The Occupational Therapy Perspective of Occupation, Health and Well-being
This essay begins by briefly introducing some key terms used in occupational therapy (OT) and then discusses how and why the relationship between occupation, health and well-being is so important from the OT perspective. In order to understand this relationship it is necessary to look at the history of the profession and the theory that guides OT practice.
“Occupational therapy enables people to achieve health, well being and life satisfaction through participation in occupation” (College of Occupational Therapy (COT) 2004 as cited in., COT, 2010).
The concept of occupation has evolved throughout the history of the OT profession, as has the centrality of its role (Townsend & Polatajko, 2007). It has proved difficult to reach a clear concise definition of the word occupation, as it must encompass the importance of occupation to human development and experience (Creek, 2010b). In addition, the terms occupation and activity are used interchangeably throughout literature (AOTA, 2008) and some suggest it would be more useful to differentiate between the two terms to improve communication within the profession and with others (Creek, 2010b).
More recently, occupation has been described as the dominant ‘activity’ of human beings, usually consisting of self-care, work and leisure (Kielhofner, 2009) and as purposeful activity, which engages an individual’s time, energy and attention (Reed & Sanderson, 1983). Occupations are composed of skills and values that are meaningful to the person and are influenced by culture and environment (Creek, 2010a). Occupations shape peoples’ identity (Christiansen et al., 2005; Duncan, 2006) and are considered necessary for health and wellbeing (Kielhofner, 2009). They engage people in the world and in turn enable survival and self-maintenance (Christiansen et al., 2005). Wilcock (1998) described occupation as an amalgamation of “doing, being and becoming”, conceptualising occupation as a dynamic relationship among people’s activities of daily life, their occupational nature and their transformation and self-actualisation. These multiple dimensions highlight the complexities that underlie occupation and why it has been difficult to reach a definitive definition (Creek, 2010b).
Activities are the ‘doing’ process of occupation consisting of a series of goal directed actions that contribute to occupations (Creek, 2010b). Activities do not necessarily hold any meaning for the person (Creek, 2010b), but OT values occupation and activity, as both allow participation in life, and support and maintain health and well-being (AOTA, 2008).
The term health has also lacked a definitive definition. Historically, health has been defined in negative terms focusing only on the absence of disease (Reed and Sanderson, 1999). However, more recently, the World Health Organisation (WHO) (2001) introduced the International Classification of Functioning Disability and Health (ICF), which focuses on how people live with health conditions and can achieve satisfying productive lives (Baum, 2003). It suggests health is an interaction between bodily function, activity engagement and participation as influenced by environmental and personal factors (Baum, 2003). This definition recognises the importance of participation in life, and the negative impact of environmental barriers to occupation on health (Townsend &Polatajko, 2007). This is consistent with the OT perspective, that occupation engagement and participation is fundamental to establishing, maintaining and restoring health (Kielhofner, 2009; Townsend &Polatajko, 2007).
Well-being is a subjective experience that varies between people, consisting of feelings of comfort, pleasure, and health (Schmidt, 2005). Well-being encompasses physical, mental and social dimensions (WHO, 2002 as cited in Wilcock, 1998), extending beyond health to quality of life (Townsend &Polatajko, 2007). People experience well-being when they engage in occupations they perceive as conducive with their values and preferences, which support their plans, goals, occupational identities and their ability to competently perform their valued roles (Townsend &Polatajko, 2007).
Since its inception during the early 20th century the OT profession has been concerned with occupation and its links to health and well-being (Molineux, 2004). The consensus of a profession’s core beliefs (Duncan, 2006) is captured in its paradigm, which helps to guide and make sense of practice (Mayers, 2000). The underlying assumptions central to the first OT paradigm were that occupation was a basic human need (Dunton, 1919 as cited in Townsend &Polatajko, 2007), mind and body were linked, and a lack of occupation could result in dysfunction of the mind and body (Keilhofner, 1992). Conversely, occupation had the potential to be therapeutic (Townsend &Polatajko, 2007) restoring health and function (Kielhofner 2009). The person connected to the environment through occupation (Kielhofner, 2009), and occupation was thought of in terms of ‘work’, which was vital to happiness and wellbeing (Townsend &Polatajko, 2007). Participating in a ‘balance of occupations’ organised a person’s use of time (Meyer, 1992 cited in Letts et al., 2003) and brought structure to living (Townsend &Polatajko, 2007). The paradigm valued holism and recognised the importance of occupation and its links to health and human dignity (Duncan, 2006). People were viewed as occupational beings, with the right to engage in meaningful occupation (Kielhofner, 2009) and the focus of the profession was on intrinsic motivation and the effect of the environment on occupational performance (Duncan, 2006).