SCIENTIFIC ARTICLES

 

"So I have to be positive, no matter how difficult it is": A longitudinal case study of a first-generation occupational therapy student

 

 

Viki Janse van Rensburg^I; Rochelle Kapp^II

^IB.AOT (Stell), M Phil, (UWC); PhD Education(UWC) Educational advisor - Faculty of Health Sciences, University of Cape Town
^IIBA Hons (UCT), MA English (UCT), PhD Education (UCT) Associate Professor, School of Education, University of Cape Town

Correspondence

 

 

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ABSTRACT

INTRODUCTION: This article describes and analyses the learningjourney of Zinhle, a first-generation university student from an impoverished rural village who studied occupational therapy at a relatively elite South African university. Using educational theory on learning, identity and reflexivity, the article describes Zinhle's multiple transitions as she experienced academic failure and success
METHOD: Qualitative longitudinal analysis was used in a single case study to analyse four interviews conducted with Zinhle over the course of her undergraduate years. Each semi-structured interview was spaced a year apart to allow Zinhle to reflect on her experiences of the previous academic year. Data were analysed inductively by the two researchers. Ethical approval was obtained prior to the study
RESULTS: The data illustrated her high levels of agency and reflexivity in responding to failure and in repositioning herself by re-evaluating how to engage with the new discipline, make use of resources and develop new learning strategies. The data revealed that this process entailed uncovering the norms and values of the discipline of occupational therapy which she experienced as tacit, as well as unlearning the de-contextualised, rote-learning practices that had characterised her schooling. Shifts in her subject position were indicative of her view of herself as a "rural girl" as well as an agent for change in her community
CONCLUSION: Zinhle's impoverished home and school circumstances both hindered and enhanced her learning as an occupational therapy student. Her mode of advanced reflexivity enabled her to succeed and to adopt a position as an agent for change. The data also revealed that some impediments in teaching and learning structures hindered Zinhle's learning journey. The data raise the question of how the discipline might engage with and adapt the structural aspects of the curriculum and environment that hinder epistemological access and retention of students from disadvantaged backgrounds

Key words: Identity, agency, reflexivity, longitudinal narrative analysis, student learning

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INTRODUCTION

This article describes and analyses the learning journey of Zinhle (not her real name), a first-generation university student from a small, impoverished rural village who studied occupational therapy at a relatively elite South African university from 2009-2013. After failing first-year courses in the mid-year examination of her first year, Zinhle was enrolled into an extended programme that lasted a year. She then returned to the mainstream programme where she experienced further difficulties, but nevertheless, progressed successfully and graduated. As is commonly the case, Zinhle's initial experiences of higher education resulted in a crisis in self-confidence and self-esteem as she struggled to make sense of the new academic environment and requirements. Nevertheless, she demonstrated high levels of agency in reflecting on her own subject positions and repositioning herself in response to failure by developing new learning strategies and constantly re-evaluating how best to make use of available professional and social resources. We describe Zinhle's process of coming to understand what is required in the discipline of occupational therapy and argue that although the student is highly motivated and hard-working; the process of understanding the norms, values and ways of being that characterise occupational therapy takes time and is non-linear. Moreover, the process of negotiating meaningful access to the discipline and dealing with multiple pressures from home, entailed significant levels of reflexivity and resilience. The article ends with a consideration of how the teaching and learning support structures and methods could be adapted to facilitate earlier epistemological access, as well as ensure retention of students from disadvantaged backgrounds.

 

LITERATURE REVIEW

Research and experience in South Africa and internationally has shown that students struggle with the transition to higher education for a range of academic, linguistic and psycho-social reasons. Schooling socialises students into particular approaches to learning, attitudes and dispositions that are often at odds with what is required within higher education settings¹. In some disciplines, there are also significant gaps in content knowledge which present challenges for articulation. Policies of widening access in higher education sectors around the world have meant an increase in numbers of students who enter into the institution without the "cultural capital"² deemed necessary by higher education institutions. In South Africa, large numbers of first-generation students, have to learn to negotiate norms, values, attitudes and beliefs very different from their home discourses both within the institutions and within their disciplines and this process often produces considerable conflict and ambivalence^3,4.

