Listen: Apple | Spotify | YouTube
Full Course Details: Public course page
Learn more about our guest: Dr. Zipporah Brown, OTD, MS, OTR/L, DipACLM
Agenda
Breakdown and analysis of journal article (5 minutes)
00:00:00 Intro
00:03:07 Background on OT, habits, and health promotion
00:05:36 Why this scoping review is needed
00:06:43 Purpose of this paper
00:07:01 Methods
00:07:42 Results
00:09:41 Article Discussion and Conclusion
Discussion on practical implications for OTs (50 minutes)
00:11:26 Intro to Zipporah Brown
00:14:52 How Zipporah became interested in habits
00:18:33 How habits intersected with Lifestyle Medicine
00:22:19 Article impressions
00:27:30 Environmental modification and habit change
00:31:38 Communicating the power of habit change
00:35:04 Setting habit-based goals
00:39:04 Impactful interventions for habit change
00:49:44 How habit change can advance our profession
00:56:25 Habit change in practice and curriculums
Supplemental Resources
- Subscribe to the American College of Lifestyle Medicine Newsletter at the bottom of this page.
- Implementing Lifestyle Medicine Competencies in Didactic and Clinical Settings for Allied Health Professionals: A Call to Action
- Intervention to modify habits: A scoping review.
- Optimizing occupations, habits, and routines for Health and well-being with lifestyle redesign®: A synthesis and scoping review.
Article Review
Read Full Text: Habits and Health Promotion in Occupational Therapy: A Scoping Review
Journal: Annals of International Occupational Therapy
Year Published: 2021
How many times have you had to explain what occupational therapists do?
Unfortunately, efforts to help the public understand the power of OT simply have not been as successful as we would like.
But, perhaps the growing public consciousness around the power (and difficulty) of habit change offers a unique opportunity for us to clearly communicate how we can help people change their habits to change their health.
Emphasizing our role as habit change agents has multiple upsides:
It differentiates us from our rehab colleagues.
It positions us as leaders in caring for those with chronic conditions.
It captures the long-term impact of our care.
It highlights the skill and necessity of OT.
It naturally connects our work to system-level change.
It allows us to draw on important research from adjacent fields like psychology.
And, as we’ll see in this week’s scoping review on OT and habit change/health promotion, we’ve been addressing habits since 1912! It’s also a core part of our 2020 practice framework and is increasingly embedded in OT research.
(I should say that weaving this language into our marketing messaging is not the focus of this article—that passion is all my own.) 
Next week on the OT Potential Podcast, we’ll welcome Dr. Zipporah Brown. She and I will discuss ways you can embed best practices around habit change in your OT practice.
Let’s dive in.
Background on OT, Habits, and Health Promotion
As noted in the OT Practice Framework, habits are central to the domain and scope of occupational therapy. They are one of the framework’s 4 outlined performance patterns, along with routines, roles, and rituals.
According to the World Health Organization, health promotion enables people to increase control over their own health. This effort covers a wide range of social and environmental interventions designed to benefit and protect individual health and quality of life by addressing and preventing the root causes of ill health—rather than focusing solely on treatment and cure.
There’s a natural intersection between habits, health promotion, and OT—as occupational therapists are uniquely trained to evaluate and change the very contexts in which habits exist. They play a role in health promotion by encouraging engagement in the healthy habits and routines that facilitate optimal health.
A note on the difficulty of habit change
While changing habits to promote health sounds relatively simple, the reality is that habits are notoriously resistant to change. Goals and good intentions often are not enough to change a habit. Because habits are typically tied to environmental and contextual cues, we need evidence-based interventions to promote habit change.
Habit theory with occupation
Habit change has been a central concept of occupational therapy throughout the history of the field. Dating back to 1912, habit training was established as a form of rehab intended to retrain individuals in activities of daily living and instill habits linked to meaningful occupation.
One of occupational therapy’s most popular theories, MOHO (The Model of Human Occupation), which linked habits to the environment, was originally published in 1980—foreshadowing the popular science around habits.
