Everyday Occupations and the Process of Redefinition: A Study of How Meaning in Occupation Influences Redefinition of Identity in Women with a Disability

The purpose of this qualitative study is to examine how debilitating diseases or accidents can influence occupation and identity. Ten women facing disabilities as adults were interviewed. Data are analysed with a phenomenologic-hermeneutic approach, and indicate that changed or reduced everyday occupations influence their interaction and presentation of self, which again has consequences to their identity. Early in the process of redefinition, a variety of occupational strategies help keep the identity as disabled at a distance. The women are keeping their jobs as long as possible, they hold on to their usual routines, they avoid places where they have to struggle doing, they barely talk about their occupational problems, avoid technical aids and membership in an interest organization for people with a disability. After some time the strategies change, making it possible to invest time and energy in meaningful occupations, to join interest organisations for disabled people, and engage in occupations tied to their role as women as well as leisure activities. Involvement in meaningful occupations tended to influence the way in which the women viewed themselves and brought about a redefinition of the meaning of disability.     

Reflections on doing, being and becoming*

Occupation, and its relationship with health and well-being, is very complex. It can be described in many different ways by the profession within which it is so central that it provides its name. A simple way to talk about occupation that appears to appeal to a wide range of people is as a synthesis of doing, being and becoming. In the present paper I reflect on how a dynamic balance between doing and being is central to healthy living and wellness, and how becoming whatever a person, or a community, is best fitted to become is dependent on both. Doing is often used as a synonym for occupation within our profession and is so important that it is impossible to envisage the world of humans without it. Being encapsulates such notions as nature and essence, about being true to ourselves, to our individual capacities and in all that we do. Becoming adds to the idea of being a sense of future and holds the notions of transformation and self actualization. It is a concept that sits well with enabling occupation and with ideas about human development, growth and potential. Occupational therapists are in the business of helping people to transform their lives through enabling them to do and to be and through the process of becoming. In combination doing, being and becoming are integral to occupational therapy philosophy, process and outcomes, and some attention is given as to how we may best utilize these in self growth, professional practice, student teaching and learning, or towards social and global change for healthier lifestyles.     

Value of life stories in occupation-based research

Life stories are valuable resources in occupational therapy because they are personal interpretations of people's occupational participation throughout their life course. Life stories can be used as data in occupation-based research to understand the form, function and meaning of occupation at different stages of a person's life. As occupational therapy aims to enable people to participate in meaningful occupation, understandings gained from life-story analysis can be incorporated into the knowledge base of occupational therapy, to advance practice.     

Expanding client-centred thinking to include social determinants: a practical scenario based on the occupation of breastfeeding

Abstract

Background: Client-centred thinking in occupational therapy underemphasizes the influence of social determinants and societal-level factors on occupation across the life course. When client-centred thinking focuses solely on the local or immediate contexts of individuals, therapists may not fully recognize or understand how social determinants can create barriers to occupational participation and performance. Aim/Objectives: This article critically examines gaps in traditional thinking concerning client-centredness and demonstrates how the complex interplay between social determinants and societal-level factors may lead to occupational injustices. Material and methods: A practical example from a recent study on breastfeeding and accompanying scenario is used to examine limitations in current client-centred reasoning. The Life Course Health Development framework, a theoretical framework examining contexts of health disparities, is applied to illustrate the opportunity to expand thinking about client-centredness. Results: The Life Course Health Development framework may be a useful addition to client-centred thinking about social determinants of occupation. Conclusion and significance: Expanding client-centred thinking to include awareness, understanding, and respect for social determinants of occupation may enhance therapist–client interactions and outcomes of the occupational therapy process, and address gaps in current thinking that may contribute to occupational injustices.     

Enabling occupation in the 21st Century: Making good intentions a reality

Occupational therapists intend to collaborate with individuals, groups, agencies, and organizations in their search for meaningful occupations to promote health and justice. Since the 1997 publication of Enabling Occupation: An Occupational Therapy Perspective, Canada's latest guidelines on client-centred practice, the author has interwoven her ethnographic research in mental health services and client-centred practice to raise awareness of disjunctures between intentions and actual practice. Her 1999 Keynote Presentation at OT Australia's 20th National Conference in Canberra offers stories of George and Martha as allegories of the potential for enabling occupation in the 21st century. George presents a story of enabling occupation directly with people in need; Martha's story is about organizing services for enabling occupation. Through these stories, Dr Townsend calls occupational therapists to develop the language, organization and practice needed to make the profession's good intentions a reality in the 21st century.     

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract

Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.     

