“Words are time bound.”
- What are the definitions of occupation and activity?
- What about purposeful activity?
- What are the similarities and differences between them?
- Can these words be used interchangeably?
- Why should we even bother with understanding the history, definitions, purpose, and usage trends of each word?
After reading this post, you will have a good understanding of what these words mean, which to use in practice, and ‘how’ to practice as an occupational therapist.
Frequency of Usage
Many definitions for occupation and activity exist and these two words have been used throughout the history of the profession. Some of the earliest documented uses of the words occupation and activity are from the 1920s.
Source: Bauerschmidt, B., & Nelson, D. L. (2011). The terms occupation and activity over the history of official occupational therapy publications. American Journal of Occupational Therapy, 65, 338–345. doi: 10.5014/ajot.2011.000869Figure one was created from a study that analyzed the frequency of the two words across 9 decades. 1 Notice that the word occupation declined from the 1920s but started to increase again in the 1980s. The word activity almost had an inverse relationship from the 1920s to the 1960s, but seemingly ceased to be used in the 1970s. Activity seems to be increasing just as occupation has since the 1980s.
It is easy to describe and notice a pattern from this chart, but it is important to note that there are probably many reasons why these terms fluctuated dramatically over time – most of which I do not understand because I was not around at this time.
Why Care?
The use of the words occupation and activity affect our profession, but also our society as a whole. The usage of these words are embedded in our practice as occupational therapy practitioners. After all, we are called occupational therapists. These words and the understanding of these words play a role in how we communicate amongst ourselves, other allied health professionals, insurance, and the public. You probably are reading this article because you are confused about the terms yourself. The public is likely confused as well as the profession has been facing the ongoing problem of “nobody knows what we do”.
When occupational therapy practitioners understand and can define these terms to clients, colleagues, insurances, family members, and the public, they help to advocate for the profession, its research, and most importantly, the value of occupational therapy to society.
“Lack of differentiation between the two has a chilling effect on disciplinary discourse, impedes research, reduces practitioners’ moral surety and effectiveness, and muffles the profession’s political voice.” 2
Modern Importance
Just as how search terms and keywords are important to Google websites, so are the words that are used in the profession such as in research. Even I debated for several minutes whether to call the post “occupation vs activity” or “activity vs occupation”.
When an author writes their manuscript to share their research, they have to make a decision between which terms to use. This can have an influence on other researchers, educators, occupational therapy practitioners, other professions reading the research, and even the public. Just as researchers looked at the usage of the words from 1920, a researcher 100 years from now will likely look back on the usage of the terms in 2021. This is why your (as is my) understanding and usage of the words is important.
Occupational therapy is not and should not be isolated from politics. If left alone, many other professions could likely attempt to assume of occupational therapy roles. Some critics who may be feeling hopeless or burned out often say that “occupational therapy is dead” and that other professions such as physical therapy could replace it. In my opinion, this will never be the case – as long as occupational therapy maintains a clear distinction and definition of the word occupation (and activity) to claim its market share.
Rapid Evolution of Language
With the Internet and more people being connected, the conversation and our collective languages are likely to be evolving at a rapid pace. What is so unique about modern technology is that, unlike the spoken word which may be lost or take a long time to be adopted for widespread use, the Internet allows many forms of communications to be recorded – in text, spoken word, videos, comments, etc. If the printing press made a significant impact on human history for language and knowledge, one can consider the Internet to be Printing Press version 2 for even just languages alone.
Let’s Just ‘Delete’ These Terms?
The word occupation was never always welcomed throughout the history of the profession. Many critics of the word occupation have even called for its banishment, claiming that it would clear up the confusion of what occupational therapists do. “Some of us, in fact, think that if we could jUSt delete the word occupational from the name of the profession, we would be far better off. To one in this frame of mind, our claim about an emerging occupational science may seem at best just another occupational nightmare.” 3 I thought about this too at one point. “Maybe we should just rename the profession.” So too has there been proposals to banish the word activity. 4
However, these two words, despite being used interchangeably in history5 6 , each have their place in the occupational therapy lexicon as they have each their definition and situations when each should be used over the other word.
