Abstract
Introduction. The South African government introduced a reengineered primary healthcare approach to promote universal health coverage. The approach was to ensure equitable, efficient, and quality health services for consumers in private and public healthcare sectors. The transition toward a more comprehensive primary healthcare approach to intervention requires occupational therapists who predominantly worked in private and hospital settings to extend their services to clients who previously would have had little access to such services. This study was conducted to identify the key competencies required by occupational therapists to deliver appropriate primary healthcare services to communities from previously disadvantaged periurban and rural areas. Methods. An exploratory, qualitative study design was used. Through the use of policy documents and data from key informants (), established therapists (), and novice occupational therapy graduates (), the study identified and mapped the stakeholders’ perspectives of the competencies required by graduates to practice in periurban and rural settings in KwaZulu-Natal in South Africa. Data was collected using semistructured interviews, a focus group discussion, a document review of the university’s curriculum, and the local and global regulatory documents. A framework based on the seven roles of the university’s competency framework informed the data analysis process. The seven roles are health practitioner, communicator, collaborator, health advocate, leader and management, scholar, and professional. Findings. Participants highlighted the need for graduates to have adequate knowledge and understanding of the impact of the Department of Health policies and social determinants of health on occupation and the client’s health. They also needed to be suitably skilled in culturally sensitive communication, negotiating shared goals with the stakeholders, and managing a department. Graduates needed to be socially accountable and develop services to advocate for their clients. Conclusion. The study offered insights into the essential graduate competencies identified by the stakeholders and recommended measures to prepare rehabilitation graduates for service delivery in primary healthcare contexts.
1. Introduction
The COVID-19 pandemic has highlighted the shortage of healthcare providers on a global scale. It accentuated the continued inequities to health services for underserved rural and marginalized communities in low- and middle-income countries. The trend to deliver contextually relevant community-responsive health practitioners to serve in the 21st century has been highlighted in the Lancet report [1]. The report recommends that health profession education institutions globally use an interprofessional education approach and ensure opportunities for transformative learning experiences during health profession training. Failure to expose graduates to varied contexts and setting with different socioeconomic determinants of health, cultures, and communities, training in disciplinary silos, and lack of integrative learning experiences are reasons listed in the report as to why graduates are poorly prepared for team-based care and unable to advocate for those in their care. Many countries in the global north and south have since implemented more population- and primary healthcare-based training programmes to address local health and social issues, including facilitating livelihoods and work opportunities through an occupational justice framework [2, 3]. Higher education institutions are therefore urged to expand the use of more innovative, student-centred, and community-engaged health profession education programmes to include training in low-resourced peripheral facilities. Such a shift is believed to promote the development of contextually relevant and work-ready graduates who would be more competent and confident to function in unfamiliar settings and better advocates for the social and health needs of people living in all settings including disadvantaged communities.
The need to increase access to health is central to uplifting people who live in marginalized communities [4]. This need is equally apparent in the South African (SA) society, where access to equitable health care, a constitutional right, remains fragile due to gross neglect during SA’s apartheid era. Access to health care in SA predominantly favoured some communities based on ethnicity and geographic locations ([5] : 165). South Africa has since formulated a National Development Plan to address widespread inequality and inequity, including implementing a national health insurance and primary healthcare (PHC) strategy to achieve equitable health for all SA citizens.
A PHC approach is internationally recognised as encompassing the use of a comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care strategy to prioritize healthcare services for individuals, families, and communities to optimize health and advocate for policies that promote and protect health and well-being [6]. It is envisioned that the integrated health service framework will address individualized health needs through primary healthcare and that the needs of the population will be met through public health functions [6]. The National Health Insurance (NHI) White Paper, which guides public sector service delivery in SA, similarly emphasizes a shift toward a more population-orientated primary healthcare approach to health and well-being [7]. The policy formation has accelerated the need for occupational therapists to embrace more primary healthcare approaches as part of the government’s strategy to ensure universal access to healthcare.
In the medical education context, authors have affirmed the role of higher education institutions (HEIs) in ensuring that a socially just approach is followed in activities relating to education, research, and community service to address the priority health needs of local communities [8]. In 2018, South Africa recorded a ratio of 0.9 occupational therapists per 10000 population. Although the number of occupational therapists registered with the Health Professions Council of South Africa has increased to 5638 in 2020 [9], the number is still inadequate to provide for the rehabilitation needs of the population. SA have traditionally trained limited numbers of occupational therapists, which resulted in their preference to working mainly in urban hospital settings and focusing on remedial and rehabilitative interventions at an individual level [10]. After completing a four-year undergraduate degree, occupational therapy graduates are regarded as qualified to enter public practice in the SA setting. New occupational therapists have experienced difficulty in delivering PHC services due to their lack of preparedness to cope with cultural differences and inadequate exposure to the needs of people living in periurban and rural communities during their training period [10, 11].
