A theory of occupational agency : an international investigation of occupational therapists’ negotiations

Perryman-Fox, Michelle Susan (2020) A theory of occupational agency : an international investigation of occupational therapists’ negotiations. PhD thesis, Lancaster University.

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Abstract

A core belief of the occupational therapy paradigm is the essential need to engage in meaningful and purposeful occupation to enable health and wellbeing. Investigations of the occupational therapists “occupation” are concerned with what we do, rather than why we do it. Occupational science and theory have permitted understanding of the value of occupation. However, investigation is required to understand the therapist agency and negotiations of being occupational therapists within the structures that are part of and surround our practice. This understanding will contribute to evidence base to enable the occupational therapist to carry out their role with meaningful and purposeful intent. This research used a pragmatic constructionist grounded theory methodology (Charmaz, 2014) with threads of symbolic interactionism (Blumer, 1967). This is combined with the practice of heuristic analysis (Moustakas, 1990). Three data generations were carried out with in total 14 participants in three international countries. The data collection methods used included interviews, focus groups, observations and ongoing researcher reflections throughout the research process. A review of the literature was constructed through the principles of the constructivist grounded theory process to embed the voices of the participants within the developed theory. Ethical approval was obtained, and informed consent was confirmed. An overarching exploratory theory was constructed; “Occupational Agency, The Hope to Live Coherently”. The theory identifies with; the process of the internal system of the occupational therapist. The occupational agency; the negotiation of the values, habits, roles, routines, meaning and perception of engagement within occupation. The perceived external structures being a barrier or facilitator to occupation, and subsequently, the consequences of the negotiations. These four factors are bound together by the unifying core category of “occupational agency”. This stance highlights the interaction which occurs in the context of the therapist actions in response of the dynamic and ever-changing occupational therapist, occupation, identity and role within the health care system. The performance profile is offered as a tool to support an opportunity for action through reflective and reflexive practices. The overall theory provides an opportunity to further investigate the occupation of the occupational therapist within practice, education and research.