Journal of Occupational Science

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Occupational Balance: A Scoping Review of

Current Research and Identified Knowledge Gaps

Petra Wagman (Assistant Professor), Carita Håkansson (Associate Professor)

& Hans Jonsson (Associate Professor)

To cite this article: Petra Wagman (Assistant Professor), Carita Håkansson (Associate
Professor) & Hans Jonsson (Associate Professor) (2015) Occupational Balance: A Scoping
Review of Current Research and Identified Knowledge Gaps, Journal of Occupational Science,
22:2, 160-169, DOI: 10.1080/14427591.2014.986512

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Published online: 08 Dec 2014.

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 Occupational Balance: A Scoping Review
of Current Research and Identified
Knowledge Gaps

This article reports a comprehensive review of the research conducted

Petra Wagman,
Carita Håkansson regarding occupational balance. A scoping study method was used to explore
& Hans Jonsson and describe current research about occupational balance and to identify
research gaps. Twenty-two articles published between 2009 and 2014 met the
inclusion criteria. The articles reported studies conducted in eight countries on
four continents, but the majority were conducted in Europe and North
America. The articles contributed to knowledge about the concept itself, its
importance, levels of occupational balance, and the relationship between
occupational balance and health and well-being. They also described what is
important for occupational balance or how to enhance/create/recreate it and
differences between people. Several research gaps were identified which
include the need for studies about perceptions of occupational balance among
people beyond western societies. Furthermore, systematic research is war-
ranted with regards to levels of occupational balance, and how to enhance it.

Keywords: Occupational balance, Terminology, Scoping review

& Petra Wagman, PhD, Reg

OT, Assistant Professor,
Jönköping University, Sweden
& Carita Håkansson, PhD,
Reg OT, Associate Professor,
Lund University, Lund,
Sweden
& Hans Jonsson, PhD, Reg
OT, Associate Professor,
Karolinska Institutet, Sweden
& Correspondence to:
Petra.Wagman@hhj.hj.se
© 2014 The Journal of
Occupational Science
Incorporated
Journal of Occupational Science,
2015
Vol. 22, No. 2, 160–169,
http://dx.doi.org/10.1080/
14427591.2014.986512
Occupational balance is a central
concept in occupational science that
has its historical roots in the early
founders of occupational therapy as a
profession. “Our concept of man is
that of an organism that maintains
and balances itself in the world of
reality” (p. 641) wrote the physician
Meyer in his classic 1922 article
(Meyer, 1922/1977). He talked about
the “big four”: work, play, rest and
sleep. All were necessary but how
they stood in relation to each other
was not defined theoretically. He had
a line of argument developed from
patients who spent long periods in an
institutional environment, as he saw
the need to offer them some kind of
meaningful work. However, if this
could not be achieved, it was very
important that there was time for
playful activities after work. Meyer’s
reasoning had its roots in Moral
Treatment ideas, developed 100 years
earlier, of enhancing health in insti-
tutional settings by imitating the
structure of everyday life with a
variety of activities that created a
healthy mix (Kielhofner, 2009).
These ideas spread internationally in
the second half of the 19th century.
For example, Dr. Ernst Westerlund
was one of the most well-known
Swedish physicians between 1860
and 1920 (Hulter Åsberg, 2010). He
became known for his prescription of
activities which were often specified
in type, time and sequence. In an
analysis of the ideas that guided his
treatment, balance between different

