Chapter outline
An occupation analysis requires an understanding of the centrality of the concept of occupation from an occupational therapy (OT) and occupational science perspective. This chapter considers that engagement in occupations occurs because individuals, groups and communities possess skills or values that facilitate choice and performance of specific occupations within particular contexts. The chapter proposes six innate intrinsic elements and seven environmental contexts that influence performance of occupations. Occupation analysis explores the transactional relationship between three components of occupational performance: the occupation itself; the participating individual, group or community and the contexts surrounding the occupational participation.
Chapter objectives
The reader should be able to:
• Define occupation from an OT perspective.
• Recognize differences between occupation, activity, task and action.
• Identify and explain the 'areas of occupation' defined by the American Occupational Therapy Association (AOTA) in the Occupational Therapy Practice Framework, 2008.
• Explain the need for an occupation analysis.
• State and connect the components of an occupation analysis.
• Outline the occupation analysis process.
Concepts implicit within occupational therapy
Occupational therapists are concerned about the needs, desires, experiences and expectations of individuals and/or groups and the role of occupation in meeting those needs and achieving those expectations. Until the late twentieth century a major focus of OT practice was the therapeutic use of occupations to improve skills and occupational performance. The late twentieth century saw a growing understanding of the purpose and power of occupation in influencing health, wellbeing and participation in life (Wilcock, 2006). This understanding supports the use of occupation as an intervention and facilitates the unique synthesis of knowledge from various fields into a scholarly discipline known as occupational science. Occupational science is dedicated to examining the form, function and meaning of occupations (Zemke & Clark, 1996). Occupation became more than using objects for therapeutic benefit or successful performance of an activity. It became a force that potentially empowers engagement and performance, thereby contributing to and maintaining health, participation and a sense of wellbeing. Thus, occupational therapists believe that appropriate engagement in relevant occupations has the potential to structure, shape and transform the lives of individuals, groups and communities. In order to analyse occupation in the lives of people with occupational needs, it is necessary to explore this concept.
Occupation: an occupational therapy perspective
There are various definitions for the word 'occupation'. Reflection upon definitions found in OT literature contributes to understanding the concept of occupation from this perspective.
Learning Point
Stage One: Consider the definitions below, or other definitions of occupation found in OT literature. Choose or create a favourite definition and provide a rationale for this definition.
Stage Two: Share this definition and rationale with others (either a small group or the entire class).
Stage Three: Evaluate and discuss chosen definitions. Record points of difference and relevant comments that challenge your choice.
Stage Four: Compose your own definition and be prepared to explain that definition to another health professional, a relative, a member of the public and a physiotherapist.
• 'Occupations are defined in the science as chunks of daily life that can be named in the lexicon of the culture' (Zemke & Clark, 1996, p. vii).
• 'Activities that people engage in throughout their daily lives to fulfil their time and give life meaning. Occupation involves mental abilities and skills, and may or may not have an observable physical dimension' (Hinojosa & Kramer, 1997, p. 865).
• 'Daily activities that reflect cultural values, provide structure to living, and meaning to individuals; these activities meet human needs for self-care, enjoyment, and participation in society' (Crepeau et al., 2003, p. 1031).
• 'Goal-directed pursuits that typically extend over time, have meaning to the performance, and involve multiple tasks' (Christiansen et al., 2005, p. 548).
The above definitions indicate that occupations are part of daily life. They are all the things people do and they give life meaning (Fisher, 2006). Occupations exist within a dynamic relationship between the unique person and their ability to perform occupations in particular contexts (Nelson & Jepson-Thomas, 2003). They require abilities and skills; they are affected by many factors, including culture; and they can contribute to the needs of individuals, groups or societies (Law et al., 1997). They have a purpose or are goal directed and provide a structure for living. As such, occupations are essential for sustaining human life (Wilcock, 1993), influencing the quality of life experiences and determining the health and wellbeing of individuals, groups or communities (Wilcock & Townsend, 2008). Occupations are central to the identity and competence of people, as individuals, groups or communities assign priority and meaning to occupations according to their values and beliefs. Occupation is more than paid employment or occupying time; rather, occupation encompasses what Wilcock (2006) defines as being, doing and becoming.
