STATEMENT

Occupational Therapy in the Promotion of

Health and Well-Being

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balanced pattern of occupations enhances the health and fulfills the needs of

A
individuals, families, communities, and populations (American Occupational
Therapy Association [AOTA], 2014b; Hocking, 2019; Meyer, 1922). Occupations
are personalized “everyday activities that people do as individuals, in families, and
with communities to occupy time and bring meaning and purpose to life” (World
Federation of Occupational Therapists, 2012, para. 2). The purpose of this
statement is to describe occupational therapy’s role and contribution in the areas of health
promotion and prevention for internal and external audiences. AOTA supports and
promotes the involvement of occupational therapy practitioners1 in the development and
delivery of programs and services that promote health, well-being, and social participation
of all people.

Definitions environmental, (3) financial, (4) intellectual, (5) occupa-

tional, (6) physical, (7) social, and (8) spiritual.
Well-Being
Well-being is the ultimate goal of health promotion. Well- Health Promotion, Health, and Healthy Life
being is an evolving concept that includes “the presence It is important to frame the discussion of occupational
of positive emotions and moods (e.g., contentment, therapy’s role in health promotion by first defining health
happiness), the absence of negative emotions (e.g., promotion and health. According to the Ottawa Charter
depression, anxiety), satisfaction with life, fulfillment, and for Health Promotion,
positive functioning” (Centers for Disease Control and Health promotion is the process of enabling people
Prevention, 2018, para. 1). In occupational therapy, well- to increase control over, and to improve, their health.
To reach a state of complete physical, mental, and
being also includes satisfaction with participation in oc- social well-being, an individual or group must be able
cupations and daily activities that enhance quality of life to identify and to realize aspirations, to satisfy needs,
(QoL). Eight dimensions of well-being are identified in the and to change or cope with the environment. Health
is, therefore, seen as a resource for everyday life,
Substance Abuse and Mental Health Services not the objective of living. Health is a positive con-
Administration (2016) model: (1) emotional, (2) cept emphasizing social and personal resources, as
1
When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy
assistants (AOTA, 2019). Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the
safety and effectiveness of the occupational therapy service delivery process. Occupational therapy assistants deliver occupational therapy services
under the supervision of and in partnership with an occupational therapist (AOTA, 2014a).

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well as physical capacities. Therefore, health pro-

motion is not just the responsibility of the health
Strategies for Preventing the Onset and
sector but goes beyond healthy lifestyles to well- Progression of Disease and Injury
being. (World Health Organization, 1986, para. 2,
italics added) A key purpose of health promotion is improved health and
well-being; quality of life; and participation for individuals,
For nearly 40 years, the U.S. Department of Health and
families, and populations. Health promotion, manage-
Human Services (DHHS) has established health pro-
ment, and maintenance for people with or without dis-
motion and disease prevention objectives to facilitate abilities requires the implementation of prevention
and measure improvement in health (DHHS, 1980, 1990, strategies. Prevention, generally categorized into pri-

