Understanding culture and the KAWA Model (Matumo Ramafikeng, University of Cape Town)
Author: Matumo Ramafikeng, Health Sciences UCT, 2011 (confirm)
The Kawa (River) model was developed by Japanese occupational therapists in the 1990s in response to a need for an occupational therapy framework that socially and culturally communicated their worldview of occupation and well-being. This model is a framework that embraces the issue of culture in occupational therapy. The model serves as a departure point from Western based models of practice that strongly value and strive for the client’s independence and autonomy in occupational performance. On the contrary, the Eastern perspective focuses more on collective shared interest and consensus between the client and the environment. For example, the self is seen not as an individual, but a part of a larger whole, which could be a community, the environment or family. This indicates that the individual according to this perspective is inextricably linked to the larger whole, therefore the actions and experiences of an individual cannot be separated from the whole.
The Kawa Model aims to provide a framework that would enable therapists and students to understand and be sensitive to the client’s circumstances in context. This would enable development and use of intervention strategies that are truly client-centered. Occupational therapy is faced with a challenge of having culturally relevant conceptual models and ideas about occupation or doing, as well as appropriate methods of delivery of therapy. Therefore, the Kawa model also presents an opportunity for critical reflection on occupational therapy frameworks and their applicability in diverse cultural settings. Occupations and occupational performance have different meanings to people from different spheres of life and who have different experiences or circumstances. Therefore, occupational therapists need frameworks that are conscious of cultural differences between the people that they serve, so as to plan intervention appropriately. Kawa means river (in Japanese) and the Kawa model uses it as a metaphor for life flow.
The central concept of the Kawa Model is harmony, which is described as a state of being, where the individual or community is in balance, which relates to the presence of coexistence and interdependence within the context that one is part of. The essence of the harmony is life flow. Wellbeing is characterized by a state in which all elements coexist in harmony within the context and disruption of harmony interferes with the coexistence or life flow. Therefore occupational therapy intervention would be focused on enabling the client to enhance balance in the life flow.
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