A qualitative exploration of the challenges and support needs of orientation and mobility practitioners in South Africa

Abstract

Orientation and mobility practitioners occupy an important role in supporting people to adapt to life with visual impairment. This paper presents results from qualitative research on the challenges and support needs of practitioners in South Africa. Semi-structured interviews were conducted with 18 participants, including practitioners, trainees, facilitators, and managers at the South African College of Orientation and Mobility. An exploratory-descriptive qualitative design was adopted, and thematic analysis was used. Practitioners’ challenges included (1) managing multi-dimensional client needs; (2) negotiating socio-cultural barriers; (3) facing socio-economic challenges and (4) occupying a precarious status in relation to the rehabilitation profession in South Africa. Practitioners recommended various ways in which they could be supported. When designing and implementing practitioner training, especially in under-resourced contexts, attention must be paid to emotional and socio-cultural issues. A holistic and trauma-informed approach to training and practice can ensure that practitioners (and their clients) are adequately supported.

Introduction

Orientation and mobility (O&M), including instruction on navigating with a white cane and orienting in home and work environments, is an important aspect of the rehabilitation of people with visual impairment (Bauserman et al., 1977; Blake, 2021; Godley & Hatch, 1976; Higgerty & Williams, 2005). ‘Visual impairment’ in this paper refers to a broad scope of vision-related conditions which may cause people to require rehabilitative interventions. O&M practitioners are often the first source of information and practical solutions for adjusting to life with visual impairment, for people with both congenital and acquired conditions, and their families (Dodds, 2013; Tuttle & Tuttle, 2004). Given the practical and emotional upheaval that is likely to accompany vision loss, practitioners may find themselves fulfilling a multi-dimensional role, providing not only the technical skills associated with O&M, but facilitating access to other services and supports such as those related to social protection, further or re-training, and mental health care, providing information on the availability and use of various assistive technologies, and responding to the psycho-emotional distress of clients and families (Dodds, 2013; Kaiser et al., 2019; Tuttle & Tuttle, 2004). It has been argued that practitioners ‘set the tone’ for what people who are newly visually impaired and their families can expect as they move into life with disability, and that there is a resulting need to foster a human rights and social justice approach to disability and rehabilitation in practitioner training (Botha & Watermeyer, 2022; Watermeyer, 2025). Practitioner’s roles may also extend to include community awareness and education on visual impairment, and the building of awareness within health professions of the work and importance of O&M (Kaiser et al., 2019).

In South Africa, this multi-dimensional role is in many ways amplified due to the intersecting vulnerabilities that practitioners are likely to encounter in the field (Maguvhe et al., 2012). South Africa remains one of the most unequal societies in the world, characterised by the legacy of apartheid racialised inequality (Louw et al., 2023). Louw et al. (2023) describe the status quo of disability and health in this context as ‘a never-ending cycle of poor health, disability, unemployment, lack of education, and poverty’ (p. 2). Rehabilitation has not been prioritised for financial and human resources investment within primary health care, with combatting communicable diseases taking precedence (Morris et al., 2021). It has been argued that this demonstrates a fundamental misunderstanding of the shifting health circumstances of an ageing population, the rising prevalence of non-communicable chronic health conditions, the socio-economic role and importance of rehabilitation, and the capacities and potential of people with disabilities as socio-economic contributors (Hussein El Kout et al., 2022; Morris et al., 2021).

O&M is in an even more precarious position as it does not have status as a registered health profession in South Africa (Louw et al., 2023). O&M practitioners are trained and operate in non-profit community organisations, and the practice has no official registration, such as with the Health Professions Council of South Africa (HPCSA) (Louw et al., 2023; Maguvhe et al., 2012). O&M practitioners therefore do not form part of multi-disciplinary rehabilitation teams and tend to work in isolation. This, coupled with the reality of referral pathways in health care described as ‘broken’ (Louw et al., 2023), often leaves these practitioners having to manage the complex physical and psycho-emotional needs of their clients with little support.

