Perceived Control: How Is It Related to Daily Occupation

in Patients With Mental Illness Living in the Community?

Mona Eklund

KEY WORDS Perceived control is of significance in occupational therapy, as revealed in empirical research and suggested
• community in practice models. This study investigated the relationship between perceived control and occupational per-
• mental illness formance in persons with long-term mental illness. The 177 participants were assessed regarding perceived
control (locus of control and self-mastery) and occupational performance (activity level and satisfaction with
• occupation
daily occupations). Subgroups with respect to diagnosis and having gainful employment or not were also
• schizophrenia explored concerning the targeted association. The results indicated relationships between perceived control
and occupational performance in the sample as a whole and in all subgroups except that representing people
engaged in gainful employment or education. The latter was a surprising result, considering that the impor-
tance of perceived control was originally identified in the work science area. The results strongly supported that
perceived control should be included in the clinical reasoning of occupational therapists working in mental
health care.

Eklund, M. (2007). Perceived control: How is it related to daily occupation in patients with mental illness living in the com-
munity? American Journal of Occupational Therapy, 61, 535–542.

Mona Eklund, PhD, OT (reg), is Professor, Department erceived control, a belief that outcomes in life are the consequences of one’s own
of Health Sciences, Division of Occupational Therapy and
Gerontology, Lund University, PO Box 157, SE-221 00
P actions, has attracted attention in various research fields. Originally, interest in
perceived control was evoked in the work science area, because perceived control
Lund, Sweden; mona.eklund@med.lu.se.
was found to be vital for satisfaction with work (Aronsson, 1989; Jackson, 1989;
Karasek & Theorell, 1990). More recently, Bengtsson-Tops (2004) suggested that
perceived control was an important indicator of empowerment for people with
severe mental illness, and it has been shown to be important for their well-being,
quality of life, and functioning (Bengtsson-Tops, 2004; Eklund, Bäckström, &
Hansson, 2003; Hansson et al., 1999; Rosenfield, 1992). A sense of control, in
terms of perceived self-mastery, is an indicator of pervasive recovery, beyond
reduced symptomatology (Buist-Bouwman, Ormel, de Graaf, & Vollebergh, 2004;
Fava et al., 2001). Thus, perceived control has been shown to be related to health,
well-being, empowerment, and recovery, all of which constitute important treat-
ment goals in mental health care. Moreover, a recent study showed that perceived
control mediated the relationship between psychopathology and self-rated health
in persons with severe mental illness (Eklund & Bäckström, 2006). This finding
indicates that perceived control could be one missing link in explaining why
improvements on a symptomatic level often are not followed by improvements in
subjective well-being. Perceived control might thereby be a potential mediator
between therapeutic interventions that affect psychopathology and the subjective
feeling of health and should be explored further in the context of mental health
care.
Perceived control has been proposed to be an important determinant of human
occupation in occupational therapy models (Kielhofner, 1985, 1995). In the struc-
The American Journal of Occupational Therapy 535
ture “personal causation,” which is part of the motivational
and intentional subsystem “volition” of the Model of Human
Occupation (MOHO), the individual’s sense of control has
been emphasized as important (Kielhofner, 1995). The
model presupposes that perceived control is the main ingre-
dient in an individual’s sense of efficacy, which, together with
knowledge of capacity, forms personal causation. Thus, per-
ceived control, regarded as a trait-like variable, is one of the
determinants of occupational performance (Henry & Coster,
1997; Kielhofner, 1995). In the most recent version of the
MOHO (Kielhofner, 2002), locus of control and sense of
efficacy have been replaced by self-efficacy, and control is used
in the sense of self-control and control over one’s emotions
and actions. However, this article focuses on perceived con-
trol as introduced by Rotter (1966) and adopted in the ear-
lier versions of the MOHO (Kielhofner, 1985, 1995), denot-
ing the belief that outcomes in life are the consequences of
one’s own actions and control (internal locus of control) as
opposed to being dependent on the initiative of others, luck,
faith, or other types of external control (external locus of con-
trol).
