Exploring the Effectiveness of an Occupation-Based Intervention: An Experimental Study With Calligraphy

PURPOSE: Central to the profession of occupational therapy is the belief that occupation should be used both as the means and end in therapy. That is, occupation is both the goal to be learned and the change agent. Emerging research has shown that occupation-based interventions promote well-being, improved health, and quality of life. Despite emerging evidence, a greater emphasis has been placed on activity-based interventions and preparatory tasks due to set protocols, time restrictions, and reimbursements. The purpose of this study was to further investigate the meaningfulness of occupation-based interventions and their importance in clinical practice.

DESIGN: A quasi-experimental design was used to compare three intervention approaches for learning calligraphy. The occupation-based group participated in a calligraphy course, the activity-based group learned only strokes and calligraphy techniques, and the preparatory task group engaged in hand exercises. Each group consisted of two 1-hr sessions, 1 wk apart. Forty women and seven men participated across the three interventions; ages ranged from 20 to 58 yr. Participants were healthy adults with no prior instruction in calligraphy or existing hand conditions.

METHOD: Participants completed pre and post measures including a demographic questionnaire, fine motor ability assessments, and measures related to subjective and objective calligraphy skills, class satisfaction, meaningfulness of calligraphy, and ability to attend to task. Participants engaged in focus groups after participation that were guided by 12 semistructured items. Focus groups were transcribed verbatim, coded, and categorized both individually and as a group. Three final themes emerged. For quantitative data, related-samples Wilcoxon signed-rank tests and independent-samples Kruskal–Wallis tests were used to compare groups and measure changes.

RESULTS: Quantitative results showed that while participants in both the activity-based and occupation-based groups perceived that their calligraphy improved, only those in the occupation-based group significantly improved on objective measures. Those in the activity-based and occupation-based groups reported significantly higher course satisfaction than the preparatory tasks group. This finding is noteworthy because the use of calligraphy tools and activities, even if only strokes or components of tasks were presented, resulted in greater satisfaction in comparison with the preparatory task group.

Three themes emerged from qualitative data analysis: (1) expectations and satisfaction, (2) learning and skill progression, and (3) occupation-based. All participants were excited to participate yet nervous about performance. Those in the occupation-based and activity-based groups reported that their expectations were met or exceeded. Next, participants in the occupation-based and activity-based group perceived improvement and progression in their calligraphy skills, while those in the preparatory task group expressed that they had learned patience and mindfulness through course participation. Last, benefits were noted for all three intervention strategies. Participants reported that use of an occupation-based intervention was most meaningful when learning a new skill.

CONCLUSION: Findings of this study highlight the importance of interweaving interventions to present a just-right challenge while focusing on occupation-based goals. In clinical practice, it is important to use occupation-based interventions in order to develop clients’ skills and increase their satisfaction and engagement in therapy.