Definitions of key terms vary not only from author to author but sometimes within the same work.7
Looking at the history of the words occupation and activity, it can be very confusing. Some very smart people: occupational therapy theorists, academics, and researchers have either used these words interchangeably, contradicted themselves, or started to favor one of the words over the other (even within the same author). For example, the earlier AOTA’s Occupational Therapy Practice Framework contained many ambiguous or contradictory uses of key terms and their definitions. 8
What about other non-English languages and their uses of these words then? “Nelson and Jonsson reported anecdotal evidence of changes in terminology and confusion regarding occupational terminology across countries and language systems.” 9
Definitions
There are many definitions of occupation and activity. The ones mentioned here are only a handful of ones that I thought were noteworthy, or significant, e.g., they come from the OTPF. Comparing and contrasting the two words can get really confusing, really fast. For example,
OTPF
The current definitions as defined in the OTPF-4 are:
Occupation: Everyday personalized activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life.
Activity: Actions designed and selected to support the development of performance skills and performance patterns to enhance occupational engagement.
The previous definitions as defined in the OTPF-3 are:
Occupation: Daily life activities in which people engage. Occupations occur in context and are influenced by the interplay among client factors, performance skills, and performance patterns. Occupations occur over time; have a purpose, meaning, and perceived utility to the client; and can be observed by others (e.g., preparing a meal) or be known only to the person involved (e.g., learning through reading a textbook). Occupations can involve the execution of multiple activities for completion and can result in various outcomes.
Activity: Actions designed and selected to support the development of performance skills and performance patterns to enhance occupational engagement.
Notice that in both versions of the OTPF, occupation is defined with the use of the word activities. So it seems according to the OTPF, that occupations are broader or higher in the hierarchy than activity. One theme that is consistent from not only the OTPF, but many of the definitions for occupation is the association with meaning. It is important to make the distinction between meaning and purpose, because they are technically not the same, as illustrated by the existence of the word “purposeful activity”.
Some may find the evolution of these terms from iterations of the OTPF very controversial. After all, shouldn’t some definitions stay the same to avoid confusion and different practitioners adopting different definitions? There also seems to be a large gap between new practitioners and old practitioners not only in the choice of theory and intervention, but even terminology alone. For example, one of my fieldwork instructors was not aware of the occupation “IADL”. On the flip side, as mentioned earlier, society and language also evolve – so it may be necessary for definitions to change (at least with the pace of society and culture).
Additional Definitions of Occupation
- Occupation is as necessary to life as food and drink…Sick minds, sick bodies, sick souls may be healed through occupation. 10
- A person’s personally constructed, one-time experience within a unique context. 11
- Those activities that occupy a person’s time, involve achievement, and address the economic realities of life. 12
- The relationship between an occupational form and an occupational performance. Occupational performance means the doing. Occupational form means the thing, or the format, that is done. 4
- Chunks of culturally and personally meaningful activity in which humans engage that can be named in the lexicon of our culture. 13
- ‘Doing’ by the individual, is goal-directed, carries meaning for the individual, and is repeatable. 14
- Occupation, that is, purposeful activity, is a central aspect of the human experience. 15
- A general term that refers to engagement in activities, tasks and roles for the purpose of meeting the requirements of living. 16
- Engagement in self-initiated, adaptive, purposeful, culturally relevant, organised activity. 17
Additional Definitions of Activity
- The proper use of gratifying activity appeared to me a fundamental issue in the treatment of any neuro-psychiatric patient. 18
- A more general, culturally shared idea about a category of action. 11
- The observable result of the use of the hands as they are energized by mind and will. 19
Definitions of Purposeful Activity
- The primary tool of the occupational therapist for the remediation of performance areas and performance components is a purposeful activity. The purposefulness of an activity is determined by the context in which it is performed 20
-
Goal-directed behaviours or tasks that comprise occupations. An activity is purposeful if the individual is an active, voluntary participant and if the activity is directed toward a goal that the individual considers meaningful. 21
Summary of Definitions
| Term | Characteristics | Focus | Relevance to OT |
| “Occupation” | Meaningful, purposeful | Client | Central |
| “Activity” | Meaning and relevance absent | Practitioner | Minimal, Adjunctive |
| “Purposeful Activity” | Purposeful, context absent | Society, Practitioner | Used within therapy programs |
Similarities and Differences
Occupation vs Activity
Activities are more general, descriptive categories whose meanings are culturally shared rather than originating with the person. Occupation is unique to a person’s experience, is meaningful to them, and includes their personal and contextual experience as well.
Take for example “eating”. As an occupation, it is tied to one’s unique experience that includes their thoughts, mood, the meaning of eating, sensations, social factors, time, place, cultural meaning, and so on. “Eating” can be also described as an activity that one human to another would understand, such as when a couple asks each other if they would like to consider the activity of eating. However, your experience with eating breakfast this morning was an occupation that is different than mine, even if we both sat next to each other and participated in the activity of eating.
