Examination of Work and Engagement, Activity and Occupation Terms in Occupational Therapy Literature: Turkey Sample


  • Meral HURİ
  • Barkın KÖSE

Received Date: 24.09.2019 Accepted Date: 05.03.2020 Bezmialem Science 2020;8(4):444-450

Although the use of terms of work and engagement (WE), activity, and occupation varies from country to country, time and cultural structure, these terms are among the most commonly used terms in occupational therapy (OT). The aim of our study was to examine the process of use, change and development of WE, activity and occupation terms in the national and international literature in Turkey. A search by using the funnel method using “occupation”, “WE”, “WE treatment’’, “activity”, “occupation” and “OT” keywords was done. The abstracts of national and international articles published in the Web of Science, Scopus, Index Medicus, Medline, Copernicus, EBSCO, Ulakbim Journal index and TR ATIF index between 1970- 2018 were reviewed and 3467 articles were reached. Two hundred and nineteen which met the inclusion criteria were included in the study. The data obtained were recorded. It was found that in national and international studies, the terms “WE”, “activity” and “occupation" were both used in similar and different meanings. In the development process, it was observed that there was a shift towards the use of the terms “activity” and “occupation" by moving away from the term “WE” which had a limited conceptual content. Historical development and change in the use of terms “WE”, “activity” and “occupation" in OT science are parallel with development of OT in our country. To continue and deepen the studies and harmonize the terminology according to the spirit of time and changing conditions will accelerate the development of OT paradigm in Turkey.

Keywords: Occupation, activity, work and engagement, occupational therapy


Occupational therapy (OT) has been serving individuals from all groups for over 100 years. In our country, OT is accepted as a newly established professional group that is at the very beginning of its development. Considering the historical development of occupational therapy in our country, the foundations of the profession were first laid with the establishment of the Physical Therapy and Rehabilitation School affiliated to Hacettepe Faculty of Medicine and Health Sciences. This school was opened by Prof. Dr. İhsan Doğramacı to train rehabilitation therapists. The departments specified in the regulation published in the Official Gazette dated July 24, 1964 included Occupational Therapy and Occupational Treatment departments. Studies on these issues have been carried out with the establishment of the School’s Work and engagement treatment unit. The Work and engagement treatment unit was first introduced by Prof. Dr. Hülya Kayıhan in Hacettepe University Hospitals Physical Medicine and Rehabilitation Department and Physical Therapy and Rehabilitation School, closed after operating for a while, and started to operate in Hacettepe University Hospitals Physical Medicine and Rehabilitation Department again since 1981. Then, between 1983-2008, it continued its activities in the School of Physical Therapy and Rehabilitation. In 1996, Hacettepe University Institute of Health Sciences, Physical Therapy and Rehabilitation Master and Doctorate Programs were opened. On 18.02.2009, an education program was opened under the Faculty of Health Sciences of Hacettepe University in accordance with the item 7/d-2 of the Law numbered 2880 and the Law numbered 2547 by the High Education Council. Hacettepe Occupational Therapy major education program was accredited by the World Federation of Occupational Therapists in 2012, and by the Health Sciences Education Programs Evaluation and Actreditation Association recognized by the High Education Institution in 2018 [Kayıhan and Köse (12)].

Although the terms “Activity” and “Occupation” have been used similarly to each other in occupational therapy literature for a long time, they also appear as two different concepts that are confused with each other [Salles and Matsukura (21)]. While “Activity” is defined as “activity, being active” according to the Turkish Language Association, it is conceptually defined as a general classification of human actions such as playing games and cooking. Ocupation, on the other hand, is an ergotherapy term that originates from the Latin word occupare/occupatio and was introduced into English from the old French language as “occupation” in the 16th century. Although the Turkish word for “occupation” appears as “iş”, “uğraşı”, “uğraş” and “meşguliyet”, this Turkish equivalents do not meet the comprehensive content of the term “occupation” used in ergotherapy. As a result of the consultations with the Turkish Language Institution, it was agreed that “okupasyon” was used as the Turkish equivalent of “occupation” as a scientific term and that the word “work/occupation”, which was a dictionary meaning, would be more appropriate when defining handicrafts and artistic activities.

