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Fresh perspectives on occupation: creating health in everyday patterns of doing.

The everyday is taken for granted

The starting point for this presentation is that if we understand the complexity of everyday occupations and their various relationships to health, we also know how to alter aspects of our daily occupations in order to maintain and enhance health. The everyday is made up of occupations, the things we do. In Sweden we talk about the ordinary and grey everyday. The everyday is like a road we travel, on our way to what is regarded as more important or exciting, like the weekends or a holiday. The everyday is often taken for granted but, with its predictability, it constitutes a security and a structure that we can trust and rely on.

We expect the everyday to float on in a steady pace, like the traffic, when everything is working as it should. Much of the ill health that currently exists in our societies is however, a consequence of people's lifestyles in their everyday not providing the balanced and meaningful occupations they need; situations that may constitute risks for illness and disease. For some individuals the everyday can be too full of chores. Occupational imbalance might also be due to lack of ability to organise the daily occupations or that certain occupations take too much time. For others the opposite might be true; that every day is like an empty road, with only a few tasks and oceans of free time. For these people, the experience of occasionally having a lot to do may be something that gives great satisfaction. As well, there are groups in the society that have an imbalance in their everyday lives caused by a shortage of things to do, and people are denied a healthy variety of tasks because of, for example, unemployment or functional limitations.

Usually, we do not think so much on how we are doing, when and where, and why-our daily lives are in balance. In a way we can be quite disrespectful towards everyday life and see it as something that is always there. It is therefore not surprising that the profession of occupational therapy (at least in Sweden) often is regarded as common sense. We work with the ordinary that everyone knows and takes for granted. The everyday life is however, a phenomenon that many people think they know everything about but few really understand the depth and importance of it. It is in everyday life that the consequences of sickness and injury become most obvious. An injury or illness often means that the ability to manage everyday chores is lost or reduced. The importance of being able to do what we usually do, and want to do becomes so much more evident when the doing is no longer as doable as it was before.

This is why occupational therapists should be considered and respected as a necessary profession in all health care areas. To regain balance and routine in daily life, people need professional support and guidance from expertise in people's everyday occupations.

But how do we investigate, define and handle balance among the daily occupations in the everyday? As an occupational therapist I see it as logical to call for occupational analyses and more specifically it seems urgent to explore the organisation of occupations in time.

Patterns of occupations in three time perspectives

The occupations we do throughout life make up certain individual patterns of occupations, the everydays are organised in patterns of daily occupations, and in fact there is a specific pattern or structure of actions building up each single occupation. These three time perspectives are presented in the Value and Meaning in Occupations Model (Persson, Erlandsson, Eklund, & Iwarsson, 2001). The model is developed in our research group with the purpose of describing and illustrating the complexity of individuals' occupational patterns and the values they hold. It has turned out to be a useful model for analysing people's doing, in time.

A life course perspective

To explain the perspectives in the ValMO model I need a new metaphor and I choose trees and forests. The first time perspective in the ValMO model, the Macro perspective, refers to a life course perspective illustrating the changes in the pattern of daily occupations over a life span. If the daily occupations are viewed as the creation of a tree (Figure 1), a child's life perspective is like a small plant. It has few branches and it is formable. The tree grows with age and the everyday becomes more complex; new and different branches are added and the tree becomes taller. The old tree gradually loses branches and thereby complexity and it also becomes more fragile.

The occupations dominating everyday changes with ageing are different in different life stages. Most children's daily patterns are dominated by play and school occupations. In contrast, adults' of working-age have other and usually more occupations, often including paid work occupations. With age, a decline in ability to perform daily routine occupations may develop and self-care and rest occupations may take up a considerable part of the daily pattern of occupations among very old adults.

Similar patterns

If you look at a forest all trees may look the same. Likewise, from a life course perspective, you can get the impression that everyone does the same things, at the same time. For example: at a certain time, around 12 o'clock most Swedes do exactly the same occupation. The children at day care, at school and adults at workplaces are all having lunch. This is true also for elderly people since for example after retirement the pattern of daily occupations is imprinted by the years in paid work and so the rhythm is maintained (Bjorklund, Gard, Lilja, & Erlandsson, 2013) and of course lunch is served at 12 in elderly people's homes.

