Scandinavian Journal of Occupational Therapy. 2014; 21: 227–231
ORIGINAL ARTICLE
Introducing the Occupational Balance Questionnaire (OBQ)
PETRA WAGMAN1 & CARITA HÅKANSSON2 1
Jönköping University, School of Health Sciences, Jönköping, Sweden, and 2Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
Abstract Objective: The concept of occupational balance is frequently used in occupational therapy but the fact that it has been defined and measured differently is a limitation. This article introduces the Occupational Balance Questionnaire (OBQ), which focuses on satisfaction with the amount and variation of occupations. It consists of 13 items measured on six-step ordinal scales. It has shown good content validity in a sample of 21 occupational therapists but other psychometric properties have not been investigated. The aim was to investigate the OBQ regarding internal consistency, test–retest reliability, and floor/ceiling effects. Methods: The OBQ was administered twice to a sample selected through convenience sampling. Internal consistency was investigated by Cronbach’s alpha and test–retest reliability analysed with Spearman’s Rho correlation for the total score and weighted kappa on each item. Potential floor/ceiling effects were explored by checking for the percentage of participants who scored lowest and highest. Results: The results demonstrated that the OBQ has good internal consistency (Cronbach’s alpha 0.936) and sufficient test–retest reliability (Spearman’s Rho for the total score was 0.926) and, thus, seems stable over time. No floor or ceiling effect was detected. Conclusions: The OBQ therefore showed promising reliability, although further instrument development studies to examine its construct validity are required.
Key words: validity, reliability, occupational therapy, instrument development
Introduction Occupational balance has a long history (1) but is still a frequently used concept in occupational therapy – only during the past few years has it appeared in publications related to several populations: people with a common diagnosis (2–4), students with disabilities (5), retirees (6), and women in a general population (7). However, it is a limitation that occupational balance has not been operationalized and measured coherently. This makes it difficult to compare results from different studies, adding to earlier criticism (8,9). A new instrument is introduced, the Occupational Balance Questionnaire (OBQ). The conceptual framework for this instrument is based on results from previous research, in the form of perceptions of balance in different groups (10–12). In focus-group interviews with women recovering from a stress-
related disorder, the results identified the importance of strategies to manage and control everyday life; a harmonious occupational repertoire; and engaging in personally meaningful occupation (10). In another study, individual interviews were conducted among working men and women with no recent long-term sick leave. These participants stressed the importance of different dimensions of balance: activity balance, balance in body and mind, balance in relation to others, and time balance (12). Moreover, in a study researching what is considered more or less important for life balance, one of the four different viewpoints identified concerned occupational balance. This viewpoint highlighted, for instance, the importance of balance between work, home, family, and leisure occupations as well as having sufficient time for mandatory and voluntary occupations (11). The conceptual framework proposed is also based on a concept analysis of occupational balance defining it as
Correspondence: Petra Wagman, Jönköping University, School of Health Sciences, Box 1026, SE-551 11 Jönköping, Sweden. E-mail: [email protected] (Received 19 September 2013; accepted 28 February 2014) ISSN 1103-8128 print/ISSN 1651-2014 online 2014 Informa Healthcare DOI: 10.3109/11038128.2014.900571
228
P. Wagman & C. Håkansson
“the individual’s subjective experience of having the right amount of occupations and the right variation between occupations in his/her occupational pattern” [(13), p. 326]. Concept analysis has been described as a valuable tool for developing instruments (14). Taken together, the conceptual framework proposed in the present article focuses on the variation in the occupational pattern, the amount of each occupation, as well as the total amount of occupations in relation to the available resources, and the meaningfulness in the occupations. It is hypothesized that all these aspects are necessary for an individual to perceive occupational balance. The importance of this perspective on occupational balance has also gained support in the results of studies among general groups (15,16) and populations facing health conditions: people with severe mental illness (17), systemic sclerosis (18), and rheumatoid arthritis (19). The OBQ has been under development for some time. Different prototype versions of the instrument were developed and discussed between the authors before the content and design of the initial version of the instrument were