Older men and women
Fox and Quinn (2012)
Cooking festive meals
Wright-St. Clair et al. (2013)
Adult and older women
Reading picture books
Lee et al. (2003)
Singing in a choir
Tonneijck et al. (2008)
Beyond their knowledge of occupation and its place in people’s lives, occupational therapists who work with people with disabilities need to appreciate how health conditions impact engagement in occupation. Here also, the evidence accumulated by occupational scientists is salient. It is also, at times, generated expressly to inform occupational therapy practice. For example, studies have revealed how occupational routines can support family well-being when an adolescent has a mental illness (Koome et al. 2012), that while children with dyspraxia cannot be ‘cured’ they can enjoy and succeed in gymnastics (Hessell et al. 2010), that occupation is meaningful to people with chronic mental illness (Eklund et al. 2012) and the complex knowledge academics with multiple sclerosis build up as they navigate the university campus and workload demands (Dale Stone 2009). Other researchers have entirely reframed recovery from mental illness from an occupational perspective (Sutton et al. 2012) and uncovered the participation skills that community members need to be able to support children to engage in everyday occupations after a brain injury (Jones 2014).
Occupational Science Generating New Interventions
Several new interventions developed by occupational scientists also support the move back to occupation-centred practice. These are based on studies that have investigated people’s occupational concerns, and how patterns of occupation affect people’s health. For example, the ReDesigning Daily Occupations (ReDO) programme developed in Sweden by Erlandsson (2013) is a 16-week facilitated programme based on research about patterns of everyday occupations among women with complex family situations (Erlandsson and Eklund 2003, 2006). The Value and Meaning in Occupations model developed by Persson and colleagues (Persson et al. 2001) formed the theoretical framework that underpinned the ReDO programme. Important elements of the ReDO programme are based on occupational science and occupational therapy principles, such as reflecting on one’s occupational history, identifying interests, stressors and rewards, mapping how time is used and becoming aware of the value and meaning that may be found in everyday occupations. The aim of the ReDO programme is for participants to have begun a long-lasting change to their patterns of daily occupations, providing knowledge and understanding of each participant’s unique patterns of daily occupations and what shapes them, through a process of occupational analysis. Research has shown that the ReDO programme has a greater return to work success rate than ‘care as usual’ (Erlandsson and Eklund 2011) and that the ‘ReDO interventions showed greater gains for the higher educated and older women in this middle aged sample’ (Eklund et al. 2013, p. 91). These results point to the ReDO programme being a promising occupational therapy intervention.
Another example of a new intervention is based on the work of occupational scientists from the University of Southern California. The team led by Florence Clark and her colleagues identified that the occurrence of pressure ulcers could have an occupational underpinning and as such could be a barrier to participating in everyday occupations. The initial study, the Pressure Ulcer Prevention Study I (Clark et al. 2007) began as a holistic ethnographic study to explore the life contexts that contributed to the occurrence of pressure ulcers. From the data gathered in this study, the occupational science researchers were able to develop a model for occupational therapy intervention. This required testing of the efficacy of the intervention and manualising the therapeutic methods. The manual provisionally included such topics as occupational story making, habits and routines, participation and activity and spirituality (Blanche et al. 2011). A randomised control trial, the Pressure Ulcer Prevention Study II, has been developed to evaluate the cost effectiveness of the new intervention compared with standard care. Its goal is to provide occupational therapists with a theoretically guided, evidence-based intervention programme to reduce the risk of pressure ulcers.
Occupational Science Opening up New Practice Opportunities
In addition to supporting current practice, occupational science challenges and equips occupational therapists to establish new roles in population health and social justice. The first call to make that shift, by reorienting practice from rehabilitation and prevention to health promotion , was in the World Health Organization’s Declaration of Alma-Ata (1978). Recognising gross inequalities in people’s health status, that document declares health to be a fundamental human right and a worldwide social goal. Knowing that occupation is the foundation of good health, it is easy for occupational therapists to see that the profession has much to offer. Concepts developed by occupational scientists bring clarity to the profession’s role in population health, explaining the relationship between poor health and burdensome or restricted participation in occupation. Two concepts are pivotal: occupational deprivation and transactionalism.
The consequences of being deprived of a sufficient range of occupations include actual and important reductions in well-being , with long-term implications for health (Wilcock and Hocking 2015). That outcome has been validated in a number of studies. For example, marginalization within the workplace , inflexible workloads and schedules, and provision of necessary health services within normal work hours can make it impossible for people with disabilities to sustain employment (Dale Stone 2003; Jakobsen 2004), pushing them into poverty and alienating them from the rest of society. Equally, refugees and asylum seekers, whose access to work and other culturally significant occupations is severely curtailed, describe challenges with constructing meaningful routines, maintaining parental roles, preserving their culture and preparing for the future (McElroy et al. 2012; Steindl et al. 2008). A population health approach addresses such issues as a matter of justice, using interventions designed to change attitudes and practices across work, transport, housing, immigration, health and social sectors. Horghagen and Josephsson’s (2010) account of promoting the visibility of asylum seekers housed in a Norwegian reception centre by engaging them in a theatre production is one example. Taking a transactional approach, which views people as both shaped by and shaping their context, is imperative. Only in that way can we fully appreciate the ways people mediate environmental demands and restrictions, to best fit their beliefs, capacities and circumstances (Connor Schisler and Polatajko 2002).
Occupational science is a relatively new field of study. There is much work to do before we can claim that it provides a comprehensive understanding of the nature, performance and outcomes of the things people do in their everyday lives. Even so, it is changing the ways occupational therapists intervene with people who have difficulty doing the things they want, need and have to do. In every practice area, occupational science informs practice by revealing the rich and complex meanings occupation holds, which occupational therapists need to understand if we are to appreciate the significance of people’s occupational goals and to engage them in the interventions we offer. In some practice areas, the science is generating new, evidence-based interventions that address costly threats to health, such as the ReDO programme for workers experiencing unsustainable levels of stress and the pressure ulcer prevention programme for people with spinal cord injuries. In population health, occupational science offers a fresh perspective to understanding the nature of the health threats affecting diverse populations. Thus equipped, occupational therapists can stand alongside others working in that field to promote health and well-being by challenging restrictions on people’s access to occupation and helping them to change patterns of occupations that undermine health.