Previous work has identified a severe shortage of practitioners in relation to the population of people with visual impairment who would benefit from O&M (Higgerty & Williams, 2005; Maguvhe et al., 2012). Currently, the website of the South African Guide-Dogs Association (SAGDA), under whose auspices the South African College of O&M operates as the only local provider of practitioner training in O&M, states that there are between 50 and 60 working practitioners in South Africa (SAGDA, 2025). In contrast, census data from 2022 reports 8.3% of the population (4.5 million people) experienced ‘some difficulty’ with seeing, 1.5% (84,247 people) experienced ‘a lot of difficulty’, 0.1% (56 376) experienced ‘not being able to see at all’, and 0.1% (52,077) did not know (Statistics South Africa [StatsSA], 2024). Self-reporting can be influenced by such factors as education, employment status, other socio-economic factors, and gender (Naidoo et al., 2015), meaning that vulnerable individuals may fall through the reporting cracks. In short, the percentage of the population that could benefit from vision-related rehabilitation services might be underestimated.

This paper presents findings from qualitative research which explored experiences of both training and practice in O&M. To strengthen and expand South African O&M, we need to better understand the experiences, challenges and support needs of practitioners. This is necessary to combat attrition, safeguard the physical and mental wellbeing of practitioners, and to design responsive training and post-training interventions to support them. To this end, this study sought answers to the question: What are the current challenges and support needs of O&M practitioners in both training and practice in South Africa? Ultimately, supporting practitioners is essential to ensure that high quality services are provided to people with visual impairment. Though focused in this specific context, the results and recommendations presented here may have broader relevance, particularly for other under-resourced contexts.

Materials and methods

This study used an exploratory-descriptive qualitative design, as described by Hunter et al. (2019), to develop an understanding of the experiences – including challenges and support needs – of South African O&M practitioners. This design is useful when dealing with under-researched phenomena, and is a way to co-create new knowledge with participants, who are positioned as experts, producing a detailed account from their perspective (Hunter et al., 2019). This detailed account will establish a knowledge base for the development of support and capacity-building interventions in future (see recommendations in this paper).

Context

The South African College of Orientation and Mobility is the only institution accredited to offer the South African National Diploma in Orientation and Mobility Practice. This is a two-year diploma course which equips students to provide technical skills for those adapting to life with blindness and visual impairment. The course includes modules on eye health and diseases of the eye, childhood development (for those who will work with children), safe mobility with a white cane or sighted guide, skills to orientate and manage tasks in the home, disability advocacy and awareness, and basic counselling. Graduates from this programme seek employment across the country; some are employed by special schools for learners with visual impairment, some within local non-profits providing rehabilitation (including a cohort who practice from the college itself), and a small number enter into private practice. As noted, these practitioners fulfil multiple roles in contexts where poverty and disability intersect, resulting in challenges to access health care and social services, resources and appropriate information (Louw et al., 2023).

The College of Orientation and Mobility (hereafter, the college) operates under the auspices of the SAGDA. To avoid confusion, it is important to clarify a distinction between the participants in this study and its focus on O&M, and the training and use of dog guides. The college only trains practitioners who work with clients on acquiring the technical skills of mobility with a white cane, and orientation in home and other environments – this includes skills to cook, clean, dress, and manage other activities of daily living (SAGDA, 2025). The training of dog guides, and the matching and training of people with visual impairment with dog guides, does not form part of the college’s mandate, and is not the focus of this paper. South Africa’s socio-economic realities, as well as socio-cultural norms related to dogs, mean that guide dog users tend to be found in the white minority population, who tend to have more financial security and access to resources, and who live predominantly in suburban areas. The vast majority of people with visual impairment, in contrast, use white canes for mobility, with the college noting that most of its practitioners provide services in urban township and rural areas (SAGDA, 2025). Therefore, the experiences and challenges which practitioners outline here are based on the majority experience for people with visual impairment in South Africa, which includes difficulties accessing referral pathways in public health care, and other resource constraints.

