Defining the complexities of an occupational pattern—A concept analysis and theoretical validation

Figures & data

Table 1. Search string and additional information regarding identifying concept use.

Search string

activity patterns OR occupational pattern OR patterns of daily occupations OR patterns of daily activities AND occupational therapy OR occupational science

Inclusion and exclusion

The inclusion of data required articles to specify ‘occupational pattern’, patterns of daily occupations, or activity patterns in the title or abstract of the article. Articles and literature were excluded if they were not in English or Swedish, were opinion texts, or if they merely addressed physical activity patterns, a different concept used within other sciences. An abstract, if found relevant, was fully reviewed.

Full texts

Each full-text article was reviewed and chosen to encompass a diversity of representations of the concept itself. Articles and other documents were retained if they contained a definition, operationalization, or measure of the concept. The articles were read carefully, and all content related to occupational patterns was collected in MAXQDA, a software program designed for computer-assisted analysis in research [8], regardless of whether it was mentioned in the introduction, results, or discussion, or how much or little was written about it (which varied considerably between different articles). Secondary definitions and/or descriptions (i.e. referred to in the articles included) were also included without using the source. The reason for including secondary sources as well as references in the introduction is to include different operationalisations or descriptions of the concept, despite it coming from already-included theoretical references. After full texts had been read, OT reference literature and articles’ reference lists were manually searched.

Figure 1. Flowchart presenting steps for the identification, screening, and eligibility and included scholarship in the concept analysis, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Table 2. Included articles, as well as other references, in the concept analysis.

