Individuals with severe mental illness (SMI) often experience limited community participation and reduced quality of life. Occupation-based group interventions informed by culturally responsive models such as the Kawa Model may support well-being and engagement. This study aimed to examine the effects of a Kawa Model–guided occupation-based group intervention on quality of life and community participation in individuals with SMI.
Method:
A single-group pretest–posttest design was used. Eight adults with SMI participated in a 10-week group intervention guided by the Kawa Model. Quantitative outcomes were assessed using the World Health Organization Quality of Life–BREF (WHOQOL-BREF) and the Community Integration Questionnaire. Qualitative data were collected through Kawa-based interviews and real-time reflections.
Results:
Post-intervention improvements were observed in community integration and social relationships. Participants reported enhanced self-expression, motivation, and a greater sense of belonging. River drawings illustrated changes in occupational identity and perceived life flow.
Conclusion:
A Kawa-guided group intervention may enhance participation and well-being among individuals with SMI. Findings support the utility of culturally grounded, metaphor-driven approaches in occupational therapy mental health practice.
AkyurekGSalarSBuminG, et al. (2016) Turkish adaptation of the Community Integration Questionnaire (CIQ) and its validity and reliability in people with SCI. Archives of Physical Medicine and Rehabilitation97(10): e41–e42. https://doi.org/10.1016/j.apmr.2016.08.123
2.
AygünDAkelBS (2018) Kawa Modeli’nin Kullanımına İlişkin Olumlu ve Olumsuz Özelliklerin İncelenmesi. Ergoterapi ve Rehabilitasyon Dergisi6(2): 111–116. https://doi.org/10.30720/ered.463553
3.
BarlottTShevellarLTurpinM, et al. (2020) Destabilising social inclusion and recovery, and pursuing ‘lines of flight’ in the mental health sector. Sociology of Health & Illness42(6): 1328–1343. https://doi.org/10.1111/1467-9566.13106
4.
Birgitta GunnarssonAWagmanPHedinK, et al. (2018) Treatment of depression and/or anxiety–outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy. BMC Psychology6: 25. https://doi.org/10.1186/s40359-018-0237-0
5.
BrownCLBroadwaterARChristianDD (2023) The power of Kawa: Metaphor in counseling supervision. Journal of Creativity in Mental Health18(2): 263–276. https://doi.org/10.1080/15401383.2021.1950093
6.
ChooCCChewPKHoCS, et al. (2019) Quality of life in patients with a major mental disorder in Singapore. Frontiers in Psychiatry9: 727. https://doi.org/10.3389/fpsyt.2018.00727
7.
CreswellJWCreswellJD (2017) Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Sage Publications.
8.
DefarSAbrahamYRetaY, et al. (2023) Health related quality of life among people with mental illness: The role of socio-clinical characteristics and level of functional disability. Frontiers in Public Health11: 1134032. https://doi.org/10.3389/fpubh.2023.1134032
9.
EserEFidanerHFidanerC, et al. (1999) WHOQOL-100 ve WHOQOL-BREF’ in psikometrik özellikleri. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi7(Suppl 2): 23–40.
10.
GreggBTHowellDMQuickCD, et al. (2015) The Kawa River model: Applying theory to develop interventions for combat and operational stress control. Occupational Therapy in Mental Health31(4): 366–384. https://doi.org/10.1080/0164212X.2015.1075453
11.
HertzogMA (2008) Considerations in determining sample size for pilot studies. Research in Nursing & Health31(2): 180–191. https://doi.org/10.1002/nur.20247
12.
HockingCTownsendEMaceJ (2022) World Federation of Occupational Therapists position statement: Occupational Therapy and Human Rights (Revised 2019)–the backstory and future challenges. World Federation of Occupational Therapists Bulletin78(2): 83–89. https://doi.org/10.1080/14473828.2021.1915608
13.
HsiaoH-YWangT-YLeeC-H, et al. (2024) Advancing readiness for change in substance use for people with substance use disorders using the Kawa model based intervention program: A quasi-experimental study. Hong Kong Journal of Occupational Therapy37(2): 91–101. https://doi.org/10.1177/15691861241268143
14.
IwamaMK (2006) The Kawa Model: Culturally Relevant Occupational Therapy. Elsevier Health Sciences.
15.
IwamaMKThomsonNAMacdonaldRM, et al. (2009) The Kawa model: The power of culturally responsive occupational therapy. Disability and Rehabilitation31(14): 1125–1135. https://doi.org/10.1080/09638280902773711
16.
