Defining Occupational Competence and Occupational Identity in the Context of Recovery in Schizophrenia.

ABSTRACT

IMPORTANCE The Occupational Self Assessment (OSA) measures two constructs from the Model of Human Occupation occupational competence and occupational identity. In the field of mental health, the recovery movement has sparked discussions about what constitutes personal, clinical, and functional recovery. However, how occupation-based terminologies are related to the recovery framework is unclear. OBJECTIVE: To elucidate how domains of recovery and psychological constructs are related to the OSA's constructs of occupational competence and occupational identity in order to inform occupational therapy practice in the recovery arena. DESIGN: Cross-sectional study. SETTING: Outpatient mental health unit. PARTICIPANTS: Sixty-six community-dwelling adults with schizophrenia recruited through convenience sampling. OUTCOMES AND MEASURES: Participants completed the OSA and clinical, functional, and personal recovery assessments. They also completed five scales that measured psychological constructs of recovery such as hope, resilience, empowerment, internalized stigma, and subjective well-being. Participants also identified up to four OSA items that were priorities for change. Tests of association and multiple regression analyses were conducted to identify predictors of occupational competence and occupational identity. RESULTS: Personal recovery predicted occupational competence, whereas depressive symptoms and hope predicted occupational identity. Functional and clinical recovery did not predict occupational competence. The top three OSA priorities for change were performance items "managing my finances," "concentrating on my tasks," and "taking care of myself." CONCLUSIONS AND RELEVANCE Occupational therapy interventions should not be limited to functional improvement. Instead, they should account for clients' affective states and seek to instill recovery-oriented psychological states such as hope and efficacy. WHAT THIS ARTICLE ADDS Occupational competence is achieved by enhancing personal states of self-efficacy in fulfilling valued occupations rather than through functional improvement. The top three occupations prioritized for change were performance tasks that were observable by service users and immediate caregivers. Empowering clients to partake in these everyday performance tasks such as finance management, concentrating on tasks, and self-care may pave the way to enhancing occupational competence and identity.