A broad overview of habit theory in OT includes two key themes:
- Habits are often understood as a subset of routine, which in turn constitutes an occupation.
- Habits are often influenced, or even triggered, by the context with which they occur.
Why this scoping review is needed now
While habit change has long been a part of OT practice and theory, our expertise in habits is needed now more than ever.
Poor habits are inflicting unprecedented harm on global society, with 80% of deaths now attributed to 4 main disease categories that are linked to lifestyle habits:
- Cardiovascular disease
- Cancer
- Respiratory disease
- Diabetes
Conversely, a recent study projected a lifespan increase of 12–14 years in individuals who maintain these 5 healthy habits:
- Not smoking
- Keeping a healthy body mass index
- Participating in regular physical activity
- Having low alcohol consumption
- Having good nutrition
With global health heavily dependent on good habits—and given the difficulty of modifying habits—our expertise as OTs is more needed than ever before, which leads us to the purpose of this study…
What was the intent of this research?
The intent of this research was to map occupational therapy literature related to the role of habits in health promotion, with a goal of shaping future occupational therapy research and practice.
Methods
This article was scoping review, the protocol for which was assembled by the first author, Erin Epley, as she worked toward her post-professional OTD. (See her capstone project in our Capstone Catalog!)
Studies were included in the review if they:
- Focused on prevention, health promotion, or wellness.
- Had the implicit or explicit definition of “habit” as a behavior cued by a situation, context, or environment.
- Addressed habits with particular relevance to occupational therapy.
Results
The review included 20 articles: 13 empirical studies and 7 non-empirical studies.
All 20 articles were published between 2008 and 2020, with 16 written after 2014. 18 of the articles originated in the United states. 1 was from Australia, and 1 was from Denmark.
Empirical Sources
Here are some specific highlights and strategies from the articles:
This article featured the habit module, “pick two to stick to,” which used habit change techniques such as goal-setting, action-planning, self-monitoring, and motivational interviewing to help change habits for adults with metabolic syndrome.
This article used motivational interviewing and education to help adults prevent progression to fragility.
This article showcased a study on the effects of goal setting and accountability partners among college students.
This study and this study featured community-based programs that worked with children and families on practicing routine awareness and embedding healthy behaviors into occupations.
Lastly, this study employed the REAL Diabetes intervention, which uses goal-setting, self-management techniques, and social support.
Non-Empirical Sources
3 non-empirical studies that stood out to me were:
This scoping review of habit interventions, which featured literature from outside the realm of OT.
This article, which advocated for the role of school OTs in promoting healthy habits.
And this article, which discussed the contribution of occupational science to healthy lifestyle changes through the pursuit of occupation.
Discussion
There has been a recent focus on habits in OT literature, especially since 2014.
The 6 empirical studies and 3 non-empirical studies noted the unique training that OTs have in environmental modification as a strength in their support of habit formation and change.
2 empirical studies mentioned the importance of embedding healthy habits within overarching routines—another strategy in which OTs are uniquely skilled.
As this was a scoping review, the efficacy of different habit change strategies was not explored. But, the strategies identified included:
- Action-planning,
- behavior practice and rehearsal,
- client education,
- goal-setting,
- motivational interviewing,
- peer/family support,
- problem solving,
- providing information on consequences, and
- self-monitoring.
Key implications for practice
Occupational therapy professionals should use their knowledge and expertise in environmental supports, barriers, and modifications to foster positive habit formation and change, ultimately promoting health for their clients.
And, given the importance of routine in supporting habit formation and retention, OT clinicians should assess routines and help their clients embed new habits into their existing routines.
Review %open%
After earning your certificate, please consider taking a moment to answer the following three questions:
1.) On a scale of 1-5 please indicate the degree to which the learning objectives were met.
- 1
- 2
- 3
- 4
- 5
2.) Please rate our instructors on a scale of 1-5.
- 1
- 2
- 3
- 4
- 5
3.) On a scale of 1-5, please rate the learning environment of the Club.
- 1
- 2
- 3
- 4
- 5
, and focus on structuring my environment!