160 J O U R N A L O F O C C U PAT I O N A L S C I E N C E , Vo l . 2 2 , N o . 2 , 2 0 1 5
 P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
types of activities was identified as a central
principle (Jonsson, 1998).
Moving forward in time, occupational balance
was one of the central concepts (Christiansen,
1996) when occupational science was introduced
in 1989-1990 to develop a systematic base of
knowledge about human occupation (Clark et al.,
1991; Yerxa et al., 1990). Somewhat later, Wil-
cock et al. (1997) published an empirical study
in which many participants perceived occupa-
tional balance to be approximately equally
involvement in physical, mental, social and rest
occupations. Wilcock followed up with a discus-
sion about occupational imbalance in her book,
An Occupational Perspective of Health (Wilcock,
1998). Subsequent empirical research includes
studies of how mothers caring for a child with a
functional limitations orchestrate everyday tasks
(Larson, 2000) and balance/imbalance in retire-
ment (Jonsson, Borell, & Sadlo, 2000).
Given the prominence of the concept, it is
perhaps surprising that definitions of occupa-
tional balance are vague. In 2004, Backman
summarised this as:
Despite its long history, occupational balance
remains an abstract and evolving concept,
and is, perhaps, not understood as well as
more concrete and observable phenomena
…. While it is often mentioned … it is
seldom clearly and succinctly defined.
(Backman, 2004)
However mounting empirical research makes it
possible to begin to analyse more precisely how
researchers have conceptualised occupational
balance. In one published study of gender and
balance, the authors concluded that four balance
perspectives could be found: the quantity of
involvement across occupations; congruence
between occupations, personal values and goal
orientations; the fulfilment of demands of roles/
occupations; and compatibility in the arrange-
ments of occupations (Wada, Backman, & For-
well, 2010). In a second study, a concept analysis
aimed to clarify the concept, resulting in two
J O U R N A L O F O C C U PAT I O N A L S C I E N C E , Vo l . 2 2 , N o . 2 , 2 0 1 5
defining attributes; occupational balance is a
subjective concept and it implies experiencing
the right amount and variation of occupations
(Wagman, Håkansson, & Björklund, 2012).
Extending that initial work, this article reports a
scoping study (Arksey & O’Malley, 2005) of
recent research into occupational balance.
Method
The scoping review methodology gives a picture
of the current situation in a specific research
field. One of the common reasons for conducting
scoping studies is to also identify research gaps.
Hence, the aim was to explore and describe
current research about occupational balance and
to identify research gaps in the existing literature.
Articles published in international peer reviewed
journals were used as data. The criteria for
inclusion were:
. written in English
. published in 2009 or later
. reporting primary research
. the term occupational balance in the
title, abstract or key words.
The search process was conducted in two steps:
first, in data bases using the sole search term
occupational balance and second by pearling
citations and reference lists of the articles
included (Figure 1). The searches were con-
ducted up to 4 April 2014.
After the searches were completed, relevant
content in the included articles was extracted
into a data charting form (Arksey & O’Malley,
2005). It consisted of columns containing
authors and year of publication, country, aim,
design and sample. Furthermore, it included
information about occupational balance and
how occupational balance was used, as well as
the overall study results and the results related to
occupational balance. Finally, the way the study
contributed to the knowledge about occupational
balance was recorded. Both the charting form and
the whole articles were used during the analysis.
161
 P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
Searches in databases.
AMED: 14 hits, 6 included
CINAHL: 31 hits, 8 included
Academic Search Elite: 25 hits, 2 included
Pubmed: 11 hits, 3 included
Controlling each included article’s
citations in Google Scholar
Controlling each included article’s
reference list
Figure 1. The Search Process
Results
Twenty-two articles, published between 2009 and
2014, met the criteria. The included articles are
presented in Table 1. The findings are presented
together with the gaps identified regarding two
major aspects of the research. First, the countries
where the study was conducted as well as its
design and participants are presented. Second, a
description of the knowledge gained about occu-
pational balance follows.
The countries, design and participants
The studies were conducted in eight countries on
four regions: Asia, Europe, North America and
Oceania. However, the majority were conducted in
Europe (14 articles), followed by North America
(6 articles). The majority of articles were pub-
lished from two countries: Sweden with 9 and
Canada with 5 articles. This result implies a gap
regarding the geographic area where occupational
balance is researched, highlighting the need for
research in broader contexts. This research gap is
further evidenced when considering that all the
eight countries are western societies.
The study design used varied between the arti-
cles. Nine articles reported qualitative research.
These had mostly used individual in-depth inter-
views but sometimes were combined with obser-
vations, focus groups or a time-use diary. One
162 J O U R N A L O F O C C U PAT I O N A L S C I E N C E , Vo l . 2 2 , N o . 2 , 2 0 1 5
19 articles included
+
2 articles included
+
1 article included
= 22 articles included
study was longitudinal (Edgelow & Krupa,
2011). The number of participants varied from
5 to 15 and their ages varied from 9 to 88 years.
Ten studies used a quantitative design, mostly
cross-sectional. However, one study used a longit-
udinal design (Håkansson & Ahlborg, 2010) and
one was a randomized controlled trial (Edgelow &
Krupa, 2011). Participant numbers varied from 18
to 2,683, and they were aged between 18 and 70
years old. These results highlight the need for
more studies using quantitative designs other than
cross-sectional. Other designs may contribute by
gaining further knowledge about, for instance,
changes over time, predictors of occupational
balance, as well as whether occupational balance
predicts health or well-being. Finally, three articles
reported studies not easily described as either
quantitative or qualitative. One used Q methodo-
logy and the others used mixed methods.
In three studies an intervention intended to
enhance occupational balance was used. These
interventions were rehabilitation in a therapeutic
garden for women with a stress-related disorder
(Eriksson, Westerberg, & Jonsson, 2011), a time
use intervention for people with mental illness
(Edgelow & Krupa, 2011), and an occupational
therapy group for children (Bazyk & Bazyk, 2009).
The samples differed considerably. In several articles
the participants came from general populations
 Table 1: Description of the Included Articles

