Occupational Therapy and Primary Health Care

Occupational Therapy and Primary Health Care: A Practice Paper

 

FEBRUARY 1995

CONTENT EXPERTS

• Ron Berard B.M.R., (O.T.M.)
• Ann Booth B.Sc., (O.T.), M.B.A.
• Jeanette Edwards B.O.T., (O.T.M.), M.H.A.
• Marcia Finlayson B.M.R., (O.T.M.), Adv. Cert. Gerontology.
• Robin Goodfellow Dip.O.T./P.T., B.O.T.
• Candace Plouffe B.M.R., (O.T.), M.Sc. (Sp.Ed.)

What is the Purpose of this Paper?

Primary Health Care is a comprehensive and community driven approach to health. Occupational therapists have long had a holistic, client-centred approach to health care, which lends itself well to community based models of practice.

The purpose of this paper is to outline the characteristics of Primary Health Care, and the philosophical principles of Occupational Therapy so as to demonstrate how the two compliment each other.

Future directions for the profession of Occupational Therapy to facilitate its role in Primary Health Care are also outlined.

 

What is Primary Health Care?

Primary Health Care as defined at the Declaration of Alma-Ata in 1978, is a holistic, community driven model of health care which emphasizes health promotion.

Health, in this context, is based on the World Health Organization (W.H.O.) definition:

Health is the extent to which an individual or group is able... to realize aspirations and satisfy needs, and to... change or cope with the environment. Health is a... resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources as well as physical (mental and spiritual) capacities. (1984)

Primary Health Care emphasizes the ability of the individual/family/community to be self reliant in achieving health (W.H.O., 1978). It involves an integrated, interdisciplinary and intersectoral approach to health delivery.

Primary Health Care is not simply the delivery of health services as we currently understand them. It goes beyond the health sector and encompasses all sectors that affect health. Such sectors may include but are not limited to housing, sanitation, water supply, education, nutrition and employment. The diagram below demonstrates the potential interplay of these sectors.

 

An intersectoral approach is a key component in Primary Health Care. The members of the team vary, depending on the needs and issues affecting the health (in the broadest sense) of the individual/family/community.

Another key component in Primary Health Care is the responsibility of the individual/family/community in promoting and achieving health. This concept of self-care "incorporates the decisions and actions controlled by an individual/family/community with the promotion and protection of health as its ultimate goal" (Health and Welfare Canada, 1989).

In conclusion, the World Health Organization notes that "the links between people and their environment constitute the basis for the socio-ecological approach to health" (W.H.O., 1984, p.101). The socio-ecological approach recognizes that "health improving activities range much further than the provision of health services. Poverty, nutrition, land tenure, irrigation and urbanization, for example are seen in part as health problems" (Mangay Naglacas, 1984).

 

What is Occupational Therapy?

Occupational Therapy is an art and science which utilizes the analysis and application of activities specifically related to occupational performance in the areas of self-care, productivity and leisure. The purpose of Occupational Therapy is to "prevent disability; and to promote, maintain or restore occupational performance, health and spiritual well being" (Health and Welfare Canada, 1983, p.xvi). Occupational Therapy services are delivered within a variety of sectors, such as health, education, housing, government and social service systems.

Occupational Therapy has long used a client-centred approach in practice. Key components of a client-centred philosophy include:

a. The individual is an active participant within the therapeutic relationship;

b. Occupational Therapy acknowledges and practices within a humanistic view of the individual as a whole person;

c. The essence of a healthy, functioning person is the balanced integration of four components (mental, physical, sociocultural and spiritual self) to provide a sense of well being. Individuals integrate these components by engaging the social, cultural and physical aspects of the environment which (s)he affects and by which (s)he is affected;

d. The role of the Occupational Therapist is to facilitate the individual's engagement with his/her environment; and

e. The individual's progress is affected by the status of his/her performance components and the social, cultural and physical elements of the environment.

The Occupational Therapist, when practising within this client-centred framework, considers key aspects which facilitate the health of the individual/family/community. Two of these key aspects include considering the impact of the client's environment in the attainment of health and the importance of health promotion in maintaining health.