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2000, 2010, 2018a). The vision of Healthy People 2030 is mary, secondary, and tertiary levels, is often a collabo-
the realization of “a society in which all people achieve rative interdisciplinary endeavor (Reitz et al., 2010).
their full potential for health and well-being across the Individuals, groups, and populations at all levels of
lifespan” (DHHS, 2018a, para. 11). Attention to all di- abilities can benefit from occupation-based strategies at
each of these levels (AOTA, 2014b; Pizzi et al., 2018).
mensions in health promotion programming is essential
Definitions and occupation-based strategies for these
to facilitate overall well-being. Healthy People 2030 has
categories are as follows:
five major goals: n Primary prevention is defined as education or health
1. Attain healthy, thriving lives and well-being, free of promotion efforts designed to prevent the onset and
preventable disease, disability, injury, and pre- reduce the incidence of unhealthy conditions, dis-
mature death. eases, or injuries. These attempts to identify, reduce,
2. Eliminate health disparities, achieve health equity, and eliminate risk factors for disease and injury may
and attain health literacy to improve the health and
include modifying the physical and social environ-
well-being of all.
3. Create social, physical, and economic environments ment. Other strategies can include improving nutrition
that promote attaining full potential for health and through family occupation-based education on meal
well-being for all. planning and preparation; increasing physical ac-
4. Promote healthy development, healthy behaviors, tivities through leisure education and participation;
and well-being across all life stages.
quitting smoking; managing weight; and screening
5. Engage leadership, key constituents, and the public
across multiple sectors to take action and design for heart disease, diabetes, and cancer. All can be
policies that improve the health and well-being of beneficial to individuals with existing health condi-
all. (DHHS, 2018a, para. 11) tions and to the general population.
n Secondary prevention strategies typically include
Active engagement in life and overall health status, screening, early detection (e.g., using a long-handled
not just longevity, are emphasized in these goals. A mirror to monitor skin integrity of the feet), and in-
healthy life means the use of capacities and adapta- tervention after disease onset or injury has occurred.
tions across the lifespan, allowing people to enter into Secondary prevention involves limiting the develop-
satisfying relationships with others, to work, and to play ment of secondary conditions and their subsequent
impact on function and QoL (Kinne et al., 2004).
in their community. From a national perspective, a
n Tertiary prevention refers to services and policies
healthy life means a person is able to be a vital, cre-
designed to prevent the progression of a condition,
ative, and productive citizen and resident who contrib-
including poverty. Strategies include promoting equal
utes to the development of flourishing communities opportunity, full participation, independent living,
and a thriving nation. See Appendix A for more terms economic self-sufficiency, advocacy, and self-
and definitions. advocacy (Pizzi et al., 2018).

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outcome of participation in their chosen environments

Population Health Approach
and contexts (AOTA, 2014b, 2015b).
The Triple Aim was introduced in 2008 by the Institute for The essence of occupational therapy is the “belief that
Healthcare Improvement as a method not only to improve active engagement in occupation promotes, facilitates,
the health care experience of individuals but also to supports, and maintains health and participation”
improve the health of populations, enhance patient ex- (AOTA, 2014b, p. S4). Health management, including
perience, and manage costs (Berwick et al., 2008; physical and mental health management and mainte-
Obucina et al., 2018). Population health focuses on nance, is an important occupation for clients within the
aggregates, or communities of people, and the many domain of occupational therapy. Health promotion and

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factors that influence their health. The health of a pop- prevention are identified as occupational therapy in-
ulation is the product of multiple determinants including tervention approaches, and prevention, health and
biology and genetics, individual health behaviors, social wellness, QoL, participation, well-being, and occupa-
factors, economic factors, government policies, avail- tional justice are potential outcomes of occupational
ability and quality of health services, and physical en- therapy services (AOTA, 2014b).
vironments. A population health approach strives to Occupational therapy health promotion programs and
identify and reduce health disparities as well as enhance interventions may target individuals, communities, pop-
the overall health and well-being of a population ulations, and policymakers. The focus of these efforts
(Finlayson & Edwards, 1997; Kaplan et al., 2015). includes but is not limited to
n Prevention or reduction in the incidence of illness or
The appropriateness of occupational therapy in-
volvement in population-based health promotion is sup- disease, accidents, and injuries in the population
ported by the Occupational Therapy Practice (e.g., through activity analysis and environmental
Framework: Domain and Process (AOTA, 2014b). In adaptations and modifications);
addition to providing occupational therapy interventions n Promotion of positive mental health through com-
for individuals, occupational therapy practitioners de- petence enhancement strategies, such as skill de-
velop and implement occupation-based health ap- velopment, environmental supports, and adaptations
proaches to enhance occupational performance and of tasks and contexts;
participation, QoL, and occupational justice for pop- n Mitigation of mental illness through risk reduction
ulations. Examples of population health approaches strategies across the lifespan, such as establish-
appear later in this statement. ing healthy habits and routines and providing
training in relaxation and coping techniques
(AOTA, 2017c);
Role of Occupational Therapy in n Reduction of health disparities among racial and
Health Promotion ethnic minority groups and other underserved pop-
ulations (e.g., through advocacy and support for self-
Occupational therapy services are provided to clients advocacy);
(i.e., individuals, groups, and populations) of all age n Enhancement of mental health, resilience, and QoL
groups, infants through older adults, from a variety of (e.g., through culturally relevant healthy occupational
socioeconomic, cultural, and ethnic backgrounds, who engagement);
have or who are at risk for impairments, activity limitations, n Prevention of secondary conditions and improvement
or participation restrictions. Occupational therapy prac- of the overall health and well-being of people with
titioners recognize that physical and mental health is chronic conditions or disabilities and their caregivers
supported when clients are able to engage in occupations (e.g., through health management training and oc-
and activities that allow them to achieve the desired cupational and environmental adaptation); and

