Anne M. Hillman, Christine J.Chapparo.

This paper is a copy of an article published in the Journal of Occupational Science: Australia, Vol. 2, No 3. (pp. 88-99), 1996. Reprinted with permission of the authors.

Anne Hillman BAppSc(OT) is a lecturer in the School of Occupational Therapy, Faculty of Health Sciences, The University of Sydney.

Christine ChapparoMA,DipOT,OTR, FAOTA, is a senior lecturer in the School of Occupational Therapy, The University of Sydney.

INTRODUCTION

This paper is an introduction to research which investigates the occupational role performance of men who have had a stroke and are living at home. It contains a discussion of the nature of life roles and of their occupational roles in particular. The conceptual framework for this research is a person centred occupational performance model. The rationale for using this approach is given and the data collection methods are briefly described. Preliminary findings are presented, together with a case history to illustrate these findings.

OCCUPATIONAL ROLE

Life roles can be described as social, cultural and occupational roles. These divisions are not intended to be absolute, however, and involve considerable overlap, such that social cultural roles also have an occupational or doing element to them, while occupational roles can be seen to have social and cultural elements.

One model of occupational performance, developed by Chapparo and Ranka (Chapparo & Ranka, 1993, October), describes occupational roles as patterns of behaviour composed of self maintenance, work, leisure and rest activities. Occupational role performance refers to the way these activities are carried out. Occupational roles are established through need and/or choice and are modified with age, ability, experience, circumstance and time (Chapparo & Ranka, 1994). It follows that occupational roles are one means by which daily activities are determined and organised.

It has long been assumed that occupational role performance has a direct influence on lifestyle and health issues (Barris, Kielhofner & Watts, 1988). More recent research has demonstrated such links (Bränholm & Ful-Meyer, 1992). Elliott & Barris, (1987) have established a relationship between the number of roles performed, the degree of meaningfulness of such roles and overall life satisfaction. Although the depletion of occupational roles that occurs following the onset of major disability may be assumed to lead to a corresponding decrease in overall lifestyle or role performance satisfaction, nobody has investigated this specifically in relation to people who have had a stroke. Indeed, very little is known about the specific occupational roles of the elderly, or about the way elderly people who have had a stroke organise their daily activities following resettlement at home.

The saying that reality is only what individuals perceive of the world around them can be applied to people’s perspectives of their roles in life. People’s perceptions about their roles are coloured by their own life experiences and beliefs and attitudes. In describing role performance, health professionals often make assumptions about the meaning and balance that is ascribed by clients to their own life roles (Kielhofner, 1995; Oakley, Kielhofner, Barris & Reichler, 1986). For example, the initial focus of many rehabilitation programs is on the development of specific self care skills determined by the institution. These are seen as underpinning general performance at the role level (Culler, 1993; Levine & Brayley, 1991) as well as enabling the continued performance of self maintenance roles such as personal carer and home maker (Foster, 1992; Hill, 1993). The researchers believe this process often reflects the meaning and importance that the health care team attributes to a self maintainer role rather than the meaning and priorities of the client (Chiou & Burnett, 1985). In order to reduce the bias that these assumptions may introduce, this study adopted a person centred interview approach whereby the participants were invited to identify their own roles, give reasons for performance that relate to occupation, and talk about meaning in terms of value and satisfaction.

Although role assessment instruments have been developed for adults and the elderly, they have limitations in the scope and type of information they provide. Principally, they either rely upon interpretation of information by the investigator to determine role performance, like The Occupational Performance History Interview (Kielhofner & Henry, 1988), or, like The Role Checklist (Oakley, 1981), provide the person with a list of assumed roles and ask them to indicate participation and value. Satisfaction with performance is not always considered. Assessments like The Role Change Assessment (Jackoway, Rogers & Snow, 1987) also reflect an assumption that everyone views a named role in the same way. For instance, that everyone would see the role of household cook as self maintenance. The researchers adopt Chapparo & Ranka’s (1994) view that a given role can be given a different meaning by different people. For example, the role of cook may be self maintenance to one person, productivity to another, and leisure to a third. Indeed, the same person may view such a role in different ways in different circumstances. For example, preparing Sunday breakfast may be seen as a family activity, while cooking the regular evening meal could be seen as work.

