What is the PEO Model? The Person-Environment-Occupation (PEO) Model is an occupational therapy model of practice, which was developed in Canada by Mary Law, Barbara Cooper, Susan Strong, Debra Stewart, Patricia Rigby and Lori Letts in 1996. The PEO Model emphasises that there are transactional relationships between the person, environment and occupation throughout lifetime that can affect occupational performance (Law et al.,1996). Essentially, every purposeful or meaningful activity or task that a person performs is (or part of) an occupation, therefore how well a person can perform an occupation in the environment is known as occupational performance (Law et al.,1996).
Figure 1a. A Person-Environment-Occupation Model of Occupational Performance. Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L., The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance, Canadian Journal of Occupational Therapy (Volume: 63 issue: 1) pp. 9-23. Copyright © 1996 by SAGE Publications. https://doi.org/10.1177/000841749606300103 Reprinted by permission of SAGE Publications, Inc. This material is the exclusive property of the SAGE Publications, Inc. and is protected by copyright and other intellectual property laws. User may not modify, publish, transmit, participate in the transfer or sale of, reproduce, create derivative works (including course packs) from, distribute, perform, display, or in any way exploit any of the content of the file(s) in whole or in part. Permission may be sought for further use from SAGE Publications, Inc., attn. Rights Department, 2455 Teller Road, Thousand Oaks, CA 91360, Email: permissions@sagepub,com. By accessing the file(s), the User acknowledges and agrees to these terms. http://www.sagepub.com
Figure 1b. Depiction of the Person-Environment-Occupation Model of Occupational Performance across the lifespan illustrating hypothetical changes in occupational performance at three different points in time. Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L., The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance, Canadian Journal of Occupational Therapy (Volume: 63 issue: 1) pp. 9-23. Copyright © 1996 by SAGE Publications. https://doi.org/10.1177/000841749606300103 Reprinted by permission of SAGE Publications, Inc. This material is the exclusive property of the SAGE Publications, Inc. and is protected by copyright and other intellectual property laws. User may not modify, publish, transmit, participate in the transfer or sale of, reproduce, create derivative works (including course packs) from, distribute, perform, display, or in any way exploit any of the content of the file(s) in whole or in part. Permission may be sought for further use from SAGE Publications, Inc., attn. Rights Department, 2455 Teller Road, Thousand Oaks, CA 91360, Email: permissions@sagepub,com. By accessing the file(s), the User acknowledges and agrees to these terms. http://www.sagepub.com
Main Concepts and Assumptions of the PEO Model
A person is a human being with qualities, attributes, abilities and skills who is able to take part in many roles (Law et al.,1996). A person is ever changing, developing and interacting with the environment while performing occupations (Law et al.,1996)
The environment is made up of the physical, social, cultural, institutional and socio-economic domains (Law et al.,1996). The environment is the context at which the person takes part in occupations (Law et al.,1996).
An occupation is a group an activities or a tasks that are meaningful and purposeful to the person and meets their needs (Law et al.,1996). Occupations are essential for living and are considered to meet the person’s needs within their roles and enviroment (Law et al.,1996).
Temporal aspects of the PEO model emphasise that interactions between the person, environment and occupations will vary over a lifetime (Law et al.,1996).
The dynamic results of the transaction between the person, enviroment and occupation is known as occupational performance (Law et al.,1996). Occupational performance can be measured both objectively and subjectively (Law et al.,1996).
The person-environment-occupation fit is the idea that the person, enviroment and occupation interact regularly over time and space, where congruence can increase or decrease (Law et al.,1996). The better the fit or compatibility between the person, enviroment and occupation, then the greater the occupational performance (Law et al.,1996).
Recommended readingLaw, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23
Introduction
The model was founded by Law et al (1996) in a response to an identified need of occupational therapy literature that describes the theory and clinical application of the interaction between the person, the environment and the occupation. The model is a framework that guides clinical reasoning in analysis and understanding of the interdependent interaction and therefore can form a foundation for application in practice. However, the model does not prescribe a set of assessments or provide intervention guidelines, therefore allows use of other occupational therapy assessment tools and interventions. Person-Environment- Occupation model of occupational performance adopts a transactional, rather than an interactive approach towards the relation between the person and environment. The transactional approach emphasises the interdependence between the environment and the person.