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n Promotion of healthy living practices, social par- As noted previously, one goal of Healthy People 2030
ticipation, occupational justice, and healthy com- is to eliminate health disparities (DHHS, 2018a). The term
munities, with respect for cross-cultural issues and health disparities refers to population-specific differ-
concerns (e.g., through facilitation of culturally ences in disease rates, health outcomes, and access to
relevant and inclusive programming in the health care services. Populations with differing health
community). outcomes include, but are not limited to, members of
Occupational imbalance, deprivation, and alienation racial and ethnic minority groups (DHHS, 2019a), people
are risk factors for health problems. They also may with disabilities (DHHS, 2019b), and people who identify
result from or lead to the development of other risk
as LGBTQ+ (DHHS, 2019c). Addressing health dis-
factors, which in turn can result in larger health and

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parities is consistent with the tenets of the occupational
social problems. Causes are varied (e.g., unanticipated
caregiving responsibilities, losses in employment or therapy profession. Inclusion is the acceptance and
housing) and can lead to occupational imbalance, support of diversity wherein the uniqueness of beliefs,
deprivation, and alienation, which can then lead to values, and attributes is welcomed, valued, and lever-
individual health problems such as stress, sleep dis- aged for maximum engagement (Taff & Blash, 2017).
turbance, and depression (Wilcock, 2006). Addressing
occupational imbalance, deprivation, and alienation
can promote health and prevent further health Occupational Therapy Health
problems. Promotion Interventions

Occupational therapy practitioners have three critical Many occupational therapy theoretical frameworks sup-
roles in health promotion and prevention that underpin port health promotion and prevention interventions. These
these programs and interventions: frameworks include the Ecology of Human Performance
1. To promote healthy occupations and lifestyles for (Dunn et al., 1994), Person–Environment–Occupational
everyone, including people with various ability levels Performance Model (Christiansen et al., 2015), and Model
and those who are marginalized and at increased risk of Human Occupation (Kielhofner, 2002; Taylor, 2017),
for health conditions; among others. The use of one or a combination of these
2. To incorporate occupation as an essential element of models will help promote comprehensive occupation-
health promotion strategies; and based interventions at the individual, community, or
3. To provide occupation-based interventions, not only population level.
with individuals but also with families, communities,
and populations. Individuals
Occupation-based primary prevention and intervention
See Table1 for case examples of the role of occupational approaches that target individuals may include
therapy in the promotion of health and well-being.
n Workplace musculoskeletal injury prevention and
It is important that practitioners promote a healthy management programs using activity and job anal-
lifestyle for all clients, their families, and communities. ysis, adaptations to the work environment, and
Wilcock (2006) defined an approach to prevention as modifications to work practices;
n Social and emotional skills, self-management skills,
the application of medical, behavioral, social, and oc-
cupational science to prevent physiological, psycho- communication skills, and anger management as well
logical, social, and occupational illness; accidents; and as conflict resolution training for parents, teachers,
disability; and to prolong quality of life for all people and school-age youth to reduce the incidence of
through advocacy and mediation and through
bullying and other violence;
occupation-focused programs aimed at enabling
people to do, be, and become according to their n Parenting skills training and family co-occupation
natural health needs. (p. 282) engagement to enhance family health, promote

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Table 1. Occupational Therapy Health Promotion Case Examples

Case Type and Description Evaluation Intervention

Primary
Working with a family: A retired couple consult The OT develops an occupational profile (AOTA, For immediate consideration, the OT recom-
an OT about a home safety evaluation to help 2014b, 2017a) using a semistructured in- mends that the couple install railings near all
them remain in their home as they age. terview and gathers information about the stairs, increase the level of lighting, and de-
couple’s goals, occupational history, health, crease the amount of furniture in the rooms
occupational performance, and satisfaction and hallways to widen passageways. The OT
level within the various performance areas, as works with them to find the best configuration
well as social connectedness and overall life of furniture placement to maximize safety
satisfaction. when walking in a room. The OT recommends

