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Decolonization of research is nowhere more pressing than in post-apartheid South Africa, where cross-cultural encounters characterize every aspect of society. The health system plays a critical role in realizing the rights of marginalized populations, particularly rural communities and people with disabilities. However, cultural divides between service users and health care workers render health care provision unexpectedly complex. Such divides likewise obscure the meanings embedded in qualitative data, rendering research interpretations challenging. A study of the engagement between rural isiXhosa-speaking people with disabilities and primary health care workers was conducted by the first author, a White English-speaking female health care worker, in partnership with the second author, a Xhosa male research implementer. Ethnographic and narrative methods were used to create an embedded case study of 11 households of people with disabilities. Lessons on conducting ethical and culturally congruent research with this population are presented, important limitations in the qualitative paradigm raised, and alternative stances explored.

Introduction: Client-centred practice was theorised by occupational therapists in Canada and subsequently introduced into the Tanzanian occupational therapy curriculum. There has been no critique of its relevance for African countries, nor research into occupational therapists' perspectives of applying client-centred practice in African world contexts. This study aimed to determine the understanding and use of client-centred practice by occupational therapists in Tanzania. Method: A descriptive cross-sectional design was used. Working Tanzanian occupational therapists (n¼64) completed a questionnaire based on two existing instruments. Data were analysed using SSPS (version 20.0) and qualitative coding. Results: Barriers were shortage of time (79.7%), client-centred practice is too demanding for the client (78.1%) and the therapist and client have different goals (76.6%). Enablers included education about client-centred practice as a student (98.4%), client involvement in planning services (96.9%) and staff and service provider training (96.9%). Three themes were identified: clientcentred practice enriches relationships, is difficult to implement, and needs to be supported by increasing human resources, further training and client education. Conclusion: The implementation of client-centred practice in Tanzania is compromised by the resource-constrained and hospicentric health service context. Alternative practice approaches that are aligned with collectivist cultural attitudes could be considered.