The Environment:

Occupational performance involves "interacting with the environment", whereby "clients often need services and contacts with other resources in order to meet all intervention, goals and objectives (Canadian Association of Occupational Therapists, 1991). The linkages with other resources, agencies and/or individuals is essential for the successful integration or reintegration of the client into his/her community. "This liaison and coordination role played by Occupational Therapists is an outgrowth of the theoretical and practical background which prepares them to interact with the fields of health, social service, labour, education or any other setting in which the clients function" (CAOT, 1991, p.74).

Health Promotion:

Occupational Therapy also has a role within the health promotion framework. Madill, Townsend, and Schultz (1989) described the connection between health promotion and Occupational Therapy as follows:

"Occupational Therapists intervene at the individual client level and through immediate surroundings of the individual, acknowledge the conditions which are either barriers or resources of health. Therapists become involved in community action by identifying those conditions which make coping with life more difficult for certain groups of people, and by seeking appropriate solutions. The skills of enabling; advocating and mediating are required to ensure that health resources are available within the community system" (p.69).

Health promotion is therefore participatory, intersectoral, integrative and a continuous process (Letts et al, 1993).

These key principles illustrate the art of Occupational Therapy practice namely, the recognition that "the environment, both human and nonhuman is integral to the functioning of an individual" (Reed & Sanderson, 1981) and that "the environment influences all aspects of daily functioning - from the values one holds, to the ability to interact, to the reactions one has to stress" (Finlayson & Edwards, 1992).

 

How does Occupational Therapy Function Within Primary Health Care?

Primary Health Care and the practice of Occupational therapy have a common philosophical base in a number of areas.

Holistic Approach to Health:

Primary Health Care and Occupational Therapy share a holistic view of humans in that they consider the relationship between an individual's sense of well-being and the health of their social and physical environment. Illness does not take place outside the context of a person's family or community. It is therefore impossible to restore, maintain or promote an individual's health without addressing the health of his/her community as well.

Importance of Self Care:

Another commonality between Primary Health Care and Occupational Therapy is the concept of self-care or personal responsibility for achieving health. Occupational Therapists believe that people have an inherent need to be engaged in the every day activities of living in order to achieve a sense of mastery of their environment (Reilly, 1962). In the context of a Primary Health Care model, this can mean anything from activities of daily living retraining to education in accessing funding for building a wheelchair ramp. In a macro framework, Occupational Therapy knowledge has been applied to enabling seniors groups to establish their own health promotion programs and agencies through the CAOT Seniors Health Promotion Project (Finlayson, 1993).

Promotion of an Intersectoral Approach:

The most far reaching principle of Primary Health Care that Occupational Therapists share is the concept of a intersectoral approach. As previously stated, illness and wellness occur in the context of an individual's social and physical environment. This process implies that the restoration or promotion of health cannot occur within the confines of the traditional health care sector, nor be restricted to any single sector for that matter. This intersectoral approach further demands a multidisciplinary and interdisciplinary approach.

It is important to highlight how Occupational Therapists have worked within a Primary Health Care framework by examining the wide range of sectors that they currently practice in.

Occupational Therapists currently employed in the health care sector must routinely address issues of housing, transportation and employment when helping a client to reintegrate from an institutional setting to independent community living. Similarly, Occupational Therapists employed in the educational sector work with a team of providers and consumers which span the educational, health and individual/family/community sectors.

Occupational Therapists also work in the business and industrial sector providing services such as: bringing consumers and industry together to stimulate the production of useful adaptive technologies; developing injury prevention and work reintegration programs; and, providing vocational training and rehabilitation.

And lastly, through consultation and voluntarism, Occupational Therapists have assisted non-profit self help groups to identify and address all forms of barriers to health.

 

What are the Implications of Primary Health Care on the Future Practice of Occupational Therapy?

The adoption of a Primary Health Care model is necessary for the future of health care.

In light of changing demographics in a society facing ever dwindling resources, the promotion and maintenance of health in the future is dependent upon shifting resources away from the traditional illness based model of health delivery, towards a comprehensive family and community focused health and wellness model.