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that the couple consider changing the land-
Both spouses are overweight but able to per-
scape to include clearly defined and level
form daily tasks with a high level of satisfaction. walkways that also will accommodate wheeled
They have a strong social support network and
mobility, should that ever be needed.
report being very satisfied with their life.
A second set of recommendations includes
The OT explores the health history of their how to retrofit the house if mobility impair-
parents and learns of a history of Alzheimer’s
ments preclude stair climbing in the future.
disease and diabetes. The OT assesses the The OT describes optimal placement of an
environment (i.e., home, yard, neighborhood)
elevator from the 1st to the 2nd floor. There is
for accessibility and safety using the SAFER tool not an easy placement of an elevator from the
(Oliver et al., 1993). basement to the 1st floor, so the OT describes
The OT notes that the living area is on 3 levels how the occupations now performed in the
(several steps have no railings); rooms and basement (e.g., exercise, laundry, computer
hallways are generally poorly lit; and the rooms use) may be transferred to the other 2 floors.
have too much furniture, leaving narrow or The OT works with the couple to identify
obstructed passageways. The yard has uneven solutions regarding transportation, should
and poorly defined walkways. The couple lives driving become difficult, and recommends
in a residential neighborhood with a distance of community resources that promote healthy
3 miles to shopping. No public transportation is weight management.
available, even for people with mobility
impairments.
Working with a business: A commercial bakery The OT observes the work performed at the The OT recommends ergonomically designed
contacts an OT to evaluate the various work- various workstations and interviews the workstations that can decrease the amount of
stations in the bakery and make recommen- workers. The OT notes body mechanics, re- static work, time standing, travel, or lifting and
dations for improvements. Management goals petitive motions, machine design, layout of that can improve working positions. Because
include increasing productivity and decreasing workstations with travel distances, weights some jobs involve repetitive motions that may
sick days and worker compensation claims. lifted and number of lifts per time unit, work not be avoided, the OT instructs the managers
speed and load, noise, temperature, air quality, about the benefits of rest breaks and instructs
clothing comfort, and length and frequency of the workers in stretching exercises. Pain
rest breaks. The OT also notes worker-to- management techniques, including alternative
worker interaction and interaction among pain relief strategies, are also provided to the
workers, supervisors, and managers. The su- workers. Workers are instructed in proper
pervisors and management seem approachable body mechanics at their specific workstations.
and open to suggestions from the workers.
The OT works with the managers to design a
The OT identifies a high frequency of lifting and daily schedule that allows for an even work-
repetitive motion done by the workers. Work- flow to decrease times of high stress. The OT
stations require a significant amount of static returns every 6 mo to reevaluate and to in-
standing, which contributes to many muscu- struct new employees.
loskeletal problems. Travel distances are long,
work speed is rapid, noise level is high in certain
parts of the bakery, and the temperature is
uncomfortably warm.
(Continued )

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Table 1. Occupational Therapy Health Promotion Case Examples (Cont'd)

Case Type and Description Evaluation Intervention

Working with a school: An elementary school is The OT surveys the proposed playground area, The OT provides the school with a report
planning a new playground, which must be including the dimensions, drainage, slope, detailing the recommendations for the play-
accessible to every child in the school. An OT is ground cover, distance to parking, and natural ground equipment and layout. The OT is careful
consulted for input on design features that will shade. The OT uses guidelines for play areas to identify all safety issues and suggests ways to
make the playground aesthetically pleasing, developed by the U.S. Access Board (2007) to make the playground as inclusive as possible for
fun, and challenging for children of all abilities ensure minimum requirements are met. The OT children of all sizes and abilities. The report also
and sizes. then researches commercially available play- includes recommendations for landscaping so
ground equipment to find equipment that will that children using wheeled mobility can easily
be fun and challenging to use for all children in navigate around the playground. The OT remains
the school, as well as encourage interaction on the design team for consultation until the