Example 2: Shopping as an activity is a culturally shared general idea about doing. However, to me, shopping is not a meaningful activity that I would prefer to engage in compared to someone who likes to shop. If I was a patient and the OT practiced shopping with me, it would merely be an activity, maybe a purposeful one (as I practiced physically retrieving an item from a shelf for my range of motion and coordination), but at the end of the day, it was not a meaningful occupation.
“The important influence of the physical, social and cultural environment is not evident in the application of activities, yet this is a crucial aspect that sets our professional practice apart from that of other health care professionals.” 22
This is a good reminder that although we classify and organize and label occupations, e.g., in the OTPF, not all occupations are “occupations” to everyone, only if they are meaningful to them. Not even purposeful, but meaningful. And that should be an important consideration when occupational therapy practitioners aim to be client-centered and promote a client’s engagement in occupation – it should be meaningful to them. This is why activities (e.g., preparatory activities, or even purposeful activities) when performed in isolation without occupation are not considered occupational therapy intervention by modern-day practitioners.
Activity vs Purposeful Activity
An activity is not necessarily purposeful. For example, an occupational therapy practitioner may fabricate a splint for a client. However, this is passive for the client and they do not achieve anything purposeful, even if the occupational therapy intends for the splint to achieve a purpose. The difference here is engagement, active vs. passive, and whether the client fulfills a purpose. A client who practices fine motor skills with board game pieces may be doing an activity, but if they are not playing the actual game with the rules, it is not purposeful. Would the client who plays the board game be considered doing an occupation? It depends. Is this board game meaningful to the client, or are they playing just because the OT suggested it and they are not having any fun or enjoyment from it (if the purpose of the board game by the OT was for leisure)?
Occupation vs Purposeful Activity
According to Pedretti, purposeful activity has been at the core of OT since its inception. 20 Although purposeful activity may appear to be the same as occupation, purposeful activity does not consider the context, e.g., environment. Another differentiation between occupation and purposeful activity as mentioned in the board game example is occupation is meaningful to the client, while purposeful activity may simply be purposeful, e.g, achieving a task, but is not meaningful to the client.
Activity is Still Important
- “Activity is a common sense word that serves quite well for communicating in a simple, general way”.
- “Activity is an area of expertise with which occupational therapy has long been associated” (and activity analysis too).
- As activity is tied to culture and its ideas, occupational therapy practitioners will need to constantly research and update interventions to be relevant, effective, and functional.
- “Activity is also used in important ways in the health care system within definitions of billable service, assessments of function and degree of disablement, and even the naming of entire fields.” 11
- Activity may be necessary for recovery and function, e.g., splinting, PAMs, using the bathroom.
- Occupational therapy plays a role in rehabilitation and recovery with activities for health, wellness, and return to daily functioning.
Putting It All Into OT Practice
- Use a top-down approach in addition to or instead of a bottom-up approach.
- Collaborate with the client and be client-centered.
- In addition to activities (e.g., preparatory) and purposeful activities, always try to promote occupation.
- Consider the client’s context, culture, and social participation to promote occupation.
- Activity is not bad, but occupation should be the means and the goal.
- Avoid diversional activities. These are considered valueless, not engaging, meaningful, or skill-based, e.g., an activity directory or aide may fulfill this role.
- Be careful when imposing purposeful activities with clients or a group of clients, e.g., even in mental health.
- While disease focus (bottom-up) may be desired, aspects of the symptom or barriers should be addressed with the client to find meaning (top-down) to avoid completing activities in the session.
- Therapeutic use of common medium or tools, e.g, theraputty, stacking cones, art, and crafts, may all be activities (maybe even purposeful), but without meaning, it is not occupation or occupational therapy intervention.
- Participation in ADLs (while very common, expected, and covered by insurance, or important), may not necessarily be the priority or goal of the client. This would merely be a purposeful activity and not their occupation due to the lack of meaning.
- Educate clients, colleagues, health professionals, insurance, families, the general public, and relevant stakeholders about the terminology, purpose, and value of the profession.
- While it may be tempting to use the best EBP, evaluate whether the intervention is occupational or if there can be ways to incorporate it. For example, CIMT and mirror therapy have strong evidence for stroke rehabilitation, but how can it be made occupational and not just be an activity? If the client likes basketball, for example, then they can participate in an occupational basketball game using CIMT by engaging their involved extremity to throw a ball in a basket. However, if the same activity is used with someone who is not interested in basketball, it is merely an activity, despite it helping improve their function in rehab.