Recent educational theory has emphasised the complexity of the interplay between structure and agency in the educational process^5,6,7. Post-structuralist theorists have argued that individual lives are constrained by structural and cultural conditions, but that individuals have the capacity to improvise^{8: 279} and to act purposefully, that is to be agentic⁹. Individuals invest in certain subject positions rather than others at particular times in relation to structures of power and opportunity. Here, identity is viewed as "an ongoing process of interpreting and reinterpreting oneself as a certain kind of person in a given context"^{10: 1188}. Individuals negotiate who they are and who they want to be in relation to past and present interaction and importantly, in relation to the desire for recognition, the desire for affiliation, and the desire for security and safety¹¹.

Archer's¹² social realist perspective has argued that it is crucial to understand how agents engage with structure. This involves a specification of how structural and cultural powers impinge on agents, and secondly how agents use their personal powers to act in particular ways¹³. Archer^{13: 4} described reflexivity as "the regular exercise of the mental ability, shared by all normal people, to consider themselves in relation to their contexts". She argues that individuals use their personal powers in reaction through a process of reflexivity which involves self-talk or inner dialogue.

Furthermore, Archer¹³ describes a development sequence of levels of reflexivity. She foregrounds the importance of the concept of reflexivity, in mediating the interface between structure and agency¹². Drawing on this theory, Luckett and Luckett⁶ propose that a precondition for academic success is the development of a sense of personal identity and social agency. They argue that for many students who enter into relatively elite institutions from disadvantaged backgrounds, learning entails "shifts in consciousness, identity and modes of reflexivity related to severe contextual discontinuity"⁶⁴⁸⁰. Reference to the centrality of identity has started to emerge in medical education^10,14. While socialisation into the profession of Occupational Therapy and the development of students' professional identities are reported^15,16 little is known about how students interpret their social and learning spaces, how they make use of the subject positions and resources available to them in order to make meaning and gain meaningful access to their disciplines. Rather than reifying identity, the longitudinal perspective of the research allows us to see how Zinhle made sense of her experiences over time as she positioned and repositioned herself in relation to her current learning environment, her past and her future.

With the current focus in the health professions on mastery of competencies, it is argued that identity development in health science students' learning cannot be ignored: "Including identity alongside competency allows us to reframe our enquiries towards questions that include a focus on being rather than an exclusive focus on doing"^{10: 1185}. It also enables us to move away from deficit notions that locate the problem with the student towards a perspective that allows how to see what changes need to be made to the teaching and learning environment to facilitate meaningful access, as well as retention through to graduation.

 

METHOD

This single case study was situated within a larger longitudinal study that aimed to track the undergraduate experiences of 100 students from disadvantaged backgrounds in five faculties of the university. The main research aim of the study was to explore the factors that facilitated or hindered access and success in higher education of the first cohort of students who matriculated in 2008 with the new National Senior Certificate. Importantly, these students are a generation who have grown up and been educated, albeit in schools set up within the apartheid structure, in post-apartheid South Africa. In the larger study, semi-structured individual interviews were conducted with students from a variety of courses offered by five faculties. Hour-long interviews were scheduled either at the end of an academic year before the examination or at the beginning of the following year to allow students to reflect on their past academic year. Zinhle was one of five health sciences students who had completed all the interviews and had graduated within five years. Zinhle's case was purposively selected for the persistence and resilience revealed in her quest to become a health professional, despite encountering academic and psychological challenges. What set her apart from the other students was her remarkable agency and reflexivity. She stood out from the other students in the manner in which she engaged with constraints to overcome adversity. Qualitative longitudinal analysis was used to explore the lived experiences of the student¹⁷. Thomson^{9: 16} argued that a qualitative longitudinal study is a method particularly suited to capturing the "subject in process". She described interviews as "snapshots of particular times and places", and argued that whereas single interviews of participants tend to freeze participants' images in particular times and places, multiple interviews enabled snapshots "to be articulated, providing a timescape"^{9: 150} that enables one to see how individuals reflect and position themselves. Exploration of a single case illuminated the particular, deep, multi-faceted complexity of an individual's experiences¹⁸.

