Scandinavian Journal of Occupational Therapy. 2014; 21: 415–420

ORIGINAL ARTICLE

Exploring occupational balance in adults in Sweden

PETRA WAGMAN1 & CARITA HÅKANSSON2

1Jönköping University, School of Health Sciences, Sweden, and 2Division of Occupational and Environmental Medicine,Lund University, Sweden

AbstractAim: The aim of this study was to describe the relationship between occupational balance (measured by the occupationalbalance questionnaire [OBQ]) and self-rated health and life satisfaction. A secondary aim was to explore differences inoccupational balance among adults in Sweden. Methods: The 153 participants (63% women), recruited using conveniencesampling, answered a questionnaire comprising demographic questions, the OBQ, one item about self-rated health, and oneabout life satisfaction. The OBQ was analysed for correlation with subjective health and life satisfaction. The OBQ and itsindividual items were also analysed for correlations with age and for differences between men and women and participantsliving with children younger than 18 years versus not. Results: The OBQ was significantly positively correlated to self-ratedhealth and life satisfaction, supporting the relationship between occupational balance and health. No significant correlationbetween age and the total OBQ was identified but some differences in occupational balance, related to whether the participantwas living with or without children at home, were revealed. Conclusions: The results should be interpreted with caution due tothe nature of the sample and data but they can serve as a point of departure for further studies and hypotheses regardingoccupational balance in different populations.

Key words: Occupational Balance Questionnaire, health and well-being, demographic differences, cross-sectional study

Introduction

Occupational balance is a core concept in occupa-tional therapy and a common philosophical assump-tion is that “a balance of occupations is beneficial tohealth and well-being” [ (1), p. 432]. The relationshipbetween occupational balance and health has alsobeen shown empirically. Participants in qualitativestudies have described occupational balance as relatedto health and well-being (2-5) and occupationalbalance has been recognized as a health determinant(6). Results of quantitative studies over the years havealso supported the relationship with subjective health/well-being. One of the first empirical investigations ofoccupational balance researched current and desiredparticipation in physical, mental, social, and restoccupations. Among the results was the findingthat the less difference between these occupational

patterns, the healthier the participants rated them-selves as being (7). Furthermore, a study of womenfrom the general population, which aimed to examinethe relationship between health and the participants’experience of their occupational pattern, includedquestions about occupational balance. The resultsshowed that participants with higher occupationalbalance were more likely to rate high life satisfaction(8). Similarly, a longitudinal study with workingmen and women identified occupational balanceamong the predictors of good subjective health (9).The relationship between occupational balance andhealth/well-being is also seen in studies amongsamples sharing a health condition. One of the resultsin a study among participants with schizophrenia wasthat participants who had occupational balance ratedtheir quality of life and well-being higher than didthose who were under-occupied (10). Finally, general

Correspondence: Petra Wagman, Jönköping University, School of Health Sciences, Box 1026, SE-551 11 Jönköping, Sweden. E-mail: petra.wagman@hhj.hj.se

(Received 20 August 2013; accepted 10 June 2014)

ISSN 1103-8128 print/ISSN 1651-2014 online � 2014 Informa HealthcareDOI: 10.3109/11038128.2014.934917

health was found to be a predictor of occupationalbalance among men and women with rheumatoidarthritis (11).Taken together, studies support the relationship

between occupational balance and health/well-beingbut because occupational balance has been concep-tualised and measured differently it is impossible toaccumulate evidence from multiple studies, implyinga serious limitation. Therefore, future studies wouldbenefit from using common conceptualisations andmeasurements. In this study occupational balance isresearched using the relatively new OccupationalBalance Questionnaire [OBQ (12)] which is intendedto be generic i.e. possible to use generally and notlimited to a certain diagnosis or similar and, therefore,has the potential to be one common measurement ofoccupational balance. The conceptual frameworkfor the instrument,“focuses on the variation in theoccupational pattern, the amount of each occupation,as well as the total amount of occupations in relationto the available resources” (p. 228), and is based onresults among empirical studies as well as a conceptanalysis of occupational balance (12). The latterdefined occupational balance as “the individual’ssubjective experience of having the right amount ofoccupations and the right variation between occupa-tions in his/her occupational pattern” (13).Furthermore, in order to gain further knowledge

