This paper aims to explore the use and considerations needed for conducting a concept analysis within occupational therapy research. Concept analysis is a popular analytical research tool used with the methodology providing firmer definitions of ambiguous concepts.
An exploration into the use of concept analysis within occupational therapy research. Discussing current approaches of concept analysis and the implementation of this within occupational therapy research.
Concept analysis within occupational therapy research requires further consideration. Current research is favouring one approach when completing a concept analysis that leads to common flaws within the methodology.
Further consideration is required to the approaches followed when completing a concept analysis and whether a discipline-specific approach would enhance concept analysis within occupational therapy.
Background
Research within occupational therapy has been identified as an area requiring further activity (Gunawan et al., 2023; Watson, 2021), this being crucial for establishing a robust evidence base that supports clinical decision-making and demonstrates the effectiveness of interventions. The Royal College of Occupational Therapists’ Research and Development Strategy (2019–2024) emphasises the need for research development (Royal College of Occupational Therapy, 2019). Strengthening theoretical foundations is essential for building this evidence base, and analysing key concepts provides a structured means of understanding and interpreting occupational therapy knowledge. Leading to a need for further consideration into the use of concept analysis (CA) as a methodology within occupational therapy research.
Concept analysis
Debate surrounding a definition of concept has been noted. Commonly defined as the building blocks of scientific knowledge across disciplines (Rodgers and Knafl, 2000; Walker and Avant, 2019).However this has been criticised for lacking empirical support (Bergdahl and Berterö, 2016), with further critique arguing that concepts do not exist (Paley, 2021) When conducting a CA, it is imperative to clearly define the term “concept” for reader clarity. Within occupational therapy, key concepts such as meaningful activity and occupational justice are central to understanding the relationship between occupation and health. CA therefore plays a critical role ensuring understanding and consistency across practice and theory.
CA initially a popular tool in nursing research during the 1990s, is now applied broadly across healthcare research, aiming to “study, clarify, develop, and critically assess a particular concept” (Smith and Mörelius, 2021p. 406) CA is considered essential in theoretical practice and evidence-based care (Hellman, 2024). Ambiguous and emerging concepts are examined to achieve clarity, which is critical in occupational therapy to ensure consistent language and supporting the profession’s value (Recigno et al., 2024). CA positions concepts as foundational units of knowledge. It is imperative researchers conducting CA consider their own stance. Being reflexive and transparent about core beliefs to ensure authentic interpretation as CA is inherently subjective and vulnerable to bias (Walder et al., 2021).
Concerns with CA have been raised due to limited analytical depth, methodological rigour and replicability (Beckwith et al., 2008; Draper, 2014). Reduced generalisability due to flexible approaches commonly used in CA has been noted (Gunawan et al., 2023). While systematic searches and quality criteria can improve methodological rigour, challenges remain, including the absence of standardised reporting, impacting replicability (Wynn, 2024). These limitations must be carefully considered when conducting a CA.
Concept analysis approaches
Wilson’s (1963) seminal 11-step process was one of the first approaches suggested focusing on logical analysis and seen as the origins of CA. This has influenced CA approaches in healthcare research. Nevertheless, its use in healthcare has been critiqued, due to Wilson’s approach being intended for education setting not focusing on scientific knowledge. Table 1 provides an overview of four of the more popular CA approaches used in healthcare including in occupational therapy.
Four concept analysis approaches used in occupational therapy research
| Concept analysis approach | Features | Examples in occupational therapy research |
|---|---|---|
| Walker and Avant’s method; Walker and Avant (2019) | Eight-step model | Brown et al., 2019; Ekelund et al., 2014; Granholm Valmari et al., 2024; Hansen et al., 2021; Hansson et al., 2022; Lecours and Therriault, 2017; Lecours et al., 2021; Wagman et al., 2012 |
| ||
| Rogers evolutionary method; Rodgers and KNAFL (2000) | Cyclical steps | Hirose et al., 2025; Maruyama et al., 2021 |
| ||
| Principle based concept analysis Penrod and Hupcey (2005) | Four broad principles | Recigno et al., 2024; Walder et al., 2021 |
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| Three phases in which the principles are applied. These are the preparation phase, analysis phase and the results phase | ||
| Hybrid model; Schwartz-Barcott and Kim (2000) | Three phases | Dalvand et al., 2015 |
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Walker and Avant’s approach (2019) remains the most widely used approach in healthcare (Fitzpatrick and McCarthy, 2016). The Scandinavian Journal of Occupational Therapy, Canadian Journal of Occupational Therapy and Asian Journal of Occupational Therapy, these were selected to showcase the acknowledgement of CA internationally. The search was conducted in April 2026 and 14 CAs were identified, 8 using the Walker and Avant’s approach demonstrating over 50% using this approach. Strengths include clarity and simplification of concepts (Gunawan et al., 2023). Though simplification can risk reductionism, it has been stated difficult to determine how to “break” abstract ideas into attributes due to complexity (Paley, 2021). Concerns include limited justification for attribute selection (Risjord, 2009), absence of contextual perspectives and issues with reproducibility and quality assessment (Lecours et al., 2021).