Participants

Total population sampling was used, meaning that all staff and students located at the college in 2024 were invited to participate. All ten staff members and eight out of the ten students enrolled agreed to participate. The two students who declined did so for logistical reasons related to having to rewrite an examination. The total sample was therefore 18, comprising 10 staff members and 8 students. The students were all completing their final year of the diploma course when interviewed in September 2024. Staff members occupied roles as working practitioners operating from the college, facilitators providing practitioner training, material developers for this training, and college management. Some participants straddled more than one of these roles, or had done so previously in their careers. The following key is used when reporting the results to distinguish between types of participant perspectives: S = Student, p = Practitioner; T = Trainer; C = Curriculum Designer, and M = Manager.

Sixteen participants were female and two were male; one male participant was a practitioner and the other was a student. There is a potential need to attract more male practitioners to the profession, especially given the socio-cultural barriers uncovered in the findings, and the broader support related to familial roles and identity which practitioners often find themselves providing.

Data collection

Aligning with recommendations for exploratory-descriptive qualitative studies, semi-structured interviews were used (Hunter et al., 2019). An interview guide was developed to prompt participants to reflect on their experiences. Interviews spanned between 30 and 60 minutes and were audio recorded. Interviews took place in English, which is the medium of instruction at the college.

The interviews were organised around five topic areas. First, ‘Background’ explored the participant’s experiences prior to training in O&M, including their exposure to people with visual impairment and their motivation to pursue this field. Second, ‘Training Focus’ asked participants to reflect on any changing perspectives as a result of their training, and on areas where they felt more or less equipped through the course of their training. Third, ‘Technical Aspects’ focused on the ways in which practitioners acquire skills and are assessed during their training, with a view to understand aspects found to be more or less helpful. Fourth, ‘Relational Aspects’ asked participants to reflect on whether and to what extent they felt prepared to navigate relationships with clients and families, including providing psycho-emotional support, dealing with resistance from clients and families, and managing referrals. Fifthly, ‘The Field’ focused on participants’ experiences of transitioning from training to practice, including challenges, evolving perspectives, lessons learnt and support needs. This last topic was adapted for the student participants to focus on their expectations of entering the field.

Ethical considerations

The study received ethical clearance from the Health Research Ethics Committee of Stellenbosch University with project reference number S23/06/136. Study information and the interview guide were provided to participants in advance via email. Participants signed consent forms before interviews commenced and were given opportunities to ask clarifying questions. The right to withdraw from the research at any point was stressed.

Interviews were recorded and saved on a password protected device. Interviews were transcribed and anonymised. The names attributed to the quotations in this paper are pseudonyms. Both the research assistant (who was present during interviews) and the transcriber signed confidentiality agreements.

Data analysis

Interviews were transcribed verbatim. Data were coded and organised using the principles of qualitative thematic analysis, which is an iterative process of identifying patterns within a qualitative dataset (Braun & Clarke, 2006). The steps followed were: (1) familiarisation with data through re-listening to recordings and reading and re-reading transcripts, (2) generating initial codes with a focus on challenges and support needs, (3) collapsing initial codes into themes and refining these, and (4) naming and describing each theme (Braun & Clarke, 2006). The objective guiding the analysis was to identify the challenges that practitioners encounter as they move from training into practice, and to hear their perspectives on their support needs.

What follows provides a thick description of the circumstances of practitioners from their own perspectives. The recommendations provided are also drawn directly from the participants’ responses. Though rigour is a contested ideal in qualitative research (Rolfe, 2006), foregrounding participant voices through verbatim quotation is important to ensure credibility (Corden & Sainsbury, 2006). Results presented here are justified with direct verbatim quotation.

For transparency, the data analysis and interpretation were shared with the college in the form of a brief report which was circulated to participants. It was also important for me to reflect on my position throughout the data gathering and analysis process to confront and bracket potential bias (Koch & Harrington, 1998; Rolfe, 2006). I am severely visually impaired and have received rehabilitative services including instruction in O&M. While this position gives me firsthand insight into aspects of the practitioner-client relationship, I had to remain aware of preconceptions which needed to be set aside. I did this through reflective writing during the interview phase, and through debriefing with a mentor after data collection and throughout the analysis.