about occupational balance it would be valuableto explore potential differences in people with differ-ent demographic characteristics. Occupationalpatterns have been found to differ in differentsocio-demographic groups and it is possible that thesedifferences affect occupational balance and, hence,that people also differ in level of occupational balance.Erlandsson et al. (14) revealed differences betweenwomen in two age groups (38 years and 50 years)regarding disturbing interruptions in their occupa-tions: the younger women perceived more frequentinterruptions than the older ones. Perhaps this is anexample of something affecting occupational balanceand, potentially, that age differences in occupationalbalance exist and should be explored. Occupationalpatterns have also been shown to differ between menand women, making investigation of potential genderdifferences in occupational balance relevant. StatisticsSweden (15) had over 7000 men and women (15–84years) keep a time diary for one weekday and one dayof the weekend within a two-week period. This wasfollowed by an interview and differences wererevealed. For instance, working-age men spentmore time in paid work than women who, in turn,spent more time in unpaid work. Women were alsoinvolved in housework after their paid work to a higherdegree than men and had more, but shorter periodsof, free time. Moreover, Wada (16) explored

occupational balance in 15 working couples with atleast one child who not yet had begun school. Theiroccupational patterns differed and, for instance, morewomen than men worked part time. Two majoraspects related to balance were identified – “managinglife” and “participating in a mix of occupations” – andthese differed somewhat between men and women.Wada also discussed balance in relation to genderideologies, which may influence howmen and womenrate occupational balance; hence, differences betweenmen and women may exist. However, all Wada’sparticipants were parents (16). Considering thatdifferences in occupational patterns exist betweenthose who have and do not have children (15), it ispossible that parents’ and non-parents’ occupationalbalance differs. Erlandsson et al. (14) revealed differ-ences within the younger age group as well, wherebywomen living with a partner or children rated a higherdegree of interruptions than those without. Moreover,women in Sweden have more sick leave thanmen, andthe gap increases when having children (17,18), espe-cially after the second child (17). This gender differ-ence in sick leave has been discussed as related towomen being responsible for the home as well asworking (17,18) and their workload could be seenas a sign of occupational imbalance.One study has been identified as having a focus on

balance and demography. Matuska et al. (19) inves-tigated the demographics of people answering theLife Balance Inventory (LBI). In their results, differ-ences in life balance ratings were identified in parti-cipants having different gender, age, and parentalsituation among others. The LBI (20), however, isbased on questions regarding satisfaction with timespent in specified occupations. The OBQ providesanother perspective as it does not consider which theoccupations are (Table I), thereby contributing com-plementary information about occupational balance.To summarize, there is a need for continued

research on occupational balance and its relation tohealth and well-being, as well as on differencesbetween people of different ages, between men andwomen, and between parents and non-parents.Therefore, the aim was to describe the relationship

between occupational balance and self-rated healthand life satisfaction as well as to explore potentialdifferences in occupational balance in a sample ofadults in Sweden.

Material and methods

The study had a cross-sectional design and aquestionnaire was used. It included some demo-graphic questions: age, gender, highest education,children younger than 18 years living at home (yes/no [henceforth referred to as children]), occupational

416 P. Wagman & C. Håkansson

balance (12), self-rated health (21), and life satisfac-tion (22).Occupational balance was measured with the OBQ,

comprising 13 items measured on a six-step ordinalscale ranging from “completely disagree” (scored 0)to “completely agree” (scored 5) so that higher ratingindicates higher occupational balance. It can be usedas a summed total score (range 0–65) and item byitem. The OBQ has shown good content validity,internal consistency, and test–retest reliability in asample from the general population (12).Self-rated health was measured by the item “How

do you rate your health in general?” (21) rated on afive-step ordinal scale ranging from “poor” (scored 1)to “excellent” (scored 5), whereby a higher ratingimplies higher self-rated health.Life satisfaction was measured with the item “Life

as a whole is. . .” rated on a six-step ordinal scaleranging from “very dissatisfying” (scored 1) to “verysatisfying” (scored 6), whereby a higher ratingindicates higher life satisfaction (22).

Participants and data collection

A convenience sampling method was used, with thesole inclusion criterion that theparticipantwas18yearsor older. Students recruited participants by askingpeople, mostly at workplaces, at several places inSweden. Potential participants received oral and writ-ten information about the research purpose, content ofparticipation, and how the data would be used. They

were informed that participation was voluntary andthat the questionnaires would be handled with confi-dentiality. Finally, contact information was provided.The participants were given the questionnaire togetherwith a stamped, addressed return envelope. Ofthe 155 questionnaires delivered 153 were returned.