Title of book, or title of article	Aim of study, or research questions	Participants	Article identifier
Articles located via databases
A controlled study analyzing the temporal activity patterns of individuals with stroke compared to healthy adults	The study’s main research questions were ‘What are the activities that form the daily routines of individuals with stroke?’ and ‘How do the time use and temporal activity patterns of stroke individuals differ from those of healthy adults?’	50 individuals with stroke and 50 individuals without disease.	[11]
A pilot study of the activity patterns of five elderly persons after a housing adaptation	To describe the activity patterns of five elderly persons aged between 70 and 84 years and their views about the accessibility and usability of their homes before and after a housing adaptation.	Five elderly people, 70–83 years of age, with neurological and pain disabilities.	[12]
Addictions and impulse-control as occupation: a selected literature review and synthesis	To consider whether the activities associated with classifications of addiction and impulse-control disorders meet the definition of occupation and to propose potential implications of the findings to the conceptualization of occupations.	Did not include participants as it was a literature review.	[13]
Altruistic activity patterns among long-term nursing home residents	To explore patterns of altruistic expressions in older adults both before admission and as residents of a nursing home.	10 females and 1 male, all of whom were over 65 years of age and Caucasian.	[14]
Assessing the use of a portable time-geographic diary for detecting patterns of daily occupations	To test the usability of a Portable Diary Data collector (PODD) as a tool for diary data collection to detect and visualize sequences of daily activities.	94 OT students in Sweden.	[15]
Caregivers’ perspectives of occupational engagement of persons with dementia	To examine caregivers’ perception of the occupational performance of their relatives from three aspects: person, occupation, and environment.	14 family caregivers.	[16]
Case formulation in persistent pain in children and adolescents: The application of the nonlinear dynamic systems perspective	Key concepts derived from nonlinear dynamic systems theory (NDST) are used to explain how the integration of multiple systems contributes to pain and disability, assisting clinicians.	Children and adolescents.	[17]
Changing everyday activities of couples in late life: converging and keeping up	To understand, over time, changes in everyday activities as experienced by late-life community-dwelling couples.	41 individual and joint interviews were conducted with 8 couples.	[18]
Coaching for learning—supporting health through self-occupation-analysis and revision of daily occupations	The presentation of an OT intervention named Redesigning Daily Occupations (ReDO).	Did not include participants as it was a paper aimed at providing information on an intervention.	[19]
Coping strategies in daily occupations 3 months after a severe or major hand injury	To explore coping strategies used in performing daily occupations 3 months after a severe or major injury affecting the hand and arm.	13 participants with hand injuries.	[20]
‘Do-Live-Well’: A Canadian framework for promoting occupation, health, and well-being	The presentation of a new framework grounded in evidence regarding the link between what people do and their health and well-being.	Did not include participants as it was a paper aimed at providing information on a new framework.	[21]
Engagement in patterns of daily occupations and perceived health among women of working age	To examine how subjective experiences of engagement in patterns of daily occupations (gainful employment, domestic work, enjoyable and recreational occupations) were associated with perceived health among women of working age.	488 women of working age in Gothenburg, Sweden.	[22]
Everyday occupations of occupational therapy and physiotherapy students in Scandinavia	To explore the repertoire of everyday occupations of Scandinavian occupational and physiotherapy students.	22 students between 19 and 25 years of age in Denmark, Norway, and Sweden.	[23]
Experiences of daily occupations at 99 years of age	To explore experiences of daily occupations among the oldest old.	10 persons (9 women and 1 man).	[24]
Experiencing occupations with chronic hand disability: narratives of hand-injured adults	To understand how adults after a hand injury experience the impact of chronic hand disability on their occupations over time.	Four participants with a hand disability.	[25]
Health factors in the everyday life and work of public sector employees in Sweden	To explore aspects of everyday life in addition to established risk factors and their relationship to subjective health and well-being among public sector employees in Sweden	250 women and 50 men	[26]
Levels of complexity in patterns of daily occupations: relationship to women’s well-being	To test the hypothesis that among women who work at home and in the paid workforce, those with low-complex patterns of daily occupations would rate their health and well-being higher than women having medium-complex patterns. As well, those with medium-complex patterns would rate their health and well-being better than women with high-complex patterns. Furthermore, to investigate differences among these subgroups about sociodemographic factors.	100 women, variation in age (median = 36 years, range 26–44).	[27]
Lifestyle Balance: A Review of Concepts and Research	The study intended to trace the concept of lifestyle balance from early history to the present time.	Did not include participants, as it was a literature review.	[28]
Occupational Adaptation: A Return-to-Work Perspective of Persons with Mild to Moderate Brain Injury in South Africa	To describe the perceptions and experiences of individuals with brain injury about adapting to their worker roles.	Nine males and one female.	[29]
Occupational balance as described by older workers over the age of 65	To describe occupational balance among older workers in Sweden.	26 participants aged 66–71 years were included in the study (13 participants from the construction company, 7 from the technical company, and 6 from the eldercare sector).	[30]
Occupational balance from a clinical perspective	To highlight the challenges associated with the lone application of individualistic occupational balance in practice situations and propose some way forward.	Did not include participants, as it was a theoretical paper.	[31]
Occupational deprivation or occupational adaptation of Mexican Americans on renal dialysis	The specific study questions were as follows: (1) How have Mexican Americans with end-stage renal disease (ESRD) and their family members perceived living with dialysis? (2) What is the relationship between cultural values and living with ESRD and dialysis? (3) How has ESRD changed the occupational participation and performance of the family?	17 Mexican Americans with ESRD, and 17 family members.	[32]
Occupational patterns of parents of children with autism spectrum disorder: revisiting Matuska and Christiansen’s model of lifestyle balance	To synthesize literature on children with autism spectrum disorders and theorize around Matuska and Christiansen’s Model of Lifestyle Balance.	Did not include participants, as it was a literature review.	[33]
Occupational patterns of people with dementia in residential care: an ethnographic study	To answer the following research questions: How can residents’ occupational patterns in a residential care home in Norway be described, and how do residents perceive the activities in which they participate?	Seven women and one man were all diagnosed with dementia to a moderate degree.	[34]
