Thisessay discusses the contribution of occupations in health and well-being.
It starts by introducing some key term anddefinitions. In order to understand the role of occupation in health andwell-being clearly, it is important to understand how health and well-being aredefined overtime. Asthe name implies, occupation therapy is concerned with enabling people toachieve health and well-being through occupation. Occupation is at the centreof Occupational therapy. The word occupation is derived from the general conceptof occupying one self and seizing control of one’s self (Clark et., 1991).
Despitethe effort of many eminent occupational therapists and associations, there isno single generally accepted definition of occupation. The term occupation tendsto be used interchangeably throughout literature with two other terms: task andactivity. Recently occupationhas been described as the dominant ‘activity’ of human beings, usuallyconsisting of self-care, work and leisure (Kielhofner, 2009) and as purposefulactivity, which engages an individual’s time, energy and attention (Reed &Sanderson, 1983). Occupations are not any kind of activities, they have a senseof purpose and meaning ranging from basic needs to human self-actualisation.Understanding of occupation requires careful examination of the doing, thedoer, the context or situation in which the occupation is found, and therelationships among these elements (book). It is also important to seeoccupation as subjective experience, participation alone is insufficient,individual subjective experience of occupation has far greater influence inhealth (Canadian journal). According to Wilcock (1999) the simplest way todescribe occupation is as a synthesis of doing, being and becoming. Thus,occupation is not simple what is done but instead it encompasses engagement,individual’s occupational identity and performance.
(Canadian journal). Occupationperformance refer to the ability to choose and satisfactory perform meaningfuloccupations that are culturally defined, and appropriate for looking one’sself, enjoying life, and contributing to the social and economic fabrics in acommunity (CAOT, 2002). Occupational identity has a powerful effect on choosingan occupation and occupational performance. Occupational identity is developedthrough time and encompasses: a sense of who the person is, self-interest, performancehistory and beliefs. Ideas about what is health and well-being are differentaccording to cultural and spiritual philosophies, socially dominant andindividual views, the type of economy and the health technology available(Wilcock 1996). The term health haslacked a definitive definition. The current World Health Organisationdefinition of health, formulated in 1948 describe health as state of completephysical, mental and social well-being and not merely the absence of disease orinfirmity. The main criticism of the definition is, it unintentionallycontributes to the medicalisation of society and the requirement for completehealth would leave most people unhealthy most of the time (M Huber 2011).
Recently the World Health Organisation (WHO) (2001) introduced theInternational Classification of Functioning Disability and Health (ICF), whichfocuses on how people live with health conditions and can achieve satisfyingproductive lives (Baum, 2003). Itsuggests health is an interaction between bodily function, activity engagementand participation as influenced by environmental and personal factors (Baum,2003). However, wellbeing is a subjective experience, mainly people relate itto pleasure and happiness. It encompasses mental, physical and socialdimensions. But, physical well-being is the aspect that has received the mostattention and the easiest to understand. In an 80s Resource Centre for Healthand Well-being Brochure, wellbeing is defined as “a state that transcends thelimitation of body, space, time, and circumstances and reflects the fact thatone is at peace with one’s self and others” (Johnson and Schmit, 1986).
(Description). Morerecently well-being has also been defined within the health promotionfraternity as: – a subjective assessment of health- which is less concernedwith biological function than with feeling such as: self-esteem and asense” of belonging through social integration (Wilcock 1996). (Description) The relationship between what we do and our health iscomplex. Many people can identify occupations that make them feel good andoccupations that make them feel no so good. However, understanding clearly howand why occupation affect health and well-being is critical as it enablesoccupational therapists to provide effective service to those in need. AnnaWilcock, an eminent occupational scientist, argued that occupation is essentialto individuals and species survival, because the basic biological needs forsubstances, self-care, shelter, and safety are met through the things people do(Wilcock 1993). It is important to note that developing skills is not sufficient,rather becoming part of a community and developing skills necessary to surviveas a community.
In addition, through participation in occupation, we expressourselves, develop skills, experience pleasure and involvement, and achieve thethings we believe to be important (Willard and Spackman’s 11 edition) (description).Mary Catherine Bateson, a well-known anthropologist and author wrote: thecapacity to do something useful for yourself or others is the key topersonhood, whether it involves the ability to earn a living, cook a meal, puton shoes in the morning, or whether other skill needs to be mastered at themoment (Bateson, 1999). People use occupation to develop an understand of whothey are, what they might do, the context in which they might act, who theymight become (Hocking 2001).
A notable study of how occupation influenceshealth and wellbeing was Clark et al.’s (1997) a randomized controlled trialexamining the dynamic interplay between occupation, health, and well-being ofhealthy community dwelling older adults. Clark et al. determined thatparticipating in a meaningful occupation enhanced participants’ physical andmental health, occupational functioning, and life satisfaction.