Rodgers’ evolutionary approach (2000) offers a cyclical approach, examining how concepts evolve over time and across contexts. This prioritises understanding a concept and guiding further research. Its strengths include a systematic approach (Tofthagen and Fagerstrøm, 2010). While widely used in nursing, its application in occupational therapy remains limited, possibly due to its emphasis on guiding further work rather than forming definitive concept definitions.
The principle-based CA by Penrod and Hupcey (2005) provides an alternative perspective, focusing on inconsistencies within a concept and clarifying related concepts. This approach involves following three phases and applying the four principles listed in Table 1. This approach moves beyond simply describing a concept (Walder et al., 2021), but limitations include a lack of clear guidelines. Smith and Mörelius (2021) proposed a more rigorous framework following on from this approach, incorporating systematic review and quality assessment to enhance standardisation. Limitations within occupational therapy research have been raised regarding strict criteria for search terms, which could have led to missed data (Walder et al., 2021). Occupational therapy concepts frequently use occupation within the concept; this could complicate the effectiveness of the search strategy by increasing ambiguity and narrowing the scope of relevant literature.
The final approach discussed here is the Hybrid model by Schwartz-Barcott and Kim (2000). This combines literature review, fieldwork and analysis to explore concepts in context, by triangulating professional knowledge using the current literature and lived experience. However, the initial working definition derived from literature may overemphasise professional perspectives (Wynn, 2024), and the findings have limited generalisability (Gunawan et al., 2023). Nevertheless, it can offer rich contextual understanding, which is critical in occupational therapy theory.
Current concept analysis in occupational therapy
Table 1 provides a sample of CAs conducted within occupational therapy. An example of how CA has contributed to occupational therapy is Hansson et al. (2022), who applied CA to occupational identity, highlighting the connections between occupation and identity. However, as this analysis used a modified Walker and Avant model, questions about reproducibility remain. Wagman et al. (2012) applied CA to occupational balance, providing clarity on this subjective concept occupational balance.
Occupational therapy-based CAs rely heavily on Walker and Avant’s approach. While this offers clear guidance for researchers new to CA, repeated use perpetuates methodological limitations that can include limited rigour and concerns with casual explanation when discussing case studies (Beckwith et al., 2008). Gunawan et al. (2023) examined alternative lesser used approaches such as the Simultaneous Concept Analysis and Pragmatic Utility. Showcasing the need to adapt or combine approaches to suit specific research questions, rather than defaulting to popularity. Justification for the chosen CA approach is often lacking in occupational therapy research, with no reason or the reason for selecting an approach being due to popularity, this can undermine credibility (Hansson et al., 2022; Wagman et al., 2012).
Context is a fundamental consideration in CA, as the meaning of concepts can vary across settings (Wynn, 2024; Risjord, 2009). Failing to explicitly define context may result in ambiguous findings (Recigno et al., 2024). This is particularly important in occupational therapy where the diverse roles of occupational therapists have historically led to confusion of context. Clear explanation of context can further strengthen the promotion of the discipline (Royal College of Occupational Therapy, 2025). Wynn (2024) proposed reformative CA for applied psychology. This approach considers the core assumptions of applied psychology adding context to the CA. This evidences how a discipline-specific CA is implemented in research.
Occupation-centred approach
Occupational therapists hold the core belief of the beneficial link between meaningful occupation and the person (Law et al., 1996). Alongside this the underpinning occupational science states that occupations influence people’s health and wellbeing (Anne-Le et al., 2023). It is important for all approaches used in CA are conscious of the differing epistemological, ontological and theoretical views of a discipline as these can impact the results (Tofthagen and Fagerstrøm, 2010); however, these assumptions are often not implicit. Occupational therapists completing a CA need to clearly state underpinning beliefs to add context for the reader. Furthermore, the development of a clear concept definition is essential to support the operationalisation of the concept into clinical practice. Allowing occupational therapists to demonstrate how such concepts are enacted within interventions and reflected in outcomes.
Consideration to incorporating occupational therapy core beliefs into approaches of conducting a CA requires exploring. This could include using occupational therapy–specific examples and for critique of concepts to be within an occupational therapy context. Current CA within occupational therapy are showing the concept considered within practice however not integrating the occupational therapy philosophy with CA. As with Schwartz-Barcott and Kim’s (2000) approach, the addition of lived experience of the population relating to the concept would be interesting within CA in occupational therapy. Leading to the argument for a more discipline-specific approach as the reformative CA approach (Wynn, 2024) within applied psychology.
Conclusion
CA has become increasingly prevalent in occupational therapy research and demonstrates the value of exploring core concepts. Further work is needed to ensure researchers select the most appropriate approach. Walker and Avant’s approach remains dominant, yet concerns regarding context, reproducibility and methodological limitations require attention. Incorporating occupational therapy’s unique core beliefs into a CA approach could enhance the relevance and impact of research, supporting the profession’s theoretical and practical foundations. Future work exploring occupational therapy approaches to CA is required to enable a strong framework to follow to ensure CA is embedded within occupational therapy research.
