B.O.

1. Scandinavian Journal of Occupational Therapy. 2014; 21: 415–420
ORIGINAL ARTICLE
Exploring occupational balance in adults in Sweden
PETRA WAGMAN1
& CARITA HÅKANSSON2
1
Jönköping University, School of Health Sciences, Sweden, and 2
Division of Occupational and Environmental Medicine,
Lund University, Sweden
Abstract
Aim: The aim of this study was to describe the relationship between occupational balance (measured by the occupational
balance questionnaire [OBQ]) and self-rated health and life satisfaction. A secondary aim was to explore differences in
occupational balance among adults in Sweden. Methods: The 153 participants (63% women), recruited using convenience
sampling, answered a questionnaire comprising demographic questions, the OBQ, one item about self-rated health, and one
about life satisfaction. The OBQ was analysed for correlation with subjective health and life satisfaction. The OBQ and its
individual items were also analysed for correlations with age and for differences between men and women and participants
living with children younger than 18 years versus not. Results: The OBQ was significantly positively correlated to self-rated
health and life satisfaction, supporting the relationship between occupational balance and health. No significant correlation
between age and the total OBQ was identified but some differences in occupational balance, related to whether the participant
was living with or without children at home, were revealed. Conclusions: The results should be interpreted with caution due to
the nature of the sample and data but they can serve as a point of departure for further studies and hypotheses regarding
occupational balance in different populations.
Key words: Occupational Balance Questionnaire, health and well-being, demographic differences, cross-sectional study
Introduction
Occupational balance is a core concept in occupa-
tional therapy and a common philosophical assump-
tion is that “a balance of occupations is beneficial to
health and well-being” [ (1), p. 432]. The relationship
between occupational balance and health has also
been shown empirically. Participants in qualitative
studies have described occupational balance as related
to health and well-being (2-5) and occupational
balance has been recognized as a health determinant
(6). Results of quantitative studies over the years have
also supported the relationship with subjective health/
well-being. One of the first empirical investigations of
occupational balance researched current and desired
participation in physical, mental, social, and rest
occupations. Among the results was the finding
that the less difference between these occupational
patterns, the healthier the participants rated them-
selves as being (7). Furthermore, a study of women
from the general population, which aimed to examine
the relationship between health and the participants’
experience of their occupational pattern, included
questions about occupational balance. The results
showed that participants with higher occupational
balance were more likely to rate high life satisfaction
(8). Similarly, a longitudinal study with working
men and women identified occupational balance
among the predictors of good subjective health (9).
The relationship between occupational balance and
health/well-being is also seen in studies among
samples sharing a health condition. One of the results
in a study among participants with schizophrenia was
that participants who had occupational balance rated
their quality of life and well-being higher than did
those who were under-occupied (10). Finally, general
Correspondence: Petra Wagman, Jönköping University, School of Health Sciences, Box 1026, SE-551 11 Jönköping, Sweden. E-mail: petra.wagman@hhj.hj.se
(Received 20 August 2013; accepted 10 June 2014)
ISSN 1103-8128 print/ISSN 1651-2014 online Ó 2014 Informa Healthcare
DOI: 10.3109/11038128.2014.934917

2. health was found to be a predictor of occupational
balance among men and women with rheumatoid
arthritis (11).
Taken together, studies support the relationship
between occupational balance and health/well-being
but because occupational balance has been concep-
tualised and measured differently it is impossible to
accumulate evidence from multiple studies, implying
a serious limitation. Therefore, future studies would
benefit from using common conceptualisations and
measurements. In this study occupational balance is
researched using the relatively new Occupational
Balance Questionnaire [OBQ (12)] which is intended
to be generic i.e. possible to use generally and not
limited to a certain diagnosis or similar and, therefore,
has the potential to be one common measurement of
occupational balance. The conceptual framework
for the instrument,“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” (p. 228), and is based on
results among empirical studies as well as a concept
analysis of occupational balance (12). The latter
defined occupational balance as “the individual’s
subjective experience of having the right amount of
occupations and the right variation between occupa-
tions in his/her occupational pattern” (13).
Furthermore, in order to gain further knowledge
about occupational balance it would be valuable
to explore potential differences in people with differ-
ent demographic characteristics. Occupational
patterns have been found to differ in different
socio-demographic groups and it is possible that these
differences affect occupational balance and, hence,
that people also differ in level of occupational balance.
