{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:40:12Z","timestamp":1785436812308,"version":"3.56.0"},"reference-count":47,"publisher":"AOSIS","issue":"0","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0In 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.\nAim:\u00a0To 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.\nSetting:\u00a0Research 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.\nMethods:\u00a0An 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.\nResults:\u00a0Inputs 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.\nConclusion:\u00a0Occupational therapy intervention in homeless settings is valuable, as it considers personal, social and environmental aspects affecting a person\u2019s functioning.\nContribution:\u00a0Applying the unique contribution of occupational therapy intervention in homeless settings will improve overall health- and social service delivery.<\/jats:p>","DOI":"10.4102\/hsag.v31i0.3140","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:04:53Z","timestamp":1772604293000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring occupational therapy interventions in homeless settings in Tshwane"],"prefix":"10.4102","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4626-7782","authenticated-orcid":false,"given":"Sarah","family":"Ainsworth","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g0p6g84","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pretoria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6921-1285","authenticated-orcid":false,"given":"Helga E.","family":"Lister","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g0p6g84","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pretoria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0371-1022","authenticated-orcid":false,"given":"Michelle N.S.","family":"Janse van Rensburg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref0","unstructured":"Barnekow, K. & Pickens, N.D., 2011, \u2018Introduction to occupation and co-occupation\u2019, in C. Brown & V.C. Stoffel (eds.), Occupational therapy in mental health: A vision for participation, vol. 1, pp. 637\u2013647, F.A. Davis Company, Philadelphia."},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Braun, V. & Clarke, V., 2006, \u2018Using thematic analysis in psychology\u2019, Qualitative Research in Psychology 3(2), 77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa","DOI":"10.1191\/1478088706qp063oa"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Chard, G., Faulkner, T. & Chugg, A., 2009, \u2018Exploring occupation and its meaning among homeless men\u2019, British Journal of Occupational Therapy 72(3), 116\u2013124. https:\/\/doi.org\/10.1177\/030802260907200306","DOI":"10.1177\/030802260907200306"},{"key":"ref3","unstructured":"Creswell, J.W., Hanson, W.E., Clark, P.V.L. & Morales, A., 2007, Qualitative research designs: Selection and implementation, viewed 27 April 2021, from https:\/\/docplayer.net\/35237589-qualitative-research-designs-selection-and-implementation.html."},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Cross, C., Seager, J., Erasmus, J., Ward, C. & O\u2019donovan, M., 2010, \u2018Skeletons at the feast: A review of street homelessness in South Africa and other world regions\u2019, Development Southern Africa 27, 5\u201320. https:\/\/doi.org\/10.1080\/03768350903519291","DOI":"10.1080\/03768350903519291"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Cuthill, F., 2019, Homelessness, social exclusion and health: Global perspectives, local solutions, Dunedin Academic Press, Edinburgh.","DOI":"10.2307\/jj.12639027"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Davies, A. & Wood, L.J., 2018, \u2018Homeless health care: Meeting the challenges of providing primary care\u2019, Medical Journal of Australia 209(5), 230\u2013234. https:\/\/doi.org\/10.5694\/mja17.01264","DOI":"10.5694\/mja17.01264"},{"key":"ref7","unstructured":"De Beer, S., 2022, Tshwane homeless count 2022: Everyone counted, counts!, University of Pretoria, Pretoria."