HEALTH

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 is nosingle 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 and engagement There is strong relation between occupation and healthand well-being. However, 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) Discusswhy occupation is considered important to the health and well-being of humans To understand how occupation, contribute to health andwell-being, it is important to consider the question through biologicalperspective. Anna Wilcock, an eminent occupational scientist, argued thatoccupation is essential to individuals and species survival, because the basicbiological needs for substances, self-care, shelter, and safety are met throughthe things people do (Wilcock 1993).

Understanding occupation is immenselycomplex. The three elements- people, occupation and environment and theirdynamic relationship helps to explain why understanding the nature ofoccupation is difficult. Occupation keeps us alive. In the long term,occupation can provide, the physical activity, mental stimulation, and socialinteraction we need to keep our bodies, minds and community healthy.

Inaddition, through participation in occupation, we express ourselves, developskills, experience pleasure and involvement, and achieve the things we believeto be important (Willard and spackman’s 11 edition). Mary Catherine Bateson, awell-known anthropologist and author wrote: the capacity to do something usefulfor yourself or others is the key to personhood, whether it involves theability to earn a living, cook a meal, put on shoes in the morning, or whetherother skill needs to be mastered at the moment (Bateson, 1999). That is, peopleuse occupation to develop an understand of who they are, what they might do,the context in which they might act, who they might become (Hocking 2001). Anotable study of how occupation influences health and wellbeing was Clark etal.’s (1997) a randomized controlled trial examining the dynamic interplaybetween occupation, health, and well-being of healthy, community dwelling olderadults. Clark et al. determined that participating in a meaningful occupationenhanced participants’ physical and mental health, occupational functioning,and life satisfaction.

Another recent report “Healthy people 2020” prepared forthe us government is one of the many authoritative sources asserting thatphysical activity helps maintain healthy weight for people of all ages andstrength and agility in older adults. That report also associate good mentalhealth with productive occupations, noting that mental illness often results inpeople being unable to manage their responsibility as parents and partners(Healthy people 2020, nd).  Converselypeople who are unable to participate in their choice of occupation, forwhatever reasons, can suffer from occupation imbalance, deprivation andalienation.

Occupation balance is very important, doing too little, doing toomuch or doing things that expose us to risk can have deteriorating effect. As thereis intrinsic relationship between occupation, activity, health and wellbeing,therefore occupation can be used to regain and promote good health (RCOT 2003).Occupationperformance. Occupation performance refer to the ability to choose andsatisfactory perform meaningful occupations that are culturally defined, andappropriate for looking one’s self, enjoying life, and contributing to thesocial and economic fabrics in a community (CAOT, 2002).

  Occupation performance is the result of theinteraction between the person, occupation and environment.  Change in the environment can affect person, occupationand occupation performance. Alternatively, change in the person or occupationcan bring change in the environment.   Explain therole of occupational therapists in enabling people to achieve or restorewell-beingThe 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). Occupational therapists understand the interaction between the person,the environment and the activities they need to accomplish in their daily life.

Thus, they help clients by motivating them to take an active role in ameaningful activity, monitor the therapeutic environment to minimise barriersand by providing solutions to challenges related with routines and changinghabits.   Describethe occupational therapy processOccupational therapy intervention is aprocess of collaboration and negotiation between the therapist, client andcarer in which the client is helped to identify his/her problems and/or goalsand to find effective ways of dealing with them. The occupational therapy process stages appear to besimple but occupational therapists must have enough knowledge and skills towork with clients to enable occupation.

The therapeutic relationship betweenthe client and the occupational therapist is very important, as both parts areparticipating in the process and bring different experience.  The main purpose of the occupational therapyprocess is to provide structure so that occupational therapist can address client’shealth-related problems based on evidence. According to McColl and Pranger itserves to “instruct therapist about how to intervene to produce a desiredeffect” (1994, p.

251).  The process isneither condition- (i.e., diagnosis, condition, disorder) nor age-specific andcan be applied in any practical setting-hospitals, outpatient clinic, schools,workplace, or clients home (Willard and Spackman’s 2014 p 265).  Occupational therapy practitioners customisethe process with the end goal of supporting the client’s health andparticipation through engagement in occupation (AOTA 2018).

  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: referral orreason for contact; information gathering; initial interview; reason forintervention/needs identification/problem formulation; set goals; action plan;action; ongoing assessment; outcome and outcome measurement; end ofintervention or discharge followed by a final review.

The occupationaltherapist starts by looking at the client’s range and balance of occupation,both current and feature range of activities, tasks or skills that willremediate the deficit and enable the client to enact his or her occupation moreeffectively (COT 2003). Having identified where the problem is, the practitionershifts the focus inward in to activities, tasks and skills that are meaningfulto the client and can enable the client to perform his/her occupationeffectively. At the end of the process the therapist shifts the focus outwardsagain to see what effect the intervention has had on the client’s overallpattern of occupations (RCOT 2003).    occupational therapist needs to select specifictheoretical approaches for use with a particular client.

  Models of practice help to organize how one views andassesses the things about a person or their environment that support or limittheir performance (Fisher 1998).  Modelsof occupation therapy helps the transition of occupation therapy theory in 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). MOHO is one of the models of occupational therapy. It wasintroduced in 1980s and continue to be refined up to three decades later(kielhofner 2008).

MOHO considers human beings to be an open system consistingof volitional, habituation, and performance capacity and considers how thesethree aspects interact with each other and the environment. It helpspractitioners to understand how occupation is motivated, organised, performedand affected by the environment.  

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