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are groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupations include everything that people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities.

Determinants of Health

Income & income distribution
Unemployment & job security
Employment & working conditions
Early childhood development
Personal health practices & coping skills
Food insecurity
Biology & genetic endowment
Physical environment
Access to health services
Aboriginal status
Social safety net
Social exclusion

Occupational performance

is the dynamic relationship between the person, the environment and the occupation

Intrinsic Factors of the PEOP Model


Extrinsic Factors of the PEOP Model

Social Support
Social and Economic Systems
Culture and Values
Built Environment and Technology.
Natural Environment

Self-Determination Theory (SDT)

We have innate psychological needs for autonomy, competence and relatedness

Types of motivation (quality):

Autonomous (inside)
Controlled (outside)

Type of regulation

Extrinsic, Intrinsic or Amotivation


Behavior in accordance with personal
values and interests; actions would be
reflectively self-endorsed


Sense of being effective and competent
in a given context


Feeling cared for, connected to,
sense of belonging with others

Autonomous Causality Orientation

choice- all 3 needs met (optimal functioning & well-being)

Controlled Causality Orientation

pressured -competence & relatedness, but not autonomy (rigidness, diminished well-being)

Impersonal Causality Orientation

none of the 3 (poor functioning & reduced vitality)

Conditions that Undermine Intrinsic Motivation

Reward, Deadlines, Threats
Pressuring Context
Ego Involvement
Too Easy / Too Difficult
Negative Feedback
Cold, Inattentive

Conditions that Enhance Intrinsic Motivation

Autonomy-Supportive Contexts
Acknowledge Feelings
Task Involvement
Optimal Challenge
Positive Feedback
Interested, Attentive

Three Ways to Foster Internalization

Autonomy Support
Competence Support

PAC (Physical Activity Counsellor) 7 A's Model

Address the Agenda


what moves people to act, think and develop

Three things people need to feel acc to SDT


Intrinsic Motivation

involves doing a behaviour because the activity itself is interesting and spontaneously satisfying

Effects of extrinsic motivation in intrinsic motivation

Extrinsic rewards decrease intrinsic motivation across a range of things

Positive performance feedback and intrinsic motivation

PPF has been found in some instances to enhance intrinsic motivation rather than undermine it

Informational Events

Events that convey competence w/o being controlling


Little intrinsic or extrinsic motivation

Difference between Autonomy and Indepence

Autonomy means to act volitionally, with a sense of choice, whereas independence means to function alone and not rely on others.

Three types of internalization



least effective
It involves people taking in an external contingency, demand, or regulation but not accepting it as their own. Instead, it remains somewhat alien to them and tends to control them much as it did when it was still external.
In a sense, introjection represents only a partial internalization, for people take in a control w/o feeling a sense of ownership of it and allow it to pressure and control them.


involves people accepting the importance of the behaviour for themselves and thus accepting it as their own. They identify with the value of the activity and willingly accept responsibility for regulating the behaviour


people have succeeded at integrating an identification with other aspects of their true or integrated self.

Forms of controlled motivation

external and introjected regulations

Forms of Autonomous Motivation

Identified/Integrated and intrinsic regulation

Extrinsic Goals

Focused on external indicators of Worth
eg) amassing wealth, becoming famous, projecting an attractive image

Intrinsic Goals

More directly linked to satisfaction of the basic psychological needs for autonomy, competence and
eg) personal growth, building relationships, and being generative for the community

Autonomy Support

When people's autonomy is supported, they often feel free to follow their interests and consider the relevance and importance for themselves of social norms, values and mores.

Functions of the PEO model

It provides therapists with a practical analytical tool to 1) assist therapists to analyze problems in occupational performance, 2) guide intervention planning and evaluation, and 3) clearly communicate occupational therapy practices


perception of imbalance between coping capacity and the environment"

What is a key element of stress?

A key element is that the person must perceive the imbalance to be something important - if it doesn't phase them, then it is not stressful

Psychological distress

a reaction to the environment in which there is threat of net less of resources, actual net loss of resources, or lack of resource gain following investment of resources

What are considered resources?

