Occupational Disruption: An Undeniable Reality for Occupational Beings, Part II

 Ricardo C. Carrásco, PhD, OTR/L, FAOTA

Shirish Lala, EdD, MHS, OTR/L

Structure in El Maní, Sabanetos, Mayagüez, Puerto Rico destroyed by Hurricane Maria in September 2017. https://www.weather.gov/images/sju/Huracanes/Maria/damages/Slide134.JPG

Abstract

Part I of this article differentiated occupational disruption from occupational deprivation and occupational dysfunction. The descriptive paper brought forward information and examples of occupational disruption to understand what the term means, how it evolved , and measure the severity of its occurrence, to facilitate necessary adaptations. The previous article provided historical underpinnings with real life examples of occupational disruption to illustrate our efforts to not only understand the human experience, but also assess the extent and severity of disruption, and intervene as occupational therapy practitioners. Part II reintroduces the Scale of Occupational Disruption as an innovative and inclusive assessment to detect the incidence and severity of occupational disruption. It provides some examples of how the scale has been used in research and capstone projects that were implemented in various settings and on different populations. Studies on the validity and reliability of the scale are in progress, and results are being disseminated in the United States and other places of the world.

Keywords: occupational disruption, life altering events, Scale of Occupational Disruption

Introduction and Background

The Scale of Occupational Disruption 

The Scale of Occupational Disruption (SOD) had its beginnings from a personal near death experience wherein the primary author’s recovery was punctuated with self-prescribed occupational strategies and intentional process of recovery (Carrasco, 2008).  The experience  illustrated how a negative occupational disruption (OD) can trigger resilience when an individual activates adaptation strategies that employ the power of doing. The experience served as an impetus later for a doctoral project which postulated that humans have an inherent potential to recover from the effects of a life-altering event or occupational chaos. The narrative inquiry revealed the innate resilience of research subjects to reconstruct their lives. Those who practiced mindfulness activities were  more likely to resolve their occupational chaos and achieve the necessary occupational reconstruction as compared to others (Carrasco, et al, 2018)  The project provided narratives of  research subjects with  life-altering experiences that were prodeminantly negative, such as experiencing loss of a loved one, divorce, or being diagnosed with breast cancer, stroke, or an immunocompromised condition. However, OD can be experienced in case of positive events such as getting  married, adopting  a baby, or moving to a new country. In either case, unexpected or expected events can disrupt human existence and impact their  performance across areas such as finances, social relationships, exercise, personal relationships, exercise —all of which are included on the SOD 

In the previous decade and early 2020’s, initial versions of the SOD were published by the primary author and his students.  One such study collected responses from 51 students who lived in Puerto Rico where Hurricane Maria (2017) made landfall. The project employed an online survey with the original SOD instrument and structured interviews to study the extent of disruption experienced due to the storm. The original scale (Carrasco et al,, 2018) had 13 items, divided into 4 sections: a) basic needs, b) student identity, c) transportation, and 4) occupational balance (OB).  Despite no information available on its pyschometric properties and sensitivity, the authors found that the orginial version of the SOD was effective in measuring the incidence and severity of OD experienced in Puerto Rico (Carrasco, et al, 2018). 

In another study, a modified version of the SOD (Carrasco et al., 2021) investigated the effects of the COVID-19 pandemic on OD, occupational balance (OB), and anxiety among graduate students. A Delphi study with a panel of six subject-matter experts was used to refine the original version of the SOD.  . The experts had extensive experience in areas of occupational transition and questionnaire development. Upon reviewing the original SOD, the panel recommended that we reduce the new version to 10 items which include: (a) finances, (b) exercise, (c) daily routine, (d) personal relationships, (e) time spent with others, (f) community activities, (g) hobbies, (h) spirituality/ religion, (i) academic performance, and (j) eating habits. A Likert-scale from 1–5 was used to measure the severity of OD across the ten items. A score of one on the SOD stands for no disruption experienced whereas that of five represents severe disruption. The 2021 study measured the extent of OD in graduate students associated with, OB, and pandemic-induced anxiety. The revised SOD, Occupational Balance Questionnaire (OBQ-11), and the Coronavirus Anxiety Scale (CAS) were used as the primary instruments for this study, (Wagman & Håkansson, 2014; Lee, 2014). The authors found that OD and OB had an inverse relationship with higher OD scores associated with lower levels of OB reported by the students. A significant positive correlation was noted between OD and  anxiety in students with  high levels of anxiety correlated with severe levels of OD experienced subsequently. The findings from reported adaptation strategies supported the occupational science framework of doing, being, becoming, and belonging, (Wilcock,1999).  This study fueled the primary authors’ efforts for ongoing validation to standardize the SOD and study it’s psychometric properties. 

Meanwhile, other investigators used the SOD as an instrument to measure OD varied  population groups and diverse settings.  One such mixed-methods study delved into the influence of unsanctioned occupations on OD experienced among armed forces personnel stationed at an American military base . The participants were recruited by convenience and snowball sampling. As a part of the inclusion criteria the participating service men disclosed that they had participated in at least one of the following unsanctioned occupations including porn, drugs, and gambling. The mean SOD scores of the 55 participants averaged at 20.28 which depicted  that most participants self-identified that they had  experienced, at minimum, slight OD on each of the 10 items of the SOD.  Moderate to high Pearson’s correlation coefficient (above 0.5) was also found for nine of ten items, with a p value of < 0.001.  The authors found related themes during the qualitative analysis that included the influence of unsanctioned occupations on : (1) healthy habits, (2) balance and time restrictions, and (3) comradery and relationships. The authors also suggested that military service men have increased awareness of how unsanctioned occupations can disrupt their daily routine opportunities. However, they may still choose to engage in their preferred unsanctioned occupations unless it impedes their health, wellness, and employment. (Carrasco, et al, 2023).