From a global perspective, Dahl-Popolizio et al.’s [12] commentary proposes that occupational therapists can assist in health promotion and disease prevention and reduce the development of chronic and noncommunicable diseases by working with clients and communities in primary healthcare settings. Occupational therapists’ unique approach of addressing the whole person offers an opportunity to address health behaviours by considering strategies that address the client’s context, value system, habits, community, and culture. Other researchers including Halle et al. [13] and Wood et al. [14] also highlighted the value and role of occupational therapy in primary care, interprofessional and team-based approaches, and current educational preparation for entry-level occupational therapists and occupational therapy assistants. Similarly, Wilcock and Hocking [15] and Hammell [2] emphasized the unique role that occupational therapists can play as part of an integrated primary healthcare team. Not only can they improve health outcomes by addressing the social determinants of health but they can also work across the lifespan and use a community-/population-based approach to health, health promotion, disease prevention, and lifestyle interventions [14–17]. The shift to integrate occupational therapists into PHC teams in the healthcare context is not unique. Reports have documented efforts to integrate occupational therapists into interprofessional teams in PHC settings in Australia, United Kingdom, and Canada [14, 15, 17–19]. However, there is limited published literature on the competencies required by entry-level occupational therapists for primary healthcare service delivery in African and South African settings.
While South African studies highlighted a need for occupational therapists to work at primary healthcare levels [20, 21], they also acknowledge how human resource constraints led to a prioritization of hospital-based interventions over population-based approaches. In alignment with the White Paper, the Occupational Therapy Association of South Africa (OTASA) formulated a position statement on the proposed roles of an occupational therapist in primary healthcare [22]. The statement emphasizes the relevance of the PHC approach in the South African context, and it supports the inclusion of occupational therapy services in emergent practice settings. The position paper proposes for occupational therapists to play multiple roles at the PHC level. Occupational therapists are expected to accept nontraditional roles in new complex environments, initiate and participate in intersectoral collaboration, and contribute to management structures in the PHC system [16, 19, 21, 22]. For example, in 2019, South Africa, a low-middle-income country, reported a 40.7% unemployment rate amongst 15- to 34-year-olds [23]. This statistic emphasizes the need for occupational therapists to work in PHC settings to provide greater vocational rehabilitation and engage the youth in entrepreneurship.
The position paper further envisaged the need to equip occupational graduates with knowledge, skills, and attitudes for professional practice during their undergraduate education. The vision to ensure that graduates are effectively and authentically prepared to meet service delivery needs in the community and PHC settings saw the implementation of the new vision for occupational therapy education at the local training institution. The shift encompassed clinical rotations for undergraduate students in more authentic community-based and rural training settings. The new training exposures are further from previous hospital-based service-learning sites and encompass a greater primary healthcare focus. [24, 25].
Occupational therapy educators have sought suitable models to express the roles required of competent “ready-to-practice” occupational therapy graduates in the SA healthcare setting. Faculties of health science associated with two South African universities have adopted and implemented a competency framework to inform curriculum design and to ensure that graduates attain the desired competencies as health professionals [26, 27]. This framework, adapted from the Physician competency framework [28], proposes that all cadres of health professionals develop and acquire the necessary skills in seven critical roles before graduation. These graduate competencies include the roles of the health practitioner expert, professional, communicator, collaborator, leader/manager, scholar, and health advocate.
The role of a health practitioner is essential to practice as a therapist. The professional role entails adhering to ethical standards and a commitment to pursue continued professional education. In terms of occupational therapy, graduates must demonstrate the ability to assess the impact of various health conditions on the client’s participation in life occupations, advise them on lifestyle modifications to address health risks, and advocate for health and well-being.
Much uncertainty remains over the competency mix required of occupational therapy graduates to meet workplace expectations in PHC settings especially given their new contribution to the healthcare teams in the rural and periurban SA contexts. A preliminary study reported on the challenges experienced by newly qualified graduates working in PHC in periurban and rural settings [10]. These challenges include a vague understanding of the PHC approach and being unaware of the realities of practising in a rural resource-constrained environment. They also lacked exposure to primary healthcare clinics during their training.
