T
he Occupational Performance History Inter-
Development and
Investigation of the
Occupational
Performance History
Interview
Gary Kielhofner, Alexis D. Henry
Key Words: interviews. occupational
behavior • test construction
This article describes the development of the Occu-
pational Peljormance History Interview, an instru-
ment designed to gather an accurate and clinically
useful history of an individual's work, play, and
self-care performance from psychosocially and/or
physically disabled adolescents, adults, and older
persons. FolloWing the identification and validation
of content and the development offormat, the in-
strument was field-tested and revised. An examina-
tion of reliability across time and raters indicated
that although part of the instrument ratings met or
exceeded levels of acceptable stability, further de-
velopment and testing is indicated.
Gary Kielhofner, DrPH, OTR, FAOTA, is Head and Asso-
ciate Professor, Department of Occupational Therapy, Col-
lege of Associated Health Professions, University of Illi-
nois at Chicago, Chicago, Illinois 60612.
Alexis D. Henry, MS, OTR/L, is Rehabilitation COOl-dina-
tor, Department of Rehabilitation Services, McLean Hospi-
tal, Belmont, Massachusetts. She is also a doCtoral student
in therapeutic studies at Sargent College of Allied Health
Professions, Boston University, Boston, Massachusetts.
This article was accepted for publication September 28, 1987
The American Journal of Occupational Tberapy
Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
view is designed to gather individual work,
play, and self-care performance histories from
psychiatric and physically disabled populations The
instrument was formulated to be compatible with
more than one frame of reference. This paper
presents the instrument, its development, and the re-
sults of a study of its reliability across time and raters.
Review of the Literature
Types ofInterviews
Interviews may be characterized on a continuum from
structured to unstructured. The use of the structured
interview in research is based on the ideal of inter-
view eqUivalence across subjects (Babbie, 1974) The
interviewer follows the wording of questions exactly,
uses only predetermined probes or clarifications, and
records responses exactly as given or on a predeter-
mined scale. The unstructured interview, used in eth-
nographic or qualitative field studies, is purposely
open-ended to allow the interviewer to achieve an
understanding of the psychological and cultural
viewpoint of the respondent (Edgerton & Langness,
1974; Pelto & Pelto, 1970).
The clinical interview, drawing on the strengths
of both the structured and the unstructured interview,
often takes on a semistructured format (Clare & Car-
iens, 1978; Florey & Michelman, 1982; Gurland,
Yorkston, Stone, Frank, & Fleiss, 1972; Moorhead,
1969; Swanson-Fisher & Martin, 1981). Clinical inter-
viewers use their positions as concerned care pro-
viders to elicit accurate responses and achieve em-
pathy with the respondent's point of view, while em-
ploying a clinical frame of reference as a structure for
the interview and its interpretation. Structure in inter-
views is viewed as an aid in eliminating clinical bias
(Fleiss, Spitzer, & Burdock, 1965; Gurland et aI.,
1972; Helzer, Robins, Croughan, & Weiner, 1981;
Helzer et aI., 1977; Strauss, Carpenter, & Nasrallah,
1978) .
Occupational Therapy Historical Interviews
Occupational therapy literature acknowledges the
importance of interviewing patients/clients (Cynkin,
1979; Melvin, 1977; Pedretti, 1981; Smith & Tiffany,
1983; Trombly, 1983) Moorhead (1969) published
the first historical occupational therapy interview, the
Occupational History, a lengthy, semistructured in-
terview designed from an occupational behavior
frame of reference to gather detailecl qualitative in-
formation concerning functioning in occupational
roles.
489
 Recognizing that the shift from long-term to
acute care in psychiatry made it imperative for occu-
pational therapists to have a briefer screening tool,
Florey and Michelman (1982) developed and piloted
the Occupational Role History They based the in-
strument on Moorhead's original work and on a re-
fined occupational behavior frame of reference. The
Occupational Role History was designed to provide
information on occupational roles and the following
components thereof: satisfaction and dissatisfaction
with interests, people, tasks, and environments; com-
petence in simultaneous occupational roles; areas of
skill; and the degree of balance between work,
chores, and leisure. Data from the Occupational Role
History are interpreted and analyzed to determine
how well the person fulfills the demands of his or her
various roles in life and how well he or she balances
occupational and leisure activities.
Methods of Reducing and Reporting Interview Data
Interviews can be used to make a classification deci-
sion (Helzer et al., 1977) Another approach to re-
ducing and reporting interview data is to use a rating
scale. Most rating scales incorporate either a formal or
an implicit theory of adjustment/maladjustment as
the conceptual backdrop for determining the COI1lent
of the rating (Gurland et al., 1972; Shontz & Fink,
1961) Scales may identify fields or areas of adjust-
ment/maladjustment, each consisting of types of
questions or items (Gurland et al., 1972)
Evaluating Reliability of Historical Interview
Instruments
The reliability of historical interview instruments is
generally gauged by the stability of (a) the account
given by the respondent and (b) the narrative de-
scription and/or rating that an interviewer creates
from the respondent'S account. Research designs for
evaluating reliability may be characterized by whether
they examine one or both of these factors (Carmines
& Zeller, 1979; Helzer et aI., 1977). Agreement
among raters (interrater reliability) is usually investi-
gated by having an interviewer conduct an interview
that additional raters observe directly or through vid-
eotape or audiotape. This method is a way of evaluat-
ing the stability of rating procedures, or more specifi-
cally, the amount of agreement between independent
raters who apply the same criteria to make a judgment
(Helzer et al., 1977). The test-retest method gener-
ally involves two separate interviewers independently
interviewing and rating the respondent. Technically,
this process actually incorporates both test-retest and
interrater elements; that is, when ratings are com-
pared, both interrater agreement and the effects of
different interviewers are· simultaneously assessed.