Aside from this detail we can conclude that changes in time use over the life course are universal and that the main differences in time use are instead between individuals in different ages, life stages or family situations. This knowledge is based on time use research from a number of countries (e.g. Zerubavel, 1981; Singleton & Harvey 1995; Statistics Sweden, 2010). For this presentation I thought it would be interesting to exemplify this by looking a bit closer at time use in New Zealand and Sweden.

From the time use survey 2009/10 in New Zealand it was found that women of working age spend an average of 4 hours and 20 minutes a day in unpaid work while men in the same age group spend 2 hours and 32 minutes in these occupations. The difference in time spent by males and females doing unpaid work had narrowed slightly compared to the same measure 10 years earlier; mainly because women in New Zealand have decreased their time in indoor cleaning by 11 minutes (Statistics New Zealand, 2011). In a corresponding time use survey in Sweden 2009/10 it was concluded that women of working age spent 14 minutes less on unpaid housework per day compared to ten years earlier. (We Swedish women have decreased our cleaning with 3 more minutes than New Zealand women). It was also concluded that Swedish men spent slightly more, 11 minutes, than before in the same group of occupations. Altogether, Swedish women today spend an average of 4 hours on unpaid household tasks and the men do on average 45 minutes less (Statistics Sweden, 2010).

From this comparison we can conclude that something is happening in both countries in mutual time use among men and women of working age and who are living with a partner. It seems that there is a move towards more equally divided time in unpaid household work. Or, there seems to be another but similar move: The same type of occupations, namely household chores, seem to occupy less of the daily time among both men and women in working age, in the far north as well as in the far the south of the globe!

The life stage perspective and health

The macro, life stage, perspective in the ValMO model relates to the individual in relation to populations and different groups in the society (like the trees in a forest) and it highlights similarities between people, for example, in the same age groups. This perspective on occupations in everyday at different life stages helps us to reflect on an individual's daily occupations in relation to other people in the same life situation. This perspective for occupational analysis can be connected to health issues: Our repertoire of daily occupations is to a large extent imprinted by social norms and phases in the society (Larson & Zemke, 2003). Thus, it might be of vital importance for a person to be able to do what other people in the same life stage do. A person may, however, be hindered from accessing a certain repertoire of occupations because of ill-health and functional limitations, or structural hinders such as for example unemployment or language difficulties. Nevertheless, to be unable to have a daily occupational repertoire that is similar to others with whom an individual associates, is an example of occupational injustice (Wilcock, 2006) and such a situation constitutes a considerable risk for developing ill-health. Likewise to recognize the individual stage in an occupational life-perspective, may guide occupational therapists regarding what steps to take in the rehabilitation process.

The everyday patterns of occupations perspective

The second time-perspective in the ValMO-model is the meso-perspective. Going back to the tree metaphor it can be illustrated by the branches on the tree. This perspective regards the daily patterns of occupations. Each branch represents a day that in turn and over time builds up larger branches. The day-branch is filled with leaves; occupations that are placed in a certain order. Here the complexity increases and even if there still are similarities between our everydays this perspective contains a lot of exciting dimensions!

The meso-perspective reflects the individual everyday doing (Persson et al., 2001). Irrespective of where the individual is in his or her life course, you can dive in to his or her everyday and you will see a unique pattern of occupations. The time geographer Professor Kajsa Ellegard (1999), stated that time is the most equal resource we have; everyone has exactly the same 24 hours every day, and the next day everyone gets 24 new hours.