Ethical considerations

The research ethics committee at the School of HealthSciences, Jönköping University, reviewed the studyand raised no objections from an ethical point of view.

Data analysis

Participants’ demographics were described andpotential differences between men and women wereexplored (using the Mann–Whitney U-test andPearson’s chi-square). It was possible to use thesummed total score of the OBQ as the internalconsistency in the present sample (measured withCronbach’s alpha) was 0.918, which is consideredgood (23). Correlation analyses (using Spearman’srho) were conducted between the OBQ and subjectivehealth and life satisfaction.TheOBQand its individualitems were also analysed for correlation with age usingSpearman’s rho as well as for differences (using theMann–Whitney U-test) betweenmen and women andpeople who lived/did not live with children at home.

Results

The participants were between 21 and 64 years old,and most were women. No significant differences

Table I. Content in the OBQ items.

Item Content

1. Balance between doing things for others/for oneself

2. Perceiving one’s occupations as meaningful

3. Time for doing things wanted

4. Balance between work, home, family, leisure, rest,and sleep

5. Balance between doing things alone/with others

6. Having sufficient to do during a regular week

7. Have sufficient time for doing obligatory occupations

8. Balance between physical, social, mental, andrestful occupations

9. Satisfaction with how time is spent in everyday life

10. Satisfaction with the number of activities duringa regular week

11. Balance between obligatory/voluntary occupations

12. Balance between energy-giving/energy-taking activities

13. Satisfaction with time spent in rest, recovery and sleep

Source: Used with permission from Scandinavian Journal ofOccupational Therapy (12).

Table II. Participant demographics.

Men Women p-value

n (%) 56 (36.6) 97 (63.4)

Age in yearsa 0.339b

Min–max 22–62 21–64

Median 37.5 44.5

Mean (SD) 39.8 (11.4) 42.4 (12.8)

Educationa 0.363c

University education 29 57

Otherd 27 39

Childrene <18 at home 0.566c

Yes 20 32

No 31 61

Notes: aOne woman did not answer this question. bMann–WhitneyU-test. cPearson’s chi-square. dIncluding compulsory school, uppersecondary school, residential college for adult education, and other.eFive men and four women did not answer this question.

Exploring occupational balance 417

were identified between men and women regardingtheir age, education, or child situation (Table II).Much of the range in the summed total OBQ

(henceforth referred to as the OBQ) was used,although it was more common to rate high occupa-tional balance. Table III shows the ratings of differentparticipant groups.

Correlations between self-rated health and life satisfactionand OBQ

The Spearman correlations showed that the OBQ wassignificantly positively correlated to self-rated health,0.581 (p = 0.01) and life satisfaction, 0.518 (p = 0.01).The results of the ratings per se of self-rated healthand life satisfaction are given in Table IV.

Relationship between age, gender, children at home, andOBQ

No significant correlation between age and the OBQwas identified. Analysing the individual OBQ itemsfor age correlations in the total sample identified thathigher satisfaction with time use in rest, recovery, andsleep (Item 13) correlated significantly with higher age(rho 0.242 p = 0.004). However, further analysesshowed that the item was only significantly correlatedwith age in women; the highest correlation was amongwomen living without children (rho 0.332 p = 0.012).There were also significant correlations with age insome demographic groups on three other items, nos8, 10, and 12 (Table V).There were no differences in the summed OBQ

identified between men and women or betweenparticipants who lived with children versus thosewho did not. However, there was a tendency towarda difference in OBQ ratings between women livingwith children (median 38.5) and women not livingwith children (median 45) (p = 0.052).Among the individual OBQ items, no differences

between men and women were identified in the totalsample. However, analyses for differences betweenparticipants living with and without children revealedthat those who lived with children rated significantlylower in Items 3–5.When separating men and women,two differences in women remained plus onenew one (Item 6) but only one in men (Item 3),Table VI.

Discussion

Although the roots of occupational balance can betraced back to Meyer in 1922 (24) there is still a needfor further knowledge concerning this core concept inoccupational therapy. The need to research occupa-tional balance in people not sharing a health condition

Table III. OBQ ratings in different participants.

OBQMin–max

(range 0–65) Median Q1–Q3

Total 11–64 42 35–47

Men (n = 49) 18–56 40 35–44.5

Women (n = 94) 11–64 43 35–47

University education (n = 83) 17–64 43 35–47

Other education (n = 59) 11–57 41 35–47

Living with children (n = 47) 11–52 40 34–45

No children (n = 87) 15–64 42 35–47

Table IV. Results of self-rated health and life satisfaction.