Results

Four themes related to practitioner challenges and support needs were identified. These are: (1) managing multi-dimensional client needs; (2) negotiating socio-cultural barriers; (3) facing socio-economic challenges and (4) occupying a precarious status.

Managing multi-dimensional client needs

Practitioners described encountering an array of needs as they engage with persons with visual impairment. These include support to adjust to practical challenges, understand diagnoses and manage medication, deal with emotional upheaval related to sight loss, advocate for support within the family and community, access disability grants and other social and/or rehabilitative interventions, and navigate other circumstances related to, among others, food security, substance abuse, child-care, and bereavement. The sense from practitioners, students and trainers was that training does not fully prepare one to deal with the realities and complexities in the field:

When you get to the field experience . . . that is when you feel maybe if I had studied for 10 years maybe I would be able to deal with this. – Bella (P)

I think I still have a lot to learn . . . Inasmuch as they have equipped me here with what I need to do, the skills, here and the workplace are two different things. – Kebone (S)

We train them and we send them out, but they are not fully cooked . . . And they still need a lot of support and guidance. And it tends to be that they were then just put into the field. Here you go. Here’s 10 people to train. Off you go . . . And they tend to flounder. They struggle to manage their time. – Tania (T/C/M)

Participants mentioned that it was important, given the short span of the formal training, that practitioners possess self-motivation, curiosity to learn more, the ability to develop support networks, and creativity to adapt the knowledge gained in training to different circumstances.

A central issue is the lack of functional referral pathways available to practitioners who are often faced with difficult decisions about urgent needs which fall outside of their scope of practice (Louw et al., 2023). Participants described situations where, as seemingly the only source of support for individuals and families, they found themselves filling the gaps. Below are some examples of the difficult situations practitioners can face:

I had a client. . . who lost her son. The same week she lost her son, two of her daughters lost their jobs . . . and then one of her sons got arrested and then when I got to her house she was still trying to come to terms with the ordeal . . . she started explaining, she said to me there was no food in her house . . . so I had to play the role of a Social Worker, the role of a Psychologist. – Bella (P)

I managed to find him a space to continue his education . . . I personally brought him because he didn’t have parents or anybody . . . and I acted a role as a mother at that time . . . a support system for him. – Palesa (P/T)

Though I don’t give my numbers to everyone, sometimes . . . especially like when a Gogo (Granny) who stays alone, I always say, ‘No look, have my numbers. When you need someone to talk to just call . . . I’m not going to give you answers, but I can just listen. I’m there for you’. – Ruby (P)

These practitioners feel called upon to fulfil roles as social workers, psychologists, mothers, carers, confidantes, and friends. While this humanity and care is heartening to see – previous work has identified the need for the development of greater humanity in rehabilitative services (Botha & Watermeyer, 2022, 2025) – this must be accompanied by necessary support and care for practitioners, including the ability to set boundaries. There are roles that practitioners cannot and should not be equipped to manage in their training, and which are ideally left to other professionals (Tuttle & Tuttle, 2004). For instance, practitioners should not be expected to provide direct mental health support. Yet, in a strained health care and rehabilitation system, practitioners may feel compelled to step out of the bounds of their practice. A question which emerges then is how to support practitioners to instil boundaries to preserve their own health and safety, while promoting person-centred care?

Practitioners described feeling emotionally burdened through working with people in extremely difficult circumstances. Participants said:

And when you find out . . . people that are living in poverty, and also have got this disability . . . who have not got even people to support them, financially and emotionally . . . it used to drain me a lot. – Palesa (P/T)

People will trust with their secrets and they are telling you every day and sometimes you are even a young practitioner and then . . . they are venting on you and you become so overwhelmed. – Nandipha (P/T)

I can go the extra mile but within my scope . . . because sometimes it damages you if you go over the border. – Refiloe (S)

In supporting practitioners, there is a need to recognise that they are likely to carry trauma through consistently encountering loss, struggle, and deprivation, and as a result of working within a system of health care and rehabilitation provision that is inadequate (Watermeyer, 2025). This issue is far more readily recognised in relation to medical and mental health professionals (Kanno & Giddings, 2017; Sheen et al., 2014), but these data suggest that trauma-informed approaches to supporting rehabilitation workers are needed, particularly in under-resourced and unequal contexts such as South Africa. This will be discussed further in the Discussion.

