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

Introduction 

The Occupational Self Assessment (OSA) measures the concepts of occupational competence and occupational identity from the Model of Human Occupation. In mental health, the recovery movement has sparked discussions about what constitutes personal, clinical and functional recovery. However, it is unclear how occupation-based terminologies such as occupational competence and occupational identity are related to the recovery framework. 

Objectives

This study aimed to delineate associations between occupational competence and occupational identity with the three domains of recovery. It was hypothesized that: 1)functional and personal recovery were associated with occupational competence; 2)occupational identity was associated with personal recovery. 

Method

66 community dwelling adults with schizophrenia completed the OSA, as well as clinical (Positive and Negative Syndrome Scale), functional (Personal and Social Functioning Scale) and personal recovery (Questionnaire about the Process of Recovery) assessments. In addition, they identified up to four OSA items that were priorities for change. Tests of associations and multiple regression analyses were conducted to identity predictors of occupational competence and occupational identity. 

Results 

Although there was moderate association between functional recovery and occupational competence, this was not statistically significant when personal recovery was included in the regression model. Hence, occupational competence appeared to reflect a personal state of self-efficacy in fulfilling valued occupations, rather than the actual functional ability. Interestingly, depressive symptoms and hope predicted occupational identity. It was postulated that depression could influence clients’ value perception, through over-estimating importance of an occupation or under-rating competence. In conjunction, facilitating hope needs to precede role acquisition. Lastly, the top three OSA priorities for change were all performance items: ‘managing my finances’, ‘concentrating on my tasks’ and ‘taking care of myself’.

Conclusion 

Occupational therapy interventions should not be limited to functional improvement. Instead, they should instill recovery-oriented psychological states such as hope and efficacy, while considering clients’ affective states.