Another recentreport “Healthy people 2020” prepared for the us government is one of the manyauthoritative sources asserting that physical activity helps maintain healthyweight for people of all ages and strength and agility in older adults (Healthypeople 2020, nd). Special nowadays as technology have created inactive lifestyle, people are developing habits that are problematic for maintaining goodhealth, thus most people are familiar with the idea that participating in physicalexercise promote cardiovascular fitness and weight maintenance. Converselypeople who are unable to participate in their choice of occupation, forwhatever reasons, can suffer from occupation imbalance, deprivation andalienation. Occupational imbalance is a lack of balance between work, rest, andplay, which can result in poorer health, decreased life satisfaction andwell-being (Townsend &Polatajko, 2007). Due to repetitive patterns ofoccupation or activity people develop routines, which helps them in developingstructure and managing life. For example, sleep is necessary for restorationand survival, disruption in sleep patterns can lead to occupationaldeprivation. Roles influence the occupations and associated activities peopleengage in (Keilhofner, 1995), they are mainly defined by culture and changes throughoutlife.
Changes in roles and environment can result in occupation disruption andalienation, resulting in physical and mental consequence, as found when peoplebecame homeless or institutionalised. Within the occupation science, a theory that may help toexplain the relationship between occupation and well-being is flow. Flow hasbeen defined as a subjective, psychological state that occur when people becomeso immense in an occupation that they forget everything except what they aredoing (Csikszentmihalyi and Rathunde, 1992). Also, flow does not originate fromoccupational therapy theory, it can work in complimentary with current theoriesin how occupation motivates people and how they can improve their occupationperformance.
In her literature review, Emerson (1998) found that flow wasassociated with increased level of happiness, self-esteem, role satisfaction,work productivity and satisfaction with life. A person is more likely to beinvolved in an occupation that they have found to be enjoyable in the past andincrease in performance of this chosen occupation may result in a flow state,which can lead to the highest level of wellbeing. The role of occupational therapist is to inform, support,facilitate and provide opportunity for clients to perform activities in orderto promote function, quality of life, and the realisation of potential (COT2003). However, occupational therapist does not believe participating in anoccupation is enough to influence health and well-being, but by usingpurposeful activity, occupational therapist has a unique role in helping peopleto live a fulfilling life. Developing therapeutic relationship between the clientand the occupational therapist is the first and most important stage of theoccupational therapy process, as both parts are participating in the processand bring different experience. The mainpurpose of the occupational therapy process is to provide structure so thatoccupational therapist can address client’s health-related problems based on evidence.
According to McColl and Pranger it serves to “instruct therapist about how to interveneto produce a desired effect” (1994, p.251). The process is neither condition- (i.
e.,diagnosis, condition, disorder) nor age-specific and can be applied in anypractical setting-hospitals, outpatient clinic, schools, workplace, or clientshome (Willard and Spackman’s 2014 p 265). Occupational therapy process is unique as it usesoccupation as an end goal and means to achieve the goal. In the words of fisher(2009), if we are to practice as occupational therapy practitioners, we mustuse occupation as our primary form of therapy. Creek (2003) describes 11 stages ofoccupational therapy: referral or reason for contact; information gathering;initial interview; reason for intervention/needs identification/problemformulation; set goals; action plan; action; ongoing assessment; outcome andoutcome measurement; end of intervention or discharge followed by a finalreview. The stages appear to be simple but occupational therapists must haveenough knowledge and skills to work with clients to enable occupation. The occupational therapist starts by lookingat the client’s range and balance of occupation, both current and feature rangeof activities, tasks or skills that will remediate the deficit and enable theclient to enact his or her occupation more effectively (COT 2003).
Having identifiedwhere the problem is, the practitioner shifts the focus inward in to activities,tasks and skills that are meaningful to the client and can enable the client toperform his/her occupation effectively. At the end of the process the therapistshifts the focus outwards again to see what effect the intervention has had onthe client’s overall pattern of occupations (RCOT 2003). The occupationaltherapist can use models of practice in relating occupational therapy theory topractice. Specific benefits of the occupational therapy models of practice caninclude adding structure and organisation to everyday practice, providing atransparent guide and direction to intervention, improving communication andcollaboration within occupational therapy and across disciplines, andfacilitating evidence-based, client-centred and professional reasoning practices(Hussey, et al., 2007) In conclusion, it is clear the definition of occupationin relation to health and well-being has evolved throughout history of the profession.
Occupational therapy recognises the role of occupation in health and well-beingand creates opportunity for individuals to gain the skill and confidence toaccomplish activities and tasks that are meaningful and productive and in doingso increase their occupation performance (Baum and Edwards, 1995). Equally, occupationcan have negative impact on health and well-being, doing too much, doing toolittle and doing things that can expose us to risk can all have deleteriouseffect (Willard and Spackman’s 11 edition p53). However, by carefully addressingenvironmental barriers and promoting occupational justice, engaging inoccupation can improve health and well-being.
For the profession to continue to develop it must seeknew opportunities to provide a service to those who face barriers to occupationin modern society (Parnell & Wilding, 2010).