Multi-Level Models of Health

This week, my fellow MHST601 students and I were tasked with exploring multi-level models of health, in order to deepen our understanding of the relationships between determinants of health at different levels of influence. The first model that came to my mind was the Canadian Model of Occupational Performance (CAOT, 2002), a model that has been highly influential on my occupational therapy practice. I also explored models outside my own profession, and took particular interest in the model by Dahlgren & Whitehead (1991).

Canadian Occupational Therapy Models

As a Canadian occupational therapist, the first model that came to my mind was the Canadian Model of Occupational Performance (CMOP). This was the overarching model that received the most focus in my undergraduate degree in occupational therapy, and it has been foundational in my career. This holistic model outlines the relationship between the person, their environment, and occupation. As demonstrated in figure 1, the centre of the model is the 'person' level, with spirituality at the core. In this context, spirituality does not necessarily mean religion, but it refers to the meaning and purpose a person finds in life. The 'person' level also includes physical, affective, and cognitive components. The 'occupation' level includes anything that occupies time; anything a person needs or wants to do. The main types of occupations are self-care, productivity, and leisure. At the 'environment' level are the physical, institutional, cultural, and social environments; the context in which occupations occur (CAOT, 2002).

This model has been expanded upon and adapted over time. In 2007, a new version, the Canadian Model of Occupational Performance and Engagement (CMOP-E) replaced the CMOP. This version expanded the focus from completing activities to engaging in them (Townsend & Polatajko, 2007). The CMOP-E is ingrained in my mind as a multi-level model to ensure a comprehensive assessment and treatment plan. However, I will admit that I have tended to focus more heavily on the 'person' and 'occupation', and this review of the CMOP-E has been a good reminder for me to bring my attention to the 'environment' level.

This year, a new model, the Canadian Model of Occupational Participation, has been published to replace the CMOP-E (Egan & Restall, 2022). My employer ordered a copy of the book, and it has not yet arrived to our department. I've heard a few teasers about it through the grapevine, but don't have any concrete information to share at this point. I'm looking forward to learning more and applying it in practice.

The Dahlgren & Whitehead Model of Health Determinants

As I explored models outside of my own discipline, many of the models I came across were based on a 1991 model by Dahlgren & Whitehead. According to Google Scholar, it has been cited 3679 times. This model is still relevant today (Aguirre et al., 2022). As demonstrated in Figure 2, the levels closest to the centre are individual demographics and lifestyle factors. The remainder of this model would be included in the CMOP-E under 'Environment': social and community networks, living conditions, and socio-economic, cultural, and environmental factors. An advantage to this model is that there are a number of specific socio-economic factors listed, which can prompt more in depth consideration of these factors.

Applying a Multi-Level Model

The focus of this blog post has been describing two multi-level models of health. In my next blog post, I plan to use one of these models to explore a health issue that is relevant to my practice. Stay tuned!

References

Aguirre, D.L., Perez, C., & Burkett E.K. (2022). Stability, security, and the social determinants

of health. Global Security: Health, Science, and Policy. 7(1). 13-23. https://www.tandfonline.com/doi/full/10.1080/23779497.2022.2047092

Canadian Association of Occupational Therapists (2002). Enabling occupation: An

occupational therapy perspective. CAOT.

Dahlgren, G. & Whitehead, M. (1991). Policies and strategies to promote social equity in

health. Institute for Futures Studies. https://www.iffs.se/media/1326/20080109110739filmZ8UVQv2wQFShMRF6cuT.pdf

Egan, M. & Restall, G. (2022). Promoting occupational participation: Collaborative

relationship-focused occupational therapy. CAOT.

Townsend, E.A. & Polatajko, H.J. (2007). Enabling occupation II: Advancing an occupational

therapy vision for health, well-being and justice through occupation. CAOT Publications ACE. as cited in Muscoloskeletal Key (2016). Canadian model of occupational performance and engagement. https://musculoskeletalkey.com/canadian-model-of-occupational-performance-and-engagement/