A trauma-informed approach to rehabilitation provision itself might also be valuable to support practitioners in understanding and working through the resistance they report experiencing from clients (Kim et al., 2024; Koch et al., 2020). Sight loss includes emotional and psychological aspects which practitioners will inevitably encounter (Botha & Watermeyer, 2022; Dodds, 2013). Practitioners identify an urgent need for greater mental health support for their clients, describing complex psycho-emotional needs which they are simply not equipped to meet. When encountering someone in distress, practitioners explain that they can only listen and wait:

Social workers they will tell you they have got a lot of load on their plate . . . and you wish you could fasten the progress because you also want to come and do mobility . . . and what I have noticed, it’s time on its own, it heals them . . . When you go and sit down with the client and ask, ‘Did you manage to go for counselling?’ ‘No I just counselled myself’. – Ruby (P)

Not all the clients you’ll find them ready for the training . . . you just go there, visit them, even if the client doesn’t say anything, sit with the client, just being there shows that they will end up opening up, then you can start with your training. – Lihle (P)

These practitioners are in a predicament; their role is not to assist people to process loss and trauma, yet this is a regular encounter for them. Practitioners rely upon a narrative which holds that through time, the listening techniques they have learnt in training, and with no other formal mental health intervention, the client will move through the negative emotion. This is a rational defence for practitioners who are mandated to direct people towards practical adjustment to blindness, and because the alternative reality, that clients have merely become resigned to moving forward with little support, is not able to be contained. But, this defence is also problematic, reliant on a simplistic ‘adjustment narrative’ which is likely to draw newly blind people into silencing ongoing loss and struggle (Botha & Watermeyer, 2025; Watermeyer, 2009). Disability Studies hold insight into negotiating loss related to disability which could support practitioners as they in turn support newly blind persons to acquire adaptive skills (Michalko, 1998; Watermeyer, 2009, 2025). These insights, although not taking the place of formal mental health interventions, could support practitioners as they endeavour to guide clients towards readiness for training and as they negotiate an under-resourced health and rehabilitation landscape with their clients.

Negotiating socio-cultural barriers

Practitioners described facing barriers to providing services at individual, family and community levels. According to participants, negotiating these requires flexibility, relationship building and communication skills, and cultural competence. As O&M has no official status within the health and rehabilitation professions, practitioners often do not have direct access to clients. Rather, they have to engage in community advocacy to locate and contact those who might require their services. This involves careful strategising within the socio-cultural norms and structures of specific contexts, as participants explained:

So . . . the very first stop will be the clinic and then maybe if there is a chief in that area or a community leader that will be next. And then I have to greet everybody in the community and if they have something beautiful like the artists . . . I would stop and I would appreciate their work and then talk about my work after appreciating their work. – Bella (P)

I had to learn very fast. Keeping networks, knowing the right people, and knocking at the right doors to get things done. – Lorraine (P/T)

Challenges were people believing that being blind is a curse . . . It was very difficult, and especially to use a cane . . . trying to drive the community and the clients to white cane, it was really a challenge. – Ruby (P)

Practitioners are constantly connecting with communities. They are optimally positioned to advocate with their clients towards greater community inclusion. Again, though, this additional role can be perceived as a challenge if adequate support is not provided. Alongside developing networking skills and culturally specific knowledge, practitioners need to be supported to reflect on the meanings about blindness and blind persons which they are broadcasting into the communities with whom they engage (Botha & Watermeyer, 2025). Central here is the difference between a charitable perspective and an empowerment perspective, which can set the tone for how community inclusion is actualised (Ebrahim et al., 2020).

