Examining the Concept of Self-Care in OT Literature: A Scoping Review

PURPOSE: Self-care practices such as sleep, exercise and leisure engagement are regularly identified as strategies to address increasing rates of stress and chronic disease. However, in occupational therapy, although the term is rarely formally defined, self-care traditionally has referred to basic activities of daily living (ADL). This narrow understanding of self-care may limit the profession’s ability to promote health and wellness among clients. The purpose of this scoping review was to clarify how self-care has been used in prominent occupational therapy literature by identifying the occupations to which the term refers. Secondary aims included identifying definitions of self-care, examining use of self-care within assessments and practice models, and analyzing how ambiguous references to self-care may have changed over time.

DESIGN: We utilized a scoping review design, following the Arksey and O’Malley (2005) framework. To reflect the views of occupational therapy practitioners, we searched five prominent occupational therapy journals to which we had full access. We searched Archives in Occupational Therapy, Occupational Therapy and Rehabilitation, and the American, British, and Canadian Journals of Occupational Therapy (AJOT; BJOT; CJOT; 1922-2018) for original feature articles and editorials that included the term self-care.

METHOD: We developed an initial data charting tool to ensure consistent data extraction. Next, the first author charted 50% of included articles. We then revised the data charting tool and clarified criteria for data extraction before completing data extraction from all articles. The first author primarily charted the data; however, when there was uncertainty regarding an article, it was co-rated. Information extracted fell into nine categories, including the number of self-care references per article; the self-care occupations named in the article; and the Occupational Therapy Practice Framework (the Framework; American Occupational Therapy Association, 2014) categories of occupation represented within the article. The frequencies of charted data were analyzed by individual journal and across journals.

RESULTS: A total of 1,254 articles (AJOT=323, BJOT=575, CJOT=356) were included in the review. The number of self-care references per article ranged from 1-149 (M=6.15 ± 13.7). A formal definition of self-care was provided in 12 articles. Of all included articles, 690 articles (54.9%) used the term self-care ambiguously and did not provide examples of self-care occupations. Specific occupations were named on 2,046 occasions within articles. The most frequently occurring occupation was ADL not otherwise specified (14.17%) followed by dressing (12.9%). Included self-care occupations were coded according to the Framework categories of occupation, with 41.2% of articles referencing at least one ADL and 19.8% of articles referencing at least one instrumental ADL. The remaining categories of occupation were each referenced in less than 2% of articles.

CONCLUSION: Results of this study demonstrate that occupational therapy authors use the term self-care ambiguously; however, when examples of self-care occupations are provided, authors primarily apply the term to ADL. These findings stand in contrast to other disciplines, who identify self-care as consisting of sleep, exercise, proper nutrition, social connectedness, leisure engagement and stress reduction (Cook-Cottone & Guyker, 2018; Lee & Miller, 2013).

IMPACT: Findings serve as a call to the profession to redefine the term self-care to reflect evidence from the wellness literature and foster health-promoting practices among clients. Broadening the definition of self-care would enable the profession to exert a powerful impact on population health and well-being.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice, 8(1), 19-32. https://doi.org/10.1080/1364557032000119616

Cook-Cottone, C. P., & Guyker, W. M. (2018). The development and validation of the mindful self-care scale (MSCS): An assessment of practices that support positive embodiment. Mindfulness, 9(1), 161-175. https://doi.org/10.1007/s12671-017-0759-1

Lee, J., & Miller, S. (2013). A self-care framework for social workers: Building a strong foundation for practice. Families in Society: The Journal of Contemporary Social Services, 94(2), 96-103. https://doi.org/10.1606/1044-3894.4289