Theoretical Basis of Model
The Person-Environment-Occupation Model of Occupational Performance
The model consists of three components, namely; the person (P), the environment (E) and the occupation (O). The interaction of the three components results in occupational performance (P-E-O) as presented in the Figure 1. These elements are dynamic and they continue throughout the lifespan. During a lifetime of an individual or community, there are different factors and interactions that happen within the three components and the overlap can differ in size at any one time depending on these factors. This model provides a framework for a systematic interactional analysis of: P-E; P-O; E-O.
Diagrammatic Representation of PEO
Presentation of Components
Person
The person is a unique being who assumes multiple roles and cannot be separated from contextual influences. The person brings to the context a set of attributes, skills, knowledge and experience. Roles differ and vary in degree of importance depending on the environment and developmental stage of the person. The focus of analysis is on the behaviour of the person, such as:
- Motivation: interests, cultural relevance of activity
- Consider situations/conditions that precipitate emotional responses: failure, stress, distraction
- Degree of autonomy
- The basic assumptions of the model are that person is continually developing and is intrinsically motivated.
Environment
The environment is defined as the context within which occupational performance takes place and it is categorized into cultural, socioeconomic, institutional, physical and social. All the environmental categories are equally important to consider according to the model. The environment is considered from the unique perspective of the person, household, neighbourhood and/or community. Demands and cues about expected and appropriate behaviour are received from the environment continuously
Occupation
This is defined as self directed meaningful tasks and activities engaged in throughout a lifespan (Law et al, 1996:16). The model identifies the areas of occupation as self care, productivity and leisure. Occupations are engaged in to satisfy an intrinsic need for self-maintenance, expression, and life satisfaction and they are carried out within multiple contexts in fulfillment of developmentally appropriate roles. The temporal aspects that encompass the occupational routines of the person over time are important to consider.
When analysing occupations the focus should be on characteristics of tasks (occupation), degree of structure, duration of activity, complexity of tasks and characteristics of task demands.
Function – Dysfunction Continuum
Optimal function or occupational performance results from a good fit between the three components (P-E-O). Maximum fit relates to optimal occupational performance, whereas minimum fit relates to minimum occupational performance, hence dysfunction. Disability can be associated with a minimum or poor person-environment fit rather than the impairment itself.
Implications for OT practice
There are multiple avenues from which occupational therapists could focus or target, from the person, occupation and environment perspectives to elicit change. Implementation of these interventions has to be within context and at different levels of the environment.
The model accommodates use of a wide repertoire of well-validated instruments developed by other disciplines and occupational therapists. Change outcomes can be measured in terms of occupational performance as the focus of the model is on occupation rather than performance components.
Reference
Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23.
The Person-Environment-Occupation (PEO) Model of Occupational Performance comes from the field of occupational therapy and helps identify the relationships between a person, an environment, and occupations (activities). These relationships support and enhance a person’s ability (Law et al, 1996); interestingly, that’s what universal design is all about.
The relationship between each helps us understand the quality of occupational performance (i.e., function) that results at the intersection of each component of the PEO. Our goal in every universal design process should be to maximize the “fit” between each component, which will optimize the functionality for all intended users.
The PEO shows us why universal design is difficult
Consider the definition of universal design:
Design that’s usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.
Ron Mace, 1985
“Design” in this conversation is primarily the “environment” part of the PEO Model. If there’s a desire to create a design that provides optimal function for all people, it’s critical to have a deep understanding of all intended users (including all people affected by disability) and all the different ways those users can interact with a design. Without that knowledge, it won’t be possible to identify potential barriers to usability.
This is REALLY difficult, especially because we each have different biases and understandings of how disability affects people. If bias gets foothold in the universal design process, it will result in some degree of exclusion.
The environment’s role in disability
The World Health Organization (WHO) suggests that disability results from mismatched interactions between features of a person’s body and features of the society in which he or she lives.
Consider the area of intersection between the circles in the Person-Environment-Occupation Model. If the environment is designed to be a good “fit” for all intended users (persons) and the activities (occupations) intended to be performed, then we can say that the design ENABLES people.