In Manitoba, a Task Force on Primary Health Care was commissioned to "review existing structural and financial models of community based/Primary Health Care" and also, to "review existing and potential roles of health care providers (formal and informal) in the provision of community-based health care/Primary Health Care" (Health Advisory Network, 1993, p. i). The Task Force recommended that "...the Manitoba government endorse and adopt the principles of Primary Health Care and that these be applied to all Manitobans, regardless of jurisdictional issues", and that "...all stakeholders in the Primary Health Care system, including communities, government and service providers, be involved in the planning, development, implementation and evaluation process of Primary Health Care" (Health Advisory Network, 1993, p. 13 & 15).

The implications of these recommendations, whether adopted in whole or in part, will be a dramatic shift away from the illness based model of health delivery towards a Primary Health Care model. For Occupational Therapists, this process will compel us to draw upon our tradition of holistic, client-centred practice in order to expand our models of practise across all sectors of society. In order to achieve this goal, the following must be considered for future action:

a. Occupational Therapists must continue to facilitate community action in the planning, development, implementation and evaluation process of Primary Health Care;

b. Occupational Therapy education programs must continue to develop curricula which de-emphasizes the illness model and includes Primary Health Care principles. Occupational Therapy education must refocus to community based practice and prepare students for practice in various sectors;

c. The Occupational Therapy profession recognizes and must continue to articulate the unique role(s) of Occupational Therapists in many sectors, not only the traditional health care sector; and

d. Occupational Therapists must continue to focus on marketing their skills. Marketing must involve participants such as consumers and providers from various sectors.

In summary, the principles of Primary Health Care are consistent with those of Occupational Therapy. Occupational Therapists are therefore, well prepared to embrace the changes in the health care system of today and tomorrow.

REFERENCES

Canadian Association of Occupational Therapists. (1991). Occupational Therapy Guidelines for Client-Centred Practice. Toronto: CAOT/L'ACE Publications.

Department of National Health & Welfare and Canadian Association of Occupational Therapists. (1983). Guidelines for the Client-Centre Practice of Occupational Therapy. Ottawa: Minister of Supply and Services Canada.

Finlayson, M., (1993, April). CAOT Seniors Health Promotion Project Final Project Update. Manitoba Society of Occupational Therapists Update, p. 3.

Finlayson, M. and Edwards, J. (1992). Occupational Therapy and Health Promotion: A Natural Partnership. The National, 9(1), p. 3.

Health Advisory Network, (1993, May). Primary Health Care Task Force Interim Report, p. i, 13 & 15.

Health & Welfare Canada, (1989). Knowledge Development for Health Promotion: A Call for Action. Health Service and Promotion Branch Working Paper. HSPB, 89-2.

Letts, L., Fraser, B., Finlayson, M., & Walls, J. (1993). For the Health of It: Occupational Therapy in Health Promotion Framework. Toronto: CAOT/L'ACE Publications.

Madill, H., Townsend, E. and Schultz, P. (1989). Implementing a Health Promotion Strategy in Occupational Therapy Education and Practice. Canadian Journal of Occupational Therapy, 56, p. 69.

Mangay Naglacas, A. (1988). Health for All: Nursing Role. Nursing Outlook, 36(2).

Ottawa Charter for Health Promotion (1986). Proceedings of International Conference on Health Promotion. Ottawa, Ontario, p. 3.

Reed, K., & Sanderson, S. (1981). Concepts of Occupational Therapy. 2nd Ed. Baltimore: Williams & Wilkens.

Reilly, M., (1962). Occupational Therapy can be one of the Great Ideas of the Twentieth Century. American Journal of Occupational Therapy, 16(1), p.1-9.

World Health Organization, (1978). Declaration of Alma-Ata: International Conference on Primary Health Care.

World Health Organization, (1984, July). Health Promotion: A Discussion Document on the Concept and Principles: Canadian Public Health Association Health Digest, 8(6), 101.

Health Promotion: A Discussion Document on the Concept and Principles. World Health Organization.