Feeling lucky: hierarchies of suffering and stories of endometrial cancer in a Danish context

Illness stories are a prime analytical way of understanding patient perspectives on cancer. Nevertheless, limited studies have focused on stories of endometrial cancer. An ethnographic study including participant observation and interviews among 18 Danish women with endometrial cancer was conducted to examine prevalent stories and the ways the women responded to them. In this article, the analysis focuses on two exemplary cases, which present a line of issues related to the kinds of experiences that suffering includes. Findings illustrate that feelings of luck were central to the experience of being diagnosed, treated and cured, which was related to the way health professionals framed endometrial cancer as favourable through notions of curable/incurable, trivial and gentle/invasive and brutal, and aggressive/non‐aggressive. Drawing upon the concept of a ‘hierarchy of suffering’, we exemplify how women tended to scale own experiences of suffering against others’, leading some to believe they were not in a legitimate position to draw attention to themselves nor seek help and support, despite adverse physical, psychosocial effects. Thus, feelings of being lucky were intertwined with a sense of ambivalence. We conclude by discussing how suffering arises within a moral context, suggesting that the ways we speak of cancer may make some experiences unspeakable. This calls for increased clinical attention to more diverse narratives of cancer.     

‘Men are leavers alone and women are worriers’: Gender differences in discourses of health

This paper explores gender differences in health talk, how such talk is informed by discourses at a societal level and the extent to which talking about health is a way of ‘doing gender.’ It draws on in-depth interviews with 48 women and men in their twenties and thirties showing that gender influences both the way people talk about health and their willingness to engage in health talk. It explores the way cultural constructions of gender influence the propensity to take risks with particular reference to HIV/AIDs and recreational drug use and the extent to which discourses of risk inform health talk. We discuss how changes in the occupational structure and the associated influx of men into ‘women's’ work are associated with more ‘feminized’ masculinities and a recognition among some men of the male body's vulnerability. They are also associated with men's health talk becoming more like women's. We conclude that cultural constructions of gender not only have an impact on health talk but also on the regulatory power of discourses of risk and risk management.     

重庆市农村未婚年轻成人父母对给未婚青年提供生殖健康服务的态度调查

目的：通过向未婚年轻成人的父母了解未婚年轻成人未得到生殖健康需求服务的成因，以确定给未婚年轻成人提供生殖健康服务的最佳途径和可行方法。方法：采用小组访谈法，对重庆市农村地区18-24岁有婚前性行为年轻成人的父母分别访谈，讨论的内容包括父母对未婚年轻成人婚前性行为的态度，父母对婚前性行为和人工流产影响未婚年轻成人健康的认识，父母对给未婚年轻成人提供教育和服务的态度等。结果：农村父母也给子女提一些忠告，但对子女因婚前性行为导致未婚先孕，普遍采取事后补救等被动措施表现出极大忧虑。父母赞成向子女提供有针对性的相关教育和服务，希望政府和社会机构给予重视，结论：农村未婚年轻成人婚前性行为和人工流产的普遍，与其自身文化水平和科学知识不足，家庭观念落后，如父母，教师和社会相关人员生殖健康知识水平不高及社会未重视有关，建议成立青少年生殖健康促进中心，制订相应的媒体法规及将青少年生殖健康教育和生殖健康服务纳入计划生育服务范畴，将有利于保障青少年生殖健康的需求。     

Cancer survival stories: Perception,creation, and potential use case

Background

Cancer patients often search for information about their health conditions online. Cancer patient narratives have established themselves as a way of providing information and education but also as an effective approach to improving coping with the disease.

Objective

We investigated how people affected by cancer perceive cancer patient narratives and whether such stories can potentially improve coping during their own cancer journeys. Additionally, we reflected on whether our co-creative citizen science approach can contribute to gaining knowledge about cancer survival stories and providing peer support.

Design, Setting and Stakeholders

We applied a co-creative citizen science approach by using quantitative and qualitative research methods with stakeholders (i.e., cancer patients, their relatives, friends and health professionals).

Main Outcome Measures

Understandability and perceived benefits of cancer survival stories, coping, emotional reactions to the stories and helpful characteristics of the stories.

Results

Cancer survival stories were considered intelligible and beneficial, and they potentially support positive emotions and coping in people affected by cancer. Together with the stakeholders, we identified four main characteristics that evoked positive emotions and that were considered especially helpful: (1) positive attitudes towards life, (2) encouraging cancer journeys, (3) individual coping strategies for everyday challenges and (4) openly shared vulnerabilities.

Conclusions

Cancer survival stories potentially support positive emotions and coping in people affected by cancer. A citizen science approach is suitable for identifying relevant characteristics of cancer survival stories and may become a helpful educational peer support resource for people coping with cancer.

Patient or Public Contributions

We adopted a co-creative citizen science approach, wherein citizens and researchers were equally involved throughout the entire project.     

