An introduction to Cultural Historical Activity Theory as a theoretical lens for understanding how occupational therapists design interventions for persons living in low-income conditions in South Africa

INTRODUCTION Intervention design is a key component of occupational therapy processes. Occupational therapists craft interventions aiming to respond to people’s occupational needs. Occupational therapists’ intervention design processes often foreground the intended recipients of the interventions, giving little attention to the occupational therapists and their situated processes when designing interventions. Thus the occupational therapists’ occupation(s) of designing interventions for the people they work with is not extensively considered as a unit of analysis. The traditional focus in occupational therapy literature and practice has centered on a categorical exploration of occupational therapists’ individualized cognitive processes of clinical and professional reasoning1. While valuable, this focus fails to attend to the contextually situated reasoning that emerges from the appreciation of the situational nature of intervention design as an occupation for occupational therapists1. Appreciating the transactional nature2 of the occupation (s) of intervention design, the use of CHAT as an analytical lens, draws attention to the influence of the individual therapist’s position in and experience of living and working in a particular context, inclusive of the sociocultural and historical traditions present in that context. Occupational therapists, much like the persons that they work with, are embedded in and intricately connected to the contexts in which they live and work. They are professionally socialised and enculturated by the socio-cultural influences within their contexts, shaping the meaning that they ascribe to their actions3. A particular enculturation may also exist due to the dominance of a homogenous race and gender group, that is white females within the occupational therapy profession and a resultant unilateral knowledge base4,5. Occupation often features centrally in an occupational therapy intervention, both as a means and an end6. Viewing intervention design as both an occupation for occupational therapists and an interchange between occupational therapists and those persons that they work with, as shaped by their social-cultural positioning, warrants exploration. The cultural historical lens of CHAT can be used to analyse this complex, collective and contextually situated Pam Gretschel B OT (US), M ECI (UP) Lecturer, Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, South Africa