For different branches of science in the literature, occupation refers to the work that people do to earn a living, while in the occupational therapy science, occupation is defined as all the daily life activities that make us who we are in our daily life (Nelson and Jonsson (17). In addition, occupation is shaped by the cultural structure and includes all the tasks we devote our time to making sense of our lives (Golledge (9). These tasks, on the other hand, contain numerous activities completed in their structure. Therefore, work-engagement defines the work that individuals put forward with their manual skills. Activity describes a general action that the individual is involved in or can be taken by anyone. Occupation, on the other hand, defines all life activities shaped by personal interests, desires, values and means meaning for the person. Especially, occupation reflects the unique characteristics of the individual that can only be interpreted by the person (Breines (2); Evans (8); Golledge (9).

In the literature, Trombly (25), Wilcock (27), Pedretti (1996) have used the term “occupation” to describe “purposeful activity/activity that serves any purpose”, while Levine and Brayley (1991) have used the term “activity” in the same sense with “reading”. (Pendleton and Schultz-Krohn (19); Trombly (25); Wilcock (27).

The American Occupational Therapy Association (AOTA) defines the distinction between omission, function and purposeful activity in a declaration published in 1995 as follows:

 “Occupation expresses primarily the performance dimension of the function with its contextual, temporal, psychological, social, symbolic and spiritual dimensions. While purposeful activity can cover more than one dimension, occupation refers to the biological (body structure and functions, etc.), psychological (well-being, etc.) and sociological (environment, etc.) richness of the concept of human. All readings allow for the creation of a purposeful activity, but all purposeful activities cannot be defined as occupation” [Christiansen et al. (3)].

Nelson (16), on the other hand, explained the relationship between the occupational form and occupational performance. Each occupational form has an objective structure independent of the person performing it. However, it has socio-cultural and physical characteristics. Occupational performance, on the other hand, is the action that is manifested, directed or structured by the pre-existing occupational form. According to Nelson, significance is associated with the occupational form, while occupational performance is related to purpose (Nelson (16).

Khielhofner (1995), on the other hand, defined occupational forms as sequences of action that are pursued for a purpose, consistent and strictly bound to rules, and named within the culture. For example, occupation is exemplified as working as a worker, a floor attendant, a member of a group, etc. and it contains many different literary forms in its structure. Occupational forms are explained as more thematic structures, such as the individual mowing the lawn as a worker, cleaning the kitchen as a floor attendant, working for a newspaper as a member of a group Kielhofner (13); Wu et al. (28).

According to the Model of Human Occupation (MOHO), the ocupational forms have been conceptualized as one of the four dimensions of the environment that affects the occupation. Occupational forms are pre-formed cultural meanings provided in the face of opportunities and constraints related to the subject. When viewed from the MOHO’s perspective, the literary forms depend on the individual’s past and present life history (Kielhofne (13); Kielhofner and Barrett (14). Khielhofner avoided using the word “activity” in his model to eliminate the confusion of occupation and activity, and focused on expressions of doing, thinking, and feeling in order to emphasize that occupation always involves the intertwining of an action, thought and feeling (Kielhofner (13); Kielhofner and Barrett (14); Rudman and Dennhardt (20).

When we look at the examples in the literature, it is seen that the paradigm of occupation and occupational therapy also varies from time to time. The example that best explains this situation is the dynamic cultural mechanisms that affect the behavior of individuals living in eastern culture and western culture, separately. Differences arising from the dynamic nature of the mechanisms also change the social and conceptual understanding. While the behavioral patterns and concepts developed to increase the quality of life of individuals in Western culture based on individual independence, shape the life of the individual (Rudman and Dennhardt (20), in eastern culture, the adoption of a communal lifestyle manifests itself in the pattern of behavior in the form of multiple generations living under the same roof and in the form of  meeting the needs of people who need help by other family members. For this reason, it is seen that the policies of the states in the Eastern culture have shifted to general preventive/curative and therapeutic approaches rather than person-centered approaches (person-centered approaches, individual quality of life, etc.) to delivering basic health services to all individuals rather than improving the quality of life of individuals (Mahiroğulları, 2005; Süleymanov (22).

In the behavior and life patterns observed in Turkey, a good synthesis of Eastern and Western culture dominates. The reason for this is that the social structure in cities has the characteristics of Western culture and the characteristics of eastern culture prevail in smaller settlements such as villages Süleymanov (22).