Despite the adoption of a generic competency framework to inform the education and training of all health profession students by the institution, an effective curriculum response for occupational therapy service in the KZN context requires a needs assessment to improve the alignment of curriculum goals, learning objectives, and clinical exposures to produce a “fit-for-purpose” and ready-to-practice occupational therapist. The South African health system is regulated at a national and provincial/state level. The occupational therapy programme at our institution is closely aligned with the KwaZulu-Natal Department of Health (KZN-DoH) which is the provincial government authority. KZN-DoH has mandated that health science programmes produce graduates who are capable of delivering services appropriate for periurban and rural hospitals in KZN.
This study was conducted as part of the curriculum review process [29] at one South African Higher Education Institution. The objective was to identify and report on the views of multiple stakeholders (including global and national accreditation guidelines) to define the competencies required by an occupational therapist to function at a primary healthcare level in the KwaZulu-Natal context.
2. Methodology
2.1. Study Location and Context
The study was conducted at a South African university that offers occupational therapy education in the province of KwaZulu-Natal. The occupational therapy programme is a four-year entry-grade undergraduate programme. The curriculum comprises four main pillars: occupational therapy theoretical constructs and ethical practice, occupational therapy professional practice, research, and service-learning rotations. Students deliver services during four-six to eight-week rotations in their final year in an acute hospital or nongovernmental organizational setting. One of the rotations occurs in a community setting where the students work as part of a multidisciplinary team and engage with community stakeholders.
KwaZulu-Natal is one of the more densely populated provinces with a mix of urban, periurban, and rural populations. It has the second-highest population in South Africa. It has a high disease burden, including decreased maternal, newborn, and child health; HIV and TB; noncommunicable diseases such as hypertension, diabetes, and stroke; and a high level of violence and injuries due to trauma.
2.2. Research Orientation and Design
This study was conducted to gain insight into the competencies required by occupational therapy graduates to serve in primary healthcare practice. An interpretivist paradigm guided the qualitative study. Data collection included focus group discussions, semistructured interviews, and the analysis of policy and training documents. The interpretivist paradigm recognizes “knowledge” as being socially constructed through the subjective views of the participants [30]. The subjectivist epistemological position was assumed in that the participants and the researcher coconstructed the data during the interviewing process. This position acknowledges the specific beliefs of participants about their realities and life experiences within a specific social context. The interpretivist paradigm allowed for the exploration and insight into multiple and possible diverse interpretations of reality rather than seeking a “single truth” for the data [30].
A purposive sampling strategy was used to invite representatives who are most knowledgeable and engaged with graduates from the occupational therapy programme. This strategy allowed for exploring multiple participant perspectives and acknowledging each participating group’s perspective as being embedded within the setting, culture, and unique life experiences. The three participant groups that were recruited included stakeholders from the KwaZulu-Natal Department of Health (KZN-DoH). As employers, they work closely and manage entry-level, novice, and established occupational therapists. Five key KZN-DoH participants () represented the management group. These key informants served as managers in PHC and rehabilitation at a national, provincial, and district healthcare level (see Table 1 for inclusion criteria).
Fourteen established occupational therapists were invited, and thirty-nine novice occupational therapists who worked in periurban and rural areas were recruited from the higher education occupational therapy 2012, 2013, and 2014 graduate cohorts (see Table 1 for inclusion criteria). Established occupational therapists are defined as those who had had been working for more than four years in a public sector hospital or at nongovernmental organizations in one of the two KwaZulu-Natal geographical districts where students are placed.
All participants were recruited via email or telephonic communication. Information relating to the study and an informed consent document were sent to those interested in participating before the interviews.
The perspectives of novice and established practitioners assisted in gaining an understanding of the competencies required from both perspectives as these participants had experience working in PHC settings in KZN and had been exposed to the occupational therapy curriculum at the higher education institution. The selection of these participants assisted in obtaining perspectives that were rooted within the participants’ experiences of working or living within the South African context and contributed their specific experientially based perceptions of delivering a PHC service from a grassroots worker level to that of a national manager level.