A literature search revealed few studies that had empiri-
cally investigated the role of perceived control in occupa-
tional performance. In a study of persons with schizophrenia,
Bengtsson-Tops (2004) showed that perceived control, in
terms of self-mastery, was negatively related to unmet needs
for care and support in areas such as daytime activities.
Moreover, findings from a recent study indicated that both
locus of control and self-mastery were related to occupational
engagement in persons with schizophrenia (Bejerholm &
Eklund, 2007). Lederer, Kielhofner, and Hawkins Watts
(1985) found no differences in locus of control between
delinquents and nondelinquents, but this nonfinding may
have been due to a small sample size.
Because perceived control is indicative of pervasive
recovery (Fava et al., 2001), its role in relation to daily occu-
pations should be explored. This proposed research may
generate knowledge about how much attention should be
paid to this phenomenon when devising occupational ther-
apy interventions and methods of assessment, which are
important tasks in occupational therapy practice. Treatments
have been developed that specifically address perceived con-
trol, in terms of self-mastery (Gunatilake, Ananth,
Parameswaran, Brown, & Silva, 2004; Starkey & Flannery,
1997), and this type of intervention might be a potential
supplement to existing occupational therapy practices. Fur-
thermore, the significance of perceived control must be
investigated to validate occupational therapy models, such
as the MOHO (Kielhofner, 1995). Occupational therapy
models should be tested for validity in empirical research
(Kielhofner, 2004; Mosey, 1986) because faulty models
536
might mislead clinical practice. These were the reasons for
the current study, further reinforced by the fact that no
empirical study seems to have specifically addressed the
question of how perceived control is related to occupational
performance. Occupational performance may be studied
from different perspectives, one of which is satisfaction with
daily occupations, reflecting an experiential aspect of occu-
pation. Another aspect is the individual’s activity level,
which has to do with actual doing. Experiential aspects of
occupation and actual doing have been shown to be differ-
ently associated with health and well-being in a recent study
(Eklund & Leufstadius, in press), supporting the proposal
that they constitute different aspects of occupation.
Thus, previous research has distinguished perceived
control as a vital factor for recovery, health, and well-being
among persons with mental disorders. Its role in relation to
daily occupation, both subjectively perceived aspects and
actual doing, should be studied to gain knowledge of its rel-
evance for clinical practice and for occupational therapy
theory. However, some factors need to be considered
because they may influence the nature of these relation-
ships. Cognitive functions tend to be affected in persons
with psychosis (Green, 1996; Green, Kern, Braff, & Mintz,
2000; Palmer et al., 2002); therefore, the relationships
between perceived control and occupational performance
might look different in patients with psychosis compared
with patients with other conditions. Whether persons have
gainful employment also may be important for these rela-
tionships. Gainful employment has been shown to be
related to perceived control in one sample of persons with
mental illness (Eklund, Hansson, & Bejerholm, 2001) but
not in another (Eklund, Hansson, & Ahlqvist, 2004).
The main aim of this study was to investigate the rela-
tionship between perceived control and occupational per-
formance in persons with mental illness. A further aim was
to elucidate these relationships with respect to subgroups—
patients with psychosis versus patients with conditions
other than psychosis, and patients engaged in gainful
employment or education versus patients who were unem-
ployed or on sick leave.
Methods
This study was based on two previously collected data sets
from projects investigating the influence of daily occupa-
tion on health and well-being in persons with mental illness
(Eklund et al., 2001, 2004).
Participants
Both projects were carried out in urban areas in southern
Sweden, and both included patients of working age with
September/October 2007, Volume 61, Number 5
severe mental illness. The first data set was generated from
a sample selected from an outpatient unit for patients with
severe mental illness (Eklund et al., 2001). Only patients
with schizophrenia or related disorders were chosen for that
project. Consecutive sampling was used, and 74 patients
agreed to participate.