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among the children. playground is completed.
Secondary
Working in a primary care setting: An OT The OT researches information on opiate ad- Using assessment data, the OT designs a pre-
working in a primary care setting notes the high diction, existing programs, and prevention of vention program consisting of group and indi-
number of opiate prescriptions for chronic pain relapse. Recognizing that addiction and relapse vidual sessions. Topics for groups include pain
that many patients are receiving. Chronic pain are attempts to reduce distress (either physical management, mindfulness, distress tolerance,
can lead to loss of worker and family roles, or psychological), the OT opts to focus on emotion regulation, and problem-solving skills.
sleep disturbance, depression, and social iso- diminishing and managing the distress instead Pain management interventions include educa-
lation, all of which are within the domain of of implementing an opiate-use reduction tion on the neurophysiology of the pain response
occupational therapy. In addition, the OT is strategy. The OT uses the literature to identify and nonmedical pain control modalities, such as
concerned about patients’ potential for addic- appropriate assessments and chooses the the proper use of heat and cold, safe body
tion, overdose, and relapse. COPM (Law et al., 2019) and the PFPA (Fisher mechanics, muscle tension reduction training,
et al., 2009). and regulation of activity levels.
The group setting is designed to provide social
support, and individual sessions provide an
opportunity to customize content to meet each
individual’s specific needs. The OT collects on-
going data to determine the effectiveness of the
program in reducing physical and psychological
distress, decreasing the need for opiate pre-
scriptions, and preventing addiction and relapse.
Working with a local government agency: An OT To determine the need for alternative means of The OT contacts the county office on aging to
working in home health has noticed that older transportation, the OT conducts a needs as- discuss findings and concerns from the needs
adult clients who no longer drive as a result of a sessment, gathering existing data from several assessment. The OT provides a brief pre-
variety of functional limitations have no other sources, including state and local census data sentation that includes data from the needs
means of transportation to go grocery shopping, and information from community organizations assessment and evidence from the systematic
run errands, attend appointments, visit friends, that provide services to older adults. reviews. A joint task force is formed with local
and engage in community activities. This lack of senior centers to further study the transportation
transportation limits the social engagement, experience of older adults in the county to make
physical activity, and autonomy of these older further recommendations. Cognizant of the need
adults and places them at increased risk for de- to balance the fiscal resources of the county with
pression and falls. the needs of aging county residents, the task
force develops a proposal for extending 1 bus
The OT reviews the literature for evidence and
route and including 3 additional stops on 2 other
locates a special issue of the American Journal
bus routes during weekday non–rush hour
of Occupational Therapy that includes sys-
times. The proposal emphasizes the importance
tematic reviews on the relationship between of transportation and social participation to the
occupation and productive aging (Berger et al., health and well-being of older adults. Addition-
2018; Smallfield & Molitor, 2018). The OT ally, the task force develops a brochure for
reviews additional literature regarding in- residents of the community; it includes in-
terventions for community mobility and public formation about other community resources for
transit for older adults (Mulry et al., 2017) and transportation, such as paratransit services,
commits to taking action. volunteer drivers, and ride share programs.
(Continued )

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Table 1. Occupational Therapy Health Promotion Case Examples (Cont'd)

Case Type and Description Evaluation Intervention

Working with a local nonprofit organization: The OT reviews the literature on community On the basis of the needs assessment data and
The director of a local nonprofit organization reintegration, social programs for veterans, and input from the OT, the director of the nonprofit
serving veterans with mental health issues is suicide prevention. The OT interviews several organization creates a peer support program
concerned about the high rate of suicide among veterans individually and conducts a focus and an occupation-based community re-
veterans. One risk factor for suicide in this group to identify their needs and interests re- integration group intervention. The OT is hired
population is social isolation (Teo et al., 2018). lated to community reintegration. to assist in the development, implementation,
An OT is consulted regarding strategies for and evaluation of these new service compo-
community reintegration. nents, including the training of the peer
support coaches.

