contexts and environments in occupational therapy

Department of Occupational Therapy, Bangladesh Health Professions Institute

1. CONTEXT & ENVIRONMENT Shamima Akter B. Sc ( Honours ) in Occupational Therapy & M. Sc in Rehabilitation Science Assistant Professor , Department of Occupational Therapy Bangladesh Health Professions Institute (BHPI) Centre for the Rehabilitation of the Paralysed (CRP) Chapain , Savar

2. Context and environment Engagement and participation in occupation take place within the social and physical environment situated within context. In the literature, the terms environment and context often are used interchangeably. In the Framework, both terms are used to reflect the importance of considering the wide array of interrelated variables that influence performance. Understanding the environments and contexts in which occupations can and do occur provides practitioners with insights into their overarching, underlying, and embedded influences on engagement.

3. Physical environment The physical environment refers to the natural (e.g., geographic terrain, plants) and built (e.g., buildings, furniture) surroundings in which daily life occupations occur. Physical environments can either support or present barriers to participation in meaningful occupations. Examples of barriers include doorway widths that do not allow for wheelchair passage or absence of healthy social opportunities for people abstaining from alcohol use. Conversely, environments can provide supports and resources for service delivery (e.g., community, health care facility, home).

4. Social environment The social environment consists of the presence of, relationships with, and expectations of persons, groups, and populations with whom clients have contact (e.g., availability and expectations of significant individuals, such as spouse, friends, and caregivers).

5. Context The term context refers to elements within and surrounding a client that are often less tangible than physical and social environments but nonetheless exert a strong influence on performance. Contexts, as described in the Framework, are cultural, personal, temporal, and virtual.

6. Cultural context The cultural context includes customs, beliefs, activity patterns, behavioral standards, and expectations accepted by the society of which a client is a member. The cultural context influences the client’s identity and activity choices, and practitioners must be aware, for example, of norms related to eating or deference to medical professionals when working with someone from another culture and of socioeconomic status when providing a discharge plan for a young child and family.

7. Personal context Personal context refers to demographic features of the individual, such as age, gender, socioeconomic status, and educational level, that are not part of a health condition.

8. Temporal context Temporal context includes stage of life, time of day or year, duration or rhythm of activity, and history.

9. Virtual context Virtual context refers to interactions that occur in simulated, real-time, or near-time situations absent of physical contact. The virtual context is becoming increasingly important for clients as well as occupational therapy practitioners and other health care providers.

10. Contexts Category Description Examples Culture Customs, beliefs, activity patterns, behavioral standards, and expectations accepted by the society of which a client is a member. The cultural context influences the client’s identity and activity choices. • Person: A person delivering Thanksgiving meals to home-bound individuals • Group: Employees marking the end of the work week with casual dress on Friday • Population: People engaging in an afternoon high tea

11. Contexts Category Description Examples Personal Features of the individual that are not part of a health condition or health status” (WHO, 2001, p.17). The personal context includes age, gender, socioeconomic status, and educational status and can also include group membership (e.g., volunteers, employees) and population membership (e.g., members of society). • Person: A 25-year-old unemployed man with a high school diploma • Group: Volunteers working in a homeless shelter • Population: Older drivers learning about community mobility options

12. Contexts Category Description Examples Temporal The experience of time as shaped by engagement in occupations; the temporal aspects of occupation that “contribute to the patterns of daily occupations” include “rhythm ...tempo . . .synchronization ...duration ...and sequence” (Larson & Zemke , 2003, p.82; Zemke , 2004, p.610).The temporal context includes stage of life, time of day or year, duration and rhythm of activity, and history. • Person: A person retired from work for 10 years • Group: A community organization’s annual fundraising campaign • Population: People celebrating Independence Day on 26 th March

13. Contexts Category Description Examples Virtual Environment in which communication occurs by means of airwaves or computers and in the absence of physical contact. The virtual context includes simulated, real-time, or near-time environments such as chat rooms, email, video conferencing, or radio transmissions; remote monitoring via wireless sensors; or computer-based data collection. • Person: Friends who text message each other • Group: Members who participate in a video conference, telephone conference call, instant message, or interactive white board use • Population: Virtual community of gamers

14. Environments Category Description Examples Physical Natural and built nonhuman surroundings and the objects in them. The natural environment includes geographic terrain, plants, and animals, as well as the sensory qualities of the surroundings. The built environment includes buildings, furniture, tools, and devices. • Person: Individual’s house or apartment • Group: Office building or factory • Population: Transportation system

15. Environments Category Description Examples Social Presence of, relationships with, and expectations of persons, groups, or populations with whom clients have contact. The social environment includes availability and expectations of significant individuals, such as spouse, friends, and caregivers; relationships with individuals, groups, or populations; and relationships with systems (e.g., political, legal, economic, institutional) that influence norms, role expectations, and social routines. • Person: Friends, colleagues • Group: Occupational therapy students conducting a class get-together • Population: People influenced by a city government