Articulating an Occupational Perspective

Abstract

Within the field of occupational science the term occupational perspective is widely used to guide research. However, when the term is used it is often not defined. To address the need for a common understanding that will enhance clarity and make theoretical understandings explicit, a scoping review of the definitional literature was conducted. It was determined that definitional clarity was necessary. This paper proposes a new definition: an occupational perspective is a way of looking at or thinking about human doing. The proposed definition is based on how the term has been defined within the literature and addresses the gaps in previous definitions.

Keywords:

• Occupational perspective
• Literature review
• Occupational science
• Terminology

Occupational scientists use conceptual perspectives to frame their research. The conceptual clarity of that research comes from the scientists’ understanding of the concepts used and the ability to explicitly describe them. A lack of conceptual clarity may make it difficult for readers to interpret and apply the research findings. Within occupational science, the term occupational perspective is widely used to guide research. However, the term is seldom explicitly defined; and the definitions that are provided differ across authors. The purpose of the work reported here was to bring clarity to the use of this important concept. We explored how the term occupational perspective has been defined within the literature, identified commonalities, differences and gaps, and concluded a new definition was needed. We constructed a new definition based on common constructs of the term as found in the literature. We hope this will provide a clear conceptual base for occupational scientists to frame their work, thereby strengthening the foundation for knowledge development in the science and enabling readers to understand the perspective in which the research is situated when interpreting the research findings.

Methods

A scoping literature review based on the methods described by Arksey and O'Malley (2005) was conducted to explore how the term occupational perspective is defined within the literature. Two search strategies were used to enhance the breadth of the information found. The first strategy was to review the published empirical and theoretical literature. Relevant published literature was identified by searching the electronic databases of Scholars Portal, CINAHL (Ebsco), Wilson's Database (Interdisciplinary), Dissertations International and SCOPUS (all from June Week 1 1950 until June Week 1 2011). The search was conducted using the electronic search term, occupational perspective. No methodological limitations were applied to screen for levels of evidence; therefore, all types of documents were accepted including peer-reviewed and non-peer-reviewed articles, books, dissertations, and book chapters. This yielded 85 documents. Based on the assumption that the majority of literature would be published in the fields of occupational therapy or occupational science, the second strategy was to hand search occupational therapy and occupational science journals and textbooks known to the authors. This yielded an additional 9 documents. All of the texts were accessed via The University of Toronto's libraries and databases. Microsoft Excel was used to file and manage the retrieved documents.

All retrieved documents (94) were then screened for inclusion for review using the following inclusion/exclusion criteria. Inclusion criteria: documents that contained the search term at least once within the title and/or as a keyword and/or within the body of the text, were published in English, in any country, in any year, and were accessible to the authors. Exclusion criteria were: documents that contained the term therapy inserted between occupational and perspective (viz. occupational therapy perspective) and documents that were a review of a book or another article already included in the search.

Initially the inclusion and exclusion criteria were applied to titles, abstracts, tables of contents and indexes. Through this process, 26 articles were excluded including four book reviews, one document that contained the term occupational therapy perspective, four documents not written in English and 17 that were not accessible to the authors. The remaining 68 documents were read in full to ensure that the inclusion and exclusion criteria applied to the entire document. At this stage another 10 documents were excluded due to the search term not appearing within the document. Finally, 58 documents were retained to be included in the review, comprising 41 peer-reviewed articles, 2 non-peer reviewed articles, 8 doctoral theses, 1 master's thesis, and 6 books.

For all 58 documents, key information was extracted and entered into an electronic excel spreadsheet, including: title, source and year of publication; the authors’ names, educational background and associated discipline; the country and type of institution with which the authors were associated; the content foci; the document type (e.g., article, thesis or book) and, where appropriate, the research methodology (e.g., qualitative, quantitative) and methods. The definitions of the term occupational perspective found within the documents were also entered into the spreadsheet. Together, this information formed the basis for our analyses, which included basic counts for descriptive information, and content analysis to identify the key constructs in the definitions/descriptions of the term occupational perspective. The content analysis involved reading through the definitions or descriptions found and assigning inductive codes to the definitions/descriptions. These codes were then categorized into key constructs.

