Conceptualizations of occupation in relation to health: A conversation between theory and experience-near data

Abstract

Current occupational science theory describes a positive link between occupation and human health. This theory asserts that an essential unit of analysis for understanding health is in every-day human actions (Wilcock, 2006). Indeed, extant literature has identified occupation as a powerful facilitator of health and wellbeing. Consequently, basic theory in occupational science has favored positive implications for health based on engagement in occupations. However, experience-near accounts reveal that engaging in occupation has both positive and negative implications. Recent scholarship in occupational science has recognized this conflict and asserts that further understanding of the occupation-health link is necessary (Durocher, Rappolt, & Gibson, 2014). This panel will advance the discussion between experience-near accounts and basic theory by employing case examples from interdisciplinary research. Presentation #1 will frame the discourse by providing a conceptual map (Feyerabend, 2011) of how occupational science has described the relationship between occupation and health, and identify opportunities for theoretical expansion. We will argue for adopting a dialectic perspective on the occupation-health link. To illustrate the need for expanded theory, a case example will be given employing data from a large mixed-methods ethnographic study (‘Autism in urban context: linking heterogeneity with health and service disparities’, NIMH, R01MH089474, 09/30/2009 - 08/31/2012, Solomon, O., P.I.). These data capture the experiences of a child with ASD and his family related to ways in which his medical and developmental conditions make participation in physical play both transformative and detrimental. Presentation #2 extends this dialogue to the clinical care setting by challenging notions of the health-promoting effects of healthcare providers’ recommendations within chronic disease management. This presenter will provide one exemplar case from a study on diabetes as a lens into the experiences of making agentic choices between maintaining the intensive requirements of diabetes management and engaging in developmentally normative, though potentially risky activities. These choices are further examined using theoretical tools from medical sociology and anthropology combined with concepts introduced within occupational science literature. Presentation #3 will describe the activities of a Latino gang. Drawing from a transactionalism framework and understanding the interrelatedness of contextual conditions to occupation (Dickie, Cutchin & Humphry, 2006). The presenter will discuss the affordances and constraints typical of a gang-inhabited neighborhood, and evaluate both the positive and negative health-related aspects of gangs. Additional excerpts from memoirs and first-hand accounts of former gang members (Rodriguez, 2005) will be analyzed to describe the occupational activities of gangs from a participant perspective. This presentation will critically appraise the limitations of a health-promoting view of occupation by framing culturally grounded information as necessary when describing possible impacts on health. As these presentations will illustrate, occupations lead to flourishing for some aspects of health, but may also lead to some negative impact. The panel will demonstrate the importance of including both the positive and the negative impact into conceptualizations of occupation to better understand how it is linked to human health, wellness and participation. Key Words: Health Promotion, Critical Occupational Science, Experience-Near Research Presenter information Mark E. Hardison, MS, OTR/L¹ Kristine M. Carandang, MS, OTR/L¹ Lucía I. Floríndez, MA¹ Elizabeth A. Pyatak, PhD, OTR/L, CDE² Olga Solomon, PhD² Ruth Zemke, PhD, OTR(Retired), FAOTA³ 1 = Presenter and author, 2 = Author only, 3 = Moderator Affiliation University of Southern California, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy Acknowledgements Autism in Urban Context: Linking Heterogeneity with Health and Service Disparities (NIMH, R01 MH089474, 2009-2012, O. Solomon, P.I.) Objectives for the Discussion Period 1. Participants will ask questions of the panel to clarify or expand the presentation. 2. Participants will share other experiential examples critically appraising the health-promoting view of occupation. 3. Participants and panel members will explore reconciliation of these observations with basic theory of occupation