Erlandsson et al. (14) revealed differences between
women in two age groups (38 years and 50 years)
regarding disturbing interruptions in their occupa-
tions: the younger women perceived more frequent
interruptions than the older ones. Perhaps this is an
example of something affecting occupational balance
and, potentially, that age differences in occupational
balance exist and should be explored. Occupational
patterns have also been shown to differ between men
and women, making investigation of potential gender
differences in occupational balance relevant. Statistics
Sweden (15) had over 7000 men and women (15–84
years) keep a time diary for one weekday and one day
of the weekend within a two-week period. This was
followed by an interview and differences were
revealed. For instance, working-age men spent
more time in paid work than women who, in turn,
spent more time in unpaid work. Women were also
involved in housework after their paid work to a higher
degree than men and had more, but shorter periods
of, free time. Moreover, Wada (16) explored
occupational balance in 15 working couples with at
least one child who not yet had begun school. Their
occupational patterns differed and, for instance, more
women than men worked part time. Two major
aspects related to balance were identified – “managing
life” and “participating in a mix of occupations” – and
these differed somewhat between men and women.
Wada also discussed balance in relation to gender
ideologies, which may influence how men and women
rate occupational balance; hence, differences between
men and women may exist. However, all Wada’s
participants were parents (16). Considering that
differences in occupational patterns exist between
those who have and do not have children (15), it is
possible that parents’ and non-parents’ occupational
balance differs. Erlandsson et al. (14) revealed differ-
ences within the younger age group as well, whereby
women living with a partner or children rated a higher
degree of interruptions than those without. Moreover,
women in Sweden have more sick leave than men, and
the gap increases when having children (17,18), espe-
cially after the second child (17). This gender differ-
ence in sick leave has been discussed as related to
women being responsible for the home as well as
working (17,18) and their workload could be seen
as a sign of occupational imbalance.
One study has been identified as having a focus on
balance and demography. Matuska et al. (19) inves-
tigated the demographics of people answering the
Life Balance Inventory (LBI). In their results, differ-
ences in life balance ratings were identified in parti-
cipants having different gender, age, and parental
situation among others. The LBI (20), however, is
based on questions regarding satisfaction with time
spent in specified occupations. The OBQ provides
another perspective as it does not consider which the
occupations are (Table I), thereby contributing com-
plementary information about occupational balance.
To summarize, there is a need for continued
research on occupational balance and its relation to
health and well-being, as well as on differences
between people of different ages, between men and
women, and between parents and non-parents.
Therefore, the aim was to describe the relationship
between occupational balance and self-rated health
and life satisfaction as well as to explore potential
differences in occupational balance in a sample of
adults in Sweden.
Material and methods
The study had a cross-sectional design and a
questionnaire was used. It included some demo-
graphic questions: age, gender, highest education,
children younger than 18 years living at home (yes/
no [henceforth referred to as children]), occupational
416 P. Wagman & C. Håkansson

3. balance (12), self-rated health (21), and life satisfac-
tion (22).
Occupational balance was measured with the OBQ,
comprising 13 items measured on a six-step ordinal
scale ranging from “completely disagree” (scored 0)
to “completely agree” (scored 5) so that higher rating
indicates higher occupational balance. It can be used
as a summed total score (range 0–65) and item by
item. The OBQ has shown good content validity,
internal consistency, and test–retest reliability in a
sample from the general population (12).
Self-rated health was measured by the item “How
do you rate your health in general?” (21) rated on a
five-step ordinal scale ranging from “poor” (scored 1)
to “excellent” (scored 5), whereby a higher rating
implies higher self-rated health.
Life satisfaction was measured with the item “Life
as a whole is. . .” rated on a six-step ordinal scale
ranging from “very dissatisfying” (scored 1) to “very
satisfying” (scored 6), whereby a higher rating
indicates higher life satisfaction (22).
Participants and data collection
A convenience sampling method was used, with the
sole inclusion criterionthat theparticipantwas18years
or older. Students recruited participants by asking
people, mostly at workplaces, at several places in
Sweden. Potential participants received oral and writ-
ten information about the research purpose, content of
participation, and how the data would be used. They
were informed that participation was voluntary and
that the questionnaires would be handled with confi-
dentiality. Finally, contact information was provided.
The participants were given the questionnaire together
with a stamped, addressed return envelope. Of
the 155 questionnaires delivered 153 were returned.
Ethical considerations
The research ethics committee at the School of Health
Sciences, Jönköping University, reviewed the study
and raised no objections from an ethical point of view.
