Refugee adolescents face significant barriers to daily participation, including economic hardships, health concerns, trauma, and social isolation.
Objective:
To explore occupational performance and the participation challenges of refugee adolescents at a youth center, using the Kawa model.
Design:
Qualitative, phenomenological study using semistructured interviews and Kawa model-based visual activities. The thematic analysis was guided by Braun and Clarke’s framework.
Setting:
Ankara Altındağ Youth Center in Ankara, Turkey.
Participants:
Twelve refugee adolescents (ages 10–18 yr). Participants resided in Turkey for at least 6 mo and were purposively sampled for diversity.
Outcomes and Measures:
Challenges and facilitators to occupational performance and participation were explored.
Results:
Five main themes emerged: economic hardships and survival struggles, health and safety for a secure future, seeking a new life in the shadow of war, family ties between support and burden, and hopes for the future shaped by the flow of life.
Conclusions and Relevance:
The Kawa model effectively illuminated the complex factors that influence the lives of refugee adolescents. Findings highlight the need for culturally sensitive, holistic occupational therapy interventions addressing both barriers and facilitators to participation.
Plain-Language Summary
Using the Kawa model, this study explored the daily life challenges and hopes of refugee adolescents in Turkey. Financial issues, health and safety concerns, and past trauma were identified as major obstacles, or “rocks in their life river.” Strong family ties functioned as supportive “river walls,” whereas the educational journey and hopes for the future were seen as “driftwood” and “open spaces” for progress. Occupational therapy should address both difficulties and strengths to help these young people thrive.
Positionality Statement
At the time of the study, the lead author (Emine Sağlamoğlu) was a research assistant and occupational therapist with experience working with disadvantaged youths. The second author (Hatice Abaoğlu) was an associate professor specializing in mental health and qualitative research. The multidisciplinary research team, possessing expertise in participation problems and occupational performance, conducted all interviews. A researcher with 10 yr of occupational therapy experience finalized the interview questions.
Using the Kawa model, this study explored the daily life challenges and hopes of refugee adolescents in Turkey.
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References
1.
AbdiS.Akinsulure‐SmithA. M.SarkadiA.FazelM.EllisB. H.GillespieS., … BetancourtT. S. (2023). Promoting positive development among refugee adolescents. Journal of Research on Adolescence, 33, 1064–1084. https://doi.org/10.1111/jora.12890
2.
AlhaddadL.GoodwinR., & KanngiesserP. (2023). Challenges and coping: Perspectives of Syrian and Iraqi refugee youth in Germany. Journal of Adolescent Research, 38, 1043–1080. https://doi.org/10.1177/07435584211056069
3.
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
4.
BarretoM. D. S.WolfI.SouzaN. C. D.BuzzerioL. F.VieiraV. C. D. L.Figueiredo-BarbieriM. D. C., & MarconS. S. (2024). Experiences of providers and immigrants/refugees with health care: A meta-synthesis of the Latin American context. Canadian Journal of Nursing Research, 56, 151–163. https://doi.org/10.1177/08445621231215845
5.
Belhan ÇelikS.ÖzkanE., & BuminG. (2022). Effects of occupational therapy via telerehabilitation on occupational balance, well-being, intrinsic motivation and quality of life in Syrian refugee children in COVID-19 lockdown: A randomized controlled trial. Children, 9, 485. https://doi.org/10.3390/children9040485
6.
BilselB. A., & AydönerS. (2021). Çevre faktörü ve ergoterapi: Teori ve model yaklaşımları [Environmental factors and occupational therapy: Theory and model approaches]. İstanbul Gelişim University Journal of Health Science, 2021, 616–629. https://doi.org/10.38079/igusabder.995196
7.
BlankvoortN.ArslanM.TonoyanA.DamourA. Q., & MpabanziL. (2018). A new you: A collaborative exploration of occupational therapy’s role with refugees. World Federation of Occupational Therapists Bulletin, 74, 92–98. https://doi.org/10.1080/14473828.2018.1526560
8.
BraunV., & ClarkeV. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11, 589–597. https://doi.org/10.1080/2159676X.2019.1628806
9.
