Activity Participation and Restriction for Community Clients With Schizophrenia Through the Kawa Model Perspective

BACKGROUND: Clients with schizophrenia in Taiwan may choose to attend day care centers as rehabilitation. Besides medical services, they spend a lot of time trying to participate and engage in their communities. According to the KAWA model, life is a profound and dynamic journey like a river. Individuals’ roles and social patterns are determined by the contexts they live in. As occupational therapists, we could offer a holistic service when we know more about the lens of clients through the KAWA model. Therefore, the purpose of this pilot study was to clarify the activity participation and restriction for the community clients with schizophrenia using the perspective of the KAWA model.

METHOD: This qualitative study used the principles of community-based participatory research with Photovoice methods. The participants were 20–65 yr old with schizophrenia or schizoaffective disorder and recruited from day care centers in Taipei. They had the ability to operate a camera and to engage in focus group discussions. Each group included 3–5 participants and was asked to complete three photo assignments for reflecting their community life. The “SHOWED” method was used to guide every participant’s sharing and photo discussion during each group session. The group discussions were transcribed, and the KAWA model was used to guide data analysis.

RESULTS: Twenty participants in five groups were enrolled in this study. There are three components of the KAWA model: rocks (impediments), driftwood (personal attributes and resources), and river side-wall/bottom (social and physical contexts), used in this study. The rocks included five themes, physical condition (e.g., the symptoms of schizophrenia, obesity, and stamina), financial resources, capabilities, interpersonal relationship, and lack of meaning in life. The desire to relationship, the perspective of appreciation, responsibility and private activities (e.g., watching TV, buying lottery tickets) were the four themes represented by the driftwood. Seven themes included in the river side-wall/bottom were family members, pets, religion, Internet services (e.g., Facebook, email), friends, nature environment, and medical services.

DISCUSSION: Through analyzing the components of KAWA model, the issue of struggling within interpersonal relationships between the components of impediment and personal attribute represented the vulnerability for clients with schizophrenia. How to use their personal attributes integrated with social context to empower clients with schizophrenia to purchase their interpersonal relationships will be the next research direction. Although medical services offered regular and various activities as treatment, the thought for lack of life meaning still existed. The meaning of life with mental illness could be an essential point in recovery.

IMPACT STATEMENT: This is a pilot study that used the KAWA model perspective to analyze the material coming from the community-based participatory research with Photovoice method. This research method could contribute more structure and holistic perspectives for occupational therapists to understand the challenge that clients with schizophrenia faced and find out the solution.