The data for this article comprised four individual interviews conducted with Zinhle over a period of five years. The first three interviews occurred at the end of academic years and were semi-structured as for all the other students in the study. Students were asked questions about how they interacted within their learning and social environments, as well as questions that invited reflection on past and present learning experiences and articulation of their unfolding conception of their future careers. The fourth interview in 2013 took a much more unstructured, narrative approach. The students were invited to bring a symbolic object which reflected their present identity and to reflect on their trajectory over the four years. Transcripts of students' past interviews were always available to them, but in the fourth and final interview, students were specifically requested to read their first-year transcript and to comment on any shifts they had noticed in their ideas and perceptions. The audio taped interviews were conducted by research assistants. Therefore, the researchers' positions were not that of "insiders" as is often the case in qualitative research. The interviews were transcribed and were analysed by both researchers.

Thematic content analysis was used to analyse the transcribed interviews. Data were analysed manually and inductively. The purpose was not to establish an essential truth about Zinhle. Rather, it was to identify the issues that she chose to foreground, her reflexive self-talk, how she wished to be viewed and how she re-positioned herself. Alongside other post-structuralist theorists, we were mindful of the positions from which students construct their pasts in the interviews^19,20. In the words of Holland et al.,^8:3 "People tell others who they are, but even more importantly, they tell themselves...". One expects that in the interviewing process, Zinhle would be engaged in composing and narrating as she reviewed her past in the light of her present context and her projection of a possible future. We attempted to represent this positioning in the discussion of the data.

Ethical clearance was obtained from the research ethics committee of the University of Cape Town and on-going voluntary participation and informed consent were obtained over the five years of data gathering.

 

FINDINGS

Two main themes were identified from the data. The first theme, her identity as a "rural girl" emerged from categories of home influences and her values and beliefs. The second theme of how she acquired access to the discipline was derived from the categories of English as a language challenge, withdrawal from social activities and her emerging agency and reflexivity.

Theme one: Identity as a "rural girl"

Influences from home

Zinhle's first interview was conducted at the end of her first year. By then, she had spent one semester in the mainstream and the next semester in the much smaller extended programme where she had been placed after failing her mid-year examinations. What was interesting about this interview was the way in which Zinhle juxtaposed her home environment and values with her life at university. She foregrounded her identity as "rural". Analysis of the data reflected that the meaning of this term was multi-faceted. Firstly, the term "rural" was used to signify her structural constraints. She spoke of growing up in poverty in a rural village with her parents and five sisters. The family subsisted on her father's income as a general assistant. Zinhle attended school in another village where class-sizes averaged 55 learners:

I was studying at a rural area school, a poor primary school...for my personal needs, I didn't get everything I liked but I understood that there's no money.

She described her background in terms of negation, "absence" and "lack"^{21: 362} Nevertheless, while she described the constraints of growing up without resources and opportunities both at home and school in great detail, she consistently positioned herself as an agent of change for her family and her community. In her first interview she asserted her sense of obligation and responsibility very clearly "I'm the only one who has to change the situation of my family because it's poor". Her choice of Occupational Therapy was purposeful, and again reflects her strong sense of "rural" identity:

...because I'm coming from a rural area... I have chosen this because of physically disabled people... they don't have money to buy like wheelchairs, they don't have money to buy tools to adapt to the environments, so that's why I decided to do Occupational Therapy, so that at least people who are poor from my background... can benefit from this type of provision.

Zinhle intention of changing the situation of her community revealed her view of herself as a change agent and this theme occurred quite often over the next five years. Her strong intention to become an occupational therapist seemed to be a major source of what Zinhle later called her "inner motivation". In response to a question about how she felt after failing her first semester, Zinhle said:

I felt sad but I accepted it because I knew that I deserve it. I wasn't, I didn't blame anyone, I just accepted it and I've decided to go on, I tried to be positive about myself and understand myself and the continue with IP because OT was my first choice and I like it, so I didn't think like to drop off or to do anything or to give up.

In her final interview, she reflected that there was never a moment when she considered leaving the university or doubted that she would return to her rural community to become an Occupational Therapist.

