PURPOSE: The purpose of this study was to determine whether therapists are addressing a client’s ability to participate in religious observance and, if they are, how they are addressing it in practice.

RATIONALE: In 2008, the Occupational Therapy Practice Framework: Domain and Process (2nd ed.) document introduced religious observance as an instrumental activity of daily living (IADL) within the profession’s scope (American Occupational Therapy Association [AOTA], 2008). This was not surprising; religious observance serves to organize life for many and creates opportunities for connection to something greater than one’s self that are central to purpose and meaning. Religious observance has been shown to influence a person’s health and quality of life, yet there is a paucity of literature related to the profession’s role in facilitating participation in religious observance. Religion is a controversial topic that therapists have been hesitant to address (Engquist, Short-Degraff, Gliner, & Oltjenbruns, 1997; Farrar, 2001). Has inclusion in the Framework served as an impetus for change?

DESIGN: A descriptive survey design was used to explore the beliefs and practice behaviors occupational therapists have regarding their role in addressing a client’s ability to participate in religious observance.

METHOD: The mailing addresses of 1,000 randomly selected currently practicing U.S. occupational therapists were purchased from AOTA. Therapists were sent a URL and password and asked to complete an online survey. The survey instrument consisted of 17 demographic, Likert-type, and multiple-choice questions yielding quantitative and qualitative data.

ANALYSIS: The quantitative data were analyzed using SPSS. It was hypothesized that a correlation between geographic practice region and practice behavior would exist, but no significant relationships were found. Qualitative data were coded by three researchers. Themes were created on the basis of the frequency of codes.

RESULTS: The survey had an 18.2% response rate with 181 completed surveys. Only 13% of respondents were employed by religious organizations. The sample included respondents practicing in all major U.S. geographic regions. The study revealed that 76.8% of respondents agreed that it is important to address a client’s ability to participate in religious observance. Almost 70% of respondents agreed that occupational therapists were qualified to address a client’s ability to participate in religious observance, yet the majority of respondents indicated that they “never” or “rarely” assessed or addressed (“never” = 25.4% and 28.2% and “rarely” = 27.6% and 33.7%, respectively) this IADL in practice. The reason most frequently cited (77%) for this was that this IADL was not identified as a priority by the client. Furthermore, many indicated that they do not broach the topic, leaving the client to initiate its discussion.

Analysis of the qualitative data revealed that whether religious observance was addressed was based in two themes: the client and the context in which services were offered. Analysis regarding how therapists addressed religious observance in practice revealed three themes: consultation, direct intervention, and indirect intervention.

IMPACT STATEMENT: Therapists remain reluctant to broach the topic of religious observance with clients. Qualitative insights revealed that a minority of therapists have adopted the perspective that addressing religious observance does not require discussion of religious beliefs, morals, or one’s purpose in life. Further research is necessary to develop best-practice guidelines but helping therapists to adopt a procedural- and task analysis-based approach to this IADL may result in more occupational therapists addressing this occupation in practice.

American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683. http://dx.doi.org/10.5014/ajot.56.6.609

Engquist, D. E., Short-Degraff, M., Gliner, J., & Oltjenbruns, K. (1997). Occupational therapists’ beliefs and practices with regard to spirituality. American Journal of Occupational Therapy, 51, 173–180. http://dx.doi.org/10.5014/ajot.51.3.173

Farrer, J. (2001). Addressing spirituality and religious life in occupational therapy practice. Complementary Therapies in Geriatric Practice: Selected Topics, 18(4), 65–85. http://dx.doi.org/10.1080/J148v18n04_06