Examining an application of occupation-based theoretical models to population-based occupational therapy practice: A Foucauldian critical discourse analysis

Since the mid-1980s, occupational therapy scholars and practitioners have used occupation-based theoretical models to guide best practice and explain the relationship between the person, the environment, and occupation. Theoretical models and the language used to describe their use create a body of professional knowledge, or discourse, that shapes what occupational therapy is and influences how occupational therapy practitioners think about, understand, and do therapy. Theoretical discourse has far-reaching influence and exerts power over members of the profession, clients, and other stakeholders. These theoretical models were developed primarily from a Western cultural perspective focusing on individuals as clients which may not support practice with all cultures and communities. Recently, occupational therapy scholars interested in reducing health inequities have promoted practice with whole populations, focused on prevention and action on the social determinants of health. There is a call for critical analysis of occupation-based theoretical models to ensure they equitably meet the needs of populations today, allow for collaboration with interdisciplinary population health teams, and share power with clients. Health inequities, highlighted and exacerbated by the COVID-19 pandemic, make the need to work with populations urgent, yet little instruction exists on how to use occupational therapy models with populations.

This study aimed to help students, educators, and clinicians understand and be able to apply models to population-based practice. This study’s methodology included 1) principles of culturally responsive focus group research, 2) scholarship of application by engaging three occupational therapy theory content experts to each apply one model a population-based case study, and 3) Foucauldian critical discourse analysis to examine how this emerging discourse constructs what population-based occupational therapy is and can be and to explore the implicit power relationships involved. The study determined that the ecology of human performance model, the model of human occupation, and theory of occupational adaptation can all be applied to a case study population with modification to support population-based practice and occupational justice. Further studies are warranted to examine their application beyond a simulation, to study additional occupation-based models, and to better understand how occupational justice and population health concepts can be explicitly incorporated into model discourse.