Heard (1977) developed a model of role acquisition which illustrated how internal and external expectations affected roles that were acquired. As a conceptual basis for this study, the researchers have proposed an extension of Heard’s model to highlight the place of perceived external and internal expectations on role choice, role performance and role satisfaction (see table 1).

This model shows that reasons for role performance are individually determined and depend upon the person’s own perceptions of what is expected of them by others, what they expect of themselves and what resources are available to them for achieving performance. Based on this model, it is clear that there is a need to investigate people’s own perceptions of their performance at the role level, rather than make decisions based on indirect information given. Role assessments such as The Occupational Performance History Interview, while based on the self-reporting of interviewees as their primary source of information (Kielhofner & Henry, 1988; Moorhead, 1969), do not ask them questions about their own perceptions of their performance at the role level. Instead, questions are asked about past and present behaviour and from this the interviewer interprets and rates that person’s role performance.

This study represents a starting point for a line of research that investigates self perceived occupational role performance following stroke. It describes what occupational roles are carried out post stroke, the nature of that role performance, and what satisfaction is derived as a result. If there is an overall depletion in role performance satisfaction, as distinct from the number of roles performed or the nature of role performance, then this will have an impact on the nature of health and community service provision for people who have had a stroke.

The purpose of this study, therefore, is to gather information about the self-perceived occupational role performance of elderly men who have had a stroke and are living at home. The study was restricted to men, as it was felt that the issues they face following a major life event such as a stroke differ in many ways to those faced by women.

Research design

Qualitative research methodology was employed utilising in depth interviewing. This was done for two reasons. First, it permitted explanation of questions and further probing of responses, thus facilitating a greater depth and quality of information than could be obtained by other means. Second, from the participant’s point of view, it allowed the interviewer to understand the meanings attributed to particular role performance.

Participants

18 participants so far have been interviewed. Selection criteria included the following. Participants were men over 60 years of age who had had a stroke requiring admission to hospital, and who were discharged home three to six months prior to interview. They were not engaged in paid work and lived in the Sydney metropolitan area. People were excluded from the sample if they were female, were under 60 years of age, still worked in a paid capacity, lived in an institution, had a serious handicap resulting from a chronic condition unrelated to their stroke, were discharged from hospital less than three months or more than six months ago at the time of the interview, spent less than two weeks in hospital, did not receive rehabilitation while in hospital, had more than one stroke, or required an interpreter while in hospital.

The occupational therapy departments of a number of major teaching hospitals and rehabilitation units in the Sydney metropolitan area were used in order to obtain the participant sample. Ethics committee requirements did not permit the researchers to actively engage in the selection process or in inviting potential participants to take part. Occupational therapists who agreed to assist with this study selected potential participants from their own case load or by obtaining nominations from other therapists, according to the criteria set down by the researchers. These people were then contacted by the therapist who nominated them. The researchers provided therapists with material to distribute to potential participants. This consisted of a letter containing information about the study and inviting participation. If people indicated they were interested in participating, permission was obtained by the therapist to forward their contact details to the researchers. Where people were still attending an occupational therapy outpatient program another therapist in the department who had not worked with them made the contact in the same way.

Data Collection Procedures

Of the eighteen interviews conducted so far, seven were carried out by one of the researchers of this study and eleven by people trained by that researcher. Interviewers were trained in the following way: a series of tutorials culminated in a one day workshop which included audio and videotaping of practice interviews. Following this workshop, interviewers were required to submit an audio tape of an interview, using the procedures they had been taught, with someone of their acquaintance who was over 60 years of age. This tape was evaluated by the researcher and feedback was given. If the tape was unsatisfactory, interviewers were required to do another interview and submit a second tape. No-one proceeded with interviewing for the study until they had submitted a satisfactory tape.