A further challenge relates to personal security. Practitioners described experiencing the communities in which they work as unsafe. O&M practitioners are not connected to health professions and therefore operate in isolation. While they might develop relationships with professionals at local clinics and other service providers, they are largely working alone, which can leave them feeling vulnerable when entering low-income areas where crime rates are high:

Communities that we work at are very dangerous . . . you are always worried. I am not sure if I go back the car will still be there . . . So you have to come with mechanisms to be able to fit into that community. When they see you they see you as someone who is coming to help the community not someone who is rich bringing in money. – Bella (P)

In some of the areas where we are training people, it’s not safe . . . I used to train people how to use a train, traveling by train . . . it was a risky job – Leah (P)

I have never noticed colleagues as scared as they are now . . . There is areas where they are refusing to go. – Clare (T/C/M)

Practitioners view their work as risky, which is surely anxiety-provoking. Again, we see practitioners having to develop careful strategies to engage with communities as a means to reach those who need their services.

In addition, there are complex circumstances for practitioners to navigate at the familial level. Participants described encountering suspicion from family members who fear that their work will interfere with access to social protection (in the form of a disability grant). This and other forms of exploitation and abuse of the family member with visual impairment may be encountered by practitioners. There is also likely to be strained relationships due to the upheaval that sight loss has potentially caused in the family related to roles and responsibilities (Tuttle & Tuttle, 2004);

The people who look after the client were the ones because most of them were misusing the person’s grant and now they did not want this person to be independent thinking that they would not have hands to the funds. – Palesa (P/T)

The family believes you are there for money and the client wants you, but because the client is blind and . . . relies on the family when you’re not there . . . so when you come the client has to choose; you’re going to believe the person that is a stranger or you’re gonna take the side of people that you stay with? – Ruby (P)

Practitioners require inter-personal and other soft skills alongside the ability to impart technical skills of O&M. These may be areas for continual professional development, and where group support may be valuable (see the recommendations from practitioners in the Discussion).

Facing socio-economic challenges

Practitioners expressed frustration that they cannot offer their clients solutions that involve expensive technology and other resources because these are not affordable for the client, and the government does not provide support to access these:

There are so many assistive devices that can help people out there. But now the problem is . . . they are so expensive and most of our clients, it’s people who are getting grants and they can’t afford that. – Lihle (P)

The vision impairment in the child doesn’t have to be a limitation . . . But I think it’s harder to follow through on here, just because we don’t have as much infrastructure and support. – Julia (P/T/C)

Practitioners are in a predicament where they cannot always follow through on the assertion that visual impairment does not have to be life-limiting, because when it is framed by poverty, poor service delivery and lack of resources, it often is (Louw et al., 2023). Again, this can leave practitioners feeling helpless and overwhelmed, emotions with which they need support.

Alongside the socio-economic challenges of their clients, practitioners themselves tend to come from disadvantaged circumstances. The O&M training programme, apart from capacitating practitioners to support persons with visual impairment, is positioned as a provider of employment opportunities to disadvantaged youth (SAGDA, 2025). This brings into tension different forms of disadvantage and oppression which continue to characterise post-apartheid South Africa, that is, related to disability, race, poverty and gender. While this programme certainly holds potential to create meaningful employment, and there are benefits to training practitioners who will return to serve their communities, the particularity of practitioner training in our context does mean that newly trained practitioners are likely to be young people and/or those moving into their first formal working experience. Those involved with teaching and learning noted challenges with work readiness, including self-motivation, time management and responsibility, as well as issues related to maturity, which result in difficulty relating to clients.