established. An expert panel composed of occupational therapy researchers, occupational therapists, and people representative of the target group gave the authors reiterated feedback. The first evaluation focused on the extent to which the scale appears to represent the construct of occupational balance (face validity) (20). Whether the items were unambiguous, clear, easy to understand, and made sense to the participants was also reviewed as well as the choice of response options. The next step included a revision of some items and also item reduction, and this led to the present version of OBQ consisting of 13 items (presented in Table II in the Results section) where the participant rates his/ her current occupational balance. Each item is measured on a six-step ordinal scale, ranging from “completely disagree” (scored 0) to “completely agree” (scored 5). A higher rating indicates higher occupational balance. The OBQ is intended to be possible to analyse both on item level and as a summed total score (ranging from 0 to 65 where higher score indicates higher occupational balance). The content validity of the OBQ has been examined in a sample of 21 occupational therapists in different ages. These participants either worked clinically or worked as university teachers (in some cases also as researchers) in occupational therapy and were recruited using convenience sampling. They were asked to rate the relevance of each item on a content validity index (CVI). This was conducted on a four-step ordinal scale ranging from “completely irrelevant” to “completely relevant”. Thereafter, the proportion of participants who rated the two highest options was investigated and compared with the
proportion rating the two lowest options, resulting in a value ranging from 0.0 to 1.0. The CVI should exceed 0.78 for individual items (when 6–10 people rate) and the scale’s average CVI should be at least 0.90 (21). The results of the content validity index for individual items in the OBQ ranged from 0.71 (only one item below 0.78) to 1.0 and the whole scale had an average of 0.90. Therefore, the OBQ is considered to have good content validity. However, psychometric properties of the OBQ such as internal consistency and stability, i.e. test– retest reliability, need to be explored (22). Another potential issue not yet investigated is whether the OBQ has any floor and/or ceiling effect, i.e. a high proportion of participants rating lowest or highest (20). A high floor effect implies a risk that decreased occupational balance would not be revealed and a ceiling effect that increased occupational balance is missed. This needs to be explored in order to evaluate the OBQ’s usefulness. The aim was therefore to investigate the OBQ regarding internal consistency, test–retest reliability, and floor/ceiling effects. Material and methods Participants and data collection The inclusion criterion for participating was being 18 years of age or older. The participants were recruited by convenience sampling methods using the authors’ network. The participants received written information about the purpose and content of the research, voluntary participation, contact information, and how the data should be handled and used. The questionnaire, including demographic questions (gender, age, and education) together with the OBQ, was administered on two occasions. There was an approximately one-week interval between distribution of the first and the second questionnaire. The participants received each of them together with information and a stamped addressed return envelope. The questionnaires were numbered to enable answering anonymously while also ensuring that questionnaires from the same participant were handled together. They were distributed to 80 participants. Of these, 67 returned both questionnaires and these participants were included in the analysis. Ethical considerations This study was reviewed by the research ethics committee of the School of Health Sciences, Jönköping University, which raised no objections.
The Occupational Balance Questionnaire Table I. Participant demographics (n = 67). Participants1 Gender (n): Men (%)
19 (29.7)
Women (%)
45 (70.3)
Age (in years) Mean (SD)
49.6 (11.3)
Median
49.0
Education (n): Compulsory school (%)
1 (1.6)
Upper secondary school (%)
8 (12.5)
Residential college for adult education (%)
2 (3.1)
University (%)
51 (79.7)
Other (%)
229
education and the sample comprised more women than men (Table I). Their ratings on the summed OBQ (min 0, max 65) varied from 17 to 59 (median 43.5). Separating the genders showed that men had a narrower range (min 26 max 56) than women (17–59) and a lower median (men 38, women 44). Table II gives the results for each individual item. Cronbach’s alpha in the sample was 0.936, reflecting good internal consistency (23). The correlation (Spearman’s Rho) for the total score was 0.926. The individual items’ kappa coefficients varied between 0.61 and 0.83, i.e. from good to very good (24). Finally, no participant rated the lowest or highest score in the summed total score of the OBQ, that is, no floor or ceiling effect was detected.