Data analysis
Participants’ demographics were described and
potential differences between men and women were
explored (using the Mann–Whitney U-test and
Pearson’s chi-square). It was possible to use the
summed total score of the OBQ as the internal
consistency in the present sample (measured with
Cronbach’s alpha) was 0.918, which is considered
good (23). Correlation analyses (using Spearman’s
rho) were conducted between the OBQ and subjective
health and life satisfaction. The OBQ and its individual
items were also analysed for correlation with age using
Spearman’s rho as well as for differences (using the
Mann–Whitney U-test) between men and women and
people who lived/did not live with children at home.
Results
The participants were between 21 and 64 years old,
and most were women. No significant differences
Table I. Content in the OBQ items.
Item Content
1. Balance between doing things for others/for oneself
2. Perceiving one’s occupations as meaningful
3. Time for doing things wanted
4. Balance between work, home, family, leisure, rest,
and sleep
5. Balance between doing things alone/with others
6. Having sufficient to do during a regular week
7. Have sufficient time for doing obligatory occupations
8. Balance between physical, social, mental, and
restful occupations
9. Satisfaction with how time is spent in everyday life
10. Satisfaction with the number of activities during
a regular week
11. Balance between obligatory/voluntary occupations
12. Balance between energy-giving/energy-taking activities
13. Satisfaction with time spent in rest, recovery and sleep
Source: Used with permission from Scandinavian Journal of
Occupational Therapy (12).
Table II. Participant demographics.
Men Women p-value
n (%) 56 (36.6) 97 (63.4)
Age in yearsa
0.339b
Min–max 22–62 21–64
Median 37.5 44.5
Mean (SD) 39.8 (11.4) 42.4 (12.8)
Educationa
0.363c
University education 29 57
Otherd
27 39
Childrene
<18 at home 0.566c
Yes 20 32
No 31 61
Notes: a
One woman did not answer this question. b
Mann–Whitney
U-test. c
Pearson’s chi-square. d
Including compulsory school, upper
secondary school, residential college for adult education, and other.
e
Five men and four women did not answer this question.
Exploring occupational balance 417

4. were identified between men and women regarding
their age, education, or child situation (Table II).
Much of the range in the summed total OBQ
(henceforth referred to as the OBQ) was used,
although it was more common to rate high occupa-
tional balance. Table III shows the ratings of different
participant groups.
Correlations between self-rated health and life satisfaction
and OBQ
The Spearman correlations showed that the OBQ was
significantly positively correlated to self-rated health,
0.581 (p = 0.01) and life satisfaction, 0.518 (p = 0.01).
The results of the ratings per se of self-rated health
and life satisfaction are given in Table IV.
Relationship between age, gender, children at home, and
OBQ
No significant correlation between age and the OBQ
was identified. Analysing the individual OBQ items
for age correlations in the total sample identified that
higher satisfaction with time use in rest, recovery, and
sleep (Item 13) correlated significantly with higher age
(rho 0.242 p = 0.004). However, further analyses
showed that the item was only significantly correlated
with age in women; the highest correlation was among
women living without children (rho 0.332 p = 0.012).
There were also significant correlations with age in
some demographic groups on three other items, nos
8, 10, and 12 (Table V).
There were no differences in the summed OBQ
identified between men and women or between
participants who lived with children versus those
who did not. However, there was a tendency toward
a difference in OBQ ratings between women living
with children (median 38.5) and women not living
with children (median 45) (p = 0.052).
Among the individual OBQ items, no differences
between men and women were identified in the total
sample. However, analyses for differences between
participants living with and without children revealed
that those who lived with children rated significantly
lower in Items 3–5. When separating men and women,
two differences in women remained plus one
new one (Item 6) but only one in men (Item 3),
Table VI.
Discussion
Although the roots of occupational balance can be
traced back to Meyer in 1922 (24) there is still a need
for further knowledge concerning this core concept in
occupational therapy. The need to research occupa-
tional balance in people not sharing a health condition
Table III. OBQ ratings in different participants.
OBQ
Min–max
(range 0–65) Median Q1–Q3
Total 11–64 42 35–47
Men (n = 49) 18–56 40 35–44.5
Women (n = 94) 11–64 43 35–47
University education (n = 83) 17–64 43 35–47
Other education (n = 59) 11–57 41 35–47
Living with children (n = 47) 11–52 40 34–45
No children (n = 87) 15–64 42 35–47
Table IV. Results of self-rated health and life satisfaction.