Documents description

The 58 documents included in this review consisted of 43 articles, 9 theses, and 6 books, written primarily by individuals employed at/associated with a university (55), the majority of whom were occupational therapists (37) who hold a doctoral degree (22). None of the 55 authors were particularly prolific on the topic; having at most 2 publications of relevance. The 43 articles were mainly published in journals from; Australia (13), Canada (10), USA (8) or a Scandinavian country (5). Most of the articles were peer-reviewed (41) and were published in occupational therapy (21) or occupational science (11) journals.

Findings

Range and scope of an occupational perspective

The term occupational perspective first appeared in 1953 within the political science literature, in an article reporting on the social tensions among businessmen and bureaucrats. Although not explicitly defined, the term occupational perspective encompassed the nature of occupation as it related to paid work (Lane, 1953). The idea that an occupational perspective only encompassed the nature of occupation as it related to paid work was used by researchers from a broad range of disciplines including business, economics, sociology, psychology, journalism, statistics, tourism, criminology, and geography. This application of the term occupational perspective continued from 1953 to the mid 1990s.

It was not until 1996 that the term occupational perspective appeared in reference to occupations other than paid work and this occurred in the occupational science and occupational therapy literature. That year both Hocking and Kendall published work that had used the term to frame their research; Hocking (1996) with individuals entering long-term care and Kendall (1996) working with adults preparing for retirement. From 1996 on, the term began to be used increasingly in the occupational science and occupational therapy literature, with the majority of documents (32) using the term being published after the year 2005. By that time the use of the term had all but disappeared from the broader literature.

For the most part, the term occupational perspective is neither defined nor described. In 44 of the 58 documents the term occupational perspective appeared only in the title or the abstract; with no further use of the term in the document. Very few of the documents were focused on an examination of the concept per se. Rather, they reported on work guided by an occupational perspective. For the most part this was qualitative inquiry (14) using interviewing (12) as the method of data collection. The populations studied varied greatly. They included children with disabilities (2), adults with mental illness (7), adults who had experienced a variety of medical conditions (5) including stroke, multiple sclerosis and hearing loss. Six studies explored the occupational perspective of people transitioning to or having reached retirement age.

Of the 14 documents providing a definition or description of occupational perspective, 10 created their own, 6 cited from another source, and 2 did both (see Table 1). Townsend (1997) was the first to explicitly define the term: “a perspective attending to other forms, nature, locations, processes, and other features of occupation as people interact in the context of their environment” (p. 20). This definition was, however, not taken up in future work. Rather, all the definitions/descriptions appearing in these documents are unique, although commonalties are apparent.

