The kawa (kawa is Japanese for 'river') model of occupational therapy has recently emerged in response to the needs for culturally sensitive conceptual models of practice that adequately address clients' diverse cultures and belief systems (Iwama, 2006a). The present article reports two case studies in which the kawa model was used to guide occupational therapy intervention with two individuals with multiple sclerosis in Ireland, with the aim of exploring the effectiveness of the recently emerged kawa model. A qualitative grounded theory approach using case-study methodology was undertaken. Semi-structured interviews based on the kawa model were completed with two participants with multiple sclerosis before and after occupational therapy intervention. The authors also documented their experience of using the model in reflective diaries. Analysis revealed a core category of the guiding nature of the kawa model creating both opportunities and challenges. Opportunities afforded by the model included enablement of the occupational therapy process and facilitation of occupation-based practice. Challenges created by the use of the kawa model included participant uncertainty and the influence of therapist preconceptions. Limitations and recommendations for future research are discussed in terms of generalizability. Further research with greater numbers and more diversity of study participants is required to validate the tentative theory proposed.

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