Learning from the margins: Enabling effective occupational therapy

Introduction: This study investigated the practice of occupational therapy in marginal settings to see if it could offer anything to take forward the development of occupational therapy theory and practice. Method: The study began with the assumption that occupational therapy consists of an idea and a practice, both embedded in particular times, places and contexts. An interpretive methodology was selected to explore how the idea and practice develop as practitioners try to make sense of their practice. A multiple case study design was employed, using qualitative interview methods to explore the perceptions of practitioners working in marginal settings. The research design was not fully specified from the beginning, but emerged during the course of the study. Findings: The practice of occupational therapists working on the margins differed from that in the mainstream in several features, but the differences tended to be of degree. Practitioners shared five characteristics which enabled them to practise effectively in resource-poor conditions: agency; openness; commitment; responsiveness; and resourcefulness. Conclusion: Developing these enabling characteristics in occupational therapy students and practitioners has the potential to make them better able to make an effective contribution to meeting complex health and social care needs in developed and developing countries.