2.3. Data Collection
Data was collected using semistructured interviews and focus group discussions with the key informants from the KZN-DoH, established occupational therapy practitioners, and novice service occupational therapists (see Table 1) by the primary author. The primary author is a university academic with experience in qualitative data collection methods. The core question that guided the interviews was “What competencies are required by a new occupational therapy graduate to deliver a service in the PHC setting?” The focus group was held in person at a venue and time convenient to the participants. The focus group was conducted in English for approximately 90 minutes. The focus group allowed the participants to share their views in a supportive environment and deepened the discussion. Only one focus group discussion was held due to the availability of participants. The focus group was held after the semistructured interviews. The primary author initially conducted semistructured interviews on a one-to-one basis as this was found to be preferable in terms of convenience for the participants. The participants were given pseudonyms during the semistructured interviews and the focus group discussion. Additionally, a review of relevant documents was conducted using the university’s competency framework roles as the lens to explore the global and national training standards and outcomes and the university’s perspectives on the competencies required for practice (Table 1).
2.4. Data Analysis
A hybrid approach to data analysis as per the protocol outlined by Fereday and Muir-Cochrane [31] was used for data analysis. This process involved both inductive thematic analysis and the use of a deductive a priori template of codes that was based on the competency framework as used at the institution. The codes in the codebook were based on the different roles outlined in the competency framework. After data saturation was reached, the verbatim transcripts from the interviews and focus group were initially read and reread to become familiar with the data. The second reading helped to identify emerging codes. The primary author then applied a template approach. This involved developing a template from codes from a codebook. The codes from the codebook guided in identifying the data sets and organising the text and collapsing the data into themes based on the competency roles. The primary author discussed and verified the codes and the themes with the second author to reach a consensus on the codes and themes and to ensure there was no bias. The second author is a senior researcher with experience in qualitative data analysis. The data review revealed that the participants had only identified five of the seven a priori roles outlined in the codebook. Hence, only five roles are described in the study, namely, health professional, communicator, health advocate, leader/manager, and collaborator. After the roles emerged, the data were categorized into knowledge, skills, and attitudes to identify competencies required by entry-to-practice level occupational therapists. A peer debriefing process with the second author (an educationalist and not a teacher on the programme) allowed us to reach a consensus on the data analysis and extraction process. The authors were aware of their position within the research process. They occupied an insider perspective as all authors were involved in the research and had exposure to the institutional occupational therapy programme.
2.5. Ethical Consideration and Trustworthiness
Ethical approval for the study was granted by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (UKZN-BE248/14) and the KwaZulu-Natal Provincial Ethics Committee of the Department of Health. Principles of confidentiality and the right to withdraw were adhered to in the study. All participants received written and oral information relating to the study before signing the consent forms. Pseudonyms were used to protect their anonymity.
Trustworthiness was operationalized through the triangulation of data to ensure multiple perspectives of the KZN-DoH stakeholders and the occupational therapy stakeholders. Data method triangulation was achieved by using focus groups, semistructured interviews, and document analysis. Member checking was completed at the end of each interview, key points generated through the focus group discussions were summarised, and participants were asked to verify the accuracy thereof. These strategies ensured the credibility of the data. The dependability of the data was achieved through the use of an audit trail. The researcher kept field notes and wrote memos during the data collection and analysis to provide an accurate record of decisions.
3. Findings
Participants identified only five of the seven UKZN competency roles as essential for PHC practice. These roles included those of the health practitioner, communicator, collaborator, leader, and health advocate. The roles have been subdivided into the knowledge, skills, and attitudes required of occupational therapy graduates for PHC practice. A summary of the key competencies highlighted by participants is provided below. Tables 2–6 provide more details of the identified themes linked to verbatim quotes to substantiate the relevant roles. Participants are named using numbers to ensure anonymity.
3.1. Theme One: Role of a Health Practitioner
The occupational therapist’s role as a health practitioner was viewed as essential and central for graduates to deliver equitable PHC services. The knowledge required includes a sound understanding of the PHC approach, the roles expected from graduates at different levels of care, and an overall understanding of how the health systems function. Graduates should have insight into governmental procedures particularly to how policies and procedures impact health and service delivery. Additionally, participants emphasized that graduates should know the contextual, structural, and cultural factors that influence community participation in occupation.
Graduates need context-specific skills that are community-focused that acknowledge the cultural context of the community where they work. They also need profession-specific skills to address prevalent conditions and to deliver contextually relevant and culturally specific interventions in the community context.
Numerous attributes were mentioned relating to this role. It was identified that graduates should be problem solvers, “think out of the box,” adaptable, resilient, persevering, resourceful, proactive, and demonstrate social accountability and empathy. Additionally, graduates need an awareness of the power relationships and to be culturally sensitive when dealing with clients.