Participants were contacted by the researchers and an appointment was made. Interviews were held in the participants’ own homes. In most cases there was no third party present. The length of interview varied from 45 minutes to 2 1/2 hours and ended when the participant tired or saturation of information occurred. Permission was obtained to tape the interview and a tape machine and microphone were placed in full view but in a non-intrusive way on any convenient surface nearby. Participants commented more than once that they had forgotten they were being taped.

The interview process had six parts:

1) Explanation of purpose of interview.

2) Recording demographic information.

3) Gathering information about role performance.

4) Participant identification and confirmation of roles.

5) Sorting roles under performance area and sociocultural headings.

6) Participant rating of roles.

The technique of ethnographic semantics (Spradley, 1979) was used to discover the way participants categorised their own immediate roles, role performance and role needs. This involved asking questions of three orders: descriptive, structural and contrast. The form of these questions changed with the understanding of the participant. The whole process commenced with a “grand tour” question such as: “Can you tell me about your roles now?” The purpose of this question was to find out what meaning the participant ascribed to the general term of role. The strong emphasis on open ended questions in this part of the interview ensured that the comments of participants were spontaneous and self-generated.

Descriptive questions yielded information about what the daily roles, functions and activities actually were for the participants. An example of a common stimulus question was “how do you spend your time?”. Further probes consisted of questions such as: “do you do anything with other people?”, “what sort of things do you do with your children?” and “what sort of things do you do around the house?” These types of questions yielded a list of tasks and activities that were later consolidated to form role patterns.

Structural questions in the form of role sorting enabled the researchers to determine how participants ascribed these role patterns into major role categories. This occurred in two stages. First, during the interview, the interviewer listed what (s)he perceived the participant’s roles to be. At the end of the interview the participant was asked to either confirm the role titles or suggest changes. The interviewer then privately sorted these roles under the major headings of productivity, self maintenance, leisure and sociocultural roles. The second stage of role sorting followed. Role titles were written by the interviewer on stickers. These were handed to the participant one by one and they were invited to sort the roles by placing each one under the heading that best described the reason for its performance. Participants were asked why they placed roles where they did and were usually able to give clear reasons for their decision.

During this second stage, a role sorting board was employed to help participants decide which role heading best described particular patterns of activity. The board was made of cardboard with a whiteboard surface and measured 610 mm x 440 mm. It carried simple definitions of each of these major role headings in large bold print for easy reading, often with clarification from the interviewer. The definitions were as follows:

Productivity: work, giving a service, doing something that can be used by others.

Self Maintenance: what you need to do to get by and get on with the rest of your life.

Leisure: fun, enjoyment.

Social Cultural: relationships, being with others, beliefs and values.

Other (no definition given).

Contrast questions were used to help participants identify what they would like to do that they were not able to do and to describe their perceptions of the frequency, value and satisfaction of role performance. Frequency was discussed in terms of how often the participant did things in that role. Value was considered as relative to the importance they ascribed to it. They were asked to consider satisfaction in terms of how they felt about their own performance in the role. Examples of contrast questions were: “if you could spend your day doing anything you wanted, what would you do?”, and “what is it that stops you doing this?”. Contrast questions of this type were used to assist participants to focus on immediate role performance needs rather than role performance prior to their stroke. Contrast questions led ultimately to participants being able to rate their role performance.

When rating their role performance, participants were asked to rate, as a single unit, the roles in each of the categories for frequency of performance, value of role, and satisfaction with performance. They were shown a five point scale represented on a large piece of card measuring 360 mm x 240 mm and asked to rate by pointing. Each scale had polar descriptions, with 1 as the lowest rating and 5 as the highest. For example, the value scale read:

“I consider this role to be:

In summary, the interview yielded both quantitative and qualitative data to describe aspects of self perceived roles. Information gathered related specifically to the participants’ own perceptions of their current role performance in the areas of productivity, self maintenance and leisure, as well as their sociocultural role performance. Perceived frequency of performance; perceived role value and degree of satisfaction with role performance were discussed and evaluated for each of these areas.