Occupational therapy interventions in the treatment of people with severe mental illness	To review research evidence regarding approaches to occupational engagement, including behavioural activation, time use, and activity promotion. We also will review studies that specifically evaluate the impact of occupational therapy interventions.	Did not include participants, as it was a literature review.	[35]
Occupations for resolving life crises in old age	To study the life experience of a Japanese elder (after a stroke) and the people surrounding her, including the occupational therapist who intervened to assist in the resolution of the resulting life crisis.	Twenty-two informants participated, including elderly persons, their families, therapists, etcetera.	[36]
Perspectives of time and occupation: experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis	To explore how people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) perceived the relationship between time and occupation through the experience of their illness.	Adults, aged 17 years and over, were referred to a UK National Health Service (NHS) specialist service with a diagnosis of CFS/ME.	[37]
Relationship between occupational performance measures and adjustment in a sample of university students	To explore relationships between occupational performance and adjustment in university.	144 students from a large, public, Midwestern urban university in the USA.	[38]
Rett syndrome: teenagers’ and young adults’ activities, usage of time, and responses during an ordinary week—a diary study	To describe 10 participants’ (teenagers/young adults) activities during seven days, the time-use, where and with whom the activities were performed, and the participant’s responses in the form of visible/audible reactions during activities.	63 informants (parents/support staff)	[39]
Stability in women’s experiences of hassles and uplifts: a five-year follow-up survey	To explore the stability in working mothers’ experiences in patterns of daily occupations, operationalized as hassles and uplifts, between the year 2000 (baseline) and the year 2005 (follow-up).	100 women, of whom 77 also participated in follow-up.	[40]
Temporal patterns of daily occupations among older adults in northern Sweden	To investigate, through three specific research questions: What are the sequences of daily occupations and sleep, what are the physical and social contexts of daily occupations and sleep, and what are the frequencies and durations of daily occupations and sleep?	151 Swedish adults.	[41]
Time use among people with psychiatric disabilities: implications for practice	To investigate what characterizes time use, occupational balance, and occupational patterns among people with psychiatric disabilities, how time use relates to health in this group, and how time use can be used in research designs and addressed in assessments and interventions.	Did not include participants, as it was a literature review.	[42]
Time use differences in activity participation among children 4–5 years old with and without the risk of developing conduct problems	To determine whether young children at risk of developing conduct problems (CoPs) have a different time use pattern concerning various activities compared to young children who are not at risk.	4983 children aged 4–5 years in Australia.	[43]
Time use concerning valued and satisfying occupations among people with persistent mental illness: exploring occupational balance	To investigate how time use and daily rhythm among people with persistent mental illness, were related to occupational balance, in terms of the value and satisfaction derived from daily occupations.	103 individuals visiting an outpatient psychosis unit.	[44]
Time use of women with children living in an emergency homeless shelter for survivors of domestic violence	To learn from women who were homeless with children about their daily time use patterns while they were living in an emergency shelter setting for women fleeing domestic violence.	23 women from 18 to 44 with a mean age of 30.9 years.	[45]
The linkage between patterns of daily occupations and occupational balance: applications within occupational science and occupational therapy practice	To review how patterns of daily occupations and occupational balance are described in the literature, propose a view of how the two constructs may be linked, and elaborate on how such a view may benefit occupational science and occupational therapy.	Did not include participants, as it was a literature review.	[46]
Using a time-geographical diary method to facilitate reflections on changes in patterns of daily occupations	To investigate the usefulness of a time-geographical diary method combined with stimulated-recall interviews, to facilitate reflections on how patterns of daily occupations change over time, and to determine the causes that lie behind these changes.	Two working, married mothers.	[47]
What is important to patients in palliative care? A scoping review of the patient’s perspective	To describe what patients in palliative care describe as important at the end of life.	Did not include participants, as it was a literature review.	[48]
Work identity development in young adults with mental health problems	To explore experiences of young adults with mental health problems who are starting to work, with a focus on the process of developing work identity.	Young adults with mental health problems aged 19–26 years, who had worked for at least three months.	[49]
Articles located in reference lists of other articles
Beyond Flow: temporality and participation in everyday activities	To explore configurations of activity factors related to time in passing and subjective experience during everyday activities for a group of young adults.	35 students at an OT program in the USA.	[50]
Fresh perspectives on occupation: creating health in everyday patterns of doing	A viewpoint article focusing on presenting three perspectives on daily occupations.	Did not include participants as it was a theoretical paper.	[51]
Occupational integrity: another perspective on ‘life balance’	To offer another perspective on life balance, one that we believe is at the root of what the term means.	Did not include participants as it was a theoretical paper.	[52]
Patterns of activity of Irish children aged five to eight years: city living in Ireland today	To explore and identify typical activities of Irish inner-city children aged 5–8 years in 2007.	Thirty-four children (aged 5–8 years) from three different classes (senior infants, first, and second class) in Ireland.	[53]
Time use of teen mothers	To examine how teen mothers allocate their time daily and to identify their level of satisfaction with their existing occupational patterns.	Nine teen mothers.	[54]
Theoretical references included in the concept analysis besides articles
A theoretical model of life balance and imbalance, chapter 11.			[55]
Enabling occupation II: Advancing in occupational therapy vision for health, well-being, and justice through occupation, several chapters.			[56]
Kielhofner’s model of human occupation (5th ed.), chapter 8.			[57]
The ValMO model: occupational therapy for a healthy life by doing, chapter 3–4.			[58]
Willard and Spackman’s occupational therapy, chapter 18.			[59]

Figure 2. Designing an occupational pattern involves considering the occupational possibilities encompassing an ‘activity repertoire’. It also includes the interplay of ‘internal and external forces for doing’, as well as ‘occupational roles’ to initiate routines, habits, and rituals. This design incorporates key dimensions, such as ‘choice and control’, ‘occupational engagement and participation’, as well as ‘occupational value and occupational meaning’, all interacting within an occupational pattern. Note that this figure does not address balance, as this is a separate process when an occupational pattern is balanced.

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