Gender, Occupational balance and Immunology: The GOBI Study

Background: Occupational science is an emerging scientific discipline dedicated to the study of people as occupational beings. As used here, the term "occupation" refers to the goal-directed activities that characterize human time use over the span of each day and over the course of life. One key-concept in linking occupation and health may be "occupational balance". Occupational balance may be preferable to "work-life balance" which emphasizes paid work and may thus be not relevant to people whose main focus may not be paid work, but other occupations, such as traditionally women or people with chronic diseases. There is a lack of empirical evidence on the concept of occupational balance in general, as well as whether the experience of balance or imbalance corresponds to "biological" variables in healthy people and in people with chronic (autoimmune) diseases. Gender- specific aspects of occupational balance may add importantly in career planning and occupational counselling of people with chronic diseases. Furthermore, gender has been described to influence the course and management of chronic autoimmune diseases. Objective: In the present project, we aim to explore a possible relationship between gender, the experience of balance or imbalance of occupations, the course of chronic autoimmune diseases and immunological factors. Method: Three studies will be performed. (i) A qualitative study following a narrative biographic methodology in the beginning of the project will explore occupational (im-) balance, gender differences, the experience of "time" and potentially positive experiences in the life stories of people with rheumatoid arthritis (RA), scleroderma (SSc), systemic lupus erythematosus (SLE) and Crohn`s disease (CD) and "healthy" people without a chronic autoimmune disease. (ii) Out of the results of the qualitative study, a questionnaire to assess occupational balance will be developed, piloted, Rasch analysed and possibly copyrighted. (iii) The third part of the project will be a survey and longitudinal analysis using the previously developed questionnaire in 500 people to analyse a potential relationship between gender, occupational balance and the biological and immunological variables, as well as the course of the chronic autoimmune disease.

Occupational science is an emerging scientific discipline dedicated to the study of people as occupational beings. As used here, the term "occupation" refers to the goal-directed activities that characterize human time use over the span of each day and over the course of life. One key-concept in linking occupation and health may be "occupational balance". Occupational balance may be preferable to "work-life balance" which emphasizes paid work and may thus be not relevant to people whose main focus may not be paid work, but other occupations, such as traditionally women or people with chronic diseases. There is a lack of empirical evidence on the concept of occupational balance in general, as well as whether the experience of balance or imbalance corresponds to "biological" variables in healthy people and in people with chronic (autoimmune) diseases. Gender-specific aspects of occupational balance may add importantly in career planning and occupational counselling of people with chronic diseases. Furthermore, gender has been described to influence the course and management of chronic autoimmune diseases. In the present project, we aimed to explore a possible relationship between gender, the experience of balance or imbalance of occupations, the course of chronic autoimmune diseases and immunological factors. Based on the qualitative analysis of the life stories of 90 people with and without chronic autoimmune diseases, the Occupational Balance-Questionnaire (OB-Quest) was developed. Internal consistency of the OB-Quest including construct validity and reliability were examined in quantitative data by using descriptive statistics and Rasch analyses. Thereafter, the questionnaire was applied to 132 patients with RA and 76 healthy people. Levels of immunological parameters, such as interleukin-6 (IL-6) and -8 (IL-8), interferon alpha (INF), tumour necrosis factor alpha (TNF), rheumatoid factor (RF), C-reactive protein (CRP) and anticitrullinated protein antibodies (ACPA) were measured. Occupational balance was associated with functional health and immunological parameters. The strongest associations were identified in the non-employed healthy-people sample with immunological parameters being within the normal range. For example, the OB-Quest items rest and sleep (rho = -0.71, p = 0.01) and variety of different activities (rho = -0.74, p < 0.01) correlated with the SF-36 sub-scale social functioning. The item challenging activities was associated with IL-8 (rho = -0.63, p = 0.04) and ACPA (rho = 0.65, p = 0.03) and the SF-36 sub-scale bodily pain was associated with IFN (rho = -0.69, p = 0.02). Employed and non-employed people differed in their age and CRP levels (older people had higher CRP-values). Additionally, gender differences were found in two OB-Quest items in that more women were able to adapt their activities to changed living conditions, while fewer men were overstressed. In conclusion, we found "physiological" evidence on the link between occupational balance and health.