The second data set (Eklund et al., 2004) was collected
in a sample from another outpatient unit for persons with
severe mental illness. The study by Eklund et al. (2001)
showed that having gainful employment was of some
importance for satisfaction with daily occupations. There-
fore, a wider diagnostic criterion, “persistent mental illness,”
was used in this second sample (Eklund et al., 2004) to
include a larger proportion of persons engaged in gainful
employment or education. Persistent mental illness was
defined in accordance with Ruggeri, Leese, Thornicroft,
Bisoffi, and Tansella (2000) as 2 years of contact with the
psychiatric services. A randomized procedure was used for
the selection of participants. In all, 103 patients partici-
pated in this project.
Informed consent was integrated in both sampling pro-
cedures, and the local research ethics committee approved
both projects. The participation rate was 62% in the 2001
sample and 60% in the 2004 sample, which is comparable
to or better than other studies on similar samples (e.g.,
Bengtsson-Tops et al., 2005). Analyses comparing partici-
pants and nonparticipants indicated no differences in med-
ical condition, age, or gender, except in the 2004 sample
where the nonparticipants were marginally older than the
participants and the proportion of women was somewhat
greater among the nonparticipants.
The two samples differed in definition of diagnosis and
proportion of participants engaged in gainful employment or
education. However, for the purposes of this study, compar-
isons between the samples were not warranted, and further
on they are treated as a single study group. Some character-
istics of the study group as a whole can be found in Table 1,
showing that patients diagnosed as having illnesses other
than psychosis and engaged in gainful employment or edu-
cation formed minority groups. However, the numbers in
these subgroups were large enough to detect moderate effect
sizes at p < .05 with 80% power (Altman, 1993).
Table 1. Characteristics of the Participants (N = 177)
Sociodemographic Variables Descriptive Statistics
Gender
Men 105
Women 72
Mean age 40.3 years
Married/cohabitating 58
Living with own children 41
Number of participants working/studying 52
Diagnosis of psychosis 134
The American Journal of Occupational Therapy
Those with gainful employment—defined as paid,
open-market work—represented a variety of vocations. Sev-
enteen percent were unskilled workers or had service jobs
that did not require special education, such as stockroom
worker or nurse assistant, whereas 27% were skilled work-
ers or had service jobs that required special education, such
as metalworker or nurse. Nineteen percent were trained in
a profession requiring a university degree, such as civil engi-
neer or physician. For 37% of the employed participants,
the type of vocation was not known.
Instruments
Perceived control was measured using two instruments, the
Locus of Control (LOC) Scale (Rotter, 1966) and the Mas-
tery Scale (Pearlin, Menaghan, Lieberman, & Mullan,
1981). The LOC scale measures the extent to which an
individual perceives reinforcement to be a function of his or
her own actions (internal control) or externally determined
(external control). A 4-point scale is used, in which a higher
value represents more external locus of control. The present
study used a short form (8 items) of the Swedish version of
the instrument (Eisemann, Perris, Palm, Palm, & Perris,
1988). The LOC scale has fair internal consistency and
test–retest reliability (Rotter, 1966). The Mastery Scale
measures self-mastery, defined as “the extent to which people
see themselves as being in control of the forces that impor-
tantly affect their lives” (Pearlin et al., 1981, p. 340). The
Mastery Scale has 7 items, consisting of statements where
control and influencing factors are addressed, and the
respondent rates how strongly he or she disagrees with those
statements. For example, the first statement says: “There is
really no way I can solve some of the problems I have.” Each
statement is rated on a 4-point scale, from agree completely
to disagree completely, and a higher value indicates a higher
level of self-mastery. The Mastery Scale has been found to
have good construct, predictive validity, and internal con-
sistency (Marshall & Lang, 1990).