},{"key":"ref8","unstructured":"Eakman, A.M., 2015, \u2018Person factors: Meaning, sensemaking and spirituality. in C.H. Christiansen & C.M. Baum (eds.), Occupational therapy: Performance, participation and well-being, 4th edn., pp. 278\u2013296, SLACK Incorporated, Thorofare, NJ."},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Garza-V\u00e1zquez, O. & Deneulin, S., 2019, \u2018The capability approach: Ethics and socio-economic development\u2019, in J. Drydyk & L. Keleher (eds.), Routledge handbook of development ethics, pp. 68\u201383, Routledge, London & New York.","DOI":"10.4324\/9781315626796-9"},{"key":"ref10","unstructured":"Geldenhuys, K., 2021, \u2018Impact of COVID-19 on the poor and homeless\u2019, Servamus Community-Based Safety and Security Magazine 114(2), 26\u201330."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Grandisson, M., Mitchell-Carvalho, M., Tang, V. & Korner-Bitensky, N., 2009, Occupational therapists\u2019 perceptions of their role with people who are homeless, The Homeless Hub, Toronto, viewed 28 June 2021, from https:\/\/www.homelesshub.ca\/resource\/occupational-therapists-perceptions-their-role-people-who-are-homeless.","DOI":"10.4276\/030802209X12577616538672"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Helfrich, C.A. & Fogg, L.F., 2007, \u2018Outcomes of a life skills intervention for homeless adults with mental illness\u2019, Journal of Primary Prevention 28, 313\u2013326. https:\/\/doi.org\/10.1007\/s10935-007-0103-y","DOI":"10.1007\/s10935-007-0103-y"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Heuchemer, B. & Jospehsson, S., 2006, \u2018Leaving homelessness and addiction: Narratives of an occupational transition\u2019, Scandanavian Journal of Occupational Therapy 13, 160\u2013169. https:\/\/doi.org\/10.1080\/11038120500360648","DOI":"10.1080\/11038120500360648"},{"key":"ref14","unstructured":"Homeless World Cup Foundation, 2024, Global homelessness statistics, Homeless World Cup, viewed 10 September 2024, from https:\/\/www.homelessworldcup.org\/homelessness-statistics."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Joly, L., Cornes, M. & Manthorpe, J., 2014, \u2018Supporting the social networks of homeless people\u2019, Housing, Care and Support 17(4), 197\u2013207. https:\/\/doi.org\/10.1108\/HCS-06-2014-0014","DOI":"10.1108\/HCS-06-2014-0014"},{"key":"ref16","unstructured":"Khadduri, J. & Shinn, M., 2020, In the midst of plenty: Homelessness and what to do about it, Wiley-Blackwell, Hoboken, NJ."},{"key":"ref17","unstructured":"Lloyd, C. & Bassett, H., 2012, \u2018The role of occupational therapy in working with the homeless population: An assertive outreach approach\u2019, New Zealand Journal of Occupational Therapy 59, 18\u201323."},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Marcus, T.S., Heese, J., Scheibe, A., Shelly, S., Lalla, S.X. & Hugo, J.F., 2020, \u2018Harm reduction in an emergency response to homelessness during South Africa\u2019s COVID-19 lockdown\u2019, Harm Reduction Journal 17, 60. https:\/\/doi.org\/10.1186\/s12954-020-00404-0","DOI":"10.1186\/s12954-020-00404-0"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Mattsson, E., Lindblad, M., Kneck, \u00c5., Salzmann-Eriksson, M. & Klarare, A., 2023, \u2018Voices of women in homelessness during the outbreak of the COVID-19 pandemic: A co-created qualitative study\u2019, BMC Women\u2019s Health 23, 1\u201315. https:\/\/doi.org\/10.1186\/s12905-023-02157-x","DOI":"10.1186\/s12905-023-02157-x"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Mbewu, G.N. & Tenai, N.K., 2020, \u2018Street homelessness in South Africa: A perspective from the Methodist Church of Southern Africa\u2019, HTS Theological Studies 76(1), 1\u201310. https:\/\/doi.org\/10.4102\/hts.v76i1.5591","DOI":"10.4102\/hts.v76i1.5591"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Munger, F., Macleod, T. & Loomis, C., 2016, \u2018Social change: Toward an informed and critical understanding of social justice and the capabilities approach in community psychology\u2019, American Journal of Community Psychology 57(1\u20132), 171\u2013180. https:\/\/doi.org\/10.1002\/Ajcp.12034","DOI":"10.1002\/ajcp.12034"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz, J.P., Dix, S. & Rechenbach, D., 