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South African Journal of Occupational Therapy

versão On-line ISSN 2310-3833
versão impressa ISSN 0038-2337

S. Afr. j. occup. ther. vol.51 no.2 Pretoria Ago. 2021 



The application of the Vona du Toit Model of Creative Ability to self-employment in South African informal microenterprises



Luther L. MonarengI, *; Denise FranzsenII; Daleen CasteleijnIII; Hester M. van BiljonIV

IBSc (Wits); PGD in Hand Therapy (UP); MSc (Wits).; Lecturer, Department of Occupational Therapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
IIBSc OT (Wits); MSc OT (Wits); DHT (UP); PhD (Wits).; Sessional senior lecturer, Department of Occupational Therapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
IIIB. Occ. Ther (UP); PGD Voc Rehab (UP); M. Occ. Ther. (Hons)(Medunsa); DHETP (UP); M. Occ Ther (UP); PhD (UP).; Associate Professor, Department of Occupational Therapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
IVB. Occ. Ther. (UFS); M. Occ. Ther. (UFS); PhD (Wits).; Private practitioner, Work-Link Vocational Rehabilitation Private Practice, Gauteng, South Africa




INTRODUCTION: Persons with disabilities experience difficulties entering the formal South African labour market despite progressive legislation to enhance their economic participation. Consequently, self-employment becomes a work placement consideration for occupational therapy clients. However, self-employment requires certain volitional attributes, and the identification of such attributes would greatly enhance the outcome of vocational rehabilitation efforts. The aim of the study was to describe the level of creative ability of self-employed business owners in informal microenterprises
METHOD: A descriptive, quantitative non-experimental research design was used. Sixteen self-employed business owners of informal microenterprises were interviewed and observed completing work tasks using the eight domains of the Activity Participation Outcome Measure (ApOM) based on the Vona du Toit Model of Creative Ability (VdTMoCA
RESULTS: Participants were between 27 and 50 years of age. Their education levels ranged from no-education (6%) to tertiary education (19%) with the majority (38%) having a high school education. Based on the APOM scores, participants functioned on three levels of creative ability namely: Passive Participation, Imitative Participation and Active Participation. Most participants functioned at the Imitative patient-directed level with the highest APOM domain scores for all participants being Communication Skills, Affect and Role Performance
CONCLUSION: To be successfully self-employed in an informal microenterprise, the required level of creative ability ranging from Passive to Active Participation, was identified. This provides occupational therapists with an understanding of these requirements when considering self-employment as work placement option

Key words: Self-employment, informal, microenterprise, Vona du Toit Model of Creative Ability (VdTMoCA), Activity Participation Outcome Measure (APOM), work, vocational rehabilitation, placement.




South Africa has progressive legislation that protects and promotes the right of persons with disability (PWDs) to enter, return and/ or remain employed in the formal open labour market. However, 25 years after the promulgation of this law, PWDs are still under-represented in the work force1 for a variety of reasons2. South Africa's unemployment statistics have reached the all-time high of 32.6% owing to the COVID-19 pandemic3-5, The Commission of Employment Equity (CEE)1 reports that PWDs make up 1% of the workforce in the open labour market. Other than the personal and socio-economic implications this holds for PWDs, it also reflects poorly on the country's compliance with not only the Employment Equity Act6 but also the United Nations Sustainable Development Goals (SDGs)7 to which South Africa is a signatory. Goal 8 of the SDGs aims to promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all, including for PWDs.

Occupational therapists have a well-defined role in facilitating clients' engagement in the occupation of work8. This role takes into account both the assessment of both the clients' work ability and work place when providing vocational rehabilitation and includes preparing a client for seeking, procuring and/or sustaining employment9. Both local and global literature shows that the vocational rehabilitation services currently offered by occupational therapists focus mainly on paid employment, with little research and focus on facilitating self-employment or entrepreneurship as a work placement opportunity for their clients10,11. Occupational therapy vocational rehabilitation services are currently not in line with the South African government's call for citizens to explore self-employment as an alternative in the face of the high level of unemployment and its effects12. Although South African occupational therapists perceive themselves as having a role to play in facilitating self-employment for PWDs, they report a lack of experience in fulfilling this role13.

