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Abstract

Background: In occupational therapy and occupational science, scholars and practitioners advocate for a stronger focus on social transformation. However, there is limited evidence on how occupation-based interventions contribute to addressing inequalities and fostering change for marginalised populations. Methods: This study applied critical occupational science and realist theoretical frameworks to examine the use of arts-based occupations for social transformation. It comprised three strands: (1) a narrative review of arts-based occupations in social change, (2) a realist review of participatory photography, and (3) a realist evaluation of a socially engaged art group in primary schools. Findings: Arts-based occupations have been employed by grassroots activists and researchers to drive social change, but their impact is often ameliorative at the meso level rather than transformative at the structural level. Participation in these interventions carries risks, including the reinforcement of injustices. A refined theory of change in participatory photography was developed, identifying key mechanisms such as psychological safety and perception of burden, which interact with contextual factors to produce both intended and unintended outcomes. The realist evaluation generated 10 programme theories explaining how and why participation in the art group was initiated and sustained, emphasising the role of perceived value and trusting relationships in enabling engagement with occupations otherwise inaccessible to seldom- heard communities. The research culminated in the ‘ReSTART’ conceptual platform, outlining key processes in effective social transformation through arts-based occupations. Conclusion: Achieving social transformation through arts-based interventions is complex and demands advanced skills from practitioners. Adoption of the ReSTART platform will support occupational therapists in socially transformative practice. In addition, to fulfil the Royal College of Occupational Therapists' vision of occupational therapists as changemakers in population health, enhanced education and workforce development are essential.

Awarding Institution(s)

University of Plymouth

Award Sponsors

Elizabeth Casson Trust

Supervisor

Alison Warren, Rebecca Hardwick, Nick Pollard, Sally Abey

Document Type

Thesis

Publication Date

2025

Deposit Date

September 2025

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