2 (3.1)
Note: 1Data are missing for three participants.
Discussion
Data analysis The OBQ’s internal consistency was explored using Cronbach’s alpha (22). Test–retest reliability for the summed total score in the OBQ was investigated using Spearman’s Rho. The individual items were analysed using quadratic weighted kappa (22). The OBQ was analysed with regard to floor and/or ceiling effects by controlling the percentage of participants who scored lowest and highest (20). Results The 67 participants (response rate 83.75%) were 26 to 69 years old. The majority had a university
This article presents the new instrument OBQ. It focuses on the satisfaction with amount and variation of occupations, regardless of which they are or how much time each occupation takes. The intention with this focus is that the OBQ should overcome the fact that occupations may have different values for different people (25) as well as the fact that the same category (such as work) can be experienced differently (26). As the OBQ is not based on specified occupations it may also overcome cultural differences of preferring different occupations or time use in, for instance, different countries. The OBQ provides a complimentary perspective to earlier instruments focusing on “amount of time” spent in wanted occupations (27,28) or perceptions of meaningful occupations and need for more
Table II. Content in the OBQ items and their ratings. Item
Content
Min.–max. (0–5)
Median
1.
Balance between doing things for others/for oneself
2–5
3
2.
Perceiving one’s occupations as meaningful
2–5
4
3.
Time for doing things wanted
1–5
3
4.
Balance between work, home, family, leisure, rest, and sleep
0–5
3
5.
Balance between doing things alone/with others
1–5
3
6.
Having sufficient to do during a regular week
0–5
3
7.
Have sufficient time for doing obligatory occupations
0–5
3
8.
Balance between physical, social, mental, and restful occupations
1–5
3
9.
Satisfaction with how time is spent in everyday life
1–5
3
10.
Satisfaction with the number of activities during a regular week
1–5
3
11.
Balance between obligatory/voluntary occupations
1–5
3
12.
Balance between energy-giving/energy-taking activities
1–5
3
13.
Satisfaction with time spent in rest, recovery, and sleep
1–5
3
230
P. Wagman & C. Håkansson
meaningful occupations (29). These instruments may be used simultaneously in future studies as together they may provide valuable contributions to the concept of occupational balance. However, it should be recognized that the OBQ does not take into consideration what the occupational pattern looks like as long as the individual is satisfied with it. This increases the need to measure occupational balance in different ways to provide a more comprehensive picture. Furthermore, in the OBQ the participants are instructed to rate their current occupational balance and the meaning of “current” may differ between them, i.e. different time perspectives may exist. Earlier results have shown that people think of balance in different time perspectives (12). Although it can be argued that the current situation is subjective and therefore reflects the participant’s perspective, future studies should be conducted to explore which time perspective is most relevant in relation to occupational balance. Methodological considerations The present results show that the OBQ has good internal consistency in a sample group from the general population as reflected in its Cronbach’s alpha. The results of the test–retest reliability analyses showed that the instrument was sufficiently stable, and so were the individual items, as none had a kappa coefficient below 0.60. However, it should be noted that the sample was recruited using convenience sampling, was quite small and included mostly women and participants with university education. All this influences the external validity. The results need to be replicated in different populations and further studies, evaluating the detailed construct validity of the OBQ, are also needed. For instance, researching whether the OBQ ratings increase during recovery or rehabilitation. Conclusion The OBQ has good internal consistency. It also showed sufficient test–retest reliability and, therefore, seems stable over time. No floor or ceiling effect was detected. Together, these results show promising psychometric properties of the OBQ but further instrument development studies to examine its construct validity are required.