Occupational performance was studied X not in its full
complexity (Law et al., 1996) but from two aspects—satis-
faction with daily occupations and activity level. Both
aspects were generated from the pilot version of the Satis-
faction with Daily Occupations (SDO) instrument (Eklund
et al., 2001). The instrument comprises 7 items regarding
the activity areas of work (4 items: being employed, being
engaged in work during the past 2 months, participating in
work rehabilitation, and participation in community-based
activity centers), leisure activities (2 items: organized activi-
ties and individually enjoyed leisure), and domestic tasks (1
item). Each item consists of a two-part question. The first
part queries whether the participant is performing that kind
of activity at the moment. The response format is yes/no.
537
The second asks the participant to rate his or her satisfaction
on a 7-point scale; that is, a person who performs domestic
tasks rates his or her satisfaction with being involved in such
activities, and a participant without involvement in domes-
tic tasks rates that condition. Two activity indexes can be cal-
culated from this scale. The first index reflects the level of
engagement in daily activities and is based on the first part
of each question. In this index a maximum of 7 points can
be obtained, 1 point for each activity that is presently per-
formed. The second index concerns satisfaction with daily
activities and is expressed as a mean of the satisfaction rat-
ings. The final SDO has satisfactory content and construct
validity and good internal consistency (Eklund, 2004). The
pilot version used in this study has exhibited good internal
consistency (Eklund et al., 2001) and, according to an anal-
ysis made specifically for the present study, it correlates
strongly, rs = .98, with the final SDO.
Procedures
Data collection was performed at the outpatient units over
6 months. Two occupational therapists were trained on the
interviews, one at each unit. They administered the instru-
ments based on self-ratings and assisted the participants if
necessary by reading the questions out loud. The collection
of data took between 2 hr and 4 hr, usually split on two
occasions. The interrater agreement was satisfactory con-
cerning assessments that built on the interviewers’ ratings,
but no such data were analyzed for the present study. The
psychiatrists in charge diagnosed the patients. In the 2001
sample (Eklund et al., 2001), diagnoses were made accord-
ing to the DSM-IV system (American Psychiatric Associa-
tion, 1994), and in the 2004 sample (Eklund et al., 2004),
the diagnoses were based on the ICD-10 system (World
Health Organization, 1993). Different diagnostic systems
were used because the clinical routines differed in this
respect between the two units.
Data Analysis
Because the instruments used were based on ordinal scales,
mainly nonparametric tests were used: Spearman correla-
tions for testing for associations between perceived control
Table 2. Levels of Locus of Control and Self-Mastery in the Sample as a Whole and in Subgroups
Psychosis
Aspect of Perceived Control (n = 134)
Locus of control
Mean (SD)a 19.4 (4)
Self-mastery
Mean (SD)b 18.8 (4.4)
a
Higher values indicate more external locus of control.
b
Higher values indicate greater self-mastery.
538
and occupational performance and the Mann–Whitney U
test for investigating group differences. To test whether the
patients with conditions other than psychosis and those
gainfully employed or studying formed separate or overlap-
ping groups, a chi-square test was performed. To identify
the group affiliation of greatest importance to perceived
control, a univariate analysis of variance was also used, with
the group variables as fixed factors. The software used was
SPSS 11.5, and the level of significance was set at p < .05.
Results
The levels of locus of control and self-mastery in the group
as a whole and in the subgroups are presented in Table 2.
Group comparisons did not indicate any statistically signifi-
cant differences in self-mastery, but there was a tendency
toward a higher level of perceived self-mastery in the sub-
group engaged in gainful employment or education. Regard-
ing locus of control, the subgroup without psychosis had a
significantly lower value than the group with psychosis, indi-
cating more internal locus of control, and the subgroup
engaged in gainful employment or education scored signifi-
cantly lower than those not working or studying.
In the sample as a whole, statistically significant rela-
tionships were found between both measures of perceived
control and the occupational performance estimates (see
Table 3). Significant correlations between these factors also
were found for the subgroups representing patients with
psychosis and patients not engaged in work or education.