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Tertiary
Working with a local hospital: A hospital offers The OTA researches information on COPD, The supervising OT works with the OTA and
health promotion classes to former patients existing programs, and their content and out- has a respiratory therapist join the team to
with chronic conditions. The programs address comes. The OTA researches and consults with develop a series of health promotion classes
concerns related to limited health literacy and the supervising OT to determine optimal group for patients with COPD based on the Lifestyle
other health management skills affecting pa- size, length of each session, session frequency, Redesign® program (Clark et al., 2015). The
tients’ health, functioning, and recidivism rates. and number of sessions based on available team discusses the ideal number of partici-
An OTA is chosen to lead a class for patients evidence and capacity of the hospital. pants, length of sessions, and topics to be
with COPD. included. The team determines that the OTA
will offer 12 monthly sessions lasting 90 min
each to 15 participants with COPD. Topics
include chronic disease self-management,
assertive communication, information seek-
ing, stress management, health literacy, and
problem-solving skills. The group functions as
a support group. The OT and OTA collect data
to determine the effectiveness of the program
in preventing secondary conditions associated
with COPD and promoting independent living
and quality of life.

Note. AOTA = American Occupational Therapy Association; COPD = chronic obstructive pulmonary disease; COPM = Canadian Occupational Performance Measure;
OT = occupational therapist; OTA = occupational therapy assistant; PFPA = Pain and Functional Performance Assessment; SAFER = Safety Assessment of Function and
the Environment for Rehabilitation.

development, and decrease stress and potential for n Education and training on how to incorporate stress
abuse; management and adaptive coping strategies within
n Fall prevention programs for community-dwelling daily routines to enhance resilience for children who
older adults with occupation-focused home evalua- have experienced trauma or adults with mood dis-
tions; and orders and posttraumatic stress disorder; and
n Health literacy interventions to support health man- n Osteoporosis management and fall prevention clas-
agement and maintenance capabilities. ses for individuals recently diagnosed with this
condition.
Examples of secondary prevention interventions may
include Examples of occupation-based tertiary prevention in-
n Education and training regarding eating habits, terventions may include
activity levels, and prevention of secondary disability n Transitional or independent-living skills training for
subsequent to obesity or mobility limitations; people with mental illness or cognitive impairments;

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n Leisure participation groups for older adults with n Educating day care staff to understand typical growth
dementia to prevent depression, enhance socializa- and development, handle behavior problems, and
tion, and improve QoL; identify children at risk for developmental delays and
n Social participation activities at a drop-in center for obesity;
adults with severe mental illness to increase social n Promoting ergonomic design in workstations, such as
and community engagement; and classroom desks for students, computer stations for
n Stroke support groups for survivors and caregivers with a staff, and other work areas (e.g., custodial); and
focus on occupational engagement to increase occu- n Providing consultation to schools to increase op-
pational performance and decrease caregiver burden. portunities for movement throughout the school day.

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Occupational therapy practitioners work as part of an Examples of community- or population-level in-
interprofessional team by adding the contribution of oc- terventions may include
cupation to programs developed by experts in health n Consulting with local transportation authorities re-
education, nutrition, exercise, and so forth. For ex- garding accessible public transportation;
ample, when working with an individual with a lower n Consulting with contractors, architects, and city
extremity amputation as a result of diabetes, the planners regarding accessibility and universal
practitioner may focus on the occupation of meal design;
preparation using foods and preparation methods rec- n Implementing a communitywide screening program
ommended in the nutritionist’s health promotion pro- for depression at nursing homes, assisted-living fa-
gram. This approach enables achievement of the cilities, and senior centers for the purpose of de-
occupational therapy goal of functional independence in veloping or providing group and individual prevention
the kitchen and reinforces the importance of proper and intervention programs;
nutrition for the prevention of further disability (Scaffa & n Providing consultation, assessment, and intervention
Reitz, 2014). for chronic health conditions at a primary care facility;
n Conducting needs assessments and implementing
Organizations, Communities, and Populations intervention strategies with other health professionals
To promote the health of a population and achieve health to reduce health disparities in communities with high
equity, the social determinants of health must be rates of disease or injury, such as lifestyle man-
addressed. These determinants include economic sta- agement programs addressing hypertension, di-
bility, education, social and community context, health abetes, and obesity;
and health care, and the neighborhood and built envi- n Addressing the health and occupation needs of the
ronment (DHHS, 2018b). Social determinants of health homeless population by eliminating barriers and en-
can be addressed through collaboration with organiza- hancing opportunities for occupational engagement;
tions and communities and through policy initiatives. n Addressing the health and occupation needs of
Examples of organization-level interventions may prison populations by enhancing opportunities for
include occupational engagement by focusing on reentry to
n Providing consultation to businesses to promote reduce recidivism; and
well-being of workers through identification of n Training volunteers to function effectively in special-
problems and solutions for balance among work, needs shelters during disasters.
leisure, and family life;
n Providing consultation to park districts regarding Governmental or policy-level interventions may include
implementation of Americans With Disabilities Act of n Promoting policies that offer affordable, accessible