Acknowledgement The authors wish to thank Birgitta Gunnarsson for providing some of the data. This study was
supported by the Swedish Association of Occupational Therapy. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Meyer A. The philosophy of occupation therapy. Am J Occup Ther 1977;31:639–42; reprinted from Arch Occup Ther. 1922;1:1–10. 2. Edgelow M, Krupa T. Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness. Am J Occup Ther 2011;65:267–76. 3. Lund A, Mangset M, Wyller TB, Sveen U. Occupational transaction after stroke constructed as threat and balance. J Occup Sci 2013; [E-pub ahead of print]. 4. Pemberton S, Cox D. Perspectives of time and occupation: experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis. J Occup Sci 2013; [E-pub ahead of print]. 5. Ekelman B, Bazyk S, Bazyk J. The relationship between occupational engagement and well-being from the perspective of university students with disabilities. J Occup Sci 2013;20: 236–52. 6. Jonsson H. The first steps into the third age: the retirement process from a Swedish perspective. Occup Ther Int 2011;18: 32–8. 7. Håkansson C, Björkelund C, Eklund M. Associations between women’s subjective perceptions of daily occupations and life satisfaction, and the role of perceived control. Aust Occup Ther J 2011;58:397–404. 8. Christiansen C. Three perspectives on balance in occupation. In Zemke R, Clark F, editors. Occupational science: the evolving discipline. Philadelphia: F.A. Davis; 1996. p 431–51. 9. Wagman P. Conceptualizing life balance from an empirical and occupational therapy perspective. Jönköping: Jönköping University; 2012. 10. Håkansson C, Dahlin-Ivanoff S, Sonn U. Achieving balance in everyday life. J Occup Sci 2006;13:74–82. 11. Wagman P, Håkansson C, Jacobsson C, Falkmer T, Björklund A. What is considered important for life balance? Similarities and differences among some working adults. Scand J Occup Ther 2012;19:377–84. 12. Wagman P, Björklund A, Håkansson C, Jacobsson C, Falkmer T. Perceptions of life balance among a working population in Sweden. Qual Health Res 2011;21:410–18. 13. Wagman P, Håkansson C, Björklund A. Occupational balance as used in occupational therapy: a concept analysis. Scand J Occup Ther 2012;19:322–7. 14. Walker LO, Avant CK. Strategies for theory construction in nursing. 5th ed. Upper Saddle River, NJ: Prentice Hall; 2011. 15. Håkansson C, Ahlborg G Jr. Perceptions of employment, domestic work, and leisure as predictors of health among women and men. J Occup Sci 2010;17:150–7. 16. Håkansson C, Lissner L, Björkelund C, Sonn U. Engagement in patterns of daily occupations and perceived health among women of working age. Scand J Occup Ther 2009;16:110–17. 17. Argentzell E, Håkansson C, Eklund M. Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scand J Occup Ther 2012;19:49–58. 18. Sandqvist G, Hesselstrand R, Scheja A, Håkansson C. Managing work life with systemic sclerosis. Rheumatol Phys Med 2012;51:319–23.
The Occupational Balance Questionnaire 19. Hjalmarsson Österholm J, Björk M, Håkansson C. Factors of importance for maintaining work as perceived by men with arthritis. Work 2013;45:439–48. 20. Kazdin AE. Research design in clinical psychology. Boston: Allyn & Bacon; 2003. 21. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health 2006;29:489–97. 22. Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 4th ed. Oxford: Oxford University Press; 2008. 23. Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994. 24. Altman DG. Practical statistics for medical research. London: Chapman & Hall; 1991.