Regarding the patient group with conditions other than
psychosis, the pattern of correlations found was similar,
except that a fairly strong relationship was found between
self-mastery and satisfaction with daily occupations and
that the association between locus of control and activity
level was not significant. In the group engaged in gainful
employment or education, no statistically significant rela-
tionships were found between perceived control and occu-
pational performance.
The chi-square analysis showed an overlap between
belonging to the group without psychosis and the group
engaged in work or education. The expected value for this
combination of groups identities was 12.6, and the observed
Nonpsychosis Working Not Working
(n = 43) P Value (n = 52) (n = 125) P Value
17.4 (3.7) .004 18 (3.2) 19.3 (4.2) .025
19.7 (4.4) .353 19.9 (4) 18.7 (4.6) .075
September/October 2007, Volume 61, Number 5
Table 3. Correlations Between Estimates of Perceived Control
and Occupational Performance Factors
Occupational
Performance Factors
Activity
Perceived Control Level
Sample as a whole (N = 177)
Self-mastery .33**
Locus of control –.34**
Patients with psychosis (n = 134)
Self-mastery .33**
Locus of control –.34**
Patients without psychosis (n = 43)
Self-mastery .35*
Locus of control –.21
Patients working/studying (n = 52)
Self-mastery .18
Locus of control –.07
Patients not working/studying (n = 125)
Self-mastery .33**
Locus of control –.36**
*p < .05; **p < .001.
value was 22 (χ2 = 13, df = 1, p < .001). A univariate anal-
ysis of variance (ANOVA) resulted in a significant model
regarding locus of control (R 2 = .064, p = .01). Having a
psychosis was the most important variable in explaining
locus of control, and no interaction between the group vari-
ables was indicated. The corresponding analysis for self-
mastery yielded nonsignificant findings.
Discussion
The results of this study mainly supported the idea that per-
ceived control is important for people’s occupational per-
formance, as suggested in the MOHO (Kielhofner, 1995,
2002). There was a difference between the working/study-
ing subgroup and the others, indicating more external locus
of control in the subgroup not working or studying. This
finding also is in accordance with the results of a recent
study on locus of control and sick leave in a diagnostically
heterogeneous group (Hansen, Edlund, & Bränholm,
2005). The findings showed that persons who were on sick
leave exhibited more external locus of control than a
healthy reference sample. The study by Hansen et al. was
based on the 40-item version of the locus of control instru-
ment, but the scores obtained in the present study indicated
more external control among these psychiatric patients than
in the heterogeneous sample on sick leave.
No differences were found between subgroups based
on medical conditions or engagement in work/education
regarding self-mastery. This result is in contrast to the study
by Bengtsson-Tops (2004), who found differences between
subgroups of patients with schizophrenia and showed that
patients diagnosed with residual schizophrenia scored lower
The American Journal of Occupational Therapy
in self-mastery than those diagnosed with a schizoaffective
disorder. There were differences regarding locus of control
between subgroups based on both diagnosis and engage-
ment in work or education. However, the fact that the two
Satisfaction
With Daily measures of control yielded different findings is not surpris-
Occupations ing, because they have been shown to be only moderately
related (Eklund et al., 2001).
.35**
–.28** Significant associations were found in the sample as a
whole and in most of the subgroups between perceived con-
.28**
trol and occupational performance, although the correla-
–.22*
tions found were moderate or low. Strangely enough, espe-
.57** cially when considering that the significance of perceived
–.35*
control was first acknowledged in studies of working life,
.28 there were no statistically significant relationships between
–.15
the measures of perceived control and occupational perfor-
.35** mance in the working and studying group. This lack of sig-
.25** nificance could not be attributed to lack of statistical power,
because the correlations were low per se; nor could it be the
result of low variation in the perceived control variables, as
indicated by the standard deviations given in Table 2.
Checking the variation in the occupational perfor-
mance variables also indicated a high degree of variability.
