How do occupational therapists assess work readiness in individuals with acquired brain injury? A qualitative study in the South African context

To explore how South African occupational therapists (OTs) assess work readiness (WR) in clients with acquired brain injury (ABI), identify contextual challenges, and propose improvements. A qualitative descriptive study using thematic analysis of semi-structured interviews with seven OTs experienced in vocational rehabilitation with individuals with ABI. Purposive and snowball sampling was used, and data was manually coded using NVivo 14. Thematic analysis, informed by the study objectives, identified three main themes: 1) how OTs assess WR 2) contextual influences on WR evaluation, and 3) recommendations for improving WR evaluation in South Africa. OTs use a multifaceted approach when assessing WR, incorporating a variety of assessments to evaluate physical, cognitive, and psychosocial skills, while collaborating with multiple stakeholders. Systemic challenges influence WR, such as unemployment, socioeconomic status, stigma, disparities between the private and public health sectors, lack of knowledge and implementation of labor policies, and the lack of contextually appropriate standardized tests. Findings suggest that South African OTs evaluate WR comparably to international practices, yet face distinctive systemic barriers that are not typically present in high-income settings. This highlights the need for a contextually appropriate guideline to enhance WR evaluations in individuals with ABI.