Participants’ Knowledge
First Author, year Country Design Population (n, characteristic) Range in Age and Gender Contribution*

Bazyk, 2009 US Qualitative 10, in after-school program 9-12 years. 6 girls, 4 boys 5
Håkansson, 2009 Sweden Quantitative 488 38 year (n = 202) and 50 years 4
(n = 286). All women
Stamm, 2009 Austria Qualitative 10, rheumatoid arthritis 38-63 years. 8 women, 2 men 1, 5
Anaby, 2010 Israel Quantitative Two samples: 122 + 24 26-60 years, 43% men 4
30-60 years, 12 women, 12 men

P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
Bejerholm, 2010 Sweden Quantitative 72, with schizophrenia 22-55 years. About two- 4, 5
thirds men
Eklund, 2010 Sweden Quantitative 103, persistent mental illness Mean age 39 (sd 7.9), 47 women, 1
56 men
J O U R N A L O F O C C U PAT I O N A L S C I E N C E , Vo l . 2 2 , N o . 2 , 2 0 1 5

Forhan, 2010 Canada Quantitative 169, rheumatoid arthritis Mean age 53 (sd 9.8), 132 3, 4,5
women, 37 men
Håkansson, 2010 Sweden Quantitative 2683 22-70 years. 2286 women, 3, 5,6
397 men
Edgelow, 2011 Canada Qualitative 18, serious mental illness 21-60 years 5
Eriksson, 2011 Sweden Qualitative 5, stress-related disorder 36-52 years. All women 5
Gibbs, 2011 Canada Qualitative 11, hip and knee osteoarthritis 60-75 years. All women 5
Håkansson, 2011 Sweden Quantitative 488 38 years (n = 202): 50 years 4
(n = 286). All women
Pettican, 2011 UK Qualitative 8, retired 48-64 years. 4 women, 4 men 5
Johansson, 2012 Sweden Quantitative 77, stress-related disorder 24-62 years. All women 5
Koome, 2012 New Zealand Qualitative 7 (3 with mental illness) 4 mothers. 1 girl, 2 boys aged 16- 5
17 years
Wagman, 2012 Sweden Q-method 32 21-67 years. 16 women, 16 men 6
Lund, 2013 Norway Qualitative 8, stroke 69-88 years. 5 women, 3 men 5
Pemberton, 2013 UK Qualitative 14, chronic fatigue syndrome/myalgic 17-65 years. 12 women, 2 men
encephalomyelitis
Roy, 2013 Canada Mixed methods 50 (19 with psychic disorder, Mean age 22.7/24 years.14 1, 3, 6
31 comparisons) women, 35 men
Dür, 2014 Austria Qualitative 15, with Crohns disease 25-63 years. 8 women, 7 men 2
Hodgetts, 2014 Canada Mixed methods 139 mothers of children with autism 26-63 years. All women
Wagman, 2014 Sweden Quantitative 67 26-69 years. 45 women, 19 men 3, 6