Data Analysis

Seven sets of data have been analysed at this stage of the study and form the basis of the findings reported in this paper.

Truthfulness of Data

Several checking measures were used to determine trustworthiness of the data collected. First, member checking was employed by ensuring that judgements on role identification and role categorisation were made by the participant rather than the interviewer.

This process establishes credibility of the data whereby the truth value is determined by how well the researcher is able to represent the participant’s experiences rather than the defined a priori of the researcher (Sandelowski, 1986). Second, comparisons were made between the qualitative information obtained in the interview section and the quantitative ratings made by the participants at the end of the interview. This process allowed the researchers to determine the consistency of the data and to track where variability in the data occurred. Third, another researcher reviewed a number of transcripts and role ratings made by the interviewers. Comparisons were made between the findings of the first researcher and the findings of the second (Minichiello, Aroni, Timewell & Alexander, 1990). Following this, additional questions relative to the style of questioning used in interviews and interpretation of the data were proposed. This process assured a certain freedom from bias in interpretation of the data that came from the natural biases, motivations and perspectives of the researchers themselves (Guba, 1981). This resulted in constant modification and refinement of the interview technique.

Data analysis procedures

All taped recordings of interviews were converted to written transcripts (Miles & Huberman, 1984). After each transcription was complete, the notes were edited by researchers for accuracy. The data set from each interview was read and researchers identified the possible scope of the data. Topics and themes that occurred and re-occurred were identified and assigned preliminary codes that subsequently became the initial content label discussed under ‘preliminary findings’ in this paper.

The level of detail of coding was multi-sentence ‘chunks’ rather than word or sentence coding (Miles & Huberman, 1984). Multiple copies of the transcribed and reduced data were made and passages of text were coded using descriptive terms according to the thematic interpretation made by the researcher as outlined below. Specifically, texts were examined for information relating to roles that had been identified by that participant. The text was then further examined for statements of frequency, value and satisfaction relating to performance of each of the roles identified. The entire data set of seven participants was double coded (Miles & Huberman, 1984) to determine the internal consistency of the researcher’s interpretation of the text. For this reason, the preliminary findings presented below will focus on interpretations of these seven participants.

Preliminary Findings

The preliminary findings are presented according to the themes that emerged. As each theme is discussed, narratives will be included to demonstrate similar and contrasting thematic perspectives as identified by the researchers.

These are preliminary findings. They will be discussed relative to the following four aspects of the analysis:
1) statements that relate to specific role performance,
2) commonly occurring roles that were identified,
3) findings related to role sorting, and
4) findings related to role rating.

Role Statements

As described previously, the interview commenced with a “grand tour” role question. Participant responses to this question were often revealing, in that they summed up the nature of that person’s focus or outlook on life.

Participant 16 was asked “can you tell me what your roles are now?

He responded:

“My main idea is to get out of the wheelchair and able to walk, that’sthe main thing I want to do. That’s why I will do whatever therapy they’ve got for me to do. They can tell you what you’ve got todo. They can’t make you do it. You’ve got to do it yourself”.

A great deal of his conversation and responses revolved around this theme. He explained at length how he managed his wheelchair, how he transferred and many other issues. Managing the after effects of his stroke was a major role for him, which he discussed with a passion.

Next, Participant 2:

Interviewer:”How do you see yourself? I mean we all have a lot of different roles in life…”

(Pause – Bursts into tears) “/…/ I got six kids … /…/ andfourteen grandchildren. /…/ So I’m just Grandpop to them.”

This gentleman was quite labile. His sociocultural roles were of particular importance to him and he discussed at length his relationships – good and bad – with those around him. Again, there was passion in his responses on this theme that was absent when discussing other areas of his life.