LimKH (2018) Personal Journeys of Recovery: Exploring the Experiences of Mental Health Service Users Engaging with the Kawa ‘River’ model. Brunel University London.
17.
MarsdenETorgersonCJ (2012) Single group, pre-and post-test research designs: Some methodological concerns. Oxford Review of Education38(5): 583–616. https://doi.org/10.1080/03054985.2012.731208
18.
NagataSTownleyGBrusilovskiyE, et al. (2020) Community participation differences between adults with or without serious mental illness. Psychiatric Services71(11): 1191–1194. https://doi.org/10.1176/appi.ps.201900608
19.
NaidooOChristopherCLingahT, et al. (2023) The Kawa model: A self-reflection tool for occupational therapy student development in practice placements in Australia. Occupational therapy international2023(1): 2768898. https://doi.org/10.1155/2023/2768898
20.
NewburyRSLapeJE (2021) Well-being, aging in place, and use of the Kawa model: A pilot study. Annals of International Occupational Therapy4(1): 15–25. https://doi.org/10.3928/24761222-20200413-02
21.
OberJLNewburyRSLapeJE (2022) The dynamic use of the Kawa model: A scoping review. The Open Journal of Occupational Therapy10(2): 1–12. https://doi.org/10.15453/2168-6408.1952
22.
OwenA (2014) Model Use in Occupational Therapy Practice with a Focus on the Kawa Model. University of the Witwatersrand, Johannesburg.
23.
PaxsonDWinstonKTobeyT, et al. (2012) The Kawa Model: Therapists’ experiences in mental health practice. Occupational Therapy in Mental Health28(4): 340–355. https://doi.org/10.1080/0164212X.2012.708586
24.
QueirozAGGalanACDarbyshireL, et al. (2021) Leisure in mental health occupational therapy interventions: a Qualitative investigation. Research, Society and Development10(11): e200101119439. https://doi.org/10.33448/rsd-v10i11.19439
25.
ScaffaMEReitzSM (2020) Occupational Therapy in Community and Population Health Practice. FA Davis.
26.
SolaruAMendoncaRDonovanC (2023) Lived experiences of community-dwelling adults with serious mental illness related to mental health services: An exploratory study. The American Journal of Occupational Therapy77(Suppl 2): p7711505161–p7711505163. https://doi.org/10.5014/ajot.2023.77S2-PO163
27.
TaylorRR (2017) Kielhofner’s Model of Human Occupation: Theory and Application. 5th ed. Wolters Kluwer.
28.
TeohJYIwamaMK (2015) The Kawa Model Made Easy: A Guide to Applying the Kawa Model in Occupational Therapy Practice. 2nd ed. Kawa Model Website. Available at: www.kawamodel.com
29.
TownleyGBrusilovskiyESnethenG, et al. (2018) Using geospatial research methods to examine resource accessibility and availability as it relates to community participation of individuals with serious mental illnesses. American Journal of Community Psychology61(1–2): 47–61. https://doi.org/10.1002/ajcp.12216
30.
Valverde-BolivarESimonelli-MuñozAJRivera-CaravacaJM, et al. (2022) Occupational therapy in severe mental disorder—A self-controlled quasi-experimental study. Healthcare (Basel)10(3): 493. https://doi.org/10.3390/healthcare10030493
31.
WeisAKugelJDJavaherian-DysingerH, et al. (2019) Life after losing an adult child to a drug overdose: A Kawa perspective. The Open Journal of Occupational Therapy7(3): 1–14. https://doi.org/10.15453/2168-6408.1488
32.
WillerBRosenthalMKreutzerJS, et al. (1993) Assessment of community integration following rehabilitation for traumatic brain injury. The Journal of Head Trauma Rehabilitation8(2): 75–87. https://doi.org/10.1097/00001199-199308020-00009
33.
World Health Organization (1998) Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine28(3): 551–558. https://doi.org/10.1017/S0033291798006667
34.
XieZTannerRStrileyCL, et al. (2022) Association of functional disability with mental health services use and perceived unmet needs for mental health care among adults with serious mental illness. Journal of Affective Disorders299: 449–455. https://doi.org/10.1016/j.jad.2021.12.040
35.
ZarboCAgostaSCasiraghiL, et al. (2022) Assessing adherence to and usability of Experience Sampling Method (ESM) and actigraph in patients with Schizophrenia Spectrum Disorder: A mixed-method study. Psychiatry Research314: 114675. https://doi.org/10.1016/j.psychres.2022.114675