Key: * 1. The concept in general. 2. The importance of occupational balance. 3. Levels of occupational balance. 4. Relation to health and well-being. 5. Of importance for creating/recreating
occupational balance. 6. Differences between people.
163
 P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
(Anaby, Backman, & Jarus, 2010; Håkansson &
Ahlborg, 2010; Håkansson, Björkelund, & Eklund,
2011; Håkansson, Lissner, Björkelund, & Sonn,
2009; Wagman & Håkansson, 2014; Wagman,
Håkansson, Jacobsson, Falkmer, & Björklund,
2012). In others they had a common diagnosis:
Crohns disease (Dür et al., 2014); mental illness
(Bejerholm, 2010; Edgelow & Krupa, 2011;
Eklund, Erlandsson, & Leufstadius, 2010; Koome,
Hocking, & Sutton, 2012; Roy, Rousseau, Fortier, &
Mottard, 2013); osteoarthritis (Gibbs & Klinger,
2011); rheumatoid arthritis (Forhan & Backman,
2010; Stamm et al., 2009); severe fatigue (Pember-
ton & Cox, 2013); stress-related disorder (Eriksson
et al., 2011; Johansson, Eklund, & Erlandsson,
2012); and stroke (Lund, Mangset, Wyller, & Sveen,
2013). Finally, studies of retired men and women
between 48 and 64 years (Pettican & Prior, 2011),
mothers of children with autism (Hodgetts, McCon-
nell, Zwaigenbaum, & Nicholas, 2014) and children
(Bazyk & Bazyk, 2009) were found. These results
show breadth in the populations studied, although
most studies among general populations were
conducted in Sweden.
The majority of the studies included participants
of working age. Only one study was conducted
solely among children (Bazyk & Bazyk, 2009)
and one included three adolescents and their
mothers (Koome et al., 2012). Similarly, few
studies included older people and only one was
conducted solely with people older than 65 years
(Lund et al., 2013). Further studies among
people of different ages, especially among the
youngest and the oldest, are therefore warranted.
A predominance of female participants was also
identified. In six studies only women were
included (Eriksson et al., 2011; Gibbs & Klinger,
2011; Håkansson et al., 2009; Håkansson et al.,
2011; Hodgetts et al., 2014; Johansson et al.,
2012). Women made up at least 70% of the
participants in another six articles (Forhan &
Backman, 2010; Håkansson & Ahlborg, 2010;
Pemberton & Cox, 2013; Roy et al., 2013; Stamm
et al., 2009; Wagman & Håkansson, 2014). No
study was identified with such a focus on men, but
one article included about two-thirds men
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(Bejerholm, 2010). Taken together, about 80% of
the sample across all articles was female, implying
a research gap. However, it should be recognized
that the majority of women, in some cases,
reflected their dominance in certain diagnoses.
Conceptual development of occupational balance
The degree of focus on occupational balance
varied within the articles. Some articles, using
quantitative as well as qualitative designs, had
occupational balance as their point of departure
and whole rationale for the study. For instance,
Stamm et al. (2009) aimed to “explore the
concept of occupational balance in people with
rheumatoid arthritis” (p. 33). They conducted
interviews with eight women and two men and
revealed three dimensions of balance important
for these participants: balance between occupa-
tions that were challenging and those that were
relaxing; balance between occupations differing
in who they are meaningful to, the individual or
the context; and balance between taking care of
themselves and taking care of others. Another
example is Wagman and Håkansson (2014), who
developed an instrument measuring occupational
balance and explored its psychometric properties.
Further, Anaby, Backman and Jarus (2010) aimed
to gain knowledge about the relationship between
occupational balance and health. They concluded
that harmony and conflict among occupations
should be measured separately.
In other articles, occupational balance appeared as
an outcome. For instance, Gibbs and Klinger’s
(2011) study explored the importance of rest in
women with hip or knee osteoarthritis, while Dür
et al. (2014) identified determinants of health
among people with Crohn’s disease. These authors
found that occupational balance was among the
concepts reported as most important.
The articles also contributed to knowledge about
the concept itself and its importance in different
ways: levels of occupational balance; and the
relationship between occupational balance and
health or well-being. Furthermore, the results
contributed to knowledge about what is important
for occupational balance and/or how to enhance/
 P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
create/recreate it. Finally three kinds of differences
were identified between men and women
(Håkansson & Ahlborg, 2010); between people
with and without a mental disorder (Roy et al.,