Table 1: Occupational Perspective: Definitions and Descriptions

Document	Created by document authors	Cited from another source
Kendall, 1996	None indicated	“The occupational perspective is described in the definition of wellness given by Dossey and Guzetta (1989), Wellness is one's philosophy of living where there is awareness of purpose, meaning, and unique striving toward reaching human potentials” (pp. 69–84). Dossey, B., & Guzzetta, C. (1989). Wellness, values, clarification and motivation. Holistic health promotion. A guide for practice Rockville: Aspen Publishers.
Townsend, 1997	“A perspective attending to other forms, nature, locations, processes, and other features of occupation as people interact in the context of their environment.” (p. 20).	“Each feature is discussed from an occupational perspective, the active process of occupying ourselves is the way we learn about our bodies, minds, and spirits as we proceed through life” (p. 20). Bateson, M. C. (1994). Peripheral visions: Learning along the way. New York: Harper Collins.
Wilcock, 1998	“A particular view of health from the perspective of humans as occupational beings.” (p. 97).	None indicated
Whiteford, 2000	“An occupational perspective is a requisite to considering the occupational needs of people as individuals and within society, separately from consideration of how these can be met through the provision of therapeutic interventions.” (p. 203).	“To view the world through occupational eyes, seeing phenomena that have previously been viewed from other perspectives (for example, medical, psychological and social) as essentially occupational phenomena” (p. 203). Townsend, E. (1999). Enabling occupation in the 21st century: Making good intentions a reality. Australian Occupational Therapy Journal, 46, 147–159.
George, Wilcock, & Stanley, 2001	None indicated	“To learn the meaning of occupation for an individual” (p. 460). Wilcock, A. A. (1998). An occupational perspective of health. Thorofare, NJ: Slack.
Wilcock, 2001	“An occupational perspective does not provide a prescriptive programme of therapy. It does provide a way of thinking in whatever area of practice you pursue; a way to consider individual and community needs; a way to approach individuals, families, communities, doctors, bureaucrats and politicians; and a way to enable health through occupation” (p. 417).	None indicated
Davis, 2004	“The occupational perspective draws no such artificial boundaries between paid work and unpaid work, or the occupations of the workplace and those of daily life. As occupation-oriented therapists, we understand the role that various forms of occupation, including paid work, play in people's lives, and the centrality of occupation to health and well-being. We believe that the meaning and purpose of people's occupations can only be completely understood when viewed in the context of their unfolding lives and the other occupations they perform” (p. 19).	None indicated
Hemmingsson & Jonsson, 2005	“Refers to a body of knowledge developed in the literature of occupational therapy … An occupational perspective focuses on the ordinary things that people do and occupational aspects of importance for health and development … Important aspects of an occupational perspective include: 1) The subjective experience of meaning, 2) The subjective experience of autonomy and self-determination 3) The complex interrelationships between different kinds of occupation” (p. 572).	None indicated
Laliberte Rudman, Hebert, & Reid, 2005	“A comprehensive understanding of occupation and its enablement demands that we take on the responsibility of conducting research framed within an occupational perspective” (p. 150).	None indicated
Fok, Shaw, Jennings, & Cheesman, 2009	None indicated	“Thus, an occupational perspective entails a detailed description of the occupation itself, the requirements and demands, the available resources to support individuals or groups, and the work contexts (e.g. workplace)” (p. 370). Shaw, L., & Lysaght, R. (2008). Cognitive and behavioural demands of work. In K. Jacobs, Ergonomics for therapists (3rd ed., pp. 103–122). Missouri: Elsevier.
Kirsh et al., 2009	“A belief in occupational engagement as a basic need and a determinant of health and quality of life” (p. 393).	None indicated
Huot & Laliberte Rudman, 2011	“An occupational perspective involves highlighting how occupations are connected with doing, being, becoming and belonging, whether implicitly or explicitly. The incorporation of being and becoming into an occupational perspective emerged from Wilcock's (1998a, 1998b) scholarship, which extends the notion of occupation beyond the ‘doing’ of purposeful or goal- directed activities to address individuals’ past, current and anticipated sense of self” (p. 69).	None indicated
Pettican & Prior, 2011	None indicated	“The centrality of work in fulfilling basic human needs and the importance of acknowledging the diversity of people's experiences of the retirement transition” (p. 13). Jonsson, H., Borell, L., Sadlo, G. (2000). Retirement: An occupational transition with consequences for temporality, balance and meaning of occupation. Journal of Occupational Science, 7, 29–37.
Whiteford & Townsend, 2011	“An occupational perspective includes examining what individuals do every day on their own and collectively; how people live and seek identity; how people organize their habits, routines, and choices to promote health; and how systems support (or do not support) the occupations people want or need to do to be healthy” (p. 67).	None indicated

Differing constructs of an occupational perspective

Our analysis revealed that the definitions or descriptions provided differ markedly from one another. The first point of difference was whether an occupational perspective is situated at the micro-level (individual) or at a more macro-level (society at large). For example, Hemmingsson and Jonsson (2005), writing about the concept of participation in the International Classification of Functioning, Disability and Health, stressed that an occupational perspective is held at the level of the individual; “Important aspects of an occupational perspective include: 1) The subjective experience of meaning, 2) The subjective experience of autonomy and self-determination” (p. 572). In contrast, Whiteford and Townsend (2011), writing about the construct of occupational justice, viewed an occupational perspective as related to the broader societal context; “An occupational perspective includes examining what individuals do every day on their own and collectively; how people live and seek identity; how people organize their habits, routines, and choices to promote health; and how systems support (or do not support) the occupations people want or need to do to be healthy” (p. 67).

Another difference found was in how the term perspective was defined. Townsend (1997) characterized the term perspective using the words, view and eye, which is in line with the definition provided by the Oxford Dictionary (2012): “A particular attitude towards or way of regarding something; a point of view”. However, other authors used the term belief in their description of an occupational perspective. For example, Kirsch et al. (2009) refer to an occupational perspective as “a belief in occupational engagement as a basic need and a determinant of health and quality of life” (p. 393). The word belief is defined in the Oxford Dictionary (2012) as “the acceptance that something exists or is true without evidence”.

Key common constructs of an occupational perspective

A number of common dimensions were associated with the term occupational perspective: that it can apply at the level of individual doing through to societal doing; considers contextual factors; assumes occupations are connected to health and well-being; attends to the form, function, and meaning of occupations; and can contribute to being, becoming, and belonging.