Indeed, it seems that perceived control in the working/
studying group was not related to the participants’ activity
level or satisfaction with daily occupations; however, the
reason for this remains obscure. A tentative explanation
could be inferred from results from previous studies on
locus of control and sick leave, showing that people who
returned to work exhibited a more external locus of control
than those who remained on sick leave (Hansen, Edlund, &
Henningsson, 2006; Hansen Falkdal, 2005). The explana-
tion given was that working people have to take heed of
employers and workmates, in turn being explained as an
adaptive cognitive style that probably makes their locus of
control develop in the external direction. Thus, participat-
ing in gainful employment leads to demands on consider-
ing the will of other people and of compromising, which
might lead to some consequences that trigger the individ-
ual’s internal locus of control and some that reinforce exter-
nal locus of control. This is merely a hypothesis, however,
which should be tested in future research.
The studies within work science that have demon-
strated the importance of control for work satisfaction and
well-being have been performed on healthy, working popu-
lations, and the relationship might look different in samples
of persons with a disability. That such differences may exist
was the reason the associations between perceived control
and occupational performance were analyzed separately in
the different subgroups. However, the deviant result pattern
in the working/studying group—lower correlations than in
the other subgroups—was unexpected. Perhaps working
539
conditions should not be too heterogeneous when studying
the impact of control, because different jobs probably
require varying degrees of external locus of control, depend-
ing on the degree of work autonomy. Grouping together
people representing different vocations, as in this study and
in the studies by Hansen and colleagues (2005, 2006), may
obscure possible relationships. The unexpected results and
the nonfindings of this study and previous research regard-
ing perceived control and occupational aspects (Erlandsson
& Eklund, 2003; Hansen et al., 2006) suggest that the role
of perceived control should be further explored both in the
occupational therapy context and in work science.
Interestingly, perceived control was related to both activ-
ity level and satisfaction with daily occupations. Otherwise,
locus of control and self-mastery are variables closely related
to the self (Eklund et al., 2003), and their associations to the
satisfaction aspect of occupation might therefore have been
more prominent. The strongest association found was
between self-mastery and satisfaction with daily occupations,
but the prevailing pattern among the relationships was that
activity level was as consistently related to perceived control
as was satisfaction with daily occupations. This finding sup-
ports the notion that perceived control seems as important
for the actual doing as for how the doing is perceived, which
is in contrast to studies investigating relationships between
occupation and health, where findings indicate a more con-
sistent relationship between experiential aspects of occupa-
tion and health (Aubin, Hachey, & Mercier, 1999; Eklund
et al., 2001, 2004; Goldberg, Britnell, & Goldberg, 2002;
Strong, 1998) than between actual doing and health (Eklund
& Leufstadius, in press).
Both diagnosis and employment were of importance
for the pattern of relationships that emerged between per-
ceived control and occupational performance. The chi-
square analysis indicated an overlap between belonging to
the group without psychosis and being engaged in gainful
work or education. To ascertain the relative importance of
these influences, a univariate ANOVA was used. The result
was nonsignificant for self-mastery and, therefore, could
not reveal any primary influence. However, concerning
locus of control, the analysis suggested that having a psy-
chosis was more important than not being engaged in work
or education for perceiving external locus of control. Con-
sidering that the majority of those with a psychosis had
schizophrenia, this result is in line with Starkey and Flan-
nery (1997), who stated that loss of control is one of the
main characteristics of schizophrenia, expressed in terms of
hallucinations and delusions.
Regarding diagnosis as a determinant of capacity for
work and other daily occupations, previous research has
yielded inconsistent results. Haglund, Thorell, and Wålinder
540
(1998) showed that persons with schizophrenia had more
difficulties in daily occupations than persons with other
medical conditions. The severity of the illness may be more
important than the diagnosis for people’s occupational life,
however, and Brown (1998) and Nagle and associates
(Nagle, Valiant Cook, & Polatajko, 2002) showed that per-
sons with schizophrenia performed fewer meaningful occu-
pations when their illness became worse. Thus, fluctuations
in stage of illness might explain inconsistent findings
regarding the significance of diagnosis for occupational per-
formance. Moreover, the severity of the illness may be con-
tingent on an individual’s opportunity to lead a meaningful
and active life, suggesting that the relationship between par-
ticipation in meaningful occupation and illness severity is
dynamic (Emerson, Cook, Polatajko, & Segal, 1998).