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25. Persson D, Erlandsson L-K, Eklund M, Iwarsson S. Value dimensions, meaning and complexity in human occupation: a tentative structure for analysis. Scand J Occup Ther 2001;8: 7–18. 26. Jonsson H. A new direction in the conceptualization and categorization of occupation. J Occup Sci 2008;15:3–8. 27. Matuska K. Description and development of the life balance inventory. OTJR: Occupation, Participation and Health 2012; 32:220–8. 28. Matuska K. Validity evidence of a model and measure of life balance. OTJR: Occupation, Participation and Health 2012; 32:229–37. 29. Eakman A. The meaningful activity wants and needs assessment: a perspective on life balance. J Occup Sci 2013. [E-pub ahead of print]
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ORIGINAL ARTICLE
Introducing the Occupational Balance Questionnaire (OBQ)
PETRA WAGMAN1 & CARITA HÅKANSSON2 1
Jönköping University, School of Health Sciences, Jönköping, Sweden, and 2Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
Abstract Objective: The concept of occupational balance is frequently used in occupational therapy but the fact that it has been defined and measured differently is a limitation. This article introduces the Occupational Balance Questionnaire (OBQ), which focuses on satisfaction with the amount and variation of occupations. It consists of 13 items measured on six-step ordinal scales. It has shown good content validity in a sample of 21 occupational therapists but other psychometric properties have not been investigated. The aim was to investigate the OBQ regarding internal consistency, test–retest reliability, and floor/ceiling effects. Methods: The OBQ was administered twice to a sample selected through convenience sampling. Internal consistency was investigated by Cronbach’s alpha and test–retest reliability analysed with Spearman’s Rho correlation for the total score and weighted kappa on each item. Potential floor/ceiling effects were explored by checking for the percentage of participants who scored lowest and highest. Results: The results demonstrated that the OBQ has good internal consistency (Cronbach’s alpha 0.936) and sufficient test–retest reliability (Spearman’s Rho for the total score was 0.926) and, thus, seems stable over time. No floor or ceiling effect was detected. Conclusions: The OBQ therefore showed promising reliability, although further instrument development studies to examine its construct validity are required.
Key words: validity, reliability, occupational therapy, instrument development
Introduction Occupational balance has a long history (1) but is still a frequently used concept in occupational therapy – only during the past few years has it appeared in publications related to several populations: people with a common diagnosis (2–4), students with disabilities (5), retirees (6), and women in a general population (7). However, it is a limitation that occupational balance has not been operationalized and measured coherently. This makes it difficult to compare results from different studies, adding to earlier criticism (8,9). A new instrument is introduced, the Occupational Balance Questionnaire (OBQ). The conceptual framework for this instrument is based on results from previous research, in the form of perceptions of balance in different groups (10–12). In focus-group interviews with women recovering from a stress-
related disorder, the results identified the importance of strategies to manage and control everyday life; a harmonious occupational repertoire; and engaging in personally meaningful occupation (10). In another study, individual interviews were conducted among working men and women with no recent long-term sick leave. These participants stressed the importance of different dimensions of balance: activity balance, balance in body and mind, balance in relation to others, and time balance (12). Moreover, in a study researching what is considered more or less important for life balance, one of the four different viewpoints identified concerned occupational balance. This viewpoint highlighted, for instance, the importance of balance between work, home, family, and leisure occupations as well as having sufficient time for mandatory and voluntary occupations (11). The conceptual framework proposed is also based on a concept analysis of occupational balance defining it as
Correspondence: Petra Wagman, Jönköping University, School of Health Sciences, Box 1026, SE-551 11 Jönköping, Sweden. E-mail: [email protected] (Received 19 September 2013; accepted 28 February 2014) ISSN 1103-8128 print/ISSN 1651-2014 online 2014 Informa Healthcare DOI: 10.3109/11038128.2014.900571
228
P. Wagman & C. Håkansson