When the world literature on the occupational science is examined, it is emphasized that the development of OT is closely related to cultures and cultural differences, and that there is lack of studies examining the use of concepts, terms and approaches related to OT in different cultures in detail Awaad, (1); Watson (26). Our study was planned with the aim of examining the conceptual use of “WE”, “activity” and “occupation” terms in Turkey, which were also often used in the national-international occupational therapy literature, mapping the use of these terms and studying the developmental processes of occupational therapy in our country in detail.

Clinical and Research Effects

Our study was planned as a systemic review using quantitative and qualitative data. Inclusion criteria in the study: (1) The articles published between 1970 and 2018, (2) The articles including the keywords of WE, work and occupation therapy, activity, occupation, and OT, (3) The methods used in practice should include evaluation/intervention methods of occupational therapy and rehabilitation. Funnel method was used to scan the publications in the literature. A general sample was created by scanning the summaries of all the studies in which the keywords were included in the framework determined by this method. Publications in Web of Science, Scopus, Index Medicus, Medline, Index Kopernicus, EBSCO, Ulakbim Journal Index and TR ATIF index were used for sampling. Screening was performed by BK and CK using Hacettepe University Access.

While BK scanned English publications included in international indexes published by Turkish researchers, CK searched national publications in the TR ATIF index. The abstracts of the publications that were published in the Turkish Journal of Physiyotherapy Rehabilitation before 1990 but could not be transferred to the online system, were examined by scanning the journal archive with the special permission of the editor DII. The author list, title, age group, subject and content information of the studies obtained as a result of the main searches were systematically recorded. All studies to be included in the study were reviewed for the second time. The full texts of the included studies were examined by MH and grouped in terms of the conceptual content of terms and terms used. All results were interpreted by the research team and turned into quantitative and qualitative outputs.


As a result of the first search, a total of 3467 studies containing keywords were found. When the articles were re-searched in terms of the terms and conceptual content of the terms used, it was found that 2127 studies did not meet the inclusion criteria. When the remaining 1340 studies were examined in detail, it was concluded that the researchers of the 1121 studies were from outside the OT field. A total of 219 studies were included in the study. One hundred and fifty two of these included articles were found to be scanned in national indexed journals and 67 of them were found to be scanned in international indexes (Flow Chart).

In the studies conducted between 1970 and 1996, the words “WE”, and “work and occupation” were frequently used, and the studies conducted between 1996 and 2009 included terms such as “activity”, “leisure activity”, and “occupational activity”. In addition, the term ‘’activity’’ has been used with increasing frequency since 1970, and especially after 2009, “activity” has not been used alone and used as “activity performance”, “activity participation”, or “activity balance” which help to reveal more conceptual content (Table 1). In the articles published after 2017, it has been determined that the frequency of use of terms such as “the Human Ocupation Model” and “occupational form” has increased.

When the journals in which the articles were published were examined, it was found that the studies conducted before 2009 were frequently published in journals containing rehabilitation and physiotherapy, and 96 studies in accordance with the criteria conducted between 2009-2018 were published in journals on rehabilitation and occupational therapy. While 62 of these articles used the keywords “occupation”, “activity”, “OT”; 34 articles used the words “occupation” and related “activity participation”, “activity balance”, “role balance”, and “person-environment-activity relationship”.

It was observed that in all of the 67 English-written studies, which were scanned in international indexes and found in accordance with the criteria; “occupation” and “activity” terms were used in different meanings, and that the term “occupation” was used in a wide sense covering all life activities affecting health and well-being.


As a result of our study, which was planned to examine the conceptual meanings of the terms “WE”, “activity” and “occupation”, which were frequently used in the OT literature, and the usage map of these terms in detail according to the developmental processes of OT in our country; it was observed that while the use of the terms “WE”, “work and occupation”, “work and occupation therapy” prevailed in early national ergotherapy studies, the use of the term “occupation” with its meanings including health and well-being increased with the establishment of the occupational therapy department and after the graduation of the first occupational therapy in 2014, and increased rapidly after 2017. In addition, it was observed that the conceptual distinction in the use of “activity” and “occupation” terms was evident in the studies of experts dealing with the science of OT and contributing to its development, published in international databases. Also, it was determined that the terms used in studies conducted by Turkish scientists in the field of OT did not differ from other internationally published studies.