On the flip side, if there’s a poor Person-Environment-Occupation fit, then we can say that the design DISABLES people. We ought to take the following statement by the WHO seriously when designing things.
“Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.” (source)
Let’s not exclude people because of health problems that can’t be changed. The way things are designed can be changed. That’s what we need to focus on. Have you seen the video of Zach Anner and his quest to get a rainbow bagel? This is well worth 7 minutes of your time:
Zach experiences different types of environmental barriers. Some are physical, and some are attitudinal. Sure, he makes it look funny, but you can see how the environment plays a significant role in successfully completing tasks (occupations) that typically-abled folks wouldn’t think twice about.
An hour to get outside of his hotel? RIDICULOUS. Anyway…
How the PEO helps us design homes universally
Our homes have a direct impact on how well we can live our lives, care for ourselves, care for our family, and more. When someone isn’t able to take care of their own daily needs (e.g., bathing, dressing, cooking, cleaning, etc.) because they’re unable to easily use their home, external support is often necessary. This can be a major frustration for the individual, and an extra stressor for anyone assisting. Roles and routines, such as taking care of children and/or pets, are important to many people too. The design of the places we live is often the factor that enables us to successfully do the things that are most important to us.
When designing a home for universal access, the Person-Environment-Occupation model helps us slow down and consider all possible users of the home. We want to accurately be able to say “this home is designed for people of all ages and abilities.” To do that, we have to not only recognize who “people of all ages and abilities” includes, but we have to think about all the typical activities (occupations) that “people of all ages and abilities” do in a typical home environment. The PEO Model will help designers quickly realize that there’s a whole lot more that goes into a universally designed home than a no-step entry, wide doorways, and lever door handles.
As an occupational therapist, I can’t tell you how many stories I heard of people just “getting by” in their homes. One couple talked about making a reservation in a hotel every few weeks for her husband to get a real shower because the only bathroom in their house was on the second floor. One gentleman wasn’t able to continue his love for woodworking because it was too much effort to walk down to the basement. Over and over I’ve seen people struggle because of design issues. This needs to change.
The design of our homes needs to support the abilities of people in our communities. Is this really too much to ask?
While it’s great that businesses have been working to help improve the safety and functionality of people in their homes, the market is largely focused on remodeling to address what needs to be fixed, not changing the way homes are designed from the beginning.
How the PEO helps us design programs universally
Similarly to the design process of homes, the PEO Model is incredibly useful for program design. If we want to accurately be able to say “this program is designed for people of all ages and abilities,” that means we not only have to be able to identify the full diversity of who we want to be able to participate, but the different methods those people may utilize to participate. Without this knowledge, it will be difficult to successfully accommodate some people and create a welcoming program environment.
It’s common knowledge that physical activity is good for one’s health, but there are less obvious benefits to participating in an activity alongside others, especially for individuals with disabilities. These can include the development of friendships, increased self-image via acceptance into community, increased self-esteem, greater self-sufficiency, decreased negative stereotypes, and more (Anderson & Kress, 2003; Schleien & Green, 1992; Snow, 2013b). Furthermore, the social benefits of recreation may be more impactful than the physical or psychological benefits (Anderson & Heyne, 2012).
Understanding the benefits to social participation is important, if for no other reason than to acknowledge that there’s just as much of a need for opportunities for people affected by disability as there is for our typically-abled neighbors. Active engagement in activity can play an important role in improving quality of life, especially when people feel welcomed and included in the program in which they are participating (Anderson & Kress, 2003). The challenge is to design activities that facilitate this level of social inclusion for people affected by disability.
Can people do universal design without the PEO?
At the time of this writing, there is no “standard” universal design process. There’s no requirement to use any model like the PEO. The only way to gauge whether universal design has been executed successfully is to determine if anyone is excluded from using a design.
The PEO Model is useful because it forces us to look beyond design features and characteristics. When we truly understand the functional diversity of the people who may benefit from a design, in addition to the variety of ways those people can use and interact with a design, and those variables influence the design itself, only then will we be able to ensure that what we create will be welcoming to people affected by disability.