Rodriguez (2024) designed a capstone project revolving around the experience of mothers and the extent of OD experienced postpartum.The study administered the SOD to 117 subjects who were at least 18 years of age (mean age=30.5 years). The subjects were primarly English-speaking women who had delivered a baby within a previous 12-month period. The results indicated that the three most disrupted occupations reported by new mothers include: (a) the ability to participate in hobbies, (b) engagement in community activities, and (c) time spent with others. Conversely, the study found that participants did not report higher disruptions in schoolwork, spiritual or religious activities, or paid employment secondary to their role as a parent. . 

Another study investigated the level of OD experienced by athletes after retiring  from active sports (Dell’Arciprette & Dell’Arciprette, 2023).  The subjects included 116 former athletes recruited via social media, and connections with athletic associations. All participants were former athletes with experience performing at the collegiate level or higher. The results indicated that all respondents had  experienced OD when they transitioned to a non-athlete state. The SOD scores revealed five occupation areas with the highest level of disruption: 1) exercise (85%), 2) eating habits (82%), 3) daily routines (77%), 4) hobbies (76%), and 5) sleep (75%). The areas that showed the least amount of disruption were: 1) spirituality/religion (33%) and 2) finances (40%). The study also explored the relationship between OD and athlete mental health .  Dell’Arciprette and Dell’Arciprette reported  that 64% of the participants experienced signs of   depression after termination of their active sports lifestyle. In 2024, as part of their capstone project, Brion and Russo (2024) implemented an intensive mental health program designed for American children, adolescents, and youth whose parents were stationed in Europe. The purpose of their project was to develop mental health and early intervention programming for 2- to 22- year old dependents, of American military personnel who were deployed overseas. The intervention included 3-hour daily occupational therapy sessions for a span of 10-weeks. The authors administered the SOD to parents, teens, and youth to understand the contextual factors that influence the occupational needs of the subjects. The SOD was primarily used as a screening tool to assess the levels of OD, if any, to develop supports and resources that could moderate the effects of the intervention 

In addition, the SOD was recently employed as one of the instruments to identify referral opportunities for chiropractic services for pain management. The SOD and the Modified Barthel Index, Soumajal, et al, 2023) were administered concurrently on 25 patients during their intake assessment to determine the extent of OD they experienced in their activities of daily living. The patients were between the ages of 25 and 76 years, 19 out of 25 experienced pain. The SOD results revealed that subjects experienced elevated scores, particularly in the areas of hobbies, exercise, and sleep. The patients were also referred to occupational therapy, after they received chiropractic care. 

Conclusion:

The SOD is a self-report scale used to determine the incidence and severity of a life-altering event. The scale assumes that humans experience life transitions that may be positive or negative, resulting in some type of disruption of typical habits, routines, or roles. The instrument has the potential of contributing to occupational science in understanding the experience of occupational disruption and the inherent resilience of the human being to employ occupations to resolve life challenges. 

The 10 items of the SOD were developed by a panel of experts in a Delphi study. The latest version of the SOD features 10 items rated using a Likert scale from no to severe disruption represented on a numerical scale of 1 – 5. The ten items include: a) finances, 2) exercise, 3) daily routine, 4) personal relationships, 5) time spent with others, 6) community activities, 7) hobbies, 8) spirituality/religion, 9) academic performance, and 10) eating habits. The SOD assists in identifying the level of OD caused by a life-altering event. The results of the SOD may be instrumental in knowing the type and severity of OD experienced, and in what specific areas everday living. This article showcased two applications of the SOD across diverse age ranges and conditions : 1. as a screening tool for deficits due to pain and for implementing mental health  programs among youth and adolescents for ex-patriot families (Royer, 2023; Dell’Alciprete, 2023; Rodriguez, 2024; & Russo, 2024); 2. as an assessment of disruption in a sports-related engagement, and measuring  OD in women post-partum.  While still in development, the SOD offers promise in identifying occupational challenges in various settings and populations served by occupational therapy 

Figure 1

The Scale of Occupational Disruption

 Findings support the underpinnings of a basic science since the inception of OS in the 1980s. Still there is a gap in the literature how to measure the incidence and severity of OD as experienced by humans. Recent literature is paving the way to resolving this gap.  For example, a reflection paper on OD and self-initiated occupational reconstruction strategies served as an inspiration for several studies on the topic (Carrasco, 2008).  To date, few other studies have added to the literature (Carrasco et al, 2018, 2021, 2022, 2023, 2024, Carrasco & Lala, 2024). Encouraging results suggest an evolving psychometric validity of the SOD, including the current initial validity and reliability studies being conducted by a cohort of university researchers. Dissemination has included publications and presentations during state conferences, as well as an international occupational therapy congress to inform occupational scientists and occupational therapists about the background and thebapplication of the scale. Further studies are planned, including data collection in various locations in the world. An unofficial version of the SOD is featured with this article, and the reader is encouraged to contact the primary author to request permission and training on the use of the instrument. Collaborative studies are welcome.

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