The development of scientific branches occurs as a result of the intense efforts and efforts of scientists who are trying to find solutions to meet the needs of humanity. The first emergence of OT in the world occurred as a result of the work of a group of nurses who expanded their field of study in the United States during World War I (Dunlop (7). In Canada, it started with the development of the work of a child psychiatrist who was influenced by Mill’s work on Moral Philosophy to raise the morale of children hospitalized for tuberculosis treatment (Driver (6). In both studies, it was stated that as the science of ergotherapy developed, the methods and terminology used changed. The development of ergotherapy science in Turkey has been pioneered by professionals specializing in ergotherapy from different professional disciplines who are interested in the subject, in parallel with world examples. This result is similar to the study of Cutchin and Dickie. (4) which has demonstrated that OT terminology and occupational therapy paradigm have improved with a better understanding (Cutchin and Dickie (4). According to the results of our study, it is believed that terminology related to ergotherapy in Turkey has developed with an in-depth understanding of the ergotherapy paradigm, the nature of activity and activity participation, and complex relationships related to health.

The increase in the competence of newly developing sciences in self-evaluation, clinical decision-making and intervention methods in the literature is directly proportional to the spread of professionals working in the field and the widening of their application areas (Rudman and Dennhardt (20). Scientists emphasized that the in-depth perception of the content and scope of science-specific terminology and science-specific terms begins with specialization (Gleick (11). As a result of our study, in line with the literature, we think that the establishment of WFOT certified occupational therapy education programs in Turkey,  transition from Work and Engagement Therapy Department to Occupational Therapy Department, and employment of the first occupational therapists in various sectors and academia after graduation, have led the use of terms such as “WE” and “work and occupation” and have made them widespread by allowing a better understanding of the expressions underlying the terms specific to activity and OT. (Huri and Kayihan (10); Pekçetin et al. (18); Şahin et al. (24); Şahin and Uyanık (23). In parallel with the increasing awareness, specialized terms such as “activity performance”, “activity participation”, and “activity balance” have started to be used more frequently in studies. However, although scientists who publish their work in the field of OT increase their frequency of using the term “okupasyon” conceptually, they may experience some problems in timing to find the equivalent of words entering or to be entered into Turkish from a foreign language, improper use of suffixes, pronunciation and phonological compatibility, public offering of the word, and use in media and school books. In addition, des Langues et al. (5) in their work on the use of terms in different languages ​​and their translation from the native language to another language; They stated that the subject is expressed using the terminology in the language in which the subject is to be described and that the incomplete or out-of-scope terms are parallel to the variety of terms used in that language (des Langues (5). Similar to the literature, we think that the term of reading is needed from the terms of work-occupation and activity due to its meaning content, but it is still in the process of dissemination. In addition, in their work on the use of terms in different languages ​​and their translation from the native language to another language, des Langues et al. (5) stated that the subject intended to be expressed in a language was made using the terminology in that language in which the subject would be described, and that the missing or excluded terms were parallel to the diversity of the terms used in that language des Langues et al. (5).  We think that the term of “okupasyon” is needed to be used due to its meaning content instead of the terms of “WE” and “activity”, but it is still in the process of dissemination.

Both printed and digital sources were used in our study. The printed archives were scanned in order to reach the works published between 1970-1990. The fact that there were missing pages in some journals, although in a small number, caused limitations in the evaluation of the conceptual content in the full texts of published studies, and this was a limitation of our study.

Given that the science of ergotherapy in Turkey is developing both clinically and academically; examination of the issues such as terminological usage, practices philosophy and paradigm in detail  and deepening of OT related terminology work and its continuation, and adapting to changing conditions and the spirit of time will accelerate the development of ergotherapy by strengthening the infrastructure of the ergotherapy paradigm in Turkey.                  

Peer-review: Internally and Externally peer reviewed.

Authorship Contributions

Concept: M.H., Design: M.H., B.K., Data Collection or Processing: B.K., C.D., Analysis or Interpretation: M.H., Literature Search: B.K., C.D., Writing: M.H., B.K., C.D.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.

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