BrownC. L.BroadwaterA. R., & ChristianD. D. (2023). The power of Kawa: Metaphor in counseling supervision. Journal of Creativity in Mental Health, 18, 263–276. https://doi.org/10.1080/15401383.2021.1950093
CaccianiL.BaglioG.RossiL.MateriaE.MarcecaM.GeraciS., ... GuasticchiG. (2006). Hospitalisation among immigrants in Italy. Emerging Themes in Epidemiology, 3, 4. https://doi.org/10.1186/1742-7622-3-4
12.
CrawfordJ.KapisavanhuN.MooreJ.CrawfordC., & LundyT. (2023). A critical review of social exclusion and inclusion among immigrant and refugee women. Advances in Public Health, 2023, 8889358. https://doi.org/10.1155/2023/8889358
13.
CrosbyA. M. (2023). Using the Kawa model to improve early education teachers’ social-emotional health [Doctoral dissertation, Medical University of South Carolina]. MEDICA@MUSC. https://medica-musc.researchcommons.org/muscotd-ppotd/9
14.
DarawshehW. B. (2019). Exploration of occupational deprivation among Syrian refugees displaced in Jordan. American Journal of Occupational Therapy, 73, 7304205030. https://doi.org/10.5014/ajot.2019.030460
15.
DemirB. (2022). Göçmenler ve sağlık [Immigrants and health]. İnsan Hareketliliği Uluslararası Dergisi, 2, 298–313.
16.
EssexR., & KalocsányiováE. (2022). Between resistance and complicity, the Australian healthcare community and 30 years of immigration detention. Journal of Immigrant and Minority Health, 24, 1599–1601. https://doi.org/10.1007/s10903-022-01389-7
17.
GarramoneP.Knis-MatthewsL.BrandeisP.KretM.SliwaL., & LevaA. (2021). Against the current: Exploring the experiences of five fathers with a history of substance use. Occupational Therapy in Mental Health, 37, 332–356. https://doi.org/10.1080/0164212X. 2021.1980174
18.
GreggB. T.HowellD. M.QuickC. D., & IwamaM. K. (2015). The Kawa river model: Applying theory to develop interventions for combat and operational stress control. Occupational Therapy in Mental Health, 31, 366–384. https://doi.org/10.1080/0164212X.2015.1075453
19.
GulerJ., & BermanS. L. (2019). Acculturation, identity distress, and internalizing symptoms among resettled adolescent refugees. Journal of Adolescence, 76, 129–138. https://doi.org/10.1016/j.adolescence.2019.07.016
20.
GuoL.LiL.XuK.WangW.NiY.LiW., … ZhangW.-H. (2023). Characterization of premigration and postmigration multidomain factors and psychosocial health among refugee children and adolescents after resettlement in Australia. JAMA Network Open, 6, e235841. https://doi.org/10.1001/jamanetworkopen.2023.5841
21.
HamariL.KonttilaJ.MerikukkaM.TuomikoskiA.-M.KouvonenP., & KurkiM. (2022). Parent support programmes for families who are immigrants: A scoping review. Journal of Immigrant and Minority Health, 24, 506–525. https://doi.org/10.1007/s10903-021-01181-z
22.
HettichN.SeidelF. A., & StuhrmannL. Y. (2020). Psychosocial interventions for newly arrived adolescent refugees: A systematic review. Adolescent Research Review, 5, 99–114. https://doi.org/10.1007/s40894-020-00134-1
23.
HynieM.OdaA.CalaresuM.KuoB. C. H.IvesN.JaimesA., … McKenzieK. (2023). Access to virtual mental healthcare and support for refugee and immigrant groups: A scoping review. Journal of Immigrant and Minority Health,25, 1171–1195. https://doi.org/10.1007/s10903-023-01521-1
24.
IversM., & RiegerP. (2020). Understanding values, beliefs, and spirituality within a diverse country: Implications for health care professionals (Occupational Therapy Capstone 453) [MOT capstone, University of North Dakota]. UND Scholarly Commons. https://commons.und.edu/ot-grad/453/
25.
IwamaM. K. (2006b). The Kawa model: Culturally relevant occupational therapy.Elsevier Health Sciences.
26.
IwamaM. K. (2006a). The Kawa (river) model: Client centred rehabilitation in cultural context. In DavisS. (Ed.), Rehabilitation: The use of theories and models in practice (pp. 147–168). Elsevier.
27.