1990 (Pub. L. 101-336) requirements; health care to everyone, including people with

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disabilities and those from other historically mar- prescription drug bottles, participate in chronic disease
ginalized backgrounds; self-management, follow physician recommendations,
n Promoting barrier-free environments for all ages, in- fill out complex forms, communicate with health care
cluding aging in place and universal design; providers, and navigate the health care system.
n Supporting full inclusion of children with disabilities in Therefore, health literacy is an important component of
schools and day care programs; health management.
n Lobbying for public funds to support research and The Occupational Therapy Code of Ethics (2015)
program development in areas related to improve- (AOTA, 2015a) establishes principles that guide safe and
ment in QoL for people at risk and those with dis- competent occupational therapy practice that must be

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abilities; and applied when providing occupational therapy services.
n Promoting policies that establish opportunities for Although practitioners recognize the distinct role of oc-
recovery in the community for people with mental cupational therapy in health promotion and prevention, it
disorders. is also important for them to acknowledge and respect the
contributions of other health care professions in this arena.
Occupational therapy practitioners should operate within
Ethical Considerations
their scope of practice and training and partner with other
The roles of occupational therapy practitioners in eval- health promotion disciplines with specialized expertise in
uation and intervention in health promotion practice are areas such as public health, health education, nutrition,
based on the Guidelines for Supervision, Roles, and and exercise science. This professional behavior is in
Responsibilities During the Delivery of Occupational perfect alignment with Principle 6: Fidelity of the Code of
Therapy Services (AOTA, 2014a). Occupational therapy Ethics (AOTA, 2015a).
practitioners have the basic knowledge and skills to carry
out health promotion interventions to prevent injury and
Evidence Base for Occupational
maximize well-being. However, this area of practice is
Therapy in Health Promotion
broad, and practitioners must continually expand their
knowledge in health promotion to be effective and Health promotion services should be based on the best
competent members of a team (Reitz, 2017). available evidence. Through AOTA’s (n.d.) Evidence-
Individuals, groups, and populations are best served Based Resource Directory, occupational therapy prac-
when community leaders, stakeholders, and a variety of titioners can review the latest evidence-based resources
health and education professionals work in interprofes- for work with individuals through the lifespan as well as
sional teams to provide health promotion and preventive with families, communities, and populations. Several
services. Occupational therapy practitioners’ knowledge evidence-based occupational therapy interventions for
of occupations, activity analysis, and group functioning health promotion have been developed.
makes them essential members of such teams. A systematic review of mental health services and
Being cognizant of and ready to address health literacy programming for children (Arbesman et al., 2013) found
is one example of occupational therapy practitioners’ strong evidence that schoolwide antibullying programs
evolving knowledge base. Ensuring health literacy is a and after-school programs are effective in improving
focus of national health policy and marks ethical practice social and emotional skills. In the same systematic review,
across health disciplines. The Healthy People 2030 goal strong evidence was reported “that childhood obesity
regarding the reduction of health disparities includes programs affect body mass index, particularly for children
attaining health literacy as a means of improving health aged 6–12 years” (Arbesman et al., 2013, p. 123).
and well-being (DHHS, 2018a). Health literacy affects An AOTA Critically Appraised Topic (CAT) found
people’s ability to understand information on moderate evidence for the efficacy of population-based

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STATEMENT

fall prevention interventions (AOTA, 2017b). This CAT

Summary
provides support to occupational therapy practitioners to
“consider working with interdisciplinary team members to Exercising the power of occupation can help prevent
develop population-based multicomponent fall pre- harmful health and social conditions and promote well-
vention intervention programs, which include exercise to being. Occupational therapy practitioners have the ca-
promote strength and balance, home safety education and pacity and knowledge to positively affect the health and
modification, cognitive–behavioral programs, and edu- well-being of individuals, families, communities, and
cation on fall risk factors” (AOTA, 2017b, p. 4). populations at local, national, and global levels.
Studies by Clark et al. (1997, 2001, 2012) have sup- Occupation-based health promotion services can facili-