“the individual’s subjective experience of having the right amount of occupations and the right variation between occupations in his/her occupational pattern” [(13), p. 326]. Concept analysis has been described as a valuable tool for developing instruments (14). Taken together, the conceptual framework proposed in the present article focuses on the variation in the occupational pattern, the amount of each occupation, as well as the total amount of occupations in relation to the available resources, and the meaningfulness in the occupations. It is hypothesized that all these aspects are necessary for an individual to perceive occupational balance. The importance of this perspective on occupational balance has also gained support in the results of studies among general groups (15,16) and populations facing health conditions: people with severe mental illness (17), systemic sclerosis (18), and rheumatoid arthritis (19). The OBQ has been under development for some time. Different prototype versions of the instrument were developed and discussed between the authors before the content and design of the initial version of the instrument were established. An expert panel composed of occupational therapy researchers, occupational therapists, and people representative of the target group gave the authors reiterated feedback. The first evaluation focused on the extent to which the scale appears to represent the construct of occupational balance (face validity) (20). Whether the items were unambiguous, clear, easy to understand, and made sense to the participants was also reviewed as well as the choice of response options. The next step included a revision of some items and also item reduction, and this led to the present version of OBQ consisting of 13 items (presented in Table II in the Results section) where the participant rates his/ her current occupational balance. Each item is measured on a six-step ordinal scale, ranging from “completely disagree” (scored 0) to “completely agree” (scored 5). A higher rating indicates higher occupational balance. The OBQ is intended to be possible to analyse both on item level and as a summed total score (ranging from 0 to 65 where higher score indicates higher occupational balance). The content validity of the OBQ has been examined in a sample of 21 occupational therapists in different ages. These participants either worked clinically or worked as university teachers (in some cases also as researchers) in occupational therapy and were recruited using convenience sampling. They were asked to rate the relevance of each item on a content validity index (CVI). This was conducted on a four-step ordinal scale ranging from “completely irrelevant” to “completely relevant”. Thereafter, the proportion of participants who rated the two highest options was investigated and compared with the
proportion rating the two lowest options, resulting in a value ranging from 0.0 to 1.0. The CVI should exceed 0.78 for individual items (when 6–10 people rate) and the scale’s average CVI should be at least 0.90 (21). The results of the content validity index for individual items in the OBQ ranged from 0.71 (only one item below 0.78) to 1.0 and the whole scale had an average of 0.90. Therefore, the OBQ is considered to have good content validity. However, psychometric properties of the OBQ such as internal consistency and stability, i.e. test– retest reliability, need to be explored (22). Another potential issue not yet investigated is whether the OBQ has any floor and/or ceiling effect, i.e. a high proportion of participants rating lowest or highest (20). A high floor effect implies a risk that decreased occupational balance would not be revealed and a ceiling effect that increased occupational balance is missed. This needs to be explored in order to evaluate the OBQ’s usefulness. The aim was therefore to investigate the OBQ regarding internal consistency, test–retest reliability, and floor/ceiling effects. Material and methods Participants and data collection The inclusion criterion for participating was being 18 years of age or older. The participants were recruited by convenience sampling methods using the authors’ network. The participants received written information about the purpose and content of the research, voluntary participation, contact information, and how the data should be handled and used. The questionnaire, including demographic questions (gender, age, and education) together with the OBQ, was administered on two occasions. There was an approximately one-week interval between distribution of the first and the second questionnaire. The participants received each of them together with information and a stamped addressed return envelope. The questionnaires were numbered to enable answering anonymously while also ensuring that questionnaires from the same participant were handled together. They were distributed to 80 participants. Of these, 67 returned both questionnaires and these participants were included in the analysis. Ethical considerations This study was reviewed by the research ethics committee of the School of Health Sciences, Jönköping University, which raised no objections.
The Occupational Balance Questionnaire Table I. Participant demographics (n = 67). Participants1 Gender (n): Men (%)
19 (29.7)
Women (%)
45 (70.3)
Age (in years) Mean (SD)
49.6 (11.3)
Median
49.0
Education (n): Compulsory school (%)
1 (1.6)
Upper secondary school (%)
8 (12.5)
Residential college for adult education (%)
2 (3.1)
University (%)
51 (79.7)
Other (%)
229
education and the sample comprised more women than men (Table I). Their ratings on the summed OBQ (min 0, max 65) varied from 17 to 59 (median 43.5). Separating the genders showed that men had a narrower range (min 26 max 56) than women (17–59) and a lower median (men 38, women 44). Table II gives the results for each individual item. Cronbach’s alpha in the sample was 0.936, reflecting good internal consistency (23). The correlation (Spearman’s Rho) for the total score was 0.926. The individual items’ kappa coefficients varied between 0.61 and 0.83, i.e. from good to very good (24). Finally, no participant rated the lowest or highest score in the summed total score of the OBQ, that is, no floor or ceiling effect was detected.