2013); and regarding the importance of occupa-
tional balance (Wagman, Håkansson, Jacobsson,
et al., 2012). These results are described in more
detail below.
Beginning with the results about what is important
for experiencing occupational balance, the inclu-
sion of occupations for their own sake seems very
important. For example, Johansson et al. (2012)
conducted a study about hassles and uplifts among
women on sick-leave due to stress-related dis-
orders. In their results, the authors described that
“the greatest separate source of uplifts was formed
by those occupations that the women carried out
in their own interest and they could ease off with”
(p. 242). Similarly Eriksson, Westerberg and
Jonsson (2011), also researching women with
stress-related disorders, highlighted the value of
enjoyable occupations. This importance of enjoy-
able occupations was also shown in a study of
children, providing “a glimpse into the possibilit-
ies of enhancing occupational balance and mental
health by engaging children in occupations they
find to be fun” (Bazyk & Bazyk, 2009, p. 78).
Furthermore, the importance of experiencing the
optimal variation between occupations was de-
scribed. For instance, including the right amount
of rest was found to be important among women
with osteoarthritis (Gibbs & Klinger, 2011). Parti-
cipants in a study of retired men and women also
highlighted the importance of variation between
different occupations (Pettican & Prior, 2011).
Finally, it appears that occupational balance may
be enhanced by occupational adaptations. The
value of adapting important occupations in order
to continue with them was identified in a study
among people who had a stroke (Lund et al., 2013).
Adaptations to manage better were also described
by the women with osteoarthritis, who incorpo-
rated restful occupations (Gibbs & Klinger, 2011).
Differences between participants in relation to
occupational balance were also described. In a
J O U R N A L O F O C C U PAT I O N A L S C I E N C E , Vo l . 2 2 , N o . 2 , 2 0 1 5
study exploring what working men and women
consider more or less important for life balance,
occupational balance turned out to be one of the
four viewpoints identified (Wagman, Håkansson,
Jacobsson et al., 2012). However, some aspects
recognized as very important by the participants
holding this view, for instance balance between
work, home, and leisure were not considered
very important by other participants (Wagman,
Håkansson, Jacobsson, et al., 2012). Further-
more, another study of working men and women
identified occupational balance as a stronger
predictor for health among women than among
men (Håkansson & Ahlborg, 2010). Another
difference identified between genders relates to
levels of occupational balance, where men rated
lower occupational balance than women (Wag-
man & Håkansson, 2014). However, there were
fewer men than women participating in the study,
and the difference was not tested statistically.
Further exploration of differences between
groups of people is clearly warranted.
Research regarding potential differences in occu-
pational balance is still missing to a great extent.
One exception is Roy et al.’s (2013) study of
people with mental health conditions, where one
part of the aim was “to document and compare
perceived occupational balance and time use for
both groups” (p. 234). Their results showed that
while the number of participants who were
satisfied with their time use was about the same
in both groups, the causes of dissatisfaction
differed. More participants with mental illness
reported being under-occupied while the matched
participants without mental illness were over-
occupied to a greater extent (Roy et al., 2013).
This finding provides insight into how occupa-
tional balance may differ, which is an area worth
further research.
Discussion
This scoping study aimed to explore and describe
recent studies of occupational balance as well as
identify research gaps. The results show breadth,
in relation to qualitative as well as quantitative
designs, and the development of important
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 P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
knowledge about the concept. For instance, the
importance of including enjoyable occupations was
highlighted. This supports earlier results among
diverse populations: working people with no recent
long-term sick-leave (Wagman, Björklund, Håkans-
son, Jacobsson, & Falkmer, 2011) and women
recovering from stress-related disorder (Håkansson,
Dahlin-Ivanoff, & Sonn, 2006). However, know-
ledge about how much enjoyable occupation is
necessary to influence perceptions of balance would
be interesting. Perhaps it is the experience of
sufficient occupation that is important rather than
amount of time spent. Furthermore, the potential