Here it is important to recognise that not all people around the world refer to clock time, hours and minutes. Some live in other time contexts. There are people who regard the sun as a time regulator, or who wait until it is the "right" time, whose doing is regulated by the time of the year. In interviews with people from Somalia living in Sweden we have for example learned that scheduling appointments and phone calls referring to "tomorrow" can mean approximately three days later, sometimes even longer, but never exactly specified. It is important to consider that time is not always the 24 hours that come every new day; measurable, ordered and divisible into 60 minute intervals. Time can be subjective but also shared within groups. However, clock time is still the dominating perspective in existing research rooted in industrialised societies. Accordingly, the everyday is measurable and possible to record and there are several examples through history of how people have documented and followed the flow of every day.

The diary

The most common method for documentation of the daily occupations is the diary. People have been writing diaries ever since writing on paper was invented. The history of the diary starts with handwriting and from the 13th century onwards. The wealthiest men in Italy recorded everything from money transactions to the military life (Johnson, 2011). In Sweden, the earliest kept diaries are connected to agriculture and farmers who in the 18th century began to keep records of their working days to keep track of their harvests. Like many other things in history, men are the dominating public diary writers. However, there is a niche in the historical diaries describing the everyday life among women living in the upper classes having very little to do and thereby choosing to document their everyday life. I would like to introduce lady Marta Helena Reenstierna whose diaries are considered to be an important documentation of a duchess's life at a Swedish manor in the late 18th early 19th-century. She lived with her husband at a relatively large estate with, among other things, a tobacco farm (a climate that is unfortunately lost in Sweden today). She had eight children and was writing personal diaries from 1793 until she became blind in 1839. She herself described her diaries as "... covering events in my little Sphere, changes in weather, daily chores, visitors, trips, health and indispositions, ... [translated from Swedish]" (Eriksson, 2010). On the 20th of September 1818, almost exactly 200 hundred years ago, she wrote:

Clear and lovely day--just a little wind. My work--weekends as working days--is to write, read a bit and then in the afternoon occasionally travel in to the town and do some errands, those I cannot send someone else to do [translated from Swedish] (www.facebook.com/pages/ArstafrunMarta-Helena-Reenstierna/118455131535351).

This glimpse of Marta's everyday is an interesting comparison to present day timelines that were recently introduced on Facebook. This and additional new tools like the Twitter and Instagram makes it possible for people to document their doing in time, more frequently than ever and for everyone to share.

So what do diaries tell us? Around 300 years ago James Boswell, a Scottish writer, stated that "I shall live no more than I can record. I do not live more than I can register ." (Johnson, 2011). To me this is a very optimistic statement and I would argue that documentation through diaries does not at all cover the entire doing of human's daily life. Ever since I started to work as an occupational therapist in primary health care I have been interested in the diary as a tool for investigating what people do and to identify any problems or hindrances in the areas of occupational therapy concern. To better understand the connection between what people do on a daily basis and relationships to their health we need to understand what people actually do. Therefore, I used to encourage my clients to write diaries. However, in reflecting upon my own doing I noted a discrepancy between what my clients had recorded and what I assumed they had actually been doing. What is missing and how is this related to the client's health issues?

The complexity in the everyday

In a case study (Erlandsson & Eklund, 2001), on one woman working full-time, married and a mother of three children we explored in detail her every day through self-reporting diary, direct observation, video and experience sampling. The results revealed a complexity of the everyday that I think is important for occupational therapists to reflect upon. I will use the results from this study and from the subsequent ones including 100 additional Swedish women in the same life stage, to further explain the meso and later the micro perspective on occupation as presented in the ValMO model.

What we do forms patterns of occupations that, on a daily basis, can be described as building blocks in the shape of all occupations and sleep performed by one individual during one day and one night, in 24-hour cycles (Erlandsson, 2003). The blocks of time used for different purposes are related and more or less organized in a certain order. Some occupations are located in time and have to be performed before (or after) others. For example, before you take the train you have to transport yourself to the train station. When the train arrives at your final destination it is a good idea to get off the train and then you can do the things you planned to do there. What makes it more complicated is that we do occupations in segments integrated with other occupations such as calling home while on the train (to remind a son that it is time to go to school). Thus, daily occupations are integrated and the pattern is more or less complex and also to a varying extent flexible and unpredictable.