Nevertheless, in her first interview, Zinhle also described how her teachers had actively discouraged her from applying to the university: they just told me that you are not going to make it, you can't afford.

In her final interview, she was able to describe this positioning in terms of social class:

...they will expect good for people who are coming from quite nice backgrounds, good families who have like quite high status and they wouldn't really recognise us, just students coming from those poor families.

While Zinhle resisted the subject position her teachers attempted to ascribe to her, and was critical of their instrumental teaching methods, in her first interview, she nevertheless, characterised them as victims of their rural circumstances, who were "trying".

Values and beliefs

The notion of "rural" was also used to signify Zinhle's identification with values and beliefs from her home environment. In her second interview in 2011, she emphasised the set of Christian moral values that enabled her to place limits on her behaviour and maintain the home norms and values that her parents would expect of her:

I have that thing of moral, morality, morals, so I always make limitations... and [I] ask myself, if my parents were here, were they going to do this, if I find that no, this is not right, I don't do it.

As is the case in other recent studies of South Africa youth from disadvantaged backgrounds, prayer and the bible were her major sources of consolation⁷. "I pray, I pray, I read the Bible".

In response to a question about whether her style of dressing had changed since coming to university, she replied:

For clothing it hasn't changed because I am a rural girl and you know those rules ... if you are a girl you can't wear shorts, something that is so short or all those things. I still have that mind-set and I am not wearing trousers and all those things.

While it would seem that she was merely conforming to a norm, she also distanced herself from the materialist values that characterised the views articulated by many of her peers, and indeed, many of our research participants. She asserted:

I see myself as smart when I am wearing this R30.00 skirt, it is fine for me and I don't even feel inferior when I'm walking with someone who is wearing all those labels.

This seeming confidence about her rural identity and resourcefulness, sits alongside plenty of evidence in the data of Zinhle's fear of failure, insecurity and self- doubt:

I panic a lot when things are not going well. I panic. I just feel like I'm not doing well, I'm not good, I'm not clever.

Zinhle's narrative revealed agency and reflexivity. Despite her sense of self as a rural girl from a poor background, she did not view herself as a victim. She frequently described her emotional distress and self-doubt but also countered these experiences with agentic steps to overcome the challenges.

Theme two: Acquiring access to the discipline

The theme of acquiring access to the discipline emerged from the categories of struggling with English, withdrawing from social activities, overcoming psychological distress with her faith and her significant levels of agency and reflexivity.

Struggling with English

Although Zinhle suffered considerable emotional distress after failing in her first year, she quickly realised that being placed in the extended programme in a small class setting would facilitate better access to the discipline "because in the first semester I was really struggling with OT, I didn't know what's going on". In her first interview, she described the impact of not being comfortable with English on her academic writing, her ability to participate in class and her sense of self:

Academically, since I'm not good in, I'm not perfect in the language, I'm not used to doing everything in this language. So when it comes to write the essays, I was failing. When it comes to presentations, I was having this low self-esteem because I know that OK my language is poor, it's not my mother tongue. So I was just undermining myself.

From these self-critical initial descriptions of her sense of self in an English-speaking environment, she described increasing confidence in later interviews. A shift in her identity started to emerge:

For last year, the language barrier, it was there, but then for now I think I feel more confident this year, I don't have that, I'm not good in language anyway but then I don't see that as a barrier now.

A year later during the third interview, she responded to a question:

Do you think you are a good writer?" as follows: "I think I am, because English is not my first home language so I can't be hard on myself.

Social withdrawal as a coping strategy

In her first two interviews, she made frequent references to the fast pace and high load of academic requirements and the consequent emotional effects. A further example of the psychological toll and the pressure to succeed was Zinhle's social withdrawal. She withdrew from extra-curricular social activities, except for attending church. Although, she kept up regular contact with her mother through weekly telephone conversations, she withheld information about her struggles, failures and panic because she didn't want to cause strain for mother.