Telling our story. Catholics can cultivate genuine hope by emphasizing the human dimension in culture and politics

In the West the experience of modernity frequently leads people to ask whether they are running things or things are running them. The answer lies in the connection between modernity and religious tradition. Are there useful and constructive and effective ways of thinking about the task of our living as though what Jesus taught and did makes sense, makes sense in a modern world that thinks and acts as if it has or will soon have all answers? Perhaps everything will turn out all right, but such optimism should not be confused with hope. As Vaclav Havel explains, hope "is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out." To cultivate a perspective from which things can make sense, Catholics need to find a way to tell their story so that it has relevance in the modern world. In particular, Catholics must find stories that will account for the shift that had been building in our culture over centuries but that the Church only fully acknowledged during the papacy of John XXIII. To some extent, the stories will have to offer a counterstatement to the unintended negative effects of certain facets of the modern agenda. The stories will have to address the overemphasis on individuality that has resulted from the democratization of politics and culture, the uncritical belief that change is always for the better, and the modern world's power to overwhelm our ability to think critically about it. Finally, the stories will have to return a human dimension to economic and cultural life.     

Governing the Majority World? Critical reflections on the role of occupation technology in international contexts

Background:  Within occupational therapy, increasing attention has been focussed on international development work. However, many have critiqued the focus of knowledge development within occupational therapy and occupational science, arguing that it is focussed on Western values. Questions arise about how occupational therapy and occupational science, and the knowledge and therapeutic technologies that are associated with these communities, will affect the 'developing' world, which, recently, some have described as the Majority World.
Aim and method:  Using Foucauldian analytical tools, this paper reflects on specific discourses that are foundational for development work. Specifically, this paper attempts to better understand how concepts like 'occupational justice' and the 'occupational being' are presented in the literature and relate to practices in international contexts. Within this analysis, attention is focussed on how practices associated with occupational development work might also be enmeshed in power dynamics.
Results:  This paper outlines how occupational discourses may shape and order life in particular ways and challenges researchers and practitioners to develop a better understanding of how power can operate through occupational discourses and occupational therapy practices. This paper also adds to the literature through the interpretation and explication of various theories that may underpin work in international contexts.
Conclusions/future directions:  Suggestions for future directions that will enable the development of more politically and culturally sensitive knowledge and practices are also explored. It is crucial that as a community we become more aware of how our theoretical frameworks may impact and shape practice.     

Occupational science: a renaissance of service to humankind through knowledge

The context for the development of occupational science, the study of the human as an occupational being, included the worldwide increase in the population of people with chronic impairments, decreased resources for people with handicaps, growth in the complexity of daily life and the global maturation of the profession of occupational therapy. Occupational science promises that occupational therapists will define the knowledge base of the profession and its appropriate scope of practice through scholarly work. Occupational scientists need to develop a fresh synthesis of ideas from those scholarly disciplines that view the human as a complex being who interacts with the environment by using occupation over the three time spans of evolution, human development and learning; occupation as agency; and viewing the person served as Homo occupacio, a dynamic, open human system. The occupational human engages in daily life through development of a repertoire of skills which adheres to the rules of culture. Such study will need to include the contexts in which people carry out their rounds of occupation. The ‘detective work’ of occupational scientists, contributing to but not bound by the immediate demands of occupational therapy practice, will be guided by the values and traditions of the field to ensure its relevance and ethical foundation. The most important tool of the world community of occupational therapists will be the mind of the occupational therapist, who, through knowledge of occupation, will foster human capability and influence health. Copyright © 2000 Whurr Publishers Ltd.     

Satisfaction with Daily Occupations: A Tool for Client Evaluation in Mental Health Care

Research findings suggest that in order to clarify the relationship between occupation and health, occupation needs to be framed in several different ways. One facet of occupation is satisfaction with daily occupations, assessed using the Satisfaction with Daily Occupations (SDO) instrument. The purpose was to investigate some of the SDO's psychometric properties when applied on people with persistent mental illness. Discriminant validity against occupational value and quality of life was investigated, as was internal consistency and ability to discriminate between people with different types of daily occupation. A total of 103 patients from a psychiatric outpatient unit were selected, representing people in work or studying, people visiting activity centres, and people with no organized daily occupation. The SDO showed no or weak relationships with occupational value and quality of life, and the internal consistency was alpha=0.80. Factor analysis revealed loadings between 0.44 and 0.79. Five out of 9 items discriminated between the occupational groups. In conclusion, the SDO showed discriminant validity against occupational value and quality of life, had acceptable internal consistency, and formed one single construct. The SDO can be improved by means of further revision and psychometric testing, but the present version should be valid and reliable enough to use in occupational therapy practice and research.     