2006a, \u2018Building productive roles: Occupational therapy in a homeless shelter\u2019, Occupational Therapy in Health Care 20, 167\u2013187. https:\/\/doi.org\/10.1080\/J003v20n03_11","DOI":"10.1080\/J003v20n03_11"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz, J.P., Garcia, T., Lisak, J. & Reichenbach, D., 2006b, \u2018Assessing the occupational performance priorities of people who are homeless\u2019, Occupational Therapy in Health Care 20(3\u20134), 135\u2013148. https:\/\/doi.org\/10.1080\/J003v20n03_09","DOI":"10.1080\/J003v20n03_09"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Naidoo, V., 2010, \u2018Government responses to street homelessness in South Africa\u2019, Development Southern Africa 27, 129\u2013141. https:\/\/doi.org\/10.1080\/03768350903519408","DOI":"10.1080\/03768350903519408"},{"key":"ref25","unstructured":"Obioha, E.E., 2021, \u2018Addressing homelessness through public works programmes in South Africa\u2019, Discussion paper presented at the Expert Group Meeting on the Priority Theme: Affordable housing and social protection systems for all to address homelessness, 22\u201324 May 2019, Nairobi, Kenya, Division for Inclusive Social Development."},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Parkes, T., Carver, H., Masterton, W., Falzon, D., Dumbrell, J., Grant, S. et al., 2021, \u2018\u201cThey already operated like it was a crisis, because it always has been a crisis\u201d: A qualitative exploration of the response of one homeless service in Scotland to the COVID-19 pandemic\u2019, Harm Reduction Journal 18, 1\u201316. https:\/\/doi.org\/10.1186\/s12954-021-00472-w","DOI":"10.1186\/s12954-021-00508-1"},{"key":"ref27","unstructured":"Parmenter, L., 2003, \u2018Describing and defining intercultural communicative competence: International perspectives\u2019, in M. Byram (ed.), Intercultural competence, pp. 3\u201322, Multilingual Matters, Clevedon."},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Parmenter, V., Fieldhouse, J. & Barham, R., 2013, \u2018An occupational therapy intervention service to hostels for homeless people: An overview\u2019, British Journal of Occupational Therapy 76, 242\u2013245. https:\/\/doi.org\/10.4276\/030802213X13679275042807","DOI":"10.4276\/030802213X13679275042807"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Pottie, K.E.A., 2020, \u2018Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience\u2019, Canadian Medical Association Journal 192, E240\u2013E254. https:\/\/doi.org\/10.1503\/cmaj.190777","DOI":"10.1503\/cmaj.190777"},{"key":"ref30","unstructured":"Ramaphosa, C., 2020, Message by President Cyril Ramaphosa on COVID-19 pandemic, The Presidency Republic of South Africa, viewed 21 July 2021, from http:\/\/www.thepresidency.gov.za\/speeches\/message-president-cyril-ramaphosa-covid-19-pandemic."},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Raphael-Greenfield, E.I. & Gutman, S.A., 2015, \u2018Understanding the lived experience of formerly homeless adults as they transition to supportive housing\u2019, Occupational Therapy in Mental Health 31(1), 35\u201349. https:\/\/doi.org\/10.1080\/0164212X.2014.1001011","DOI":"10.1080\/0164212X.2014.1001011"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Renkin, W., 2020, \u2018Fostering integrated, collaborative approaches to end street homelessness: A COVID-19 perspective\u2019, South African Review of Sociology 51(3\u20134), 40\u201355. https:\/\/doi.org\/10.1080\/21528586.2021.2018036","DOI":"10.1080\/21528586.2021.2018036"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Roets, L., Botha, A., Greeffc, M., Humand, S.P., Strydome, H., Watson, M.J. et al., 2016, \u2018A synthesis of homelessness in South Africa: A rapid critical appraisal\u2019, Development Southern Africa 33, 613\u2013627. https:\/\/doi.org\/10.1080\/0376835X.2016.1203756","DOI":"10.1080\/0376835X.2016.1203756"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Roy, L., Valle\u0301e, C., Kirsh, B.H., Marshall, C.A., Marval, R. & Low, A., 2017, \u2018Occupation-based practices and homelessness: A scoping review\u2019, Canadian Journal of Occupational Therapy 84, 98\u2013110. https:\/\/doi.org\/10.1177\/0008417416688709","DOI":"10.1177\/0008417416688709"},{"key":"ref35","unstructured":"Salcedo, J., 2019, Homelessness & the SDGs, United Nations Department of Economic and Social Affairs, New York, viewed 24 July 2021, from https:\/\/www.un.org\/development\/desa\/dspd\/wp-content\/uploads\/sites\/22\/2019\/07\/salcedo_jesus_presentation_2-1.pdf."