3.2. Theme Two: Role of a Communicator
Graduates need to be proficient in the local indigenous language and use alternative augmentative communication for communication. Skills required for effective communication include having good verbal and written communication, especially for feedback and for use in managerial positions. Graduates should recognize the political workplace climate and adapt their communication appropriately. If unable to communicate in the indigenous language, the graduate should elicit the assistance of a skilled translator. All participants emphasized the need for graduates to be resilient when receiving feedback and assertive when advocating for change to the health system and to improve population health in community settings.
3.3. Theme Three: Role of a Collaborator
Graduates need to demonstrate knowledge and insight into social and health legislation, policy, and procedures to develop and implement collaborative community or multidisciplinary projects. Additionally, participants highlighted the essential need for graduates to understand the benefits of establishing a network. Skills required for collaboration include creating and maintaining a network, collaborating and developing beneficial goals for the client or the project, and working with members of diverse teams. Additionally, graduates should be able to negotiate community entry, demonstrate a willingness to pay attention to stakeholder views, and take cognizance of their concerns.
3.4. Theme Four: Role of a Health Advocate
As a health advocate, graduates should know how the health systems interact in the community and how this interrelatedness influences health outcomes for their clients. Furthermore, graduates need insight into their role in empowering the client’s ownership of their health and advocating for health promotion. Skills required include serving as an advocate for clients and the community and delivering primary, secondary, and tertiary preventative programmes. They also need to develop partnerships and facilitate task-shifting with community healthcare workers to ensure the continuity of services. The graduates need to demonstrate resilience and persistence to overcome challenges when advocating for clients and programmes.
3.5. Theme Five: Role of a Leader and a Manager
Knowledge required for the role of manager and leader includes the ability to evaluate existing services and plan and develop new services as and where required. Graduates need skills to develop policies and procedures, prioritize workloads, and propose changes to improve inefficient systems. Furthermore, graduates need to develop insight into financial management and departmental administration. Being proactive and determined were the attributes highlighted as the most important for the leader and manager role.
4. Discussion
The findings from this study provided insight into the essential competencies based on policy directives and stakeholder perceptions as relevant for occupational therapy service delivery at a PHC level. The need for graduates to have expert knowledge and skills was viewed as central in delivering equitable PHC services. The key attributes highlighted include being problem solvers, adaptable, resilient, resourceful, proactive, and empathetic. Participants stressed the need for graduates to be aware of the power relationships and show cultural sensitivity when dealing with clients.
The key considerations for intervention at the PHC level included the consideration of contextual, structural, and cultural factors influencing participation in occupation, social determinants of health, different levels of care, having resource limitations, and implementing health promotion and disease prevention programmes. This finding is aligned with Hammell’s recommendation for occupational therapists to actively address the social determinants that obstruct occupational engagement. Such adherence to address the obstacles will promote occupational equity and occupational rights [2]. Additionally, graduates should have an overall understanding of the functioning of the health systems, government processes, and how this potentially influences their occupational therapy practice. The findings of the study concur with the literature on the occupational therapists’ role in PHC. [14–17, 19].
The competencies linked to the roles of communicator, collaborator, health advocate, and leader and manager had a greater skill focus. Culturally competent communication was identified as a critical skill to adapt to different political work climates, for networking, and to negotiate community entry and facilitate reciprocal learning in teams. The critical elements for cultural and competent communication in the medical context were previously stressed by Teal and Street [32]. The essential elements in culturally competent communication include recognizing potential differences, incorporating cultural knowledge, and being aware of verbal and nonverbal behaviour when negotiating and collaborating. The literature also reaffirms the need for graduates to use collaborative approaches, to being socially accountable, actively interact with the community, acknowledge their belief systems, and accommodate for perceived power differentials to facilitate productive partnerships with community members [14, 16, 33].
Collaboration, communication, and leadership skills were identified as essential competencies to initiate projects, establish and maintain networks, and facilitate common goals within diverse multidisciplinary teams and with clients, families, and other stakeholders in the community. Skills required for health advocacy included developing primary, secondary, and tertiary prevention programmes, using their understanding of the impact of the health system on the client and communicating to develop health promotion programmes such as early stimulation programmes for children and being able to task-shift to community healthcare workers to ensure continuity of care. Wilcock and Hocking [15] similarly highlighted the need to develop programmes that promote health in the community and focus on illness prevention, chronic disease management, and reduce health risk behaviour. Being a health advocate required graduates to speak up for the rights of their clients—both in the hospital and in community settings. This competency is closely linked to the graduate’s ability to recognize social injustice and their knowledge of how to apply policies to consult when advocating for clients and at-risk populations. Similar to the findings in this study, both Wilcock and Hocking [15] and Galheigo [34] suggested that a combination of advocacy, collaboration, and leadership skills should be developed in graduates to allow them to establish programmes and promote for the rights of their clients.