IwamaM. K.ThomsonN. A., & MacdonaldR. M. (2009). The Kawa model: The power of culturally responsive occupational therapy. Disability and Rehabilitation, 31, 1125–1135. https://doi.org/10.1080/09638280902773711
28.
JanusE. (2017). The Kawa model in occupational therapy and its application in the rehabilitation of a mentally challenged patient. Advances in Rehabilitation, 31, 27–36. https://doi.org/10.1515/rehab-2015-0059
29.
JeyasundaramJ.CaoL. Y. D., & TrenthamB. (2020). Experiences of intergenerational trauma in second-generation refugees: Healing through occupation. Canadian Journal of Occupational Therapy, 87, 412–422. https://doi.org/10.1177/0008417420968684
30.
KabiruC. W.HabibH. H.BeckwithS.AjayiA. I.MukabanaS.MachokaB. N., … KågestenA. E. (2024). Risk and protective factors for the sexual and reproductive health of young adolescents: Lessons learnt in the past decade and research priorities moving forward. Journal of Adolescent Health, 75(Suppl.), S20–S36. https://doi.org/10.1016/j.jadohealth.2024.03.007
31.
KhanS. A.KanjiZ.DavisJ. A., & StewartK. E. (2023). Exploring occupational transitions of Syrian refugee youth to Canada. Journal of Occupational Science, 30, 6–23. https://doi.org/10.1080/14427591.2021.1975557
32.
KronenbergF.PollardN., & SakellariouD. (2011). Occupational therapies without borders – Volume 2: Towards an ecology of occupation-based practices.Elsevier Health Sciences.
33.
LeeE. S.SzkudlarekB.NguyenD. C., & NardonL. (2020). Unveiling the canvas ceiling: A multidisciplinary literature review of refugee employment and workforce integration. International Journal of Management Reviews, 22, 193–216. https://doi.org/10.1111/ijmr.12222
34.
MajapuroH. (2017). Applicability of the Kawa model as a framework for the occupational therapy process [Unpublished master’s thesis, Jönköping University]. Jönköping University Digital Repository. https://api.semanticscholar.org/CorpusID:79584847
35.
MetznerF.AdedejiA.WichmannM. L.-Y.ZaheerZ.SchneiderL.SchlachzigL., … MaysD. (2022). Experiences of discrimination and everyday racism among children and adolescents with an immigrant background – Results of a systematic literature review on the impact of discrimination on the developmental outcomes of minors worldwide. Frontiers in Psychology, 13, 805941. https://doi.org/10.3389/fpsyg.2022.805941
36.
NewburyR. S., & LapeJ. E. (2021). Well-being, aging in place, and use of the Kawa model: A pilot study. Annals of International Occupational Therapy, 4, 15–25. https://doi.org/10.3928/24761222-20200413-02
37.
OberJ. L., & LapeJ. E. (2019). Cultivating acute care rehabilitation team collaboration using the Kawa model. Internet Journal of Allied Health Sciences and Practice,17, 9. https://doi.org/10.46743/1540-580x/2019.1827
38.
OberJ. L.NewburyR. S., & LapeJ. E. (2022). The dynamic use of the Kawa model: A scoping review. Open Journal of Occupational Therapy, 10, 1–12. https://doi.org/10.15453/2168-6408.1952
39.
OwenA. (2014). Model use in occupational therapy practice with a focus on the Kawa model [Unpublished master’s thesis].University of Witwatersrand, Johannesburg. https://hdl.handle.net/10539/15351.
40.
PaxsonD.WinstonK.TobeyT.JohnstonS., & IwamaM. (2012). The Kawa model: Therapists’ experiences in mental health practice. Occupational Therapy in Mental Health, 28, 340–355. https://doi.org/10.1080/0164212X.2012.708586
41.
RyuW. (2020). The effect of traumatic experiences of North Korean adolescent refugees upon their negative health perception: Focusing on multiple moderating effect of problem-focused versus social support-focused coping strategies. International Journal of Environmental Research and Public Health, 17, 9484. https://doi.org/10.3390/ijerph17249484
42.
YehE.HuangL.-J., & WuC. (2016). Activity participation and restriction for community clients with schizophrenia through the Kawa model perspective. American Journal of Occupational Therapy, 70, 7011510232. https://doi.org/10.5014/ajot.2016.70S1-PO6113