},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Salisbury-Afshar, E.M., Rich, J.D. & Adashi, E.Y., 2020, \u2018Vulnerable populations: Weathering the pandemic storm\u2019, American Journal of Preventive Medicine 58, 892\u2013894. https:\/\/doi.org\/10.1016\/j.amepre.2020.04.002","DOI":"10.1016\/j.amepre.2020.04.002"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B. et al., 2018, \u2018Saturation in qualitative research: Exploring its conceptualization and operationalization\u2019, Qualitative and Quantitative 52, 1893\u20131907. https:\/\/doi.org\/10.1007\/s11135-017-0574-8","DOI":"10.1007\/s11135-017-0574-8"},{"key":"ref38","unstructured":"Scaffa, M.E., 2014, \u2018Homelessness\u2019, in B.A.B. Schell, G. Gillen & M.E. Scaffa (eds.), Willard & Spackman\u2019s Occupational Therapy, 13th edn., pp. 1109\u20131123, Wolters Kluwer\/Lippincott Williams & Wilkins, Philadelphia."},{"key":"ref39","unstructured":"Schultz-Krohn, W. & Tyminski, Q., 2018, \u2018Community-built occupational therapy services for those who are homeless\u2019, OT Practice 23, Ce1\u2013Ce7."},{"key":"ref40","unstructured":"Statistics South Africa, 2023, Media release: Census 2022 population count results 10 October 2023, Statistics South Africa, Pretoria, viewed 10 November 2024, from https:\/\/www.statssa.gov.za\/?p=16716."},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Stonehouse, J., Grobler, G., Bhoora, U. & Janse van Rensburg, M.N.S., 2023, \u2018Mental health symptoms among homeless shelter residents during COVID-19 lockdown in Tshwane, South Africa\u2019, African Journal of Primary Health Care & Family Medicine 15, 3730. https:\/\/doi.org\/10.4102\/phcfm.v15i1.3730","DOI":"10.4102\/phcfm.v15i1.3730"},{"key":"ref42","unstructured":"Synovec, C., 2021, Occupational therapy\u2019s role in addressing the needs of people experiencing homelessness, viewed 28 June 2021, from https:\/\/occupationaltherapy.com."},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Thompson, J., 2022, \u2018A guide to abductive thematic analysis\u2019, Qualitative Report 27(5), 1410\u20131421. https:\/\/doi.org\/10.46743\/2160-3715\/2022.5340","DOI":"10.46743\/2160-3715\/2022.5340"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Van Oss, T., Duch, F., Frank, S., Laganella, G. & Synovec, C.E., 2020, \u2018Identifying occupation-based needs and services for individuals experiencing homelessness using interviews and photovoice\u2019, Work 65, 247. https:\/\/doi.org\/10.3233\/WOR-203076","DOI":"10.3233\/WOR-203076"},{"key":"ref45","unstructured":"Wells, T. & Wrenn, C.B., n.d., \u2018Naturalistic epistemology\u2019 \u2013 Sen\u2019s capability approach, Internet Encyclopedia of Philosophy, viewed 23 January 2023, from https:\/\/iep.utm.edu\/sen-cap\/."},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Wilcock, A.A., 1999, \u2018Reflections on doing, being and becoming\u2019, Australian Occupational Therapy Journal 46(1), 1\u201311. https:\/\/doi.org\/10.1046\/J.1440-1630.1999.00174.X","DOI":"10.1046\/j.1440-1630.1999.00174.x"}],"container-title":["Health SA Gesondheid"],"original-title":[],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:06:09Z","timestamp":1772604369000},"score":1,"resource":{"primary":{"URL":"https:\/\/hsag.co.za\/index.php\/hsag\/article\/view\/3140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":47,"journal-issue":{"issue":"0","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/hsag.v31i0.3140","relation":{},"ISSN":["1025-9848","2071-9736"],"issn-type":[{"value":"1025-9848","type":"print"},{"value":"2071-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]},"article-number":"a3140"}}