These definitions indicate the centrality of occupation to OT practice (Polatajko et al., 2004). Facilitating optimal engagement in occupations requires analysis of the occupations to support health and participation in life (DeLany, 2007). It considers the vibrant relationship between the occupation, the individual (group/community) and the contexts that support and facilitate successful occupational participation (Christiansen & Baum, 2005; Law et al., 1996, 2005).
Reviewing terms: occupation, activity and task
The word occupation is often used interchangeably with either activity or task and sometimes even action. Alternatively, some scholars view the terms occupation and activity as having different meanings (Christiansen & Townsend, 2004; Pierce, 2001; Reed, 2005). The following discussion also proposes a different meaning for these terms. In this chapter, consistent with the 'taxonomic code for understanding occupation' (Polatajko et al., 2004), the term 'occupation' is not synonymous with the terms 'activity' or 'task', it is an overarching term, which includes and builds upon both activities and tasks. For instance, voluntary movement, movement patterns and cognitive/perceptual skills initiate the action of positioning and moving specific body parts to use a keyboard to complete an assignment. This positioning and movement fulfils tasks, which might include making a plan, choosing references, completing an introduction and so forth. The completion of such tasks contributes to the performance of the overall activity of writing an assignment. The completion of the assignment is an activity within the overall occupation of communicating through writing and can be classified as a productive occupation associated with the role of a student. The occupation of communicating through writing is a meaningful occupation for many occupational roles (student, teacher, health professional, scientist, engineer and so on). Certainly, many cultures consider communicating with writing skills an essential occupation. Another significant occupation is caring for self through maintenance of personal hygiene, an occupation commonly classified as an essential self-care occupation, which belongs with activities of daily living (ADL). This significant occupation personal hygiene and grooming — includes activities such as caring for nails, hair, skin, ears, eyes, nose, teeth, and each activity encompasses a variety of tasks. Occupational therapists commonly classify occupations according to their purpose or theme (Polatajko et al., 2004), which tends to create three broad occupational groupings: self-care, productivity and leisure.
Learning Point
Using the taxonomic code for understanding occupation (Polatajko et al., 2004), name the occupation and the purpose or theme of each occupation. The first one is completed as an example.
Minute taking
Areas of occupation
The following is a brief summary of how the Occupational Therapy Practice Framework; Domain & Process 2nd edition (AOTA, 2008) classifies occupations into eight areas.
1. Activities of Daily Living (ADL). ADL are self-care or self-maintenance activities that facilitate basic survival and life satisfaction in an interactive world (Christiansen & Hammecker, 2001). Examples include eating, bathing, dressing, sexual activity, toileting.
2. Instrumental Activities of Daily Living (IADL). IADL are those activities that support daily life in the home and community. These include care of pets and others; communicating with others; managing finances, health and home; moving around the community; preparing meals; shopping; participating in religious practices; maintaining safety and responding to emergencies.
3. Sleep. Sleep includes all activities that occur because of the occupation of sleeping, specifically, preparing self and children (if necessary) and the environment to ensure restful and safe sleep. These might include covering the children, completing usual rituals or habits (e.g. saying goodnight, reading, relaxation, saying prayers), interacting with others who share the sleeping space. The occupation of sleeping also includes dreaming, night toileting and as necessary negotiating the sleeping space and covers with others.
4. Education. Education involves learning and includes all activities supporting learning. Formal education can include academic (e.g. science, reading, undergraduate or postgraduate study), non-academic (e.g. in the environs of the 'school'), extracurricular (e.g. sport, band, school discos, debating, speciality clubs such as the chess club) and vocational (e.g. activities associated with preparation for a particular vocation or profession). Self-initiated education occurs because of need or interest. It may involve organised classes or informal research and skills development.