Although there is no consensus on the definition of self-employment14, in this study a self-employed individual in the informal sector is defined as an individual who is working for themselves, being directly or indirectly involved in running a successful and profitable small business or microenterprise in order to earn an income or generate a salary, instead of being employed by another person or an employer. A microenterprise may include, but is not limited to, buying and selling, offering services and manufacturing products on a micro scale14. An International Labour Organization (ILO) report of 2019 shows that small businesses and self-employment provide the most jobs world-wide15. The informal sector has been prioritised in this study as 61% of the self-employed work force in the world falls within this sector7. To assist PWDs in exploring self-employment as a possible work opportunity or placement and in setting up and successfully running a business, occupational therapists need to understand the factors associated with self-employment to best guide their clients. Therapists need to be aware of the nature of existing knowledge and training the client has, to provide them with the support and guidance they need for successful self-employment. Furthermore, when considering this form of employment as an option in this sector, a clients' ability, level of activity participation, level of education and vocational skills need to be considered16,l7.

Du Toit postulated that motivation governs action18, which is a foundational principle of the Vona du Toit Model of Creative Ability (VdTMoCA)19. The VdTMoCA , an occupational therapy practice model that originated in South Africa18 is widely used in vocational rehabilitation by South African occupational therapists10. This model helps establish an individual's level of creative ability, which guides the occupational therapist in their expectations of a client's performance in the work place18.

The Activity Participation Outcome Measure (APOM) based on the VdTMoCA, was used in this study to establish the ability to meet the demands that self-employment places on an individual in microenterprises in the informal sector. The APOM provided a description of the self-employed individual's activity participation profile which forms the basis for deciding whether an individual has a skill at a level that would allow them to run a particular type of business. Since activity participation in the APOM20 is based on the levels of creative ability as developed by Vona du Toit, the outcome measure provides occupational therapists with information on the level of motivation and action required to successfully engage in self-employment in a microenterprise in the informal sector.

This study explored self-employment of able-bodied individuals in informal microenterprises in a low resourced urban setting, to provide occupational therapists with a benchmark of the level of activity participation required before exploring self-employment as a work option for their clients.



This study used a quantitative, non-experimental, cross sectional design, where convenience and snowball sampling21 was used to locate the business owners. The setting of the study was the low resourced Alexandra Township in Johannesburg. A sample size of l6 self-employed individuals from 46 microenterprises operating in one street (Eighth Avenue), was determined as the required sample according to Cochran's sample size formula with a 5% margin of error22. Eighth Avenue was selected to conduct this study as it represented a typical street of Alexandra Township. Microenterprise owners were selected for participation based on the following inclusion criteria: residents or/and their businesses were located in Alexandra Township; were between the ages of 18 and 65 years; and had been operating or running the business for > three years23. Their monthly income had to be greater than the monthly South African disability grant amount of Rl 600 in 202024.

The research instrument used for this study was a questionnaire which recorded demographic data (15 questions) and the APOM scores. The psychometric properties (validity and reliability) of the APOM have been assessed using Rasch analysis25.

Individuals who met the inclusion criteria were visited at their place of business and invited to participate. Appointments were made with each participant to collect the data at a time that was convenient to them. Data for this study were collected by two researchers. Each researcher interviewed each participant and completed the questionnaire specifically designed for this study. Each researcher then observed each participant operating their business for one to two hours and then completed the APOM tool based on their observations. The interview to complete the questionnaire was done first followed by completion of the APOM. The researcher also watched the participant complete their work tasks in their business for e.g., setting up for the day, interacting and/or communicating with customers.

Following the data collection phase, the researchers convened to share, discuss and concur on their findings and scores for purposes of interrater reliability i.e. APOM ratings were discussed and justified with regular reference to the APOM guidelines. The APOM scores were recorded on a spreadsheet and spider graphs20 were then generated from the data.

Data were analysed descriptively using frequencies and percentages. Demographic data of the participants and type of businesses were presented in frequency tables. APOM results (level of creative ability of the participant), type of business and category of business were described in a table. Median scores for the APOM domains were used to show the level of creative ability for each phase in each level of creative ability. Interpretation of the APOM scores are as follows: scores of 1 - 3 presents the level of Tone, 4 - 6 the level of Self-differentiation, 7 - 9 level of Self-presentation, 10 - 12 level of Passive Participation, 13 - 15 level of Imitative Participation and 16 - 18 level of Active Participation. The phases are represented by the specific score within the level e.g. a score of 13 indicates the therapist-directed phase within the level of Imitative Participation, a score ofl4 is the person (patient)-directed phase while 15 points to the transitional phase of Imitative Participation20.