In these circumstances, the college managers also faced the added issue of feeling responsible for sourcing employment for qualified practitioners, navigating the challenge that, despite the urgent need for these services, O&M is poorly understood, not recognised within the health and rehabilitation professions, and under-funded as a result (Louw et al., 2023):

We are not obliged to find them jobs, but I work tirelessly to phone everybody . . . to assist them in whatever way I can to get employment because we just spent a fortune training these people. There are people that need the services they are trained for and every single course it wears me down and then I do everything that I can . . . they are . . ..skilled, they have other problems but they have something to give and yet we can’t empower them to give it because there are no jobs and that kills me. – Tania (T/C/M)

Teaching and learning staff are faced with balancing a double mandate: to produce high-quality rehabilitation professionals and to empower disadvantaged young people. This challenge is exacerbated by the precarious status in relation to other rehabilitation professions occupied by O&M.

Occupying a precarious status

O&M lacks status within the health professions (Louw et al., 2023; Maguvhe et al., 2012). This has implications for the access practitioners have to communities and clients, referral pathways within which people with visual impairment can be lost, recognition for practitioners related to remuneration, and access to employment opportunities. A less obvious challenge is loneliness. Practitioners often do not form part of multi-disciplinary teams in clinic or educational settings. Even those who form part of the team at the college spend the majority of their time working alone in communities. Practitioners are also often placed in communities for a time, meaning that they are away from family and their support networks. This emerged as another emotional challenge with which participants felt they needed support:

I was equipped with the knowledge, but when I got to the field . . . it’s so lonely because there’s so few of us. – Lorraine (P/T)

It’s a lonely profession if I can say . . . you become so lonely where one maybe might do something. I hope you understand me . . . This work, it’s very lonely and during that time when someone feels lonely there are things that can happen in between. – Nandipha (P)

Nandipha explained when prompted that she was referring to practitioners becoming depressed, turning to substances, and not fulfilling their responsibilities in the field. These accounts also highlight the gap between technical knowledge and soft skills and the development of personal characteristics as people move from training into the field.

The challenge of status also feeds back into the emotional challenges that practitioners described as they attempt to manage multi-dimensional client needs in relative isolation. Participants expressed a strong sense that their work is not recognised and valued in the health and rehabilitation sector:

Working with somebody and with the life and health of somebody, you need to be registered and . . . recognised . . . some people, they know nothing. Remember, the college has been existing for 50 years now, but still people don’t know this profession. – Leah (P)

The other medical professions, they tend to undermine O&M . . . So I don’t know if it’s lack of knowledge in O&M specifically . . . We are supposed to be a team. But. . .. they are not interested. – Palesa (P)

An ongoing process with regard to the issue of status is the registration of O&M with the HPCSA. While this would provide practitioners with greater legitimacy, and possibly employment opportunities and support, there is also an associated trade-off related to intersecting poverty and access to quality education for practitioners. As Clare, a manager and curriculum developer explained, HPSCA registration would require practitioners to be trained at a higher level, which would not be attainable for many. She said: ‘I know we need to move the profession forward, but we are leaving behind people who are great practitioners’. This further demonstrates the gap between what training provides and what practice requires.

Discussion

The forgoing demonstrates the complex circumstances that practitioners must manage in the field, related not only to the multi-dimensional needs of their clients, and to socio-cultural barriers encountered in communities and families, but also to their own emotional and physical health and wellbeing. As noted throughout, practitioners may need more than technical training to navigate these circumstances. Flexibility, creativity, curiosity, compassion, empathy, patience, maturity, self-motivation, and emotional fortitude appear across descriptions of what makes a ‘good practitioner’ in the data. However, the primary focus of formal training must necessarily be on the acquisition of technical knowledge and skills to provide training in mobility with a white cane and orientation in home, work and community. There may, nonetheless, be opportunities to frame formal training, and to provide post-training interventions, in ways which support practitioners in the more relational aspects of their practice. As noted, a trauma-informed approach may be of value in this regard.