Components of patterns of daily occupations

From the studies of the one woman's doing it was concluded that a pattern of daily occupations is dominated, in time and awareness, by a few Main occupations (Erlandsson & Eklund, 2001). These are the occupations that we most often refer to if we are asked what we did the day before. The main occupations are the ones that from a population and life course perspective vary with age, interests and context. From an individual perspective I guess about 1-3 main occupations may dominate the day. The occupations mentioned in the diaries by the Arsta lady; read, write and do errands may be considered as her main occupations that day.

Intertwined with the main occupations are the so-called Hidden occupations (Erlandsson & Eklund, 2001). Hidden occupations are important as they belong to, and are necessary for, the rhythm of the daily pattern, but are performed in between the dominating main occupations and with less attention from the performer. The hidden occupations are what people do to be able to perform our main occupations. Hidden occupations are the occupations that are more or less forgotten or neglected when we reflect upon our daily life. We do grooming, get dressed, have breakfast and maybe read the morning paper before going to work. We do some quick errands during lunch, or read through the paper to be discussed at a meeting in the afternoon, eat, drink coffee or tea and visit the bathroom. In the evening, examples of hidden occupations may be bringing in the mail, putting petrol in the car, buying milk, or making a cup of tea. Hidden or forgotten occupations are seldom, if ever, mentioned in the historical diaries. Similarly and what is more important, the hidden occupations (since they are performed with less attention and on a routine basis) are often forgotten or missed in the diaries written by clients or not detected through interviews.

Patterns of daily occupations also include a third category, the unexpected occupations (Erlandsson & Eklund, 2001). Such occupations occur unexpectedly in one's regular pattern of daily occupations and may interrupt the on-going rhythm of main and hidden occupations. The unexpected occupations are sometimes generated from positive events and can bring joy and happiness. For example if you and some colleagues at work suddenly and unplanned decide to go and visit a local fair during the lunch hour. However, there are a significant number of unexpected events that may interrupt and disturb a daily pattern and thereby may be experienced as negative, such as a flat tire on the car or a missed bus in the morning when you are on the way to work. Unexpected situations like these force you to change the anticipated, or expected plan for the day and to engage in occupations that are suddenly necessary to cope with the situation at hand.

Finally, there is a fourth building block in the patterns of daily occupations namely sleep. Sleep is a prerequisite for the ability to participate in occupations during the waking hours but may also be interrupted by hidden or unexpected occupations that, in the long-term, can constitute a risk for ill health. The meso-perspective focuses on the 24 hour patterns of daily occupations that are dominated by main occupations, accompanied with hidden occupations and sometimes interrupted by unexpected occupations. In order to be able to perform these occupations, the patterns also include a significant number of hours of sleep.

The patterns of daily occupations and health

What about relationships between these patterns and health? First, I would like to highlight the importance of the interplay between the building blocks of occupations in the patterns. The relationship between main and hidden occupations may change and thereby have a considerable impact on subjective health and wellbeing. Remember, the main occupations were identified as dominating in time and awareness. However, when a person experiences functional limitations in any way, things he or she used to do on a routine basis, and perhaps automatically, suddenly demand more attention and time. For example, it takes longer and is harder to get up in the morning, get dressed and have breakfast. Thus, what used to be hidden occupations now demands both time and attention and most likely becomes the new main occupations. In turn, there is less time left for the occupations that used to dominate; the occupations we want and need to do at home, at work and during our free (spare) time.

The interplay between main and hidden occupations

As a young woman, Sarah was traumatically injured and now lives with a remaining tetraplegia. After months of rehabilitation, she was once again living on her own and considered to be independent with personal assistants, in no need of more rehabilitation. However, despite the successful rehabilitation she lacked wellbeing. Research has established that an impaired body as a result of a spinal cord injury impacts greatly on the ability to engage in desired daily occupations (Whalley Hammell, 2007). Thus, what used to be routine occupations in daily life now takes both more time and more energy. In talking to Sarah, it seemed that using the terminology of building blocks in patterns of daily occupations made her aware of the change between main and hidden occupations in her every day. She realised that one of the key consequences of the accident was that she had lost several of her previous main occupations; the occupations that used to affirm her as a creative person, a woman and a friend. She now strived to handle the maintenance of herself and her home and had very little time for almost anything else. The terminology of main and hidden occupations and reasoning about their internal relations helped Sarah to make changes in her pattern to limit the time for some of the previously hidden occupations in favour of important occupations to be reintroduced and given time as main occupations.

Thus, the change in time use in different types of occupations; to change the relationships between the building blocks of occupations may impact on health and wellbeing. The power of occupations lies in its impact on health--disorganisation of occupations can lead to ill-health but the same occupations can be re-organised and thereby promote wellbeing. To me this is a central issue of great concern for occupational therapists. It is important to reflect on the pattern of daily occupations that develop in a rehabilitation process, discussion might reveal a new perspective. What are the new main occupations? What used to be this individual's main occupations? Can a new main occupation in the daily pattern be taken out, replaced, or maybe altered to become hidden, in favour of full or segments of a previously valued main occupation?

The impact of unexpected occupations

We also know from the subsequent empirical studies on working, cohabitating mothers with children in pre-school age that the unexpected occupations impact on well-being (Erlandsson & Eklund, 2003). My co-researcher and I compared patterns of daily occupations, i.e. diaries transferred to time and occupation graphs, for 100 women, according to their complexity (Erlandsson, Rognvaldsson & Eklund, 2004). The occupations reported in the diaries were coded into the categories of main, hidden and unexpected occupations. The results of the analysis showed that women who were more often interrupted in their main and hidden occupations by unexpected events and hassles reported lower subjective health than women experiencing fewer unexpected interruptions (Erlandsson & Eklund, 2006).

Thus, interrupting occupations in the daily pattern seem to be a risk factor for ill-health. In parallel, opportunities to perform full occupations in an order that is, to some extent, predictable seem to be of importance for health. Interruptions in occupations at workplaces may impact on subjective health and even lead to illness. For example, an administrative assistant who was the closest co-worker to the manager for a company reported that she could almost never do what she had planned to do when at work. She was constantly interrupted and directed towards new and unpredictable tasks. As a result she had developed a routine of staying late, and working on weekends, in order to maintain her ordinary work-tasks. I met her when she had developed a stress related illness. When the woman understood what impact the interruptions and unexpected occupations had on her health and why, she secured an agreement at her workplace that when her office door was closed others should not disturb her. As a result, she could regulate her work day so that she had some designated time to complete her ordinary tasks during work hours.

The single occupation perspective

To further understand why and how the unexpected interruptions have such a negative impact on health, we need to explore the third time perspective in the ValMO model; the micro-perspective, regarding the pattern that develops within each single occupation. Referring to the metaphor we now focus on individual leaves.

The micro perspective in the ValMO model describes the sequence of actions building up to a single occupation. An occupation is the outcome of a person performing a task in a context (Persson et al., 2001). The individual takes on a task and, when doing it, it becomes an occupation. Each unique performance of an occupation means a unique set of actions (Erlandsson & Eklund, 2001). Thus, each performance of an occupation is unique depending on the mood and capacity of the individual; the way the task is performed; and where and when it is carried out. To cook dinner in the evening may be stressful due to limited time, you may be tired and hungry, there may be lack of groceries and family members may be irritated and not participating. Another day the same occupation may give a completely different experience and outcome. You may have everything you need, know what to do and have enough time. The family may take the opportunity to spend time together. The same occupation in the same environment and engaging the same individuals may give very diverse experiences.

Furthermore, the sequences of actions in the specific performance of an occupation may be more or less interrupted and the way an occupation is performed, the sequence of actions, impacts on the experience making it unique to each single performance. This explains why it is hard to argue that some occupations may be more health promoting than others. There are occupations that are assumed to be fun or relaxing, like going fishing on a weekend. This may very well be as expected but if your phone rings frequently when you are out fishing you may end up talking in the phone instead of fishing. The interruptions to the action sequence impact on the experience of the occupation and if the occupation is frequently interrupted, chopped into small sequences of actions, there is a risk that the pleasure of doing may be lost. From empirical studies we know that it is important for subjective health not to have too many interruptions in everyday occupations and to be able to do what we intend to do (Erlandsson, Bjorkelund, Lissner & Hakansson, 2010).

Occupational perspective in intervention

So far I have concluded parts of my research on patterns of daily occupations, its inner complexity and given examples of how circumstances and handling of aspects of the everyday may constitute risk factors for ill-health. My wish is that the perspectives in the ValMO model and the complexity in theses perspectives will give you some ideas of how to analyse clients' everydays. But, what then? Occupational therapists are becoming more and more skilled when it comes to assessment and analyses but I would like to take the opportunity to highlight the importance of keeping the occupational perspective following interventions and coaching of clients.

If the issues a client is dealing with are grounded in a need for re-organisation of daily occupations the effort required can be summarized in various forms of lifestyle, or rather, everyday changes. An occupational therapist is a central resource in such a process of change initiating, supporting, and guiding the individual in his or her own everyday change. The goal is to create or retrieve a repertoire of occupations that enhance the experience of health. Additionally, an important part of our efforts is to prevent individuals' patterns of daily occupations from being characterized by alienation, deprivation or overload.

To implement changes in everyday life may be a long, and often hard, process. It can also be about change in very different proportions. For some it is sufficient for a limited period of time, to do a little different, or do less. For others, it is about changing the entire daily life and adapting oneself to the new conditions, to learn new tasks, to perform old occupational patterns in a new way, or to be separated from important occupations. Based on my experience of meeting students at the university, colleagues in different settings and foremost from meeting people in different life situations I have concluded that the intricacies of daily occupations; their temporal order and structure, how they are experienced and why, are complex and not at all common knowledge. Therefore it is useful in process of changing the everyday, to depart from a knowledge base that is communicative, between colleagues, other professions but foremost that enables the client to understand his or her everyday and what needs to be changed.

The Redesigning Daily Occupations (ReDO) programme

I have developed an occupational therapy program aimed at providing knowledge about daily occupations and their impact on health (Erlandsson, in press). I introduce it here as an example of an educative approach for occupational therapists. In the ReDO programme, occupational therapists act as coaches to support learning about occupation. The group leaders use the perspectives in the ValMO model and research on patterns of daily occupations to facilitate occupational self-analysis among the group participants. Understanding the complexity in and the influence of occupation may enable sustainable changes in the everyday and patterns of daily occupations that promote health.

The ReDO-program has been evaluated for the rehabilitation of women with stress-related ill-health and it has for example been shown to improve return to work rates when compared to a control group (Eklund & Erlandsson, in press). We also know from interviews of participating women that accomplished the ReDO-program that it was found meaningful and useful (Wastberg, Erlandsson & Eklund, in press). The program is manual directed and currently we are trying to establish evidence for the method through various projects. It is being evaluated in primary health care in Sweden, foremost for women with high complex patterns of daily occupations. We are evaluating it in a health preventive program among employees in elderly home health care and it is being tested in a work rehabilitation project for immigrants on long term unemployment. In some years from now, I also hope to have results from health care sectors in New Zealand.

We are social beings

Being almost at the end of this presentation I have to admit that so far I have focused on the individual's daily patterns. However, humans are social beings and therefore I have to alert a last specific challenge with change and reorganisation of pattern of daily occupations related to that fact that humans live and act together, like trees in a forest (Figure 2). The occupations one person chooses to perform often affect others. For example, workplaces often require coordination and teamwork, and these requirements influence the occupational patterns of everyone in a workgroup. Similarly, members of the same family will influence the occupational patterns of each other. Because their actions and routines are linked together, their different schedules must be taken into account, and competing time requirements must be coordinated or synchronized.