Min–max (range) Median Q1–Q3

Self-rated health 1–5 (1–5) 3 3–4

Life satisfaction 2–6 (1–6) 5 4–5

Table V. Significant relationships between some of the items and age.

Item All menMen living

with childrenMen living

without children All womenWomen living with

childrenWomen living

without children

8. Balance betweenphysical, social, mental, andrestful occupations

rho –0.385 p = 0.039

10. Satisfaction with thenumberof occupations

rho 0.350 p = 0.049

12. Balance betweenenergy-giving/energy-takingoccupations

rho –0.346p = 0.015

rho –0.425 p = 0.022

13. Satisfaction with timeuse in rest, recovery, andsleep

rho 0.261 p = 0.011 rho 0.332 p = 0.012

418 P. Wagman & C. Håkansson

has also been emphasized (4). The aim of this studywas to describe the relationship between occupationalbalance (as measured with the OBQ) and self-ratedhealth and life satisfaction as well as to explore poten-tial differences in occupational balance in a sample ofadults in Sweden. The results showed that fewparticipants rated low occupational balance, self-ratedhealth, and life satisfaction.Another result was the finding that occupational

balance significantly correlated to self-rated healthand life satisfaction, which supports the relationshipbetween occupational balance and health. The factthat the correlations were high but not were very highis interesting as this also indicates that occupationalbalance is a health-related construct but not thesame as health or life satisfaction. This is furtheremphasized considering that the correlation betweenself-rated health and life satisfaction (also related butnot the same) was about the same as their correla-tions with occupational balance (not shown in theresults).Regarding differences in occupational balance, no

age correlation or difference between people withdifferent demographics was identified in the summedOBQ. Further research is necessary to investigatewhether this also holds true in other samples. Amongthe individual items, however, there were correla-tions between age on four items and differences onanother four. The differences are interesting, as theyseem to concern whether or not the participant wasliving with children younger than 18. This is in linewith the results of Matuska et al. (19) who identifiedlower life balance among participants who had chil-dren living at home. Furthermore, Erlandsson et al.(14) identified differences in the number of inter-ruptions between younger women living with chil-dren or a partner or not and it can be speculated thatthis affects occupational balance. The speculation isin line with one result in a study among workingadults where being frequently interrupted and dis-turbed was an example of something affecting lifebalance negatively from a short time perspective (5).

Further knowledge about occupational patterns andbalance, and similarities and differences among maleand female parents is thus very important as it canalso contribute to shedding light on the fact thatmothers in Sweden have more sick leave than fathers(17,18).

Methodological considerations

A small convenience sample of adults in Sweden, withmore women than men participating, was used, whichinfluences the validity. There is a need for furtherstudies including more participants and usingrandomized recruiting.It should also be recognized as a limitation that it

cannot be ruled out that the differences in the resultsmay have been affected by circumstances notaccounted for. The exploration of occupationalbalance also included many analyses without correc-tion for mass significances. In other words, there maybe more or fewer differences than were revealed.Altogether, this implies that the results should beviewed with caution and cannot be generalized.They can better be used as a base for further studiesand for potential hypotheses regarding occupationalbalance in different populations.

Conclusion

The results showed support for the relationshipbetween occupational balance and health and well-being as occupational balance (measured with theOccupational Balance Questionnaire) correlated toboth self-rated health and life satisfaction. The sizeof the correlations indicates that occupational balanceis a health-related construct but not the same as healthor life satisfaction. Some potential differences relatedto whether the participant was living with children ornot were revealed. However, the results should beinterpreted with caution as the sample was small andmany analyses were conducted. The results cannot begeneralized, but may serve as a point of departure forfuture studies.

Acknowledgement

The authors would like to thank former studentsSandra Jönsson, Karoline Karlsson, Evelina Linde,Maria Linder, Lena Magnusson, and EmelieRynningsjö, who collected the data.

Declaration of interest: The authors report noconflicts of interest. The authors alone are responsiblefor the content and writing of the paper.

Table VI. Significant differences in OBQ ratings betweenparticipants living with and without children.

ItemTotal sample

(p)Men(p)

Women(p)

3. Time for doing thingsone wants

< 0.001 0.003 < 0.001

4. Balance between work,home, family, leisure, rest,and sleep

0.047

5. Balance between doingthings alone/with others

0.015 0.033

6. Having enough to do 0.020

Exploring occupational balance 419

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