differences between people are worth considering.
The results also identified several research gaps.
The most obvious gap is the need to conduct
research outside western societies. Apart from the
relevance of studying occupational balance in
contexts where work, family and leisure are not
distinct categories as in industrialised societies,
the fact that all results come from western
cultures limits the conclusions to this context.
Not recognizing this limitation implies a severe
risk of ethno-centrism (Hammell, 2013). Also,
within the western culture, broader research is
necessary. The predominance of participants from
a small country like Sweden calls for an expan-
sion of research effort. Moreover, there is a need
for research encompassing old and young people,
as well as immigrant populations.
Another consideration for future research is the
fact that researchers have measured occupational
balance in different ways. Although this contri-
butes to breadth, it also implies problems gaining
systematic knowledge about, for instance, levels
of occupational balance in different populations.
Another issue in need of investigation is the time
perspective that should be used in relation to
occupational balance. Previous results have
shown that people tend to view life balance in
different time perspectives (Wagman et al.,
2011). Might this also be the case for occupa-
tional balance? If so, a related question is how
long-term and short-term balance relate to each
other. Could a short-term imbalance, such as
working very intensively on a project with
166 J O U R N A L O F O C C U PAT I O N A L S C I E N C E , Vo l . 2 2 , N o . 2 , 2 0 1 5
limited time for rest and social relations, create
circumstances for a better long-term balance?
Moreover, further theoretical discussion regard-
ing the tendency to view occupational balance
from an individual level is necessary. For
instance, how can individual balance be viewed
in relation to what society and culture consider
acceptable balance? Another area not frequently
mentioned is how the individual’s occupational
balance affects and is affected by those around
him/her. A notable exception was Hodgetts et al.’s
(2014) study of the impact of services for
children with autism as experienced by their
mothers. The authors stated that “these findings
suggest that services intended to help families
may limit occupational balance for many
mothers, beyond limitations imposed by the lived
experience of parenting a child with autism” (p.
90). Similar studies would be valuable. For
example, it is possible to imagine a situation
where one person’s occupational balance, such as
including more enjoyable occupations, negatively
affects another person’s occupational balance if it
meant doing more of the domestic work. On the
other hand, is it possible that one person’s
occupational balance may enhance another per-
son’s occupational balance? Further research
regarding balance within couples or workplaces
would add new perspectives.
Finally, the importance of theoretically relating
occupational balance and imbalance to other key-
concepts within occupational science, such as
occupational deprivation (Whiteford, 2000),
should be recognized. Several questions can be
asked. Are these concepts different but overlap-
ping? If so, how? Or, are they basically expressing
similar aspects of the relation between occupa-
tion and health/well-being? Also, the relation
between occupational balance and life balance is
important to discuss conceptually, but this sub-
ject is beyond the scope of this article.
Conclusion
This scoping study reached its aim of exploring
recent research about occupational balance and
 P E T R A WA G M A N , C A R I TA H Å K A N S S O N & H A N S J O N S S O N
research gaps were revealed. However, the pos-
sibility of not including all relevant articles must
be recognized. Only including articles written in
English risks that the restricted geographic range
of research is over stated. Additionally, relevant
articles may have used other terms than occupa-
tional balance. Including other concepts would,
on the one hand, make the results broader, but
conversely, it implies a risk that the results are
less focussed, making our choice relevant.
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To summarise, much knowledge has been gained
about occupational balance in recent years, but
there is still a great deal of research ahead. The
results from the present study show where
further research might be conducted. There is
an urgent need for studies among people beyond
western societies as their perspective is, to a great
extent, missing from current research. More
systematic research is also needed about people’s
levels of occupational balance and how to
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