The competencies identified in this study are relevant to both general occupational therapy practice and its practice in PHC settings. It is noteworthy to mention that the stakeholders were uncertain about the role of occupational therapists in the PHC setting. Occupational therapists expressed limited views on the competencies required by graduates to practice health promotion and prevention in PHC settings which may be due to their lack of training and practice experiences in the PHC setting. The uncertainty remains despite the policy imperatives both by SA’s National Department of Health [7] and the Occupational Therapy Association of South Africa advocating for more health promotion and prevention in service delivery by public sector therapists [22].
There is thus a need to guard against occupational therapy services slipping back into conventional practices. Braveman [18] suggests that uncertainty about roles and contributions could be due to the occupational therapists’ lacking clarity and insight into their roles in the new context and thus being inadequately receptive to potential areas of contribution, which in turn reflects their education and practice exposures during their undergraduate curriculum. Naidoo et al. [21] similarly found that community stakeholders articulated the need for services at a primary healthcare level; however, they were not as vocal on services required for health promotion, consultation roles, and disease prevention.
The competencies identified in this study can inform curriculum development and review to align teaching, learning, and assessment practices with PHC approaches which are now more strongly present in occupational therapy training. Occupational therapy students currently engage with PHC concepts relating to service delivery during a community rotation in their final year. However, a previous study exploring a graduates’ ability to implement primary healthcare approaches revealed perceived inabilities to manage cultural differences, to complete administrative and management tasks, and inadequate exposure to the needs of people living in periurban and rural community settings [21].
A possible solution to promote the understanding of the occupational therapy role in PHC and the required competencies needed for successful functioning is to ensure that they are embedded as learning outcomes for students to achieve during their service-learning rotation. It would be essential to inform students of the required competencies that need to be achieved for the successful completion of the rotation. There should be more opportunities for students to practice collaborative goal setting within the multidisciplinary team, intersectoral collaboration with the stakeholders from various government departments in the community, and opportunities to develop and implement health promotion and disease prevention programmes. Students should be expected to implement programmes that promote social justice during service learning in community settings [2].
5. Implications for Practice
Occupational therapy educational programmes should produce ethical and socially responsible graduates with the vision, knowledge, skill, and willingness to deliver services to previously marginalized communities.
Educational programmes need to shift their vision and focus from delivering services on a micro- and macrolevel with individual clients in hospital/clinic settings to promoting wellness and population health in community settings.
The critical task for curriculum designers is to consider the needs of the stakeholders during the curriculum review phases to include opportunities to develop, model explicitly, and assess graduate outcomes for PHC settings.
It is hoped that the findings from this study will inform aspects of future training in SA to ensure that graduates are adequately prepared to work in PHC settings. We are acutely aware of the curriculum overload in existing occupational therapy training programmes and how the implementation of these guidelines will require further negotiation amongst curriculum designers.
It should be noted that the findings are generated from a single-site study; therefore, the findings apply to KwaZulu-Natal and are not generalizable. Educators at other higher education institutions would need to review the findings against their specific contexts. It would have been beneficial to include the educator perspective to allow for greater insight and application to the curriculum, but we are confident that this phase generated sufficient insight to continue the ongoing revisions as required on this programme.
6. Conclusion
The transition toward a more comprehensive primary healthcare approach to intervention requires occupational therapists who predominantly worked in private and hospital settings to provide a broader scope of services to clients who previously had little access to such services. This study identified critical competencies required of occupational therapists to deliver appropriate primary healthcare services to clients in periurban and rural areas. The findings can inform curriculum review since stakeholders from various sectors identified the essential graduate competencies. The recommended measures also have implications for service training placements to prepare graduates more appropriately for primary healthcare service delivery.
Data Availability
Data is available on request.
Conflicts of Interest
The authors have no conflict of interest.
Authors’ Contributions
DN contributed toward the conceptualization of the work, the data collection contributed toward the analysis of the data, and the drafting of the manuscript and a critical review of the manuscript. JVW contributed toward the conceptualization, the analysis of the data, drafting of the manuscript, and the critical review of the manuscript.
Acknowledgments
The authors would like to acknowledge the participants of the study without which this study would not have been achievable.