may not be as predictable as high-income countries.

Exploring the factors that affect the transition from student to health professional: an Integrative review.

BACKGROUND: The nature of a new health professional's transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice. METHODS: Whittemore and Knafl's methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach. RESULTS: Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates. CONCLUSION: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.

Vocational rehabilitation for mental health service users with chronic mental illness in low-income to upper-middle-income countries: a scoping review protocol.

INTRODUCTION: Work is integral to the occupations of human beings and accounts for up to a third of time spent in an average adult life. Occupational therapists play a role in vocational rehabilitation of mental health service users (MHSUs) with the aim of optimising their work participation. It is advisable that occupational therapists providing vocational rehabilitation to MHSUs with chronic mental illness in mental healthcare settings are guided by a practice framework developed for that particular context. This scoping review aims to summarise existing evidence on vocational rehabilitation for MHSUs in low-income to upper-middle-income countries. The findings will inform subsequent phases of research undertaken to formulate a vocational rehabilitation practice framework for MHSUs in Namibia. METHODS AND ANALYSIS: The scoping review will employ the five stage methodological framework proposed by Arksey and O'Malley. This will be used in conjunction with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISM-ScR) and Joanna Briggs scoping review guidelines. MESH terms, Boolean operators and truncation strategies will be employed for a comprehensive article search in electronic scholarly databases. These databases will include PsycINFO, EBSCOhost, HINARI, Google scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley Online Library. Mendeley and Rayyan, both open source platforms, will be used for title, abstract and full-text screening, as well as data extraction. Data will be sifted and sorted by key categories and themes using a data charting form. ETHICS AND DISSEMINATION: The scoping review findings will be published in a peer-reviewed journal and presented at local and international conferences. Ethical clearance for this study will not be required as secondary data will be utilised and there are no patients involved.

Inter-sectoral work practice in Zimbabwe: Professional competencies required by occupational therapists to facilitate work participation of persons with disabilities.

BACKGROUND: Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor's degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe. AIMS: To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities. MATERIAL AND METHODS: This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner's Council of Zimbabwe gave ethical clearance and permissions to conduct the study. RESULTS: Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services. CONCLUSIONS: Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.

Cognitive Interviewing during Pretesting of the Prefinal Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand Questionnaire following Translation and Cross-Cultural Adaptation.

When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity.