MoHO

Model of Human Occupation (MoHO)

The core concepts of the Model for Human Occupation (MoHO) are environmental impact, volition, habituation, performance capacity, participation, performance, skills, occupational identity, and occupational competence (Kielhofner, 2008). As a person engages in occupation, their performance is influenced by these internal and external factors, including their environmental contexts and personal attributes. To perform this occupation, the person must adapt to the various contexts and factors within which it occurs.

Those living with serious illness often experience changes in health and well-being, including their functional abilities. With decreased functional capacity comes the opportunity (and necessity) for occupational adaptation in order to maintain performance capacity to a degree that the person finds satisfactory. Indeed, one of OT’s primary roles in end-of-life care is occupational adaptation: collaborating with clients and caregivers to increase satisfaction in occupational performance and participation in life. The core concepts and focus of MoHO align with the needs of clients utilizing end-of-life care services and the OT practitioners delivering them.

Figure. One visualization of MoHO core concepts and two sub-concepts most relevant to caring for seriously ill clients.

References. (Kielhofner, 2008; Turpin & Iwama, 2011)

Graphic by OTpall using Canva Pro (2023)

Two MoHO sub-concepts have particular relevance to this patient population. First is the philosophy of the lived body as the “the vehicle through which life is lived and performance is experienced” (Turpin & Iwama, 2011, p. 144). The body is the backdrop for occupation; it is how humans experience the world around us and participate in life. When impairments or other impacts to health change the body’s capacities, “the body often comes to the foreground” (Turpin & Iwana, 2011, p. 144) and shifts focus away from occupation. For those living with serious illness, whose bodies and health are anticipated to change, the experience of the lived body is very much in the foreground and should be attended to as part of the whole.

Second is MoHO’s emphasis on a lifespan perspective in which people are understood to “conduct and draw meaning from life by locating themselves in unfolding narratives that integrate their past, present, and future selves” (Kielhofner, 2008, p. 110). People with serious illness may be confronted by the possibility that their disease will result in death. Existential distress and mental illness are not uncommon experiences for clients using hospice or palliative care services (National Consensus Project for Quality Palliative Care, 2018) and OT can support these clients in processing these experiences, seeking closure, and making practical preparations (American Occupational Therapy Association, 2016; Bye, 1998; Hammill et al., 2019; Jacques & Hasselkus, 2004; Park Lala & Kinsella, 2011). For example, using craft-based occupations to engage in legacy work (la Cour et al., 2007). When faced with health deterioration or death, clients may reflect on their lives; their hopes, goals, accomplishments, and regrets. Approaching care from a lifespan perspective creates space for the client’s personal narrative and can bring meaning to life and closure in death.

Lastly, in their reflection on the role of MoHO in palliative care, Costa and Othero (2012) assert that practitioners using MoHO should approach illness, dying, and death from a cultural perspective. Citing work by Chattopadhyay and Simon (2008), Costa and Othero (2012) defined culture as “the context in which individuals experience life and understand the moral meaning of illness, suffering, and death” (p. 322). Culture influences the kind of activities a client may choose to participate in and how they prioritize engagement. Every culture has its own beliefs, customs, and expectations around, for example, how to care for the ill (and who should do the caring), what spiritual needs must be met when death may be imminent, and who should be present when a client dies. For OT practitioners to provide truly client- and family-centered care, a client’s culture and cultural schemas should be well-considered and incorporated into care. 

References

American Occupational Therapy Association. (2016). The role of occupational therapy in end-of-life care. American Journal of Occupational Therapy, 70(Suppl. 2), 1-16. https://doi.org/10.5014/ajot.2016.706S17 

Bye, R. A. (1998). When clients are dying: Occupational therapists' perspectives. Occupational Therapy Journal of Research, 18(1), 3-24. https://doi.org/10.1177/153944929801800101

Chattopadhyay, S., & Simon, A. (2008). East meets West: Cross-cultural perspective in end-of-life decision making from Indian and German viewpoints. Medicine, Health Care, and Philosophy, 11(2), 165–174. https://doi.org/10.1007/s11019-007-9106-y 

Costa, A., & Othero, M. (2012). Palliative care, terminal illness, and the Model of Human Occupation. Physical & Occupational Therapy in Geriatrics, 30(4), 316-327. https://doi.org/10.3109/02703181.2012.743205 

Hammill, K., Bye, R., & Cook, C. (2019). Occupational engagement of people living with a life‐limiting illness: Occupational therapists’ perceptions. Australian Occupational Therapy Journal, 66(2), 145–153. https://doi.org/10.1111/1440-1630.12557

Jacques, N. D., & Hasselkus, B. R. (2004). The nature of occupation surrounding dying and death. Occupational Therapy Journal of Research, 24(2), 44–53. https://doi.org/10.1177/153944920402400202

Kielhofner, G. (2008). A model of human occupation: Theory and application (4th ed.). Lippincott Williams & Wilkins.

la Cour, K., Josephsson, S., Tishelman, C., & Nygård, L. (2007). Experiences of engagement in creative activity at a palliative care facility. Palliative & Supportive Care, 5(3), 241–250. https://doi.org/10.1017/S1478951507000405

National Consensus Project for Quality Palliative Care. (2018). Clinical practice guidelines for quality palliative care (4th ed.). National Coalition for Hospice and Palliative Care. https://www.nationalcoalitionhpc.org/ncp

Park Lala, A., & Kinsella, E. A. (2011). A phenomenological inquiry into the embodied nature of occupation at end of life. Canadian Journal of Occupational Therapy, 78(4), 246-254. https://doi.org/10.2182/cjot.2011.78.4.6

Turpin, M., & Iwama, M. K. (2011). Using occupational therapy models in practice: A field guide. Elsevier Ltd. 

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