PErsonal Characteristics


house, car, computer, iphone

Personal Characteristics

confidence, beliefs, values, genetics, personality


room mate, community support for an idea, marriage, permanency in a job


time, money, knowledge, skills

Principles of COR Theory

Resource loss is more powerful than resource gain
Resources must be invested in order to gain resources or prevent their loss

What does COR Theory focus on ?

This theory focuses on threat of loss, actual loss and lack of gain in resources... all influence whether an individual experiences stress and how they function (cope)

Loss Spirals

People who are already lacking in resources are more prone.
This is where one little thing can spiral into the loss of many other things

Resource Erosion

People don't have the resources to cope with repeated loss
they lack the reserves to meet ongoing demands and may experience stress from events / circumstances that others do not experience as stressful ... this has a negative impact on health

Who will have fewer barriers to resource gain?

People who are 'rich in resources'

Action Lever

Health promoting interventions should focus on preventing resource loss and helping people gain resources as a reserve (eg. not necessarily just giving fish... but teaching someone how to fish)

The Canadian Association of Occupational Therapists with the Department of Health and Welfare (1983) published

the Model of Occupational Performance and Client-Centered Practice

The PEOP model highlights

the complexity of person-occupation-environment relationships and it defines occupational performance as the outcome of this three tier transaction.

Human Agency

Persons have an innate drive to explore their environment and demonstrate mastery within it.

When is competence reached?

Competence is reached when a person is able to perform skills that meet his own personal needs. A person is also able to use the resources (personal, social, material) within one's environment.


is defined as a process whereby persons confront the challenges of daily living and are able to use their resources to master these demands.

How do people derive a sense of self fulfillment?

From Mastery

How do people derive a sense of self identity?

From meaningful participation

Occupations (defined by COTA)

are groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupations include everything that people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities

The Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2007) defines the environment as

having cultural, institutional, physical and social elements that can enable or constrain occupational performance.

Occupational Performance is influenced by the

1) person,
2) unique environment in which one functions, and
3) occupations that consist of one's actions and tasks and ultimately create one's life roles.

Occupational performance describes

the actions that are meaningful to the individual as he self manages, cares for others, works, plays and participates fully in home and community life. It can be separated into two components: a) occupations and b) performance.

What two components can Occupational Performance be separated into?

1) occupations
2) performance

Person (Peop Model)

made up of a series of intrinsic factors that compose one's set of skills and abilities.
Intrinsic factors - psychological, cognitive, physiological, spiritual, & neurobehavioral

Environment (PEOP Model)

Participation is always impacted by the extrinsic characteristics of the environment in which it occurs.

Sensory Environment

sensory surroundings of a person" which provides information about the physical and sociocultural context surrounding someone - to help navigate, make decisions and act

Cultural environment

ethnic, racial, ceremonial, routine practices - based on ethics / values within a subsystem
-Social norms, practices and ideologies

Occupation follows sequential pattern of complexity

1. abilities
2. actions
3. tasks
4. occupations
5. social & occupational roles

Occupation (PEOP COTA)

the activities and tasks that persons do in managing their daily lives, grouped in some meaningful way so that the persons can carry out life-roles.

Occupational Performance and Participation

is the culmination of doing occupations.
The interaction of a person's factors (intrinsic), the environment (extrinsic), and one's chosen activity (occupations) all lead to occupational performance and participation


A level of competency in his/her ability to perform and master occupations.

A healthy individual demonstrates occupational performance in meaningful activities and meets a balance of personal and environmental demands.

This person can self manage, care for others, work, play and participate fully in home and community life.

He shows adaptation in his occupational performance as challenges naturally evolve in his life. He has established healthy role patterns that fulfill personal and societal expectations


A person's occupational performance is limited and restricted. Therefore, occupational competence is not achieved. Persons may demonstrate a lack of goal attainment and participation in activities.

Dysfunction patterns are noticeable when a person cannot perform roles to a level of personal or social satisfaction (competency) because of deficits in abilities / skills due to a health condition, barriers and lack of resources.

The conflicting demands of multiple roles (role conflict) and unclear role expectations can impact occupational performance.

Standardized and observational screenings

can be used to assess the person's abilities, intrinsic factors and environmental (extrinsic) conditions.

A task analysis

will assist the occupational therapist to assess the performance components of an activity that are not congruent with the client's ability at that time.

Restorative Benefits of Occupational Performance

a) Control movement, to modulate sensory input, to coordinate and integrate sensory information, to compensate for sensorimotor deficits, and to modify neural structures through behavior
b) Maintain physical health and fitness
c) Maintain cognitive skills
d) Increase motivation, develop personal identity, enhance well-being and self efficacy
e) Enhance personal meanings and collective or shared meanings.

Intervention as part of the Role as an OT

recognize the role of the environment
adapt and/or modify the actions, tasks and ultimately one's occupations to match the abilities of the client
structuring occupations for meaningful participation and competent mastery
teach compensatory techniques
enhance role functioning

Oldest Definition of Social Capital

goodwill, fellowship, mutual sympathy, and social intercourse among a group of individuals who make up a social unit

Coleman's Definition of Social CApital

aspects of social structure that facilitate collective action

Pesut's Definition of Social Capital

Social capital is the currency of relationship exchange in our civil, social, and professional lives

Social Capital Includes

Trustworthiness of social environment, information channels, norms and effective sanctions, and appropriate social organizations

Three Different Types of Social Capital


5 Capital Model of Sustainable Development

Human capital (skills, education, etc)
Social capital (social networks)
Built capital (access to amenities)
Natural capital (access to green space)
Economic capital (income)

Some BEnefits of Social Capital

Enhanced mental health
Reduced cardiovascular disease
Reduced suicide rates
Reduced violent crime rates
It's role in community resilience is still not clear, because the concept is still a bit vague - is it a construct at the individual level or community level - if it is a collective construct and measurement needs to be improved
To date there has been an over-reliance on Putnam's definition as an individual state

Some critiques of Social Capital

Exact definition is ambiguous and due to its conceptual nature it is challenging to attribute causality when applying it in studies

Cannot be any social phenomenon as this detracts from its concreteness

Need better understanding of how networks form and what resources are needed to favour the emergence of SC

Proposed alternate definition: (Huber, 2008)
"resources embedded in social networks which can be accessed or are used for actions"

Resilience acc to Norris

a process linking a set of adaptive capacities to a positive trajectory of functioning and adaptation after a disturbance

Resilience acc to Poortinga

capability of individuals or systems (such as families, groups and communities) to cope successfully in the face of significant adversity and risk

In order for resilience to be present what also has to be present?


Adaptive Capacities of Resilient Communities

Economic Development
Social Capital
Information and Communication
Community Competence

Inter-role conflict

when people have multiple roles, it is difficult to meet all the expectations (demands) because eventually they conflict in some way

Work-family role conflict

when work spills over or interferes with an individual's performance in their occupations with the family

With who does the most spillover occur?

Most prevalent among people who work more hours

Family-work role conflict

when family responsibilities or demands spill over or interfere with work performance

What occurs more work-family conflict or family-work conflict?


With whom is family-work conflict most prevalent?

Most prevalent among employees with children <18yrs


SARS was a new corona (common cold) virus

A severe acute respiratory syndrome (SARS) that resulted in more than 8,000 cases in 27 countries

4-10% mortality and no treatment or vaccine

SARS in Toronto area resulted in

Health care workers burned out
Severe tourism, racism and economic implications

Key Lessons from SARS

Health systems were not prepared
Ineffective communications
Jurisdictional boundary confusion
Leadership role confusion
Cross-disciplinary and sector tensions
Vulnerability of health care workers
Work-family conflict and stigma
Collateral damage - racism against Asian populations and businesses

What did Canada do in response to SARS?

Created the Public Health Agency of Canada (2004)
Emergency Management Act (Ontario, 2005)
Health Emergency Response Teams (HERT)
Via Nurse - database
Multi-jurisdictional coordinated

Caring About Health Care Workers Project

Psychosocial influences on health are critical considerations for workplace health promotion & emergency preparedness (Sallis, 2006; Reissman et al., 2006)
Health care workers require organizational and social supports to assist them in performing their roles (O'Sullivan et al., 2008, 2009)
Lack of support mechanisms for health care workers represents a threat to public health (Campbell, 2006)

Specific Objectives of SARS research

How do individual factors, social and physical environments, and behavioural factors interact to influence the health of health care workers?
What types of organizational and social support mechanisms are needed to assist health care workers in their roles as first responders during large scale outbreaks

Components of the SARS Project

Focus Groups (nurses)
(x5) n=100
Format: Structured Interview Matrix
National survey (nurses) n=1543
Work satisfaction; supports; preparedness; perceived health
Policy Gap Analysis
Analysis of multi-jurisdictional plans for visible supports for health care workers
Policy Forum (2007)
Dissemination and knowledge transfer (KT) to policy audiences

Why is Gender Important in Emergency Planning?

Sex/Gender are dynamic, interactive constructs that crosscut and impact all health determinants
Gender-based Analysis (GBA) provides a framework that can enhance the quality and scope of evidence based decision making;
When GBA is absent, disaster management policies and program interventions may be inappropriate and may exclude the needs and participation of women and girls
GBA is about good science, policy, programs and clinical practice, with the goal of better and more equitable health outcomes for women and men
There is a need for gender and diversity-sensitive methodologies and assessment tools appropriate to emergency planning and health policy research


the genetic, biological and physiological characteristics and processes that generally distinguish males and females


the socially constructed roles, relationships, values, attitudes, and forms of power that are commonly attributed to either men or women; includes self-representation

SARS Focus Groups: Methods

Participants: RN's, RPN's, nursing managers & union reps who had worked in hospital ER or critical care within 5 years
5 Focus groups (N=100); Ottawa (x2), Vancouver, Halifax, Toronto
Interview Matrix format: Facilitated discussion of 8 questions with 1:1 interviews among participants, small group discussions, plenary discussions
Qualitative analysis: N*VIVO software

Various Levels in Which Nurses' health is impacted by psychosocial factors interacting from


Individual Level of psychosocial factors impacting the health of Nurses

Fatigue imposed by workload, emotional burden

Community Level of psychosocial factors impacting the health of Nurses

Lack of social support or experiencing stigma; dual-role conflict

Institutional Level of psychosocial factors impacting the health of Nurses

Lack of clear information from trusted source; additional workload causing fatigue / burnout

Political Level of psychosocial factors impacting the health of Nurses

Allocation of resources to HR mobilization; facilities, equipment, training, priority grouping for vaccines; gender power relations

Environmental Level of psychosocial factors impacting the health of Nurses

Globalization and international travel; effectiveness of available vaccines; viruses which observe no borders

Individual FActors influencing Nurses' Health

Exposure, prophylactic barriers (vaccines, anti-virals), existing vulnerabilities (chronic disease, weakened immune system), fatigue, knowledge, coping skills

Behavioural Factors Influencing Nurses' Health

Compliance with infection control guidelines, stress management, lifestyle

Social Environmental Factors Influencing Nurses' Health

work-family role conflict, stigma, relationships with colleagues, work conditions; gender power relations

Physical Environmental Factors influencing Nurses' Health

adequate engineering controls, availability of protective equipment

Support Mechanisms for Nurses

Personal protective equipment and uniforms
Education for all staff regarding emergency plan
Informational support
Quarantine conditions
Emotional / psychological support
Management responsibilities
Human resource policies focused on worker fatigue / stress
Instrumental supports
Vaccination / anti-viral therapy plan
Recognition / compensation
Media strategies
Professional development

To what extent were nurses concerned they might infect family members?

Very much

To what extent were Nurses concerned they would be unable to meet their caregiving requirements?

Somewhat-Very Much

Professional, do Nurses Feel adequately prep'd and oriented to deal with an infectious disease outbreak?

Very Little-Somewhat

Are Nurses adequately trained to deal with infectious disease outbreaks?

Very Little - Somewhat

Do Nurses feel adequately equipped to work during an infectious disease outbreak?

Very Little - Somewhat

In general, how satisfied are nurses with their profession?

Somewhat satisfied - Very satisfied

How often have Nurses thought about leaving their profession to work elsewhere?


Some conclusions about the Nurses and SARS

A socio-ecological framework is useful and appropriate for examining the complexity of factors impacting nurses' health, which in turn impacts public health response capacity during a large scale outbreak
Individual factors (biological, cognitive) interact with behaviour, and social / physical environmental factors to impact nurses' health
Proactive policies & procedures are needed to enhance Canada's collective ability to combat a large scale outbreak, and protect health care workers and their families

Summary Recommendations for Hospital Pandemic Influenza Planning

Stockpiling PPE and fit testing / training for employees
Specific training / professional development - accessible for all staff
Clarify protocols and supports for different quarantine restrictions
Planned psychosocial services to reduce negative emotional impact; acknowledgement of dual-role conflict as sig. source of stress for staff
Visible leadership and support for ethical decision-making
Creative HR mobilization strategies; Monitor staff for burnout / fatigue
Concise documentation of assessed resource needs, (checklist)
Clearly defined strategies for dissemination of vaccine and anti-virals, combined with informational resources regarding priority groupings
Recognition and compensation for all staff involved in the response
Strategies to reduce sensationalism and stigmatization through regular contact and planning with the media,
Creation of calming and confidence-inspiring public messages which accurately portray health care workers and their contribution to community response

Policy Recommendations (Nurses and SARS article)

Support mechanisms are needed at multiple levels to enhance their collective impact on the health of health care workers:
Engineering controls to reduce exposure
Training opportunities / disaster drills to foster knowledge, confidence, social networks, and to reinforce behaviour
Public education and campaigns to recognize the valuable role of health care workers
Sensitive organizational policies to assist staff with challenges related to dual-role conflict

Four Adaptive Capacities of Resilient Communities

Economic Development
Social Capital
Information and communication
Community Competence

Components of Economic Development

Resource volume & diversity
Resource equity & social vulnerability

Components of Social Capital

Networks, social structures, linkages
Social support
Community bonds, commitment

Components of Information and Communication

System and infrastructure
Community and narrative

Components of Community Competence

Collective action and decision-making
Collective efficacy and empowerment

Resource volume & diversity

a few key parameters for observing "social resilience were made". The first parameter encompassed economic growth, stability of livelihoods, and equitable distribution of income and assets within populations. Economic resilience depends not only on the capacities of individual businesses but on the capacities of all the entities that depend on them and on which they depend. Past disaster research has show that participants of a low socio-economic status (SES) often experience more adverse psychological consequences than do participants of higher SES. Community resilience depends not only on the volume of economic resources but also on their diversity.

Resource Equity and Social Vulnerability

Societies do not allocate environmental risk equally, often making the poorest communities the weakest links in hazards mitigation. Poor communities not only are at greater risk for death and severe damage, but they often are less successful in mobilizing support after disasters. Ideally, the distribution or mobilization of support follows the "rule of relative needs." Simply put, the most support goes to those who need it the most. Often, however, the distribution of support follows the "rule of relative advantage" because one's embeddedness in the commuunity, political connections and social class determine the availability and accessibility of resources.

Social Capital

the basic idea of social capital is that individuals invest, access and use resources embedded in social networks to gain returns. It can also be defined as the aggregate of the actual or potential resources that are linked to possession of a durable network of relationships.

Network Structures and Linkages

On dimension of community capacity, is the presence of inter-organizational networks that are characterized by reciprocal links, frequent supportive interactions, overlap with other networks, the ability to form new associations and cooperative decisions-making processes. Uncertainty often leads to efforts to broaden the "Scope of actors, agents, and knowledge that can be marshaled." Tis trend necessitates networked versus hierarchical systems for disaster response. There is an importance of "hubs" who link one network to another. The efficiency of hubs may decreases resilience because if the hub is compromised, the entire system fails.

