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Letter to the Editor

To the Editor: We would like to comment on the article of Forhan and Backman (2010) entitled “Exploring Occupational Balance in Adults With Rheumatoid Arthritis.” We enjoyed reading this interesting article and analysis on occupational balance in people with rheumatoid arthritis. Occupational balance is—in our opinion—an important concept in occupational therapy. Equally important is the collection of empirical data about this still rather theoretical concept. However, concerning the analysis described in the article, we would like to raise some issues for discussion based on our own research on occupational balance. Most of the existing theories about occupational balance that are also cited in this article are based on theoretical assumptions rather than on extensive empirical data or research. Research previously conducted by us using semistructured interviews with people with rheumatoid arthritis revealed that the current definitions of occupational balance are not congruent with the clients’ experiences and are subsequently less applicable in clinical practice in rheumatology (Stamm et al., 2004). We would argue therefore that occupational balance needs more exploration before it can be used or measured in clinical practice or research. Based on our research, we challenge the following statement in the article “[p]rior to the exploration of factors that contribute to occupational balance, ways of measuring occupational balance need to be identified” (Forhan & Backman, 2010, p. 134), and would rather suggest the opposite approach: ”prior to defining ways of measurement, factors that contribute to occupational balance need to be identified.” In embracing our suggestion, we conducted a qualitative project using narrative biographic methodology to explore inductively how people with rheumatoid arthritis understand occupational balance and what meaning our participants associate with this concept (Stamm et al. 2008). Forhan and Backman describe occupational balance as comprising three dimensions: the satisfaction to perform the “main occupation,” which is later referred to as “work”; the satisfaction with time spent on occupations; and the satisfaction with the day’s accomplishment. We also have some reflections on these dimensions based on our previous study (Stamm et al., 2008). In reference to the first dimension, some participants in our study who retired early due to impact of their disease were relieved after leaving their job because they experienced their job as unsatisfying. We acknowledge that their experiences may have been influenced by the tight social security system in Austria. Nevertheless, such findings still raise an interesting perspective on paid work and challenge whether paid work is as important as often implied in the Western society and research. This line of thought also leads to some reflections on the second dimension of occupational balance proposed by Forhan and Backman. We would argue that asking people about their satisfaction with the balance of time spent on work, self-care, leisure, and rest leads to a categorization in which certain occupations are difficult to capture, such as commuting to work, child care, or care for a significant other. We suggest that documenting only the time spent in certain occupations does not broaden our understanding on how people coordinate and experience their occupations. Finally, the third dimension—satisfaction with the day’s accomplishments—may direct toward an underlying implicit expectation that people have to be successful when doing something, which may overemphasize the outcome rather than the process of the individual’s engagement in occupations. Based on these three reflections, we challenge the understanding of occupational balance as described by Forhan and Backman because their theoretical approach appears to be informed by an abstract, conceptual, and theoretical view that comprises values set by white, able-bodied men. For women, older people, and people with disabilities, aspects of occupations that are not captured in their conceptualization may be equally important (e.g., household tasks in addition to paid work, raising children, caring for other people, finding other challenges in mastering their chronic disease, and dealing with social security and insurance institutions). In building on our comments and reflections, we think that more creativity and diversity in research approaches are needed to define factors that contribute to occupational balance before we can eventually measure this concept.