Individual through to societal doing

While some authors, see discussion above, suggest that the term should apply at a particular level alone, in many instances the term occupational perspective was described as having relevance at multiple levels from the individual through to society at large. The following quotes illustrate the broad range of needs considered; “A way to consider individual and community needs; a way to approach individuals, families, communities, doctors, bureaucrats and politicians” (Wilcock, 2001, p. 417) and “considering the occupational needs of people as individuals and within society” (Whiteford, 2000, p. 203).

Contextual factors

Consideration of the context in which occupations are situated appeared to be inherent to an occupational perspective. Not only were people seen to “interact in the context of their environment” (Townsend, 1997, p. 20), but the influence that occupation has on the context and vice versa was seen to be important when taking an occupational perspective as illustrated in the following; “We believe that the meaning and purpose of people's occupations can only be completely understood when viewed in the context of their unfolding lives and the other occupations they perform” (Davis, 2004).

Occupations are connected to health and well-being

Examination of the ways the term was applied revealed that an occupational perspective encompasses a common assumption that occupation is “a way to enable health through occupation” (Wilcock, 2001, p. 417) and “occupational aspects [are] of importance for health and development” (Hemmingsson & Jonsson, 2005, p. 572). That is, occupation is seen as central to, important for, and as a determinant, promoter and enabler of health. Wilcock (1998) further connected health and occupation when she argued that the two are inseparable and described an occupational perspective to be “a particular view of health from the perspective of humans as occupational beings” (p. 97).

Includes all types of occupational form, function, and meaning

The need for an occupational perspective to inform an understanding of the form, function, and meaning of occupations was inherent across many definitions. This understanding is congruent with the identified focus of occupational science as the study of “how the form, function and meaning of daily activities influence health and well-being” (Larson & Zemke, 2003, p. 80). Specifically, common across the uses of the term was the idea that an occupational perspective includes all different forms of ‘doing’ as captured in the following; “The occupational perspective draws no such artificial boundaries between paid work and unpaid work, or the occupations of the workplace and those of daily life” (Davis, 2004, p. 19) and “the complex interrelationships between different kinds of occupation” (Hemmingsson & Jonsson, 2005, p. 572). Townsend's 1997 definition highlights the importance of the perspective to understanding both the form and functions of occupation; “A perspective attending to other forms, nature, locations, processes, and other features of occupation as people interact in the context of their environment” (p. 20). Furthermore, George, Wilcock, and Stanley (2001) identified the need for an occupational perspective to develop understanding of the meaning of occupations for an individual through their definition; “to learn the meaning of occupation for an individual” (p. 460).

Contributes to being, becoming, and belonging

In addition to including different forms, functions and meanings of occupations, the need to examine more than just engagement in occupations was also identified, as captured in Huot and Rudman's (2011) description that “an occupational perspective involves highlighting how occupations are connected with doing, being, becoming, and belonging” (p. 69). This idea of extending occupation beyond the doing to address individuals’ past, current and anticipated sense of self emerged from Wilcock's research (2007) into how belonging is the contextual element of the connectedness of people to each other as they engage in occupation. Doing and becoming have also been identified as fundamental to an occupational perspective, where doing was used synonymously with the term occupation, and becoming encompassed the future-oriented aspect of occupation (Gewurtz & Kirsh, 2006).

Gaps in the use of the term occupational perspective

Upon analyzing how the term occupational perspective is used in the literature, a dominant perspective emerged; only occupations that are health promoting should be explored. For instance, Whiteford and Townsend (2011) incorporated the phrases “to promote health” and “to be healthy” in their description of an occupational perspective and discuss “how people organize their habits, routines, and choices to promote health; and how systems support (or do not support) the occupations people want or need to do to be healthy” (p. 67). This conveys the idea that only health promoting occupations should be examined. However, as noted in the occupational science literature, not all occupations contribute to well-being and health. Illustrating that point, one study of young people involved in gangs in Los Angeles, United States explored some occupations considered to be harmful (Snyder, Clark, Masunaka-Noriega, & Young, 1998). Polatajko et al. (2007) emphasized that “occupations can be ‘maladaptive’, even harmful, either to the individual or society; examples include self-abusing behavior, vandalism, arson, or illegal drug use. Many people are engaged in risky, unhealthy or even illegal and illicit occupations, which can undermine health, well-being, and justice” (p. 22).