Tight Coupling versys Loose Coupling

"Tight coupling" occurs when change in one component engenders a response from other components. "Loosely coupled" systems may be better at responding to local changes since any change they make does not require the whole system to respond. The happy medium may be loosely coupled organizations (to better respond to local needs) that are able to coordinate or collaborate (to facilitate access to their resources).

Isolates vs Peripherals

There are two types of linkage cracks: "Isolates" are organizations with essential services that do not interact with the rest of the network and "Peripherals" are organizations that are connected to the network only by means of a long and indirect series of links.

Social Support

social support refers to social interactions that provide individuals with actual assistance and embed them into a web of social relationships perceived to be loving, caring, and readily available in times of need. Research on social support has long distinguished between "received support" (actual receipt of help) and "perceived support" (the belief that help would be available if needed). Social support varies on two dimensions. The first dimension, source, is reflected in the overall pattern of help utilization. The second dimension, type differentiates between emotional, informational and tangible support.

Community Bond, Roots and Commitments

Three key social psychological dimensions of social capital are thus sense of community, place attachment, and citizen participation.

Sense of Community

"Sense of community" is an attitude of bonding (trust and belonging) with other members of one's group or locale, including mutual concerns and shared values. Sense of community is a dimension fo community capacity

PLace Attachment

"Place attachment" is closely related to one's sense of community. It implies an emotional connection to one's neighbourhood or city, somewhat apart from connections to the specific people who live there. Place attachment often underlies citizens' efforts to revitalize a community and thus may be essential for community resilience. Place attachment may be of special note for disaster recovery, as these events have spatial parameters and harm built and natural environments.

Citizen Participation

. "Citizen Participation" is the engagement of community members in formal organizations, including religious congregations, school and resident associations, neighbourhood watches, and self-help groups. Three areas of citizen participation: who participates and why, how organizational characteristics influence participation and the effects of participation on community conditions and participant's own feelings of efficacy. Two factors hypothesized fall into this set of capacities: Participation, referring to member involvement and engagemtn and opportunities forsuch that are sensitive to diversity, ability, and interests of members; and Structures, Roles and Responsibilies, referring to leadership, teamwork, clear organizational structures, well-defined roles, and management of relationships with other communities.

Information and Communication

Information may be the primary resource in technical and organizational systems that enables adaptive performance. By communication, we refer to the creation of common meanings and understandings and the provision of opportunities for members to articulate needs, views, and attitudes.

Systems and Infrastructure for Informing the Public

Information increases survival only if it is "correct and correctly transmitted". A trusted source of information is the most important resilience asset that any individual or group can have.

Communication and Nrrrative

Community recovery depends partly on collectively telling the story of the community's experience and response. In fascinating analysis of disaster metaphors and myths, Tierney et al traced the impact of exaggerated and extreme portrayals of looting and lawlessness to critical policy decisions. Three days after the New Orleans levee breach, leadership's decision to re-direct police officers to attend to lawbreakers rather than life-saving activities lessened the survival chances of stranded residents.

Community Competence

the capacity to acquire trusted and accurate information, to reflect on that information critically, and to solve emerging problems is far more important for community resilience than is a detailed security plan that rarely foresees all contingencies.

Collective Action and Decision Making

A competent community is one in which "the various component parts of the community are: (1) are able to collaborate effectively in identifying the problems needs of the community; (2) can achieve a working consensus on goals and priorities; (3) can agree on ways and means to implement the agree upon goals; and (4) can collaborate effectively in the required actions."

Collective Efficacy

Collective efficacy reflects trust in the effectiveness of organized community action. Collective efficacy can also be defined as a composite of mutual trust and shared willingness to work for the common good of a neighbourhood. In the model of community resilience, collective efficacy bridges the domains of Social capital and community competence.

Collective Empowerment

Empowerment progresses through a sequence of formal empowerment (mechanisms for citizen input), intrapersonal empowerment (feelings of personal competence and confidence), instrumental empowerment (ability to participate and influence decision, as determined by knowledge, material resources, and persuasiveness), and substantive empowerment (ability to reach decisions that solve problems). Some political approaches to citizen onvolvement in decisiosn are more empowering than otehrs

Look at resources for mobilization of resilience in terms of


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