Participant 15 was different:

He was asked:”What are the roles that you have in life?”

“ Well,I’m just looking forward to the time when it foldsup, and somebody else has got to look after the problem then. /…/It doesn’t worry me. /…/ I’ve got a limited time I know, and Ijust keep on going.”

It subsequently became clear that this person had no particular focus to his life. His roles were identified, but there were none that appeared to be of particular significance to him, and there was no passion in his responses.

Commonlyoccurring roles

Role names were given by the interviewer and the participant on the basis of what seemed to best describe the role. The roles most frequently identified by participants were as shown in table 2:

Table2: Roles most commonly identified by the seven participants.

Role Sorting

Comparing Interviewer Sorting With Participant Sorting

The interviewer made sorting errors in every case and averaged 2.5 errors per interview.

Examination of Participant Role Sorting

Under the heading of productivity, four people identified a total of seven roles, while three could identify no productivity roles. All seven participants placed roles under each of the other headings. A total of eleven roles were placed under self maintenance, sixteen under leisure and twenty-four under social cultural.

There was an idiosyncratic placement of some commonly occurring roles (see table 3). For example, the role of father was placed by three people under the social cultural heading, giving it the meaning of being something the person did because of his beliefs and values and/or his relationships with others. This placement corresponds with the general view of father as primarily a social role. However, three people placed the role of father under another heading. Participant 18 placed father under leisure, saying:

“They’re my children and all that caper. Tremendous good looking children as well/…/It’s a lifetime’s pleasure really”.

Participant 17 placed the role under the productivity heading, explaining that he saw his role as a father in terms of ensuring his children were financially secure. He said:

“But we’ve got eight children. Right? /…/ What are you going to do/…/ to fix them up, without it distressing the others? Ah, itgives you something to think about.”

Participant 15 placed the role of father under self maintenance. He lived with his daughter, and seemed to be saying that, although his children cared for him, he did not reciprocate by doing anything for them. Their relationship with him seemed to focus on checking on his ability to care for himself successfully.

“I seem to have more of a relationship with them than I have with them. Do you understand?

Interviewer:”No, say that again.”

“Well,they’re always … seeking to see how I am … and I haven’t bothered about them!

Interviewer:”Oh I see what you mean. So you think the relationship’s a bit one way?

“Well,it is…Because after all, they’ve got their own relationships Participant 16, although a father, preferred to includethe role under the larger heading of family member.

Table 3 also groups together roles that appeared to go together, such as father and grandfather, and day care attender and health maintainer. The nature of some of these roles will now be explained.

Day Care Attender: In every case the person received therapy as part of a larger program.

Person with a Disability: The person carried out a remedial program at home and disability directed much of his attention and time.

Time Passer: Passive leisure, for example, television, radio, reading, talking books and street watching. This role was characterised by the statement that it “passes the time”.

These variations in sorting and placement would seem to indicate that the same role has different meanings to different people, supporting the contention that meaning cannot be arbitrarily ascribed to roles by others.

Other roles that were identified followed more closely the pattern that might expected, although there were still some surprises such as Home Maintainer and Pet Owner (see table 4).

Role Rating

The Ratings Sheet

Participants were asked to rate on three different five point scales for frequency of role performance, how much they valued the role, and how satisfied they were with their performance of that role.

Two participants completed role sorting, but did not rate their roles, leaving a total of five participants who undertook role rating.

Internal consistency between interview and ratings

Using a subjective comparison of the ratings with statements made by the participants in the text, it was estimated that approximately 75% consistency was achieved.

Preliminary consideration of role ratings for the seven participants analysed so far indicate certain themes. A total of fifty-four ratings were made overall, for frequency, value and satisfaction in the four areas of productivity, self maintenance, leisure and social cultural. When all the ratings are viewed together, the majority of participants rated at the top end of the five point scale. 63% rated five for any given rating, 18.5% rated 4, 16.5% rated 3 and 2% rated 2. No participant rated one, the lower end of the scale, for any rating.