Discussion

Bringing together an occupational perspective

As the majority of the literature that uses the term occupational perspective, since the 1990s, is written by and for occupational scientists and occupational therapists, coincident with the inception of occupational science as a discipline, we believe that the concept needs to have relevance for these disciplines. Therefore, as occupational scientists, we propose the following definition of an occupational perspective: a way of looking at or thinking about human doing. This definition is congruent with the Oxford Dictionary (2012) definition of a perspective as “a particular attitude towards or way of regarding something; a point of view”. Additionally, in incorporating the idea of looking or thinking, it shows that an action (e.g., regarding something) is taking place. Our use of the construct ‘perspective’ is also congruent with how we discovered others have used the term in their definitions of an occupational perspective. The choice of the words ‘human doing’ reflects that this perspective is focused on occupation, the core construct in all the reviewed definitions. However, we suggest using the term ‘human doing’ so as not to have to use the term occupation – which would make the definition somewhat tautological. The focus on doing also highlights what distinguishes an occupational perspective from other perspectives. For example, examining a person riding public transport from an occupational perspective might address how the person is occupationally engaged, whereas using a social perspective might focus on interpersonal actions that are occurring, while a gender perspective could look at how and why men and women experience public transport differently.

In comparison to the previously used definitions, our proposed definition of an occupational perspective does not go beyond the core concept of occupation. Based on our definition, it is assumed that individuals bring their own occupational perspective, which holds their definition, assumptions, and models/theories about occupation; therefore, the specifics of each individual's perspective may differ but under our definition each would be using an occupational perspective. Having this basic definition of an occupational perspective would enable occupational scientists to recognize when a person is using an occupational perspective, while also requiring an explicit statement of their underlying assumptions, given the large range of possible assumptions an occupational perspective could hold.

The definitions/descriptions reviewed here include a number of assumptions, namely: occupations are connected to doing at all levels; the connections between occupations and doing relate to health and well-being; occupations hold form, function, and meaning, doing can contribute to being, becoming, and belonging; and occupations occur within a particular context and time, where occupation and context are reciprocally influential. This list of assumptions is neither unique nor exhaustive (see Polatajko et al., (2007) for a discussion of assumptions underlying the concept of occupation). It is our view that assumptions are inherent in an occupational perspective but should not be part of the definition itself. We believe that keeping the assumptions separate from the definition allows for broader use of the definition, as each researcher can then specify the assumptions underlying his/her own occupational perspective.

The positioning of an occupational perspective in occupational science and occupational therapy notwithstanding, of note in this review is the observation that the term occupational perspective had its origins outside these disciplines. The term is not unique to occupational science and occupational therapy; it appears in the literature of business, economics, sociology, psychology, journalism, statistics, tourism, criminology, and geography. This fits well with the expressed intent of occupational science to be multidisciplinary. Having a broad definition of an occupational perspective supports this multidisciplinarity. Interestingly, within the occupational science and occupational therapy literature, there has been very little, if any, discussion of whether an occupational perspective is specific to occupational therapy or occupational science. The comments that have been made appear to be contradictory, e.g., “an occupational perspective refers to a body of knowledge developed in the literature of occupational therapy” (Hemmingsson & Jonsson, 2005, p. 572) versus; “using an occupational perspective was seen to be applicable to exploring a wide scope of phenomena, not those only concerned with occupational therapy practice” (Whiteford, 2000, p. 203). It is argued here that the construct, by virtue of history, is not unique to the discipline of occupational science and therefore a definition that promotes a multidisciplinary future should be adopted.

Conclusion

The majority of the literature included in this scoping review used the term occupational perspective as though there is a common understanding of the term; however, our review did not support that assumption. No single definition has, to date, prevailed. To address the need for a common understanding, this paper proposes that an occupational perspective be defined as a way of looking at or thinking about human doing. It is considered that adoption of this basic definition will provide a common understanding of the term occupational perspective, thereby enhancing the clarity of future theoretical and empirical endeavors.

This review further identified a number of underlying assumptions, namely: a connection to doing that contributes to being, becoming, and belonging; a relationship with health and well-being; containing form, function, and meaning from individual to societal levels; and a transactional relationship with the context. While these offer a starting point, each researcher needs to specify the assumptions underlying his or her own occupational perspective. The delineation of commonly held assumptions is beyond the scope of this review.