Besides her faith in religion, Zinhle's most pronounced strategy for improving her academic performance was to fall back on the sense of herself as a "hard worker" which had sustained her at school and to devote more time to her studies by excluding all social activity except church attendance:

The only way that I make sure that I do manage my time is not to be involved in many societies of the campus. So ja, after school, I do whatever I want to do in my room and then before I sleep, I read something, I study something, not specifically just because I have a test, any time that I know that I'm free, I study something.

It is significant that it was only after Zinhle had been in the yearlong extended programme that she was really able to conceptualise and articulate the academic literacy requirements of occupational therapy and to analyse and reflect on her earlier failures. It became clear to Zinhle that she had failed to understand the significance of the theory/practice relationship in occupational therapy. Consequently, she had engaged in decontextualized, rote-learning study practices that had worked at school. Initially, she had studied only the power- point lecture slides in preparation for tests, focussing on theory without realising the need to integrate theory with practice.

Later she realised that course outcomes and lecture slides guided the selection of text:

that is where I start reading from the text book and then refer to the slides because I see that the slides is just a summary of what is in the text book.

This insight was clarified for her only during the extended programme, towards the end of her first year.

Agency and reflexivity

Zinhle's narrative revealed marked examples of her agency. Overcoming obstacles to enrol at university was an early indicator of Zinhle's agency:

In terms of support, I can say no, the school didn't support me, because I didn't even get support for applying to UCT. They just told me that you are not going to make it, you can't afford UCT and I knew that I can't afford it. Anyway, but it is not true, there is support, and I'm here.

In the small classes of the extended programme, she felt comfortable to break the silence which characterised her first semester. She started to engage actively in class by asking questions, taking risks by venturing explanations and monitoring her learning through feedback:

If I'm not understanding something, I can't allow myself to be left behind, I ask questions, I try to explain what I think I understand and then I also like my tutor to help me if I'm not right.

During her third interview, Zinhle's agency was revealed in a shifting perspective of her identity:

I can just say that accepting yourself, that if you did bad, don't blame yourself, if you not doing the way you think you should be doing, you can't put pressure on yourself.

Furthermore, she reflected on the broader meaning of learning from failure:

No, it is not really about failure only but it's also about improving and using the time that you have to be more productive.

In her final interview, she identified help-seeking behaviour as critical to her success and said:

I seek professional help if the situation is too bad, in a way that it is just beyond my own strength ...if the situation is actually affecting my functioning now, I seek professional help.

While her religious faith continued to be a primary spiritual resource, she acted purposefully to ask for help and to develop skills to deal with her stress levels by attending stress management workshops and making use of the Writing Centre. Her agency in overcoming challenges emerged from the data of her later interviews. Zinhle worked out how to plan and structure her time in a productive, process-oriented manner rather than engaging in instrumental, test-focussed rote-learning:

If we are given recommended articles then I spend a lot of time reading before I write, but then when I am writing an essay I make sure that I dedicate the whole day writing it.

Agency was revealed in her perspective of being a change agent and a role model in her community:

Even though I am not doing anything now to influence change in my own community and in my own family, just people seeing that it is possible to succeed, especially academic success, if people in my community especially the young ones are actually saying that she is coming from the very environment, the very same environment that we come from and she made it up to this point, it is possible for us as well, without even me saying anything to them, they can see it as an example and it might motivate one or two people and that is already a change.

Zinhle's reflexivity was evident in her increasing levels of meta-cognition in her senior years as demonstrated in her comments on her decision-making processes:

I have learnt that university isn't only grooming us academically. It's where we live, our families, we come here being independently. We have to take decision and we have to think about the consequences of each decision that you take, so it's also grooming us socially and the ways of how we think, how we see things and also the things that we have studied and then we go back and apply them in our societies.

From earlier descriptions of her sense of self as "being stupid, not clever enough", she progressed to the point where she identified herself as a "strong" person, a role-model to others and said "I know we all deserve to be here". She stated:

...whatever I do will leave a mark, I am not just doing something that won't have any impact, whatever I do will leave a mark.