Overall performance area ratings for the five participants were totalled using a weighted score. A rating of 5 was given five points, a rating of four was given four points and so on. This meant that if all five participants rated five for a given rating, the maximum possible score was 25. If no-one had rated it at all, the lowest possible score was 0. All five participants who completed ratings identified roles in the performance areas of self maintenance, leisure, and social cultural. Only three identified roles in the productivity area. For this reason the productivity ratings were further adjusted so that ratings for each area could be compared on the same level of five respondents.

From figures 1 to 4, it can be seen that social cultural roles and self maintenance roles were performed most frequently, with leisure roles being performed least. Social cultural roles were valued most highly, with productivity roles being valued least. Finally, social cultural roles produced the highest rating for satisfaction with performance, with productivity roles being valued the least. It must be emphasised that these results represent preliminary analysis only on a small number of participants. Data will be presented in a more meaningful way when the study has been completed.

CASE EXAMPLE – Participant 16

Findings are illustrated by the following case example:

Table 5 shows role distribution for participant 16. The role of Stroke Manager (person with a disability), ascribed as a self maintenance role, was one that took up most of this man’s time and was very involving for him.

The stroke had changed his life and had become the focus for him. A great deal of what he had to say related to how he was now dealing with his disabilities:

“The wife gives me therapy twice a day. Iget it once a week over at the day care centre. What I learn there, I’ve been able to tell the wife. We try to carry that out as further therapy. Because Ilook at this way – what you learn on Wednesdays, if you don’t get anymore done till the following Wednesday, you go backwards./…/So you’ve got to have it continuous./…/ That’s what we do./…/I go inon Wednesday and have full therapy, for walking. I walk with an aidbut can’t walk without. Because I can’t stand alone. Then I come home and tell the wife what’s been doing. Then we put the actual therapy into practice./…/ We got two hours a day doing it. First thing of a morning. Then afternoon, say about two o’clock. Then just before going to bed at night.”

This is an expression of the nature and frequency of role performance.

It is interesting to note that he had no personal carer role. It seems that for this man, Personal Carer was subsumed by Person With a Disability and had become part of that larger role.

He had successfully achieved the transition from active to passive participant in a number of roles, despite the fact that he is a man who, from the interview, seemed to need active involvement. For example, in his role as a Hydroponic Gardener, he sat

in his wheelchair at the top of the back step and directed his wife. This was his expression of satisfaction with this role:

He was asked: “The way that you carry out that role now, – do you get some satisfaction out of that?”

“Oh yes, knowing that it is going to be still done. /…/ I’ve got it in my computer, which is the brain box. /…/ And what’s got to be done is there and can be done. Somebody carries it out with the instructions, and that’s done satisfactorily so I don’t worry about it now.”

This man’s family seemed happy to participate in his roles on this basis.

Role ratings for participant 16 are shown in table 6. He rated five for satisfaction with all areas of role performance, and the researchers judged that there was agreement between this rating and what he said in the interview. However, this is what he said in relation to the role of Person With a Disability:

“Because when you get a stroke, well you are in it. And, as I say, it’s a nightmare and … you can’t get out. It’s like … going through atunnel and you can see the light at the end of it and you’re clawingand clamouring to get to it, but you can’t”.

When discussing his performance as a Person With a Disability, he said:

“Well,if you carry that out together it’s not so bad. But you feel …left alone at times. You wonder what it’s all about … whether it’sworth it or not because sometimes you can see you’ve progressed andother times you don’t have progress. /…/You don’t seem to cotton onto it. That’s how the … stroke leaves you. You don’t comprehendalways what you’ve got to do. /…/Just one of these silly damnthings. It’s aggravating and frustrating. You see things you wantto do and you can’t. When I was in hospital, with the therapy theywere giving me -it was all right. Then they asked me about what sortof therapy I thought would be the best and I told them home therapy,being in your own home. Here in your own surroundings, you do whatyou want to do.”

