The Occupational Therapy Practice Framework (AOTA, 2002) identifies personal contextual factors that support occupational performance. The Framework identifies these factors as “features of the individual that are not part of a health condition or health status.” This definition is directly quoted from the International Classification of Functioning (WHO, p. 17). Unfortunately, although contextual factors are identified in the Framework, the relationship to occupational performance is not clearly stated. So although personal contextual factors are not clearly defined, this Framework represents another step that explicitly identifies contextual factors as being critical to occupational performance.
Several different sources in the post-modern period had a strong influence on the inclusion of personal contextual factors in practice models. New practice models that specifically emphasize these factors are still being developed and refined.
Many concepts from the new discipline of occupational science have emphasized personal contextual factors in occupational therapy. Clark’s Slagle Lecture (1992) introduces the concept of individualized ethnography to elicit personal contextual factors that can guide occupational therapy intervention. Clark expresses that it may not be feasible for clinicians to conduct detailed ethnographies with their patients, but that her case example provided a “thick description” through occupational storytelling and occupational story making.
In unrelated work outside of the occupational therapy profession, Polkinghorne (1988), Frank (1979), and Bruner (1990) were advancing their own ideas about the use of narration to elicit life histories. These differing perspectives were brought together by Clark and ultimately had a significant influence on other researchers (Mattingly, 1998) that have made important contributions to occupational science. The contributions of occupational science are notable for the way that they underscored personal contextual concepts that we already knew, had partially forgotten, but still need to critically apply.
Since Clark’s Slagle lecture there has been a plethora of articles and books that specifically focus on the personal contextual aspects that influence occupational performance. The idea of “personal meaningfulness” (Clark, et.al., 1991) is now frequently mentioned in the occupational therapy literature. Gray (1997) proposed a phenomenological methodology for considering occupations; this in effect is identification that occupation can’t be interpreted separately from the person who is experiencing it, which is at the core of personal contextual meaning. Hasselkus (2002) devoted an entire book to the subject of personal meaning and occupation. Her text provides an in depth study of how occupations must be considered within a personal context.
Some recent practice models explicitly identify the relationship between the individual, the occupation being performed, and the environment. The P-E-O model (Law, Cooper, Strong, Stewart, Rigby, & Letts, 1996) explicitly states that the behavior can’t be separated from its contextual influences. Additionally, this model re-introduced the importance of history-taking for establishing personal contextual relevance for goal setting. Similarly, the Lifestyle Performance Model (Velde & Fidler, 2002) takes a congruent approach by completely embracing phenomenology as being the only possible method for understanding the personal contextual relationships between an individual and the occupations that they engage in.
Anyway, it is high time I make the rubber meet the road here. This was my train of thought (just in case you were wondering how this crazy mind works): I got to thinking about personal context because I saw a BP commercial on 'carbon footprints.' I started thinking about my own footprints in general, and the factors that make me... me. Of course I have a definition of myself, but outside of my own personal conceptualization of the world is the world itself. Certainly the world must have an opinion of me - but what is it? What constitutes my own personal contextual factors, as understood and objectified by the external world?
There are several different ways to get at this question, but I assumed that the easiest and most immediate method would be through ego-surfing. Of course this led to a rather uni-dimensional representation of myself that was centered almost totally around my work occupations.
But how exciting was it to find THIS! Yes, in another lifetime I actually enjoyed computer programming old bulletin board systems. Although I never had any formal training, I taught myself BASIC and C+ which made me dangerous enough to be able to produce add-on command modules for the Atari BBS Express Pro bulletin board system. Although my programming days actually pre-dated the public use of the WWW, my old computer programs apparently made their way onto Internet.
This was exciting stuff (to me, at least). It would be so wonderful to be able to rely on technology to catalogue and track all of our personal contextual factors. Pre-teenagers try to do this now, as evidenced by the plethora of (sometimes dangerous) personal information being left on places like MySpace.com.
In the future, what will the role of the Internet be in helping us catalogue and track these factors? Will OTs be able to use this data in assessment and intervention? What kind of permission will we need before we access the information? How interesting is it that what the pre-teen population is now putting on MySpace.com may someday lead to improved intervention planning?
I don't have the answers to this. But I sure was thrilled to re-discover my previous occupations of computer programming.
AOTA. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609-39.
Bruner, J. (1990). Acts of meaning. Cambridge: Harvard University Press.
Clark, F. (1995). Occupation embedded in a real life: Interweaving occupational science and occupational therapy: 1993 Eleanor Clark Slagle Lecture. The American Journal of Occupational Therapy, 47, 1067-1078.
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, 577-85.
Frank, G. (1979). Finding the common denominator: A phenomenological critique of life history method. Ethos, 7(1), 68-93.
Gray, J.M. (1997). Application of the phenomenological method to the concept of occupation. Journal of Occupational Science, 4, 5-17.
Hasselkus, B.R. (2002). The Meaning of Everyday Occupation. Thorofare, NJ: SLACK, Inc.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9-23.
Mattingly, C. (1998). Healing Dramas and Clinical Plots. The Narrative Structure of Experience. Cambridge: Cambridge University Press.
Polkinghorne, D. E. (1988). Narrative knowing and the Human Sciences. Albany, New York: State University of New York Press.
Velde, B., & Fidler, G. (2002). Lifestyle Performance: A model for engaging the power of occupation. Thorofare, NJ: SLACK, Inc.
World Health Organization (2001). International classification of functioning, disability, and health (ICF), Geneva, Switzerland: Author.