Occupation and health: a review of selected literature

Authors:
CREEK Jennifer, HUGHES Andrew
Journal article citation:
British Journal of Occupational Therapy, 71(11), November 2008, pp.456-468.
Publisher:
Sage

Occupational therapy is based on the belief that people can influence the state of their health through what they do. However, there appears to be a shortage of evidence to support this belief. This paper describes a review of selected literature on the effects of occupation on health. The aims were to review how occupation and health are defined in the occupational therapy literature; to find synonyms for these two terms to enable a search for relevant literature; to review evidence for a relationship between what people do and their health; and to identify factors that mediate the relationship between occupation and health. The review had five main findings: occupation and health are defined in a variety of ways by occupational therapists; there is a wealth of literature, representing a number of disciplines and a wide range of research, that explores the relationship between occupation and health; engaging in occupation carries both potential health benefits and risks to health; there is limited knowledge of the ways in which occupation influences health; and the impact of occupation on health is mediated by a complex range of factors. These findings have implications for occupational therapy research, practice and education.

Extended abstract:
Author

CREEK Jennifer; HUGHES Andrew;

Title

Occupation and health: a review of selected literature.

Journal citation/publication details

British Journal of Occupational Therapy, 71(11), November 2008, pp.456-468.

Summary

This review of 17 studies finds some evidence that occupation influences health, positively or negatively, and that personal, social and other factors interact in complex ways to mediate the relationship. However, the evidence base is patchy, and interpretation is difficult because of a lack of consensus on the definition of the basic terms ‘occupation’ and ‘health’.

The authors claim that ‘resources were not available to carry out a systematic review’: for example, all review work was carried out by the lead author, increasing the risk of bias in the selection and interpretation of studies. However, their work includes all the generally accepted elements of a systematically conducted examination of the literature.

Context

This review was undertaken by two members of the R&D group at the College of Occupational Therapists in the belief that research findings ‘are, at the least, a necessary component of evidence-based practice’. It focuses on the relationships between what people do and their health, and on the factors that may mediate this relationship.

Methods

Prior to the review proper, the lead author used her knowledge of the occupational health literature to identify different conceptualisations of the terms ‘occupation’ and ‘health’. Occupation was generally defined to mean ‘all the activities that people do in their daily lives that hold their attention, have meaning and purpose for them and are shaped by their environment and cultural context.’ The findings on health were more diverse and are listed in Table 1. Occupational therapists conceptualise health as an objectively measurable state (survival, absence of disease, absence of disability, development); as a subjective experience (absence of illness, wellness, well-being); or as a combination of the two (adaptation, participation).

 

What sources were used?

The following databases were searched for the review proper: AMED (Allied and Complementary Medicine Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature); the Cochrane Library; HMIC (Health Management Information Consortium database); OTDBASE [a Canadian occupational therapy database]; PsycINFO; PubMed; and Social Policy and Practice. The library catalogue of the College of Occupational Therapists was also searched. Citation searches of studies selected for review were also carried out.

 

What search terms/strategies were used?

Search terms were generated by the first author who identified 10 free text synonyms for the term occupation and 13 for the term health based on her knowledge of the literature ‘rather than using a thesaurus or indexing terms to represent the concepts’. They are listed in Table 2. The searches were carried out by the second author, a professional librarian, using the terms singly and in combination, and covered the period 2000-2006.

 

In commenting on the literature actually reviewed, the authors emphasise again the lack of consistency in defining both occupation and health, and the existence of other synonyms that might have been included in their list of search terms.

 

What criteria were used to decide on which studies to include?

Eligible studies, including UK dissertations and theses, were in English and presented evidence on the influence of occupation on health.

 

Who decided on their relevance and quality?

The searches produced 339 references. Initial screening appears to have been carried out by the second author, who passed 57 references to the first author (the reviewer) for further screening against a set of exclusion criteria to eliminate, for example, case studies and studies of occupational therapy on health. Twenty-six papers remained after this stage, together with another 12 identified from citation searches of these papers. The first author assessed study quality using a set of questions listed in Table 3. These were compiled from four published critical appraisal tools listed in an appendix. A further 21 papers, listed in Table 4, were excluded at this stage.

 

How many studies were included and where were they from?

Details of the 17 studies reviewed, including type of study, sample and findings, are provided in Table 5 but geographical settings are not reported.

 

How were the study findings combined?

The first author extracted text from each paper that referred to the relationship between occupation and health. This was summarised and displayed as a list, and the data sorted into four categories, listed in Table 6 with sub-categories: health benefits of occupation; health risks of occupation; nature of the relationship between occupation and health; and factors mediating the relationship between occupation and health.

Findings of the review

The studies came from a variety of disciplines, and were mostly surveys or cohort studies. Four literature reviews ‘of varying size and quality’ were included.

 

Health benefits of occupation

These are summarised in Table 7, with at least one study in support of each benefit. They are survival (reduced risk of mortality), managing chronic illness or disability, disease prevention, disability prevention, and improved life satisfaction and self-concept. Some studies suggest possible mechanisms, for example that physical activity works through biochemical, physiological and psychosocial mechanisms to improve mental health and well-being. However, ‘more research is needed to test these hypotheses.’

 

Health risks of occupation

These were identified largely from a Department of Health literature review, are summarised in Table 8 and consist of pain, injury and disease or deficit.

 

Relationship between occupation and health

Most studies did not allow for the establishment of a causal relationship, but four suggested certain characteristics of occupation that appear to have a beneficial impact on health. These are summarised in Table 9 and consist of energy expenditure, social interaction and support, challenge and complexity, and perceived competence and achievement.

 

Mediating factors

Three mediating factors were identified and are summarised in Table 10, each with an illustrative example from one study. They are social factors, the balance of activities (i.e. a mix of factors, rather than one alone, are likely to be influential), and the nature of the activity or occupation.

Authors' conclusions

Comparisons between studies were difficult because of the lack of consistency in defining occupation and health. However, five of the conceptualisations of health identified in the occupational health literature during the preliminary stage of the review did equate to those emerging from the wider literature. This suggests that the findings of work carried out in other disciplines is relevant provided key terms are clearly defined.

 

The review found evidence that what people do does affect their health, positively or negatively or both (for example, physical activity carries some risk of pain but also increases the chances of survival). However, in most studies the nature of the relationship between occupation and health, and the role that mediating factors might play, are unclear. More primary research using appropriate methods is needed, together with ‘more systematic and comprehensive reviews’ of the existing evidence base.

Implications for policy or practice

At the most basic level, ‘occupational therapists need to be able to define clearly those concepts that are central to the profession, such as occupation and health’. This will enable them to communicate their own research findings ‘in appropriate professional language’ and better judge the relevance of other research findings. The teaching of terminology should be an integral part of professional education, and both educators and practitioners need ‘to constantly update their knowledge of the most recent research findings’ in order to improve training and practice.

Related references

None
Subject terms:
leisure activities, occupational therapy, activities of daily living, health;
Content type:
systematic review
Link:
Journal home page
ISSN online:
1477-6006
ISSN print:
0308-0226

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