Abstract
This focused issue of OTJR is dedicated to occupational therapy practitioners, researchers, educators, and students who use the Person-Environment-Occupation-Performance (PEOP) Model to guide their work and advance the application of occupation-based models in current and emerging areas of practice. Over the last several decades, the PEOP Model has been used as an occupational therapy lens for everyday living. Researchers have used the Model to explore the nature of occupational performance and participation as related to person and environment factors and as an organizing framework for studies that are aligned with the research priorities of the American Occupational Therapy Foundation (AOTF). This focused issue of OTJR highlights scholarly investigations and practical application of the PEOP Model in research studies related to human occupation and screening, assessment, intervention, and health services in occupational therapy practice.
The PEOP Model is one of the several occupation-based models used in occupational therapy (Baum et al., 2015). This editorial provides a brief overview and history of the PEOP Model, discusses the importance of models in guiding occupational therapy research, practice, and education, and introduces the research articles that were selected for the focused issue.
Overview of the PEOP Model
The caption of the fourth edition summarizes the PEOP Model as, “Occupational performance (doing) enables participation (engagement) in everyday life that contributes to well-being (health and quality of life)” (Baum et al., 2015, p. 54) (Figure 1). The PEOP Model depicts the relationships among person factors, environment factors, and occupations that support performance and participation. The Model emphasizes client-centered practice, ecological influences, interactions among biological, psychological, and social factors, and person-environment fit (Baum et al., 2015). The left side of the model highlights the importance of a person’s narrative or life story, shapes our understanding of the client’s history, perspectives, and values, and serves as the basis for goal setting. The right side of the model depicts all the person, environment, and occupation factors that support (or limit) performance, participation, and well-being. The bi-directional arrows between the left and right side of the model emphasizes the transactional nature of the different components.
PEOP Model, 4th ed. (Baum et al., 2015).
The PEOP Model emphasizes performance, participation, and well-being as the transaction among a narrative, person factors (cognition, psychological, physiological, sensory, motor, spirituality), environment factors (culture, social determinants, social support, social capital, education and policy, physical and natural, assistive technology) and everyday occupations (activities, tasks, roles) (Baum et al., 2015). The PEOP Model is a bridge between biomedical and sociocultural approaches, uses familiar terminology and is aligned with the Occupational Therapy Practice Framework (OTPF-4) (AOTA, 2020) and the International Classification of Function, Disability and Health (ICF) (WHO, 2001). The PEOP Model is appropriate for different types of clients and practice settings. Clients may include individuals, groups, organizations, and populations. A PEOP Occupational Therapy Process introduces a tool for applying the PEOP Model in occupational therapy practice for persons, organizations, and populations (Bass et al., 2015) (Figure 2). The PEOP Occupational Therapy Process illustrates the practical application of the Model and is designed to meet practitioner needs for persons, organizations, and populations and in entry-level and advanced practice.
Person-Centered PEOP Occupational Therapy Process (Bass et al., 2015).
History and Evolution of the PEOP Model
Four editions of the PEOP Model capture the evolving body of knowledge in the profession and related disciplines. Each edition emphasizes performance as central to the interaction of person, environment, and occupation.
The first edition depicts person-environment-performance as an equilateral triangle with determinants, assessment, and intervention triangles intersecting in the center (Christiansen & Baum, 1991). In the forward to the first edition, Wilma L. West stated that overcoming performance deficits was the primary goal in occupational therapy and that practitioners must “be able to identify those factors [extrinsic and intrinsic determinants] that interfere with performance, . . . address performance deficits through assessment, . . . [and] organize intervention strategies by general category rather than by deficit area” (West, 1991, p. xvii). (Figure 3).
PEOP Model, 1st ed. (Christiansen & Baum, 1991).
In the second edition of the PEOP Model, occupational performance (function) and well-being are influenced by intrinsic (psychological and biological) and extrinsic (social and cultural) factors as well as self-identity, roles, tasks, and actions (Christiansen & Baum, 1997). Gail S. Fidler, OTR, FAOTA, provided the forward to the second edition and noted the shift in occupational therapy knowledge from deficit and dysfunction to health and well-being. The effectiveness of occupational performance “combines the perceptions, the criteria, and expectations of the performer as well as those of significant others” and thus is “understood as a self-other dynamic with its many complex and diverse dimensions” (Fidler, 1997, p. xxv). (Figure 4).
PEOP Model, 2nd ed. (Christiansen & Baum, 1997).