Her reflexivity was indicated by her strong sense of being a mediator for change in her community. Several references to her identity as an agent for change were evident in her interviews. In her final interview, she again claimed this perspective:

before I came here, I didn't realise that anything is possible if you actually want to make a change in your own life or if you want to influence a change in your own community, so I didn't see potential. I didn't see opportunities or ja, or any kind of hope that there will be a change in the community, but then when I came here and I actually saw that actually I am surviving even though I am not like taking anything, even though it is not as easy as I would like to, but I know that it is possible. I see it in myself. I can make it. If people want change it is possible to make change.

A further clear shift in her identity to a position of strength was also reported in her final interview:

I view myself, yes I am strong, I don't just give into life and I am a hard worker and I like success and I am someone who believes that things in life is possible, if you actually have a vision of what you want and my family also have that same view about me, they know I am strong and ja, that is why they believed in me when I left and came to Cape Town, so I can say they have the same view about myself as I have.

The data revealed Zinhle's reflexive responses when encountering the structural elements of learning to become an occupational therapist. Her identity as a rural girl and how she acquired access to the discipline revealed her agency and reflexivity in overcoming challenges and taking action to improve her own situation as well as that of her community.

 

DISCUSSION

What sets Zinhle's narrative apart from other students was the illustration of how agentic and reflexive she was in encountering challenges. Zinhle's story is one of resilience and perseverance. Archer^{13: 17} referred to the "objectivity" of structure and the "subjectivity" of agency and explained that the agent's reflexive response within this interplay shapes his or her identity. Zinhle's reflexivity emerged as the means by which the objectivity of structure and subjectivity of her agency were mediated. What was striking in Zinhle's narrative was that she did not conceptualise her role and status as a "rural girl" in terms of being a victim. Rather, this sense of self was used as a simultaneous explanation for her academic difficulties and a resource that set her apart from others and placed her in a position to be a future agent of change. The notion of a progressive narrative, of overcoming adversity seemed to act as an antidote to her emotional distress.

Significant differences between Zinhle's home environment and the academic culture and practices of university contributed to the challenges she experienced and demonstrated her "shifts in consciousness, identity and modes of reflexivity related to severe contextual discontinuity"^6:480. However, some of the sources of her distress were institutional practices and assumptions. Boughey²² suggests that academics take for granted that students understand expectations. Zinhle started to succeed academically when academic discourse practices were made explicit to her, when she was able to feel comfortable to articulate her difficulties and when she was provided with clear strategies to manage her stress levels.

Zinhle's repeated notion of herself as a change agent appeared frequently over the four interviews. We found Sfard and Prusak's²⁰ distinction between "actual" and "designated" identities useful to describe the distinctions between the present and the future in Zinhle's narrative: "... actual identity, consisting of stories about the actual state of affairs, and designated identity, consisting of narratives presenting a state of affairs which, for one reason or another, is expected to be the case, if not now, then in the future. Designated identities give direction to one's actions and influence one's deeds to a great extent, sometimes in ways that escape rationalization"^{20: 18}. The notion of her "designated identity" seemed to be a driving force that kept her motivated to achieve her goals.

We concur with Boughey's²³ view that acknowledgement of the structural constraints embedded in traditional academic culture is required in order to enhance epistemological access. A number of studies have questioned deficit notions of students from disadvantaged backgrounds^4,5,7. There have been calls for change in higher education and a move away from locating academic problems within the student²². Although we acknowledge that generalisations cannot be made from the findings of this single case study, we hope to contribute to the argument that adaptations to structural constraints embedded in traditional curricula could assist students from disadvantaged background. To this end we question whether occupational therapy curricula could be adapted to facilitate earlier experiences of academic success. More research is required to determine the prevalence of such experiences as those of Zinhle and to explore student experiences at other institutions.

 

CONCLUSION

The method of qualitative longitudinal analysis provided a lens to explore Zinhle's learning journey over the course of her studies. How she engaged with, adapted to and shifted her sense-of-self in learning emerged from the data. Her subject position as a "rural girl" was a structural constraint in achieving initial access to the university and her occupational therapy programme. Rather than taking a position as a victim, she re-worked her identity over time, demonstrating high levels of agency and reflexivity in her view of herself as an agent for change in her rural community.

 

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Correspondence:
Viki Janse van Rensburg
viki.jansevanrensburg@uct.ac.za