- Use OT’s unique approaches and methods to promote occupation: building an occupational profile, using a top-down approach, e.g., PEO-P, MOHO, and real-world participation in occupations in a context that is meaningful to the client.
Recommended Reading
- Doris Pierce – Untangling Occupation and Activity
- Janet Golledge – Distinguishing between Occupation, Purposeful Activity and Activity
-
Bauerschmidt & Nelson – The Terms Occupation and Activity Over the History of Official Occupational Therapy Publications
Sources
- Bauerschmidt, B., & Nelson, D. L. (2011). The terms occupation and activity over the history of official occupational therapy publications. American Journal of Occupational Therapy, 65, 338–345. doi: 10.5014/ajot.2011.000869↑
- Pierce, D. (2001). Untangling occupation and activity. American Journal of Occupational Therapy, 55(2), 138-146.↑
- Clark, F. A., Parham, D., Carlson, M. E., Frank, G., Jackson, J., Pierce, D., … & Zemke, R. (1991). Occupational science: Academic innovation in the service of occupational therapy’s future. American Journal of Occupational Therapy, 45(4), 300-310.↑
- Nelson, D. L. (1997). Why the profession of occupational therapy will flourish in the 21st century, 1996 Eleanor Clarke Slagle lecture. American Journal of Occupational Therapy, 51, 11–24.↑↑
- Fidler, G. S. (2000). Beyond the therapy model: Building our future. American Journal of Occupational Therapy, 54, 99–101.↑
- Fidler, G., & Velde, B. (1999). Activities: Reality and symbol. Thorofare, NJ: Slack.↑
- Nelson, D. L. (1997). Why the profession of occupational therapy will continue to flourish in the 21st century (Ele- anor Clarke Slagle Lecture). American Journal of Occupa- tional Therapy, 51, 11–24.↑
- Nelson, D. L. (2006). Critiquing the logic of the domain section of the Occupational Therapy Practice Framework: Domain and Process. American Journal of Occupational Therapy, 60, 511–523.↑
- Nelson, D. L., & Jonsson, H. (1997). Connotations of the works “occupation” and “occupational therapy” in different languages and countries [Comment]. Journal of Occupational Science, 4, 39–42.↑
- Dunton, W. R. (1919). Reconstruction therapy. Philadelphia: Saunders.↑
- Pierce, D. (2001). Untangling occupation and activity. American Journal of Occupational Therapy, 55, 138–146.↑↑↑
- Barrett, L., & Kielhofner, G. (1998). Theories derived from occupational behavior perspectives. In M. Neistadt & E. Crepeau (Eds.), Willard and Spackman’s occupational therapy (9th ed., pp. 525–535). Philadelphia: Lippincott.↑
- Clark, F. A., Parham, D., Carlson, M. E., Frank, G., Jackson, J., Pierce, D., Wolfe, R. J., & Zemke, R. (1991). Occupational science: Academic innovation in the service of occupational therapy’s future. American Journal of Occupational Therapy, 45, 300–310.↑
- Gray, J. (1997). A phenomenological perspective on occupation. Journal of Occupational Science: Australia, 4, 5–17.↑
- Wilcock A (1993) A theory of the human need for occupation. Occupational Science: Australia, 1(1), 17-24.↑
- Levine RE, Brayley CR (1991) Occupation as a therapeutic medium. In: C Christiansen, C Baum, eds. Occupational therapy: overcoming human performance deficits. NewJersey: Slack.↑
- Yerxa EJ (1994) Dreams, dilemmas and decisions for occupational therapy practice in a new millennium: an American perspective. American Journal of Occupational Therapy, 48(7), 586-89.↑
- Meyer, A. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy, 1, 1–10.↑
- Cynkin, S. (1995). Activities. In C. Royeen (Ed.), The practice of the future: Putting occupation back into therapy (pp. 7-1–7-52). Bethesda, MD: American Occupational Therapy Association.↑
- Pedretti LW (1996) Occupational performance: a model for practice in physical dysfunction. In: LW Pedretti, ed. Occupational therapy: practice skills for physical dysfunction. 4th ed. St Louis: Mosby.↑↑
- AOTA(1993) Position paper: purposeful activity. American Journal of OccupationalTherapy, 47(12), 1081-82.↑
- Golledge, J. (1998). Distinguishing between occupation, purposeful activity and activity, part 1: Review and explanation. British Journal of Occupational Therapy, 61(3), 100-105.↑