5. Work. Work includes all activities required to seek, acquire, negotiate and fulfil paid or unpaid (voluntary) employment. Work requires identification of appropriate paid or unpaid positions, applying for those positions, negotiating conditions if successful and consistently performing all required tasks associated with the position, that is, time management, and relating to co-workers, management and 'customers' (e.g. following expected work norms and procedures, applying for promotions). This area of occupation also involves preparing for retirement when appropriate. This may include searching for interesting opportunities to volunteer: to engage in unpaid work.
6. Play. Play is by far the most engaging area of occupation for children and the young at heart. Parham and Fazio (1997) define play as 'any spontaneous or organised activity that provides enjoyment, entertainment, amusement or diversion' (p. 252). Play includes exploration, practice, pretending and engaging in different types of exploratory games. It also includes regular maintenance of any 'toys' associated with play activities and playing to maintain a balance between all areas of occupation.
7. Leisure. Leisure activities involve interest and enjoyment. They are intrinsically motivated and performed during times allocated for personal pleasure. They may involve passive participation, for instance, watching television. These activities occur when there are no demands or responsibilities from other required areas of occupation (Parham & Fazio, 1997). They require participation in all support activities (e.g. maintenance of any necessary equipment such as inflating tyres on a bicycle when riding for leisure) as well as managing an occupational balance that facilitates performance of required activities in all areas of life.
8. Social participation. Social patterns of behaviour are usually governed by social norms and expectations of age, gender, position and role within the particular social system. (Mosey, 1996). Social participation requires interaction of individuals within a social structure: the community, the family and peers or friends. It requires behaviours that support successful interactions from the perspective of the participants and may require different levels of intimacy including, if desired, sexual interaction. Social participation does not always have positive outcomes; for example, group crimes and violence have meaning for the participating individuals but are not positive for everyone.
Classifying occupations or activities into areas of occupation, although important, can be problematic. People differ according to their time of life and their roles and cultures. Therefore, individuals may potentially view particular occupations differently at different times of life. Some see 'eating' as ADL, some as play, others as social participation, others leisure and some even as work. Some might consider sewing as work, others as IADL or even play, while others as leisure. These differences indicate the complex and multidimensional nature of the factors affecting the perceptions of occupation. It is necessary to include these factors in an occupation analysis.
Learning Point
Stage One: In small groups, choose an occupation or activity. Explain why your choice is classified as an occupation or an activity.
Stage Two: Identify any necessary tasks and actions associated with your choice.
Stage Three: Consider the following list of occupations or activities. Using the list of areas of occupation summarised above, classify each item into a particular area of occupation. Note any variations in opinion within the group; consider the rationale of each person for their desired classification. Explain why variations occur. Is there a wrong or right way of classifying these?
Eating; washing clothes; playing Monopoly; napping; mathematics; driving a car; brushing hair; walking the dog; sending an SMS; astronomy; sexual activity; watching a movie; teaching someone to ride a horse and playing a piano.
A traditional approach: activity analysis
Traditionally, an activity analysis has been a component of OT curricula. An activity analysis indicates the requirements for successful performance of the activity and indicates the therapeutic potential of that activity (Breines, 2006). This is essential to guide the choice of beneficial, relevant and safe OT interventions. The activity analysis process does not necessarily consider all aspects of the individual nor does it consider the contexts that surround the activities. Furthermore, it has not traditionally included the needs of groups or communities, which is a focus of much current OT practice. Generally, the activity analysis process isolates the required actions in the appropriate sequence, lists the equipment used and analyses the particular skills required for safe performance of the activity. It does not typically require the presence of the person(s) or consider individual ways of performing the activity. The activity is the focus of the analysis irrespective of the individual, group or community (Figure 1.1).
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