The third edition of the PEOP Model has four major components: occupations, performance (the doing of occupations), person factors, and environment factors (Baum & Christiansen, 2005). The interaction of capabilities of the person and supports in the environment contribute to performance of chosen occupations. Performance of meaningful occupations and participation in everyday life contribute to well-being and quality of life. The third edition also introduces occupational therapy clients as individuals, organizations, and populations and a client-centered occupational therapy process (i.e., situational analysis) (Baum et al., 2005). (Figure 5).
PEOP Model, 3rd ed. (Baum & Christiansen, 2005).
Importance of Models in Occupational Therapy Research, Practice, and Education
Occupation-based models, like the PEOP Model, organize the current body of knowledge on everyday life and provide a conceptual foundation for research, practice, and education (Baum et al., 2015). Models draw upon theories, the highest order of knowledge, to identify the major assumptions, mechanisms, concepts, and constructs that are central to occupational performance and participation (Bass et al., 2017). The PEOP Model and PEOP Occupational Therapy Process provide direction for developing, implementing, and evaluating occupational therapy assessments, interventions, programs, and services.
Guidelines and official documents in research, practice, and education emphasize the importance of conceptual foundations for our work. In National Institutes of Health (NIH) grant-funded-research, the scientific merit is emphasized in scoring criteria and is in part determined by the articulation of the conceptual framework in the significance and innovation sections of the proposal (NIH, 2023). In the 2021 American Occupational Therapy Association’s (AOTA) standards for continuing competence, application of theoretical knowledge is noted as integral to professional reasoning (AOTA, 2021). In entry level occupational therapy education, the 2023 Accreditation Council for Occupational Therapy Education (ACOTE) Standards and Interpretive Guide requires that students demonstrate application, analysis, and evaluation of the scientific evidence, theories, models of practice, and frames of reference that underlie practice (ACOTE, 2023). Thus, adoption of models is important in all areas of the profession.
Overview of Articles Selected for the Focused Issue
Three articles in the focused issue used the PEOP Model to study acquired brain injuries (traumatic and nontraumatic). Acquired brain injury conditions are one of the primary client populations in occupational therapy with major implications for performance, participation, and well-being. Bright and colleagues used the PEOP Model to examine functional outcomes for mild stroke. In this retrospective cohort analysis, they identified demographic, clinical, and social vulnerability characteristics that were associated with self-care and community participation. It was notable that half of the stroke survivors received no therapy even though they had performance deficits. Connor and colleagues used a PEOP Model lens in a cross-sectional design to study stroke survivors in two groups: with aphasia (PWA) and without aphasia (PWOA). They found that although cognition was associated with participation in cognitively-demanding activities in both groups, social support was a key mediating factor for the PWA group. Kersey and colleagues conducted focus groups of adults with traumatic brain injury (TBI) to examine social isolation and barriers to social participation experienced during the COVID-19 pandemic. They used a thematic analysis and the PEOP Model to identify critical person factors, environment factors, and tasks demands and propose new strategies to support performance and participation.
Community participation was a focus for three articles in the focused issue. Research on community mobility, education, and work illustrated application of the PEOP Model in research on major life areas. Das Neves and Unsworth explored data on encounters between bus drivers and disabled passengers using the PEOP Model as part of a framework analysis. They found the characteristics of the encounters influenced the exclusion or inclusion of disabled passengers and proposed an adaptation of the PEOP Model, the Interpersonal-Person-Environment-Occupation-Performance (I-PEOP) prototype, to emphasize the importance of interpersonal encounters in the community. Kreider and colleagues used a qualitative descriptive design and thematic analysis to identify the person and environment factors that were associated with stigmatizing experiences of college students with learning disabilities and attention-deficit/hyperactivity disorders. Social factors and stigma resilience were identified as key characteristics influencing stigmatizing experiences for these students. Munsell and colleagues proposed a framework based upon the PEOP Model and PEOP Occupational Therapy Process to identify employment interventions for people with Parkinson’s disease. Their qualitative analysis triangulated data from publications, medical records, and clinician focus groups to develop features of the PEOP Occupational Therapy Process that would address the occupation of work for individuals with Parkinson’s disease.
The final article in the focused issue is a scoping review of published studies demonstrating application of the PEOP Model. Bass and colleagues explored the extent and nature of the evidence on the PEOP Model. They analyzed 109 articles and found the PEOP Model has been used as an international framework across populations, conditions, life circumstances, settings, and areas of practice. The findings of all the articles in the special issue demonstrate the benefits of using occupation-based models, like the PEOP Model, as a framework for occupational therapy research, practice, and education. We hope this focused issue spurs the identification and application of conceptual models in submissions to OTJR.