2 (3.1)
Note: 1Data are missing for three participants.
Discussion
Data analysis The OBQ’s internal consistency was explored using Cronbach’s alpha (22). Test–retest reliability for the summed total score in the OBQ was investigated using Spearman’s Rho. The individual items were analysed using quadratic weighted kappa (22). The OBQ was analysed with regard to floor and/or ceiling effects by controlling the percentage of participants who scored lowest and highest (20). Results The 67 participants (response rate 83.75%) were 26 to 69 years old. The majority had a university
This article presents the new instrument OBQ. It focuses on the satisfaction with amount and variation of occupations, regardless of which they are or how much time each occupation takes. The intention with this focus is that the OBQ should overcome the fact that occupations may have different values for different people (25) as well as the fact that the same category (such as work) can be experienced differently (26). As the OBQ is not based on specified occupations it may also overcome cultural differences of preferring different occupations or time use in, for instance, different countries. The OBQ provides a complimentary perspective to earlier instruments focusing on “amount of time” spent in wanted occupations (27,28) or perceptions of meaningful occupations and need for more
Table II. Content in the OBQ items and their ratings. Item
Content
Min.–max. (0–5)
Median
1.
Balance between doing things for others/for oneself
2–5
3
2.
Perceiving one’s occupations as meaningful
2–5
4
3.
Time for doing things wanted
1–5
3
4.
Balance between work, home, family, leisure, rest, and sleep
0–5
3
5.
Balance between doing things alone/with others
1–5
3
6.
Having sufficient to do during a regular week
0–5
3
7.
Have sufficient time for doing obligatory occupations
0–5
3
8.
Balance between physical, social, mental, and restful occupations
1–5
3
9.
Satisfaction with how time is spent in everyday life
1–5
3
10.
Satisfaction with the number of activities during a regular week
1–5
3
11.
Balance between obligatory/voluntary occupations
1–5
3
12.
Balance between energy-giving/energy-taking activities
1–5
3
13.
Satisfaction with time spent in rest, recovery, and sleep
1–5
3
230
P. Wagman & C. Håkansson
meaningful occupations (29). These instruments may be used simultaneously in future studies as together they may provide valuable contributions to the concept of occupational balance. However, it should be recognized that the OBQ does not take into consideration what the occupational pattern looks like as long as the individual is satisfied with it. This increases the need to measure occupational balance in different ways to provide a more comprehensive picture. Furthermore, in the OBQ the participants are instructed to rate their current occupational balance and the meaning of “current” may differ between them, i.e. different time perspectives may exist. Earlier results have shown that people think of balance in different time perspectives (12). Although it can be argued that the current situation is subjective and therefore reflects the participant’s perspective, future studies should be conducted to explore which time perspective is most relevant in relation to occupational balance. Methodological considerations The present results show that the OBQ has good internal consistency in a sample group from the general population as reflected in its Cronbach’s alpha. The results of the test–retest reliability analyses showed that the instrument was sufficiently stable, and so were the individual items, as none had a kappa coefficient below 0.60. However, it should be noted that the sample was recruited using convenience sampling, was quite small and included mostly women and participants with university education. All this influences the external validity. The results need to be replicated in different populations and further studies, evaluating the detailed construct validity of the OBQ, are also needed. For instance, researching whether the OBQ ratings increase during recovery or rehabilitation. Conclusion The OBQ has good internal consistency. It also showed sufficient test–retest reliability and, therefore, seems stable over time. No floor or ceiling effect was detected. Together, these results show promising psychometric properties of the OBQ but further instrument development studies to examine its construct validity are required.
Acknowledgement The authors wish to thank Birgitta Gunnarsson for providing some of the data. This study was
supported by the Swedish Association of Occupational Therapy. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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