Ethical clearance (MI70820) was obtained for this study from theUniversity of the Witwatersrand Health Science Research Committee.* During the data collection phase, the purpose of the study and the role of participants in the study were explained using the approved information sheet. Those who agreed to participate signed an informed consent form prior to the data collection. It was explained to participants that their participation in the study was voluntary and they could withdraw without consequence at any time and that the data collected were confidential. To ensure anonymity and confidentiality data collected were coded, no names were captured on any data collection sheets and all docu-ments were kept in secure storage.



Table I (above) summarises the demographics of the 16 participants. Participants were mostly males, their ages ranged between 27 and 50 years and just over half (56%) of them were either married or co-habiting.



Participants had different levels of creative ability (VdTMoCA). Most businesses were in the retail and service and skills sector (Table II, p77). The type of microenterprises were service and skill, retail and manufacturing/production businesses13 such as a privately owned pre-school crèche, a spaza shop and a salon operating from a one-roomed brick house.

Activity Participation

The highest level of VdTMoCA observed was Active Participation for two (12.5%) of the business owners. Twelve (75%) were at the Imitative Participation level and two (12.5%) at Passive Participation.

Figure 1 (above) indicates the median scores for each domain at each phase within the different levels of creative ability for the participants. The median of the APOM domain scores indicate that all participants scored at or above the Imitative Participation level, person (patient) directed phase (<I4) for the domain of Communication Skills. Motivation domain had the lowest median score with participants on Imitative Participation (11-14) and Active Participation (15) having Motivation scores which were lower than expected for their level of creative ability. In other domains the scores varied according to the level of creative ability. The participants on Active Participation had lower than expected median scores for Process Skills (14-15) while participants on Imitative Participation person (patient) directed and transitional phase) had higher than expected scores for Self-Esteem (15-16) and Balanced Lifestyle (15-16).

The APOM median scores across business categories indicated that the highest scores were in "manufacturing" followed by the "services" and "skills" category. The lowest scores were found in the "retail" category across all domains except for the domain of Affect (Figure 2, above).



The demographics of the participants in this study are similar to those reported in the literature for self-employment in low resourced communities in South Africa, with the majority being males between 36-45 years and with 12 years of formal education22. When compared to those participants functioning at lower levels of creative ability (e.g., the Passive Participation level), those functioning at a higher level of creative ability (e.g., the Active Participation level), demonstrated better systems or more effective ways when running their business.

Two of 16 participants were on the Passive Participation level of creative ability of VdTMoCA and they were running businesses in the "service" and "skills" categories. Individuals functioning at this level have difficulty sustaining effort over time and they give up easily if they do not receive support or guidance26. Furthermore, although their task concept is developed and their pre-vocational skills are still developing, they may lack the ability to adequately evaluate a product (or service delivered) and may not be able to correct product errors or adjust service delivery where neces-sary18. The two participants at this level of creative ability had many years of experience in the service they offered, and the tasks were habituated, concrete and semi-skilled. The questionnaire results showed that these participants lacked the ability to organise, manage time and money, or marketing their business. They were simply waiting on the side of the road for customers, and this affected their income. Thus, when considering self-employment with individuals functioning at this level of creative ability, they would require guidance, supervision, and structure. With such support their chances to provide an acceptable level of service will improve.

The majority of the participants (n=12) in this study functioned on the Imitative Participation level according to the VdTMoCA. Individuals functioning at this level need less external structure than those on the Passive Participation level, due to their ability to work independently. They have better Balanced Lifestyle skills and are more organized, structured, follow socially appropriate norms, can evaluate their own performance, and with guidance and practice they can problem-solve, manage their stress and budget and manage their finances adequately20. In this study these participants all had financial systems in place, budgeting for stock, planning for fluctuating income and paying the rent. At this level a good Self-Esteem can also be expected which supports their self-efficacy, which is needed to succeed in self-employment27. Thus, when considering self-employment for individuals functioning at this level of creative ability, an acceptable level of service can be expected but business models should be kept simple to ensure success. In this study, they provided retail, services and skills-based businesses most of which were in their own yards (e.g., one room serves as a spaza shop where items are sold through the window) or based on the pavements (e.g., a gazebo is used for shelter).