Min–max (range) Median Q1–Q3
Self-rated health 1–5 (1–5) 3 3–4
Life satisfaction 2–6 (1–6) 5 4–5
Table V. Significant relationships between some of the items and age.
Item All men
Men living
with children
Men living
without children All women
Women living with
children
Women living
without children
8. Balance between
physical, social, mental, and
restful occupations
rho –0.385 p = 0.039
10. Satisfaction with the
number
of occupations
rho 0.350 p = 0.049
12. Balance between
energy-giving/energy-taking
occupations
rho –0.346
p = 0.015
rho –0.425 p = 0.022
13. Satisfaction with time
use in rest, recovery, and
sleep
rho 0.261 p = 0.011 rho 0.332 p = 0.012
418 P. Wagman & C. Håkansson

5. has also been emphasized (4). The aim of this study
was to describe the relationship between occupational
balance (as measured with the OBQ) and self-rated
health and life satisfaction as well as to explore poten-
tial differences in occupational balance in a sample of
adults in Sweden. The results showed that few
participants rated low occupational balance, self-rated
health, and life satisfaction.
Another result was the finding that occupational
balance significantly correlated to self-rated health
and life satisfaction, which supports the relationship
between occupational balance and health. The fact
that the correlations were high but not were very high
is interesting as this also indicates that occupational
balance is a health-related construct but not the
same as health or life satisfaction. This is further
emphasized considering that the correlation between
self-rated health and life satisfaction (also related but
not the same) was about the same as their correla-
tions with occupational balance (not shown in the
results).
Regarding differences in occupational balance, no
age correlation or difference between people with
different demographics was identified in the summed
OBQ. Further research is necessary to investigate
whether this also holds true in other samples. Among
the individual items, however, there were correla-
tions between age on four items and differences on
another four. The differences are interesting, as they
seem to concern whether or not the participant was
living with children younger than 18. This is in line
with the results of Matuska et al. (19) who identified
lower life balance among participants who had chil-
dren living at home. Furthermore, Erlandsson et al.
(14) identified differences in the number of inter-
ruptions between younger women living with chil-
dren or a partner or not and it can be speculated that
this affects occupational balance. The speculation is
in line with one result in a study among working
adults where being frequently interrupted and dis-
turbed was an example of something affecting life
balance negatively from a short time perspective (5).
Further knowledge about occupational patterns and
balance, and similarities and differences among male
and female parents is thus very important as it can
also contribute to shedding light on the fact that
mothers in Sweden have more sick leave than fathers
(17,18).
Methodological considerations
A small convenience sample of adults in Sweden, with
more women than men participating, was used, which
influences the validity. There is a need for further
studies including more participants and using
randomized recruiting.
It should also be recognized as a limitation that it
cannot be ruled out that the differences in the results
may have been affected by circumstances not
accounted for. The exploration of occupational
balance also included many analyses without correc-
tion for mass significances. In other words, there may
be more or fewer differences than were revealed.
Altogether, this implies that the results should be
viewed with caution and cannot be generalized.
They can better be used as a base for further studies
and for potential hypotheses regarding occupational
balance in different populations.
Conclusion
The results showed support for the relationship
between occupational balance and health and well-
being as occupational balance (measured with the
Occupational Balance Questionnaire) correlated to
both self-rated health and life satisfaction. The size
of the correlations indicates that occupational balance
is a health-related construct but not the same as health
or life satisfaction. Some potential differences related
to whether the participant was living with children or
not were revealed. However, the results should be
interpreted with caution as the sample was small and
many analyses were conducted. The results cannot be
generalized, but may serve as a point of departure for
future studies.
Acknowledgement
The authors would like to thank former students
Sandra Jönsson, Karoline Karlsson, Evelina Linde,
Maria Linder, Lena Magnusson, and Emelie
Rynningsjö, who collected the data.
Declaration of interest: The authors report no
conflicts of interest. The authors alone are responsible
for the content and writing of the paper.
Table VI. Significant differences in OBQ ratings between
participants living with and without children.
Item
Total sample
(p)
Men
(p)
Women
(p)
3. Time for doing things
one wants
< 0.001 0.003 < 0.001
4. Balance between work,
home, family, leisure, rest,
and sleep
0.047
5. Balance between doing
things alone/with others
0.015 0.033
6. Having enough to do 0.020
Exploring occupational balance 419

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