When asked to rate satisfaction with his performance he said:

“Oh yes, I’m contented. Everything’s moving along the way I want. I am satisfied all the time with what I am trying to do and the things that have been done for me. I work very hard.”

From this it appears that he was satisfied with his performance in this role, but derived no pleasure from it, and performed it through need rather than choice.

Discussion and Implications for Further Research

Preliminary analysis has revealed a number of interesting points:

When a general question about role performance is asked, such as “tell me how you see your roles now”, the response can sometimes reveal the overall focus of that person’s life. For instance, participant 16 responded to this question by saying he wanted to get out of his wheelchair and overcome the effects of his stroke. Participant 2 spoke of his relationships with those around him. Participant 17 spoke at length about his advocacy activities. In each case, the response to this initial question revealed a theme that was returned to many times throughout the rest of the interview, indicating that it was of primary importance to that person. For others, such as participants 15 and 18, responses to this role question were general and diffuse and no such theme was revealed. Further questioning also failed to reveal any particular focus and these men appeared to participate in a more passive way in what was going on around them.

Results so far seem to show that it is not possible for one person to accurately to ascribe meaning to the roles of another. For example, comparison of the two stages of role sorting in this study demonstrated that the interviewer made errors in every case, despite feeling confident, from what had been said in the interview, of how the participant would view that role.

It appears that a role sorting process can enable the principle meaning ascribed to particular roles to become clearer to both the interviewer and the participant. Role sorting required the participant to choose the main reason they performed the role in terms of the headings of productivity, self maintenance, leisure, and social cultural. While they were all able to make this choice, some did indicate that there was more than one reason for performance. For instance, participant 18 placed his advocacy role under productivity, but discussed how it also gave him great pleasure and could therefore have been viewed as leisure. Sorting allowed the discussion and clarification of the meaning roles had for individuals.

Most of the people interviewed, when asked to rate their roles, rated them positively for frequency, value and satisfaction with performance. For example, not one person rated 1 (the lowest rating) on the five point scale for any role. When the ratings for all participants for all ratings (frequency value and satisfaction) were looked at together, 63% of the responses were at 5 (the highest rating). There could be a number of reasons for this. For example, from a cultural perspective, Australian men in this age group expect and are expected by their peers to confront life events and be stoic about them (Job, 1994). This could lead to more positive ratings. Also, giving a low rating for frequency, value or satisfaction could be viewed by the participant as too self-revealing or too challenging to their own perceptions of how they are performing overall in their life roles. Again, older people are sometimes reluctant to reveal too much in case there are consequences in terms of loss of control and the imposition by others of restrictions to their autonomy (Russell, 1981). Finally, the selection method for participants meant that participants were selected and invited to participate by the occupational therapist who had worked with them during their rehabilitation. It is possible that therapists may have selected people whom they considered had a positive outlook and could give a good account of themselves. The ratings may accurately portray people who were actively participating in valued roles to a level that they found satisfying overall. The researchers estimated that there was approximately 75% agreement between the ratings and the content of the interview transcripts, indicating consistency in responses.

This study is not yet finished and further investigation of satisfaction with role performance is planned.

Summary

In summary, this paper has presented preliminary findings of research into the occupational role performance of elderly males who have had a stroke. The conceptual framework for this research is a person centred occupational performance model. The rationale for using this approach was given and data collection and analysis methods described. A case history was presented by way of illustration, and results were given and discussed.

With the established link between occupational role performance, meaningfulness of roles and positive health and well being, it is important that we do not ignore this aspect of occupation. It is hoped that further research into role performance that is person centred will enable us to develop a better understanding of the meaning ascribed to role performance by individuals.

ACKNOWLEDGEMENTS

The authors acknowledge the contributions of the participants and their families to this study, as well as the School of Occupational Therapy, The University of Sydney for partially resourcing the study.

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