Is globalisation outpacing ethics and social responsibility in occupational health?

INTRODUCTION: The definition of globalisation is varied. However, one certainty is that in a globalised world the borders are porous in many aspects; people movement, goods exchange, knowledge sharing and redistribution of labour. The concept of globalisation, its impact on society, and its direction leads to a two-sided argument. Could this be the effect of globalisation on ethics and social responsibility, as it is perceived? This paper endeavours to further our understanding of the dynamic relationship of globalisation, ethics and social responsibility in occupational health. METHOD: The multidisciplinary activity approach to occupational health was used. The globalisation, ethical and social responsibility relationship of the activities in occupational health was analysed using a schematic map of the direct and indirect influences. RESULTS: The analysis revealed areas that can be clustered to address the interaction between driving forces in occupational health ethics and social responsibility for a healthy workforce. DISCUSSION: Each cluster is discussed highlighting areas of concern. In the discussion proposals are made on how we can modify the way we think in order to avoid repeating mistakes. Suggestion is made of using an innovative method borrowed from other disciplines and adopted for use in occupational health. A partnership approach is proposed and explored on how it will be applied in situations of unequal balance of power.     

What lies behind the subjective evaluation of health status?

The evaluation of health or subjective health (SH) is considered a legitimate indicator of overall health status, providing a valid, reliable and cost-effective means of health assessment. This study looks at factors reported by respondents as influencing their SH, it analyzes to which extent people compare themselves with others when evaluating their health, and examines the difference between people with optimal or sub-optimal SH. Face-to-face interviews were conducted with 383 Israeli residents. Three models for judging health status were identified: the biomedical or disease oriented, the emotional or "general feeling", and the functional-related model. The reported influence of some factors for the evaluation of health changed by age and by level of subjective health. Respondents with sub-optimal health reported tiredness and pain as more influential. Most interviewees spontaneously reported comparing their health to reference groups. Age and level of subjective health were associated with the way people compare their health to others. The young reporting sub-optimal health did not compare themselves to people their age, but a high percentage of the old did so. Among those with excellent health, the young rather than the old were more likely to compare themselves to people their age. These findings imply that each individual tries to find ways to evaluate his/her health in a more positive light. When old and not healthy they tend to compare themselves to friends or people their age, but if young and not healthy they do not perform the comparison so as not to feel worse. Understanding how people evaluate their health can contribute to the conceptual development of subjective health.     

A question of balance: health behaviour and work context among male Glaswegians

Discussion of the persistence of social class inequalities in health has led to greater interest being paid to differences between the classes in lay health beliefs. Recent work on lay health beliefs, however, has mainly viewed social class as a proxy for wider aspects of lifestyle and paid less attention to its occupational component. Part of this can be explained by its predominant focus on the health beliefs of women. This paper remedies this imbalance by focusing on male Glaswegians' perceptions of the health effects of their occupations. It shows that not only were respondents very aware of the influence their jobs had on their health but that they also took action to redress the balance, either by compensating for such effects or controlling their work environment to minimise their influence. Respondents' degree of commitment to their work also had a direct bearing on their coping styles. Although traditional occupational class measures were found to obscure much of how occupation influences health, unskilled and semi-skilled workers did suffer the greatest limitations in coping with the health effects of work.     

'Taking charge of your health': discourses of responsibility in English-Canadian women's magazines

This article presents an examination of the ways in which responsibility for health is constructed in popular English-Canadian women's magazines. Women's magazines are a unique media form, acting as guidebooks for women on matters relating to feminine gender roles and are important to examine as part of the corpus of societal discourses which frame our understandings of what it means to be healthy and how good health is achieved. Using discourse analysis several techniques were found which reinforce women's individual responsibility to create and maintain good health for themselves and their families. The magazines instruct women/readers directly about their health-related responsibilities and outline the negative consequences of inaction or incorrect action. The magazines also use the traditional discursive technique of women's personal accounts as both cautionary tales and inspirational stories to encourage readers to actively pursue healthy behaviours. Reflecting and reinforcing the discourse of healthism, women's magazines consistently present health as an important individual responsibility and a moral imperative which creates an entrepreneurial subject position for women. The article concludes by discussing the implications for women's magazine audiences within the ongoing feminist debate about this cultural industry.     

Powerful practices: The legacy of Margaret Mort

History is our present in the making. An appreciation of occupational therapy's origins, and of key people who contributed to its development, are important to understanding the current place of our profession in health care. This paper sketches the story of Margaret Mort, an historically significant Australian occupational therapist, from her early years as a wartime therapist to her later years as a pioneer in geriatric rehabilitation. Her work exemplifies principles which underpin contemporary occupational therapy practice and which this article chronicles for the edification of those curious about our profession's rich history.