The definition of the concept of quality of life (QOL) has long been debated with contributions varying according to the different scientific disciplines, including social sciences, psychology, geography, philosophy, health economics, advertising, medical science, and history (Bowling 1995; Faruqhar 1995, Liddle & McKenna 2000). Taking into account the difficulty of defining QOL (Bowling 1995) this essay will critically discuss the suggestion that “…the experience of quality of life is not dependent upon the quantifiable, material conditions of life but upon subjective, qualitative factors: the content of life” (Hammell 2004, p299). Beginning with a brief definition of the concept QOL in relation to the concept of human occupation and the philosophy of occupational therapy (OT), it will be discussed whether quantifiable conditions in terms of socio-economic resources and measurable physical function are appropriate indicators for QOL. The discussion will then move towards the question of a suitable approach to QOL measurement and explain the implications for the role of OT.
In an attempt to define the concept of QOL, Zhan (1992) proposes an example of a conceptual model which speaks of four measurable dimensions of QOL, namely: “life satisfaction, self-concept, health and functioning and socio-economic factors” (Zhan 1992, p796), and suggests, in consensus with Liddle & McKenna (2000), that QOL is both, a subjective as well as an objective concept. Niemi et al (1988) prefer to define QOL as referring to “a person’s subjective wellbeing and life satisfaction”, which includes health, material well-being, interpersonal relationships”, as well as “personal development”, work and recreation (Niemi et al, cited in Mayers 2000, p591). In support of Hammell’s (2004) statement, many researchers emphasise that QOL is a matter of subjective individual perception, which in turn is influenced by the individual’s values that are formed in relation to the individual’s cultural environment (Liddle & McKenna 2000; Bowling 2001). The aspect of subjectivity and multidimensionality of the concept of QOL is also supported by the definition given by the World Health Organisation (WHO) QOL group, which states that QOL is: ”…(the) individuals’ perception of their position in life in the context of the culture and value systems in which they live…It is a broad ranging concept…”(WHO 1997, p3).
The view of QOL being a multi-dimensional and subjective concept (Bowling 2001) corresponds with the philosophy of OT (Liddle & McKenna 2000), and the concept of human occupation. The philosophy of OT is based upon a holistic view of the client (Sumsion 2006) and on the belief that humans are occupational beings (George et al 2001). In this context it is said that engagement in personally meaningful occupations delivers a sense of identity, worth and purpose and facilitates health and wellbeing (Liddle & McKenna 2000; George et al 2001; Mee & Sumsion 2004; Brott et al 2007).
According to Turner (2002), occupations can be described as “driven by people’s aspirations, needs and environments”, as “the fabric of ‘doings”, “the purposeful use of time”, and as “a means through which people control the balance of their lives” (Turner 2002, in Turner et al 2002, p26). The named balance aspect is also seen as a goal of OT practice, for example, the Canadian Model of Occupational Performance (CMOP) (CAOT 2002, in Sumsion 2006), illustrates the interaction and need for balance between the personal, the occupational, and the environmental component of occupational performance and aims to remind practitioners of the core of occupational performance, which is spirituality or meaning (CAOT 2002, in Sumsion 2006).
In citing Wilcock (1998), Hasselkus (2002) points out that occupation not only implies the “doing” of activities but also contributes to people’s “being and becoming”. In other words, ‘being and becoming’ are seen as “the meaning aspects of occupation”, which contribute to a human being’s sense of identity and ability to comprehend life (Hasselkus 2002, p16). Wilcock (1998, cited in Hasselkus 2002, p16) defines the term “becoming” as holding “the notions of potential and growth, of transformation and self-actualization” and defines the role of the OT in terms of enabling people to reach their potential for self-actualization and growth. The transformative power of engaging in meaningful occupations is also highlighted by Hammell (2004), who states that a traumatic life-event, such as illness or bereavement, may be followed by a process of transition as the person begins to re-evaluate what he or she finds meaningful in life. During this process the OT may play a significant role in actualizing the person’s potential and thus facilitating ‘becoming’ (Hasselkus 2002), which can be suggested to influence a person’s sense of wellbeing and experience of QOL.
A qualitative study with seven people diagnosed with Motor Neurone Disease highlights the disruptive impact the disease can have on people’s ability to perform occupations that used to give “meaning to life, expressed identity and filled time” (Brott et al 2007, p24). The significant role of occupational performance in relation to people’s experience of wellbeing is also pointed out by another qualitative study, during which clients with mental health problems were interviewed after participating in a woodwork workshop (Mee & Sumsion 2004). The authors reference Wilcock’s theory of “being and becoming” and suggest that engagement in occupation can serve as a means to developing a sense of self-identity and competence, by fulfilling the “innate need to create”, and feeling “useful” (Mee & Sumsion 2004). Similarly, Frances (2006) points out the value of using outdoor recreation as a therapeutic medium in OT to enhance QOL in people with mental health problems, as it enables engagement in meaningful occupations and fosters identity development, which “has been shown to be paramount to individuals’ wellbeing” (Frances 2006, p.185). Therefore it can be argued that engagement in meaningful occupations enhances ones’ sense of identity and individual potential for self-actualization, which are domains that can be seen as inherently subjective and qualitative and, in favour of Hammell’s (2004) statement, contribute to the content of ones’ life as well as ones’ sense of wellbeing and experience of QOL.