Study Limitations
Regarding the analyses performed in this study, one could
argue that nonparametric tests should have been used in all
cases, and a logistic regression analysis could have been an
alternative to the univariate ANOVA. However, a logistic
regression analysis requires a dichotomous dependent vari-
able, and dichotomization would have violated the variance
in the variables used to assess perceived control. Thus, a uni-
variate ANOVA was chosen.
Another methodological problem of this study is the
fairly large proportion of nonparticipants. Although com-
parable to the average participation rate in data collection
on this target group (Bengtsson-Tops et al., 2005), the
validity of the findings of this study should be discussed.
The nonparticipants did not differ in any important way
from the participants regarding the variables considered
(diagnosis, age, and gender), but they probably represented
an intermediate group with respect to severity of illness.
The more ill patients were probably more apt to decline
participation, and the more healthy ones were not included
in the 2001 sample because of the selection procedure of
choosing persons who recently visited the unit. Moreover,
some demographic variables of potential importance for the
relationships between perceived control and occupation
were not considered in this study, such as having children or
not, and living single or not.
Theoretical Implications
In line with suggestions from occupational therapy theorists
(Kielhofner, 2004; Mosey, 1986) emphasizing the impor-
tance of empirical testing of occupational therapy models,
this study investigated the assumption inherent in the per-
sonal causation structure of the MOHO, that perceived
control is one of the determinants of people’s occupational
performance. This study could not reveal the direction of
September/October 2007, Volume 61, Number 5
such a relationship, but the results strongly support its exis-
tence and thus validate the significance of one aspect of the
personal causation structure. Although perceived control
has been emphasized as an important aspect of personal
causation, criticism of the construct has also been raised. In
a literature review, Henry and Coster (1997) concluded
that locus of control seems clearly related to occupational
behavior, but they still considered measures of control to be
insufficient to assess the personal causation construct. In
fact, the construct of perceived control was not specifically
discerned in the more recent revision of the MOHO (Kiel-
hofner, 2002). However, the current study has shown that
perceived control is one of the trait-like components that
are associated with occupational performance.
Clinical Implications
The link between perceived control and occupation
demonstrated in this study suggests that perceived control
should be included in the clinical reasoning of occupa-
tional therapists working in mental health care. Results
from research within other areas of the mental health field
have shown that perceived control is linked to recovery
(Buist-Bouwman et al., 2004; Fava et al., 2001) and per-
ceived health and well-being (Bengtsson-Tops, 2004;
Eklund et al., 2003; Hansson et al., 1999; Rosenfield,
1992). Probably as a result, interventions targeting per-
ceived control have been developed, often denoted as mas-
tery-oriented interventions (Gunatilake et al., 2004;
Starkey & Flannery, 1997). This body of research, com-
bined with the findings from the present study, could
incite occupational therapists to develop mastery-oriented
treatments. Such treatments should focus on, for example,
client participation in treatment planning, client input
into unit decision making, and skills development (Starkey
& Flannery, 1997), principles that are already well known
to occupational therapists and should be easy to develop
further. Perceived control also should be incorporated into
occupational therapists’ assessment battery, and the find-
ings from this study indicate that both locus of control and
self-mastery should be addressed.
Further studies should be carried out to see whether the
findings of this study can be replicated. The next step, if the
importance of perceived control for occupational perfor-
mance is to be a consistent finding, would be the develop-
ment of a mastery-oriented intervention, followed by a well-
controlled outcome study evaluating its effectiveness. ▲
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