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ported the efficacy of occupational therapy health pro- tate the achievement of national goals outlined in Healthy
motion interventions in well older adults in urban People 2030 and the fulfillment of the Triple Aim. De-
communities. In a landmark study of community-dwelling veloping and implementing occupation-based violence
older adults (the Well Elderly Study), Clark et al. (1997) prevention programs, ensuring playground accessibility,
evaluated the effectiveness of an occupation-based providing sleep hygiene programs, advocating for
health promotion program. The intervention was found to marginalized populations, and participating in sustain-
enhance physical and mental health, occupational func- ability initiatives are just a few examples of roles that
tioning, and life satisfaction compared with a social ac- practitioners can play to positively affect health and well-
tivities program and a no-treatment control group. being. This area of practice is primed for further devel-
Clark et al. (2001) demonstrated a long-term benefit opment, and future innovative health promotion solutions
attributable to preventive occupational therapy when they will be maximized through interdisciplinary
reevaluated participants from Clark et al.’s (1997) Well collaborations.
Elderly Study and found that 90% of therapeutic gain
observed after intervention was retained at the 6-month
follow-up. In addition, the Well Elderly Study was repli- References
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Framework Philadelphia: F. A. Davis.

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Appendix A. Glossary of Health Promotion Terms

Health: Physical, mental, and social well-being (World Health Organization, 1986).
Health literacy: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and
services needed to make appropriate health decisions” (National Network of Libraries of Medicine, n.d., para. 1).
Health promotion: “The process of enabling people to increase control over, and to improve, their health” (World Health Organization,
1986, para. 2).
Healthy life: The use of capacities and adaptations to enter into satisfying relationships with others, to work, and to play.
Occupational alienation: “Sense of isolation, powerlessness, frustration, loss of control, and estrangement from society or self as a
result of engagement in occupation that does not satisfy inner needs” (Wilcock, 2006, p. 343).

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Occupational deprivation: “Deprivation of occupational choice and diversity because of circumstances beyond the control of in-
dividuals or communities” (Wilcock, 2006, p. 343).
Occupational imbalance: “A lack of balance or disproportion of occupation resulting in decreased well-being” (Wilcock, 2006, p. 343).
Occupational justice: “The promotion of social and economic change to increase individual, community, and political awareness,
resources, and equitable opportunities for diverse occupational opportunities that enable people to meet their potential and
experience well-being” (Wilcock, 2006, p. 343).
Occupational science: “An interdisciplinary academic discipline in the social and behavioral sciences dedicated to the study of the
form, the function, and the meaning of human occupations” (Zemke & Clark, 1996, p. vii).
Well-being: An evolving concept that includes “the presence of positive emotions and moods (e.g., contentment, happiness), the
absence of negative emotions, satisfaction with life, fulfillment, and positive functioning” (Centers for Disease Control and
Prevention, 2018, para. 1); in occupational therapy, it also includes satisfaction with occupational participation.

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STATEMENT

Authors
S. Maggie Reitz, PhD, OTR/L, FAOTA
Marjorie E. Scaffa, PhD, OTR/L, FAOTA

for

The Commission on Practice

Julie Dorsey, OTD, OTR/L, CEAS, FAOTA, Chairperson

Revised by the Commission on Practice, 2019

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Adopted by the Representative Assembly Coordinating Council (RACC) for the Representative Assembly, 2019

Note. This document replaces the 2013 statement Occupational Therapy in the Promotion of Health and Well-Being, previously published and
copyrighted in 2013 by the American Occupational Therapy Association in the American Journal of Occupational Therapy, 67(6, Suppl.), S47–S59.
https://doi.org/10.5014/ajot.2013.67S47

Copyright © 2020 by the American Occupational Therapy Association.

Citation. American Occupational Therapy Association. (2020). Occupational therapy in the promotion of health and well-being. American Journal of
Occupational Therapy, 74, 7403420010. https://doi.org/10.5014/ajot.2020.743003

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