Thus, family members may share time together as well as divide available time between each other (Orban, et al., 2012). The social coordination of daily occupations has been defined by Larson and Zemke (2003) as complex, concerning individuals' routines and competing desires and needs. It is unusual that a change in one individual's pattern can occur without affecting others' patterns and this may, in turn, mean a barrier for change. Even if we want and need to change our daily lives it may be difficult because others do not want to or can see what they, in turn, need to change. This is an important aspect of complexity that is not always addressed. Understanding and recognising the social coordination of patterns of daily occupations is however important in planning intervention since the progress and outcome of a process of change is highly dependent on the social context in which individuals participate. It is important for occupational therapists to also include related persons, friends and colleagues in the change process; to enable others to help, rather than hinder. In the ReDO programme we have included a session where the participants invite people close to them to a seminar presenting the complexity in daily occupations and relationships to health with a focus on how the social context can support desired and needed changes in an individual's pattern of daily occupations.

Conclusion

In this presentation I have presented my view on daily occupations. They are the building blocks that make up complex patterns in the everyday that in turn constitute our occupational life history. I have given examples of how situations or characteristics of this complexity may constitute risk factors for ill health but also how alterations may enhance recovery and wellbeing. Patterns of daily occupations are something to recognise and respect. For some individuals the absence of needed and desired occupations (main, hidden as well as unexpected) in the everyday is evidently causing ill-health.

Individuals that are denied access to what they want and need to do may as a consequence gradually develop a situation that implies an even greater challenge in their strive towards regaining a meaningful and health bringing repertoire of daily occupations. Furthermore, there is a risk that the few occupations that are accessible are risk occupations such as smoking or exaggerated alcohol consumption. Referring to the tree metaphor; to ensure occupational justice means enabling healthy leafs to once more grow on the branches (Figure 3).

We also have a responsibility to ensure that individuals that experience his or her tree as taken over by the jungle, i.e. having a too complex and chaotic everyday, get support to weed and maybe even re-plant in a new context, in a new way. This is true for individuals as well as for groups in the society. Just as there are individuals with unhealthy patterns of daily occupations there are groups that are having similar problems.

The occupational therapists' tool in this challenge is the very same daily occupations. In this presentation I have tried to emphasize the power that lies in the understanding of how daily occupations are organised, how they impact on our wellbeing and, if they are brought to light, how they can be handled and organised.

Key points

* The same occupations may generate very different experiences which could be healthy or unhealthy;

* When working with health issues related to everyday occupations it is important to carefully explore the pattern and content of the daily occupations since there are both hidden and unexpected occupations that are likely to be overlooked or missed in diaries written by clients or detected through interviews. That is, occupations that might have significant impact on the experience of health and wellbeing;

* Re-organisation of daily occupations can enhance health.

* Enabling self-directed change in patterns of daily occupations is effective.

* A desire to change aspects of daily life may be hindered by individuals or groups who do not want, or do not understand the need for change.

* Involving people close to the person in need of change to daily life process is encouraged.

I hope that my contribution to knowledge in New Zealand will empower existing practice and support you in claiming professional power. There are clear relationships between daily occupations, health and people; groups, and individuals benefit from understanding the complexity, and power, of the everyday.

Acknowledgement

The presentation is a conclusion of some of my current and previous research and I therefore want to especially acknowledge colleagues who have contributed to the research, Professor Mona Eklund and Assistant professor Dennis Persson.

References

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Lena-Karin Erlandsson (PhD, O.T. Reg.)

Corresponding author:

Lena-Karin Erlandsson

Associate Professor

Department of Health Sciences, Lund University Sweden

Email: lena-karin.erlandsson@med.lu.se
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Title Annotation:VIEWPOINT ARTICLE
Author:Erlandsson, Lena-Karin
Publication:New Zealand Journal of Occupational Therapy
Geographic Code:4EUSW
Date:Apr 1, 2013
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