Recently, the linkages between disability lived experience and trauma have been more widely explored (Kim et al., 2024; Koch et al., 2020; Liasidou, 2023; Watermeyer & Swartz, 2016). Liasidou (2023), while acknowledging that ‘disability is not trauma’, recognises that: ‘Disability experience is created, emanates from, is shaped against, and compounded by an intricately intertwined and mutually reinforcing web of social barriers and traumatic antecedents’ (p. 4). Without reducing disability to a matter of a traumatically injured body, trauma-informed approaches to rehabilitation service provision recognise that trauma – an overwhelming sense of displacement from self and belonging – may result from experiencing both impairment effects and social stigma, discrimination and exclusionary barriers (Kim et al., 2024; Watermeyer & Swartz, 2016). Failure to recognise this interplay may leave rehabilitation professionals unable to account for and respond to resistance from clients and families (Kim et al., 2024; Koch et al., 2020). Koch et al. (2020) assert that trauma-informed approaches need not require psychological expertise, but rather that rehabilitation professionals practice within a set of principles which recognise and respond to trauma as likely to be present in disability lived experience and adjustment to disability. These principles, which they draw from the Missouri Model proposed in 2014, are: safety, trustworthiness, choice, collaboration and empowerment. Future research and intervention planning should explore incorporating these principles into practitioner training and post-training support, not only for the benefit of clients, but to safeguard the mental and physical well-being of practitioners who, as we have seen, must navigate complex socio-cultural and personal circumstances in addition to multi-dimensional needs of their clients (Koch et al., 2020).

Disability Studies may also provide some useful framing for practitioner support in terms of perspectives on disability, identity, loss and grief in rehabilitation (Beauchamp-Pryor, 2011; Botha & Watermeyer, 2022, 2025; Watermeyer, 2009, 2025), and in developing the empowerment and human rights orientation of practitioners (Ebrahim et al., 2020). Regarding the former, it has been argued that a move away from a linear grief model in rehabilitation holds potential to enable people with disabilities to voice difficulties and frustrations that are likely to be ongoing as they navigate impairment effects and societal ableism, leading to the cultivation of more robust relationships, more secure sense of self, and better mental health (Botha & Watermeyer, 2025; Lourens, 2021; Watermeyer, 2009). In addition, a perspective of empowerment that is linked to the development of skills for self-advocacy, and the promotion of autonomy, diversity and rights, rather than the mere acquisition of functional skills, holds potential to deepen the transformative capacity of rehabilitation services at both individual and societal levels (Ebrahim et al., 2020; Gibson, 2016). For these reasons, the recommendations of practitioners on how their support needs might be met would benefit from a trauma-informed approach which makes use of concepts in Disability Studies.

Practitioners made several recommendations for how they could be supported both within and beyond their training. These are:

1. Extended or supplementary training, particularly in the areas of counselling, providing emotional support, child development specific to visual impairment, and working with people with multiple impairments.

2. More interaction between working practitioners and trainees, including mentorship and work shadowing.

3. More engagement in training with persons with visual impairment, including opportunities to learn from former clients, ask questions about lived experience and practice technical skills facilitation.

4. Need for ongoing support from other practitioners, including in support groups or communities of practice.

5. Need to encourage practitioners in training to develop self-care strategies in an intentional way, such as prioritising fitness, leisure time and mindfulness, and to provide these opportunities for practitioners in the field.

6. Need to focus in practitioner training on building and nurturing networks of support in communities as part of self-care.

Conclusion

This paper has outlined the challenges and support needs of O&M practitioners in South Africa, and has offered capacity-building recommendations. Though there are issues at play which are specific to post-apartheid South Africa, the recommendations made here may resonate with other under-resourced contexts. Ensuring that practitioners are both technically and emotionally prepared to enter the field is central to ensuring that clients are empowered with adequate practical and emotional support as they move into life with visual impairment (Botha & Watermeyer, 2025; Watermeyer, 2025). Practitioners noted that those who are ill-suited to the profession, or who have not been adequately equipped for the complexities of practice, can end up relating to their clients in abusive and neglectful ways, mentioning shouting, shaming and ‘body-handling’. Practitioners must recognise that they occupy a position on the ‘front-line’, shaping how their client and her family and community will relate to visual impairment, well-being, inclusion, and participation (Botha & Watermeyer, 2022; Michalko, 1998). A trauma-informed approach to training and to practice may be valuable to ensure that practitioners (and by extension their clients) are adequately supported.