Occupational therapy interventions for substance-related disorders in the public primary health care sector in the city of Johannesburg

Abstract

Introduction: The specific nature of occupational therapy interventions for substance-related disorders in South African primary health care settings remain unclear, despite these disorders posing significant intersecting health and social challenges. The 2023 Prevention of and Treatment for Substance Use Disorders Policy emphasises a shift towards collaborative care, however it remains unclear how occupational therapists enact these directives. Methods: An exploratory qualitative study explored substance-related disorder interventions provided by occupational therapists in the City of Johannesburg’s public primary health care facilities. Purposive heterogeneous sampling was used to select eighteen participants consisting of occupational therapists (n=8), multidisciplinary team members (n=6) and service users (n=4). Semi-structured interviews were audio-recorded, written, transcribed verbatim and thematically analysed.Results: Six themes emerged: (1) individualised approaches to substance-related disorder interventions, (2) campaigns and screenings, (3) barriers to service delivery, (4) socioeconomic and contextual influences on substance use, (5) service users’ experiences with occupational therapy, and (6) proposed solutions for improved substance-related disorder interventions. Conclusion: Despite challenges in South African public health settings—such as underfunding and staff shortages—occupational therapists in primary health care settings provide numerous occupation-based interventions for substance-related disorders. These interventions address occupational performance in individual and group settings, with gardening groups being the most common form of group intervention. Implications for practice: The findings suggest that occupational therapy interventions for substance-related disorders primarily focus on leisure, education, work, psychoeducation, coping skills development, and referrals to learnerships. However, health promotion and substance-related disorder prevention are often underemphasised. These findings highlight the need for occupational therapists to actively engage in health promotion, substance-related disorder prevention, and enhanced interprofessional collaboration to address these conditions more comprehensively.