An occupational perspective of wellbeing: a case study of homelessness in Townsville

Thomas, Yvonne Angela (2012) An occupational perspective of wellbeing: a case study of homelessness in Townsville. PhD thesis, James Cook University.

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There is a growing concern within the occupational therapy profession regarding the needs of people experiencing occupational injustice within our societies. People experiencing homelessness in Australia have limited opportunities for occupational engagement and are currently a focus of the government's social inclusion agenda. An initial review of the occupational therapy literature on homelessness grounded this study in an occupational therapy perspective, which I have termed 'rebuilding lives'.

Literature from other disciplines demonstrates the precarious position of the marginalised that results in poor health and high mortality of homeless people. The importance of participation in communities is reflected in government policy, and supports the potential contribution of an occupational perspective of homelessness. This study aimed to understand the occupations of people experiencing homelessness and to contribute to the occupational perspective through discovering occupations that influence subjective perspectives of wellbeing.

This constructivist case study of homelessness explored the lived experience of people who were homeless using a montage of research methods including observation, interviews and focus groups with consumers and providers of homeless services. The research journey involved a pluralistic design utilising multiple methods (path) and a reflexive process of learning (way) to progressively discover the social world of people experiencing homelessness in Townsville, Australia. A purposive sample of homeless adults aged between 22 years and 60 years was recruited through different services including a homeless drop-in centre, a crisis accommodation service for homeless families, a hostel for intoxicated public place dwellers and an Indigenous camp in the city. A strengths-based approach to data collection prioritised the voices of participants and elicited situated accounts of occupations of meaning. Thirty five in-depth conversational interviews explored the strengths, resilience, agency and capacity of participants to sustain wellbeing during homelessness. Focus groups with thirty four service providers using an abridged Appreciative Inquiry model provided triangulation of the data and evidence of effective intervention strategies.

Analysis and interpretation of the data as driven by the research questions resulted in the discovery of three nested cases within the homeless population. Presented as three collective narratives of homelessness (single males, women with children, and Indigenous homelessness) they illustrate how people who are homeless aim to achieve and sustain subjective wellbeing through the four dimensions of occupation: doing, being, becoming and belonging. Limited opportunities for occupational engagement due to poverty and marginalisation result in situations of occupational injustice for people experiencing homelessness.

The geographical context of Townsville, proximity to Palm Island and corresponding high rates of Indigenous homelessness allowed an opportunity to explore Indigenous perspectives of homelessness. Cultural mentors proved essential in negotiating the cultural interface between Indigenous knowledge and dominant Western paradigms and an understanding of the influence of culture and colonisation to Indigenous wellbeing. The study provides an Australian Indigenous perspective to the theoretical concepts of occupation and illustrates the importance of collective occupations to the wellbeing of Indigenous people.

People experiencing homelessness sustain wellbeing through engagement in occupations that ensure safety and survival, provide positive experiences, facilitate connection with others and maintain a sense of normality. Further, wellbeing is enhanced by maintaining hopefulness through occupations that support self worth and mastery. Despite limited occupational opportunity resulting in occupational injustice, acts of personal autonomy and agency guard against descending into despair and afford a sense of satisfaction with life. An occupational perspective of subjective wellbeing is supported by this study, which challenges the appropriateness of universal definitions of wellbeing for all. Individual meanings of wellbeing should be considered for each client as a goal for occupational therapy interventions.

This study illustrates the socio-cultural contexts of occupations. Neither single males nor Indigenous people invest time and effort in occupations of becoming or a future focus, in contrast to women for whom the wellbeing of children depended on attaining secure housing and improved financial stability. Indigenous people experiencing homelessness achieve occupational wellbeing through being with and belonging to 'the mob'. Spending time together yarning and drinking reinforced a sense of kinship and cultural identity. Racism and dispossession reinforced the experience of marginalisation for this group and compounded occupational injustice. Some single men achieved high levels of subjective wellbeing through positive mental strategies affirming autonomy and control over life circumstances. The collective narratives represent three different voices within the homeless population in Townsville, and demonstrate the need for services to accommodate social and cultural differences within homelessness.

Three additional interpretive findings propose an expansion of the theoretical basis of occupational justice to recognise the importance of 1) access to place and space; 2) occupations that support gender roles, particularly those of women and mothers; and 3) occupations that support the cultural values of individuals and groups. Banishment or exclusion from public and private spaces prevents engagement in occupations that affirm personal identity; similarly being unable to participate in occupations that support gendered and cultural roles inhibits wellbeing. The multiple meanings of human occupation are intricately affected and shaped by the social and cultural context and consistent with the gendered and cultural norms.

This study supports a redirection of the occupational therapy profession to work towards just and inclusive structural policies that encourage engagement in meaningful occupations and community participation for people experiencing homelessness.

Item ID: 24920
Item Type: Thesis (PhD)
Keywords: Aboriginal Australians, Aboriginal health, homelessness, indigenous Australians, indigenous peoples, occupational injustice, occupational therapy, occupations, social inequality, social justice, Torres Strait Islander peoples, Torres Strait Islander health, Townsville (Qld), wellness
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Appendices A,B,C,E and F (publications) are not available through this repository.

Publications arising from this thesis are available from the Related URLs field. The publications are:

Appendix A. Thomas, Yvonne, Gray, Marion, and McGinty, Sue (2010) Homelessness and the right to occupation and inclusion: an Australian perspective. WFOT Bulletin, 62 (November). pp. 19-25.

Appendix B. Thomas, Yvonne, Gray, Marion, and McGinty, Sue (2011) Occupational therapy at the 'cultural interface': lessons from research with Aboriginal and Torres Strait Islander Australians. Australian Occupational Therapy Journal, 58 (1). pp. 11-16.

Appendix C. Thomas, Yvonne, Gray, Marion, and McGinty, Sue (2011) A systematic review of occupational therapy interventions with homeless people. Occupational Therapy in Health Care, 25 (1). pp. 38-53.

Appendix E. Thomas, Yvonne, Gray, Marion, McGinty, Sue, and Ebringer, Sally (2011) Homeless adults engagement in art: first steps towards identity, recovery and social inclusion. Australian Occupational Therapy Journal, 58 (6). pp. 429-436.

Appendix F. Thomas, Yvonne, Gray, Marion A., and McGinty, Sue (2012) An exploration of subjective wellbeing among people experiencing homelessness: a strengths-based approach. Social Work in Health Care, 51 (9). pp. 780-797.

Date Deposited: 22 May 2013 00:17
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110321 Rehabilitation and Therapy (excl Physiotherapy) @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified @ 33%
20 LANGUAGE, COMMUNICATION AND CULTURE > 2002 Cultural Studies > 200201 Aboriginal and Torres Strait Islander Cultural Studies @ 33%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services) @ 33%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920413 Social Structure and Health @ 33%
92 HEALTH > 9203 Indigenous Health > 920302 Aboriginal and Torres Strait Islander Health - Health Status and Outcomes @ 34%
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