The study design

As outlined in section 1.4, I came to the study with a background of volunteering with a soup run for people who were experiencing homelessness. This reflects my personal commitment to respect individuals and make a small difference in whatever way possible. In addition, it introduced me to the impact of homelessness on the everyday lives and identities of persons, and the significant role charitable and voluntary organisations play for people who have experience of homelessness. This personal interest led me to working professionally in the area as an occupational therapist, as part of teams to support individuals with multiple health needs. I recognised the value of occupation as a means to wellbeing, and participation, for individuals within a complex homelessness system. I was motivated by a desire to bring the potential of occupation to the fore in homelessness, and in particular, empower people to establish and maintain tenancies. I believe this complemented my personal position of wanting to instil change and respecting individual difference. Although constrained to an extent by the professional role of an occupational therapist in a health service, in particular imposing on who could and could not be referred, the role allowed for a great deal of flexibility and creativity to work in collaboration with staff in homelessness services, outside of the statutory services. This particularly motivated me, as well as the freedom to work in an occupation-based way, over time, with persons as they transitioned from

homelessness. This experience provided me with, to an extent, the position of insider when carrying out this research so I had an appreciation of the process of leaving homelessness and allowed rapport to be developed quickly, which facilitated data collection. Yet I was also coming to the study as an outsider—as a researcher fulfilling my own agenda of pursuing a degree which has power and status attached to it. On reflection, this appeared to have more of an impact on the staff interviewees as many questioned if the information they provided was sufficient and they wanted to draw on my knowledge. I constantly engaged in reflection, recorded in my research journal, to balance this role of insider and outsider in the research process.

Simeon (2015) proposes that positionality is never fixed and stable but fluctuates according to context, feelings, and ideas expressed and this most closely reflected my experience throughout the research process as I navigated being an occupational therapist and occupational scientist. Both share a common interest in understanding human occupation and the relationship between health and occupation. Situating the study within occupational science alone, would have grounded the research more deeply to explore the meaning of occupations for people with experience of homelessness, how occupations are facilitated and inhibited as well as the impact of transitions on occupations. This is in keeping with my fundamental belief in the value of occupation within homelessness. However, as outlined, I also came to this research as an occupational therapist, wanting to inform practice and service delivery. Occupational therapy is more traditionally situated within health services research, predominantly grounded in positivist/post-positivist conceptualisations of science (Farias Vera, 2017). Following the MRC guidance on the development, evaluation and implementation of complex interventions, guided the research to identify existing evidence and develop

new theory. Systematic reviews tend to promote, by their rigorous methods, an objective reality, somewhat detached from the researcher and social construction, and more aligned with a post-positivist epistemology. This created discomfort at times for me in the research process, as I simultaneously held a constructivist stance. Epistemologically the constructivist grounded theory approach explicitly assumes that there is an interpretive portrayal of the studied world, not an exact picture of it (Charmaz, 2006). It acknowledged my role as occupational therapist as researcher, and as the researcher, I worked with the participants to actively construct the data to access the meaning of experiences. Although the study design held a complementary strengths approach and kept the integrity of each study intact; as a PhD student I felt a struggle of shifting positionalities. This created a feeling of being drawn between two worldviews, as I questioned approaches, whilst trying to develop an identity of a researcher in the PhD process. The struggle was reconciled by holding a pragmatic approach which allowed me to embrace the complexities and acknowledge their influence on the study design. As this study is not solely situated within occupational science, but is situated in the professional stance of occupational therapy and development of complex interventions, it may not have captured the depth of occupational experiences and meaning, that may have been explored with a different methodology. However the study was strengthened by explicitly situating it within a practice and ‘complex intervention’ context whilst drawing on occupational science.

The context of the study and stakeholder perspectives influenced the research design. As well as the individuals with experience of homelessness, and services who support them, in planning a potential occupational therapy intervention, beyond this immediate work, the source of future funding was a consideration. Funding authorities within

health have an underlying positivism, and place a value on systematic reviews. Mixed methods studies are common as outlined in section 3.1.1, and maintaining the complementary strengths of each study type can characterise complex phenomena more fully than either alone (Curry et al., 2013). They are increasingly recognised as useful to support development, implementation and evaluation of interventions as a strategy to address the complexity of healthcare questions (Sandelowski et al., 2012). This study although exploratory at one level because there lack of knowledge on the transition from homelessness to a tenancy from an occupational perspective, and holds an occupational justice standpoint, it is still set within the health service research. This led to some challenges in aligning the research paradigms and whilst acknowledging these tensions, I drew on a pragmatic approach to bridge the divide. Pragmatism accepts that both observable phenomena and subjective meaning can provide acceptable knowledge depending on the research question.