Only two (12,5%) participants in this study functioned on the Active Participation level of creative ability. Such individuals transcend the self, are less egocentric, their focus is on other peoples' needs, they are independent and original in their actions with innovative, problem-solving skills and have a wide repertoire of work skills for which they have received specialized training28. Due to self-determination and being action orientated, they are able to identify their goals and have successfully developed and marketed their microenterprises. They also had high scores for Balanced Lifestyle indicating they were able to manage their time well20, but their lower Motivation and Process Skills may prevent them from moving to a more competitive small business sector27. These participants showed originality in their business practices. They had raised funds for buying instead of renting premises to reduce long term costs, had regular special offers for clients, offered backup services and gave discounts to customers in order to increase sales in their business. Such individuals may be suitable for peer support and in assisting others by offering in-service training especially to those interested in starting similar small businesses.

When the median scores of the domains of the APOM were considered in this study, the high scores for Communication Skills (15) followed by the Affect domain score of 14 suggested that participants in this study had good Communication Skills and a stable mood with appropriate emotional expressions which supported the success of their businesses. A good relationship with customers and the community as well as being a people's person was reported to be instrumental in self-employment29 for customers to come back and continue to support a business. Customer relations include treating customers well and controlling emotions when dealing with their concerns.

The median score of the Motivation domain (13) was lowest which seems contrary to that suggested by literature30, but still within the Imitative Participation level, indicating that participants may not have a strong internal locus of control31. The lack of desire and motivation to expand their businesses, to branch out or operate outside the low-resourced community of Alexandra Township could also be linked to the capabilities of the participants to achieve goals in terms of the Process Skills which were also at an Imitative Participation level27. This may be affected by the circumstances under which they set up their businesses. Reasons being, due to necessity, as a result of not being able to find formal employment32 and reverting to self-employment (i.e., running their own businesses) not by choice, but related to survivalist and situation-based considerations33. Venturing into the unknown may be a challenge for an individual on Imitative Participation and thus expanding their businesses may be too anxiety provoking. These participants could benefit from a mentor who guides them into marketing and perhaps including more services in their business.



This study showed that participants with lower levels of creative ability were involved in retail businesses e.g., buying and selling of snacks on the side of the road. This finding can probably be ascribed to the fact that these businesses require less specific vocational skills and retail businesses in this sector are not complex. This also applies to the management aspect of the business which is often lower in those smaller retail enterprises as they require less organisation and completion of fewer tasks and responsibilities to sustain the business. When the product requires innovation (which participants with a higher level of creative ability are able to introduce), both manufacturing and service businesses are more likely to succeed34.

By knowing the abilities required by individuals to be successfully self-employed, occupational therapists should select clients with appropriate skills and abilities when suggesting they engage in self-employment. The use of the APOM based on the VdTMoCA proved useful in identifying individual business owners' skills on eight domains which reflected their ability to run a micro-enterprise. Although individuals at the Passive Participation level according to the VdTMoCA may be involved in self-employment, they will probably need to be supervised on a regular basis. In this study, those functioning at the higher levels of creative ability (Imitative and Active Participation), were able to independently run successful microenterprises with some differences pertaining to for example, business systems. The study provides information on the amount of support and supervision a person (patient) may need to successfully engage in self-employment, as well as the necessary therapeutic intervention and support to facilitate sustainability.



This research identified several knowledge gaps that need to be addressed to broaden contextually relevant South African evidence of self-employment for PWD in occupational therapy. The perceptions of PWD on self-employment need to be explored as this could also affect the outcome of occupational therapists' interventions. Guidelines or a conceptual framework, based on the VdTMoCA to enable occupational therapists to identify, encourage and support self-employment for PWDs should be developed.



The small sample of microenterprise owners participating in this study limits generalisation of the findings. Due to the cross-sectional nature of the observations (which included habituated tasks) may not be consistent with each business owner's general performance. A second visit for observational purposes could have been considered and would have enhanced the discussion.



The principal author, Luther Monareng, conducted the research and co-wrote the article.

Denise Franzsen and Daleen Casteleijn assisted in the development of this research, co-supervised the study and contributed to writing the article. Hester van Biljon assisted Mr Monareng with data collection and with writing the article.


Thank you to all the following departments and people who made this research possible:

University of the Witwatersrand's Faculty of Health Sciences.

Colleagues in vocational rehabilitation (Dr. Jennie McAdam, Mr. July Masango and Mr. Simon Rabothata) and Prof P de Witt for assistance with the article.

University of the Witwatersrand's Faculty of Health Sciences'

Claude Leon Merit Award Grant and

Faculty Research Committee individual grant.



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* Corresponding Author: Luther L. Monareng. Email:
* Ethical clearance for this study was granted prior to the enactment of the amended POPIA on 21-07-01

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