490
Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
Purpose
The purpose in developing the present assessment
was to create an instrument that would build upon
previous occupational history interview instruments
but offer the follOWing: (a) compatibility with more
than a single frame of reference, (b) flexibility in use,
(c) relevance to differeI1l age and disability groups,
(d) clinical usability (ie., the instrument should be
easy to learn, have a simple structure to guide the
interview, and use succinct methods for rating and
reporting data from the interview), and (e) evidence
of reliability.
Method
Development and Content Validation
Given the criteria noted above, the content of the
interview had to be broad enough to reflect different
conceptual frameworks in occupational therapy and
to address concerns relevant to different disability
groups and developmental levels. Based on a review
of the content of existing interviews, preliminary cate-
gories of content were identified and defined. These
were sent to 22 occupational therapists selected for
their known contributions to theory and practice and
approved by the AOTA Committee on Standardized
Assessments (an AOTA/AOTF ad hoc committee).
These experts were asked to comment on the appro-
priateness of the content areas, suggest revisions in
their definitions or scope, and suggest other content
areas. From the feedback received, an original six
content areas were collapsed into five and their defi-
nitions revised.
Once the content for the interview had been
identified, a set of questions to elicit the appropriate
data from the interviewee and two complementary
methods of reporting the data were developed. The
first method was a scale on which to rate the five
content areas and the second was a brief narrative
reporting form for writing a qualitative account of the
interview findings organized into the five content
areas. In addition, a user's manual was written to en-
able therapists to teach themselves to administer the
interview.
The interview and manual were field-tested na-
tionally by 90 therapists chosen to represent a variety
of treatment settings, patient/client populations, and
frames of reference. These therapists used the inter-
view and responded to questions concerning the clar-
ity of the content areas and the clinical relevance and
usefulness of the questions, the rating scale, and the
narrative reporting form. The information received
from the field test resulted in further revisions in the
definitions of the content areas, the iI1lerview ques-
tions, and the rating scale.
August 1988, Volume 42, Number 8
 Instrument
The Occupational Performance History Interview
consists of 39 recommended questions about the in-
terviewee's past and present behavior. The questions
cover five content areas, which are defined as follows:
1. Organization of Daily Living Routines: How
does the interviewee typically spend his or her
time and how does that pattern of time use
affect his or her functioning? How does he or
she balance work, play, and daily living tasks
and how satisfied is he or she with this bal-
ance?
2. Ltfe Roles: What pattern of role involvement
emerges from the interview and how well
does the interviewee fulfill the expectations of
his or her roles?
3 Interests, Values, and Goals: How well does
the interviewee identify and act on personal
interests, values, and goals, and to what de-
gree does he or she achieve satisfaction and
enjoyment?
4. Perceptions ofAbility and Responsibility.- What
is the interviewee's awareness of his or her
own control over everyday life and of his or
her ability to perform behaviors required of
everyday life?
5. EnlJironmental influences: What is the in.flu-
ence of the interviewee's present human and
nonhuman environments on his or her adapta-
tion? What was it in the past? What is it likely to
be in the future?
Although a recommended sequence and format
of questions is proVided, the interviewer is encour-
aged to add, delete, and adapt questions as clinically
indicated during the interview.
A 5-point rating scale (see Figure 1) quamifies
the interviewee's functioning in each of the five con-
tent areas. Each content area consists of two items,
which are summed to provide a score for that area.
The four content area scores pertaining to the individ-
ual can be summed to obtain a score representing the
person's overall adaptation. All five content area

Instructions: Circle the number that best characterizes the individual's adaptive status for each key item in both past and present
according to the following scale: 5- Totally Adaplive (high level of function); 4-Moderately Adaptive (basic ability to function);
3-Marginal (questionable/at· risk ability to function); 2-Moderately Maladaptive (substantial problems that interfere with
function); 1 - Totally Maladaptive (complete inability to function).
Individual Past Present
Organization of Maintenance of organized
Daily Living functional daily routines 5 4 3 2 5 4 3 2
Routines
Achievement of a balance in work,
play, and daily living tasks 5 4 3 2 5 4 :I 2
Life Roles Maintenance of involvement in
life roles 5 4 3 2 1 5 4 3 2
Fulfillment of expectations of life
roles 5 4 3 2 5 4 3 2
I nterests, Values, Identification of interests, values,
and Goals and goals 5 4 3 2 5 4 3 2
Enactment of interests, values,
and goals 5 4 3 2 ') 4 -~ 2
Perception of Ability Acknowledgment of abilities and
and Responsibility limitations 5 4 3 2 ') 4 3 2
Assumption of responsibility 5 4 3 2 5 4 3 2

Instructions: Circle the number that best characterizes the influences of the individual's environment in both the past and the
present according to the following scale: 5- Totally Supports Adaptation (conditions maximize function); 4-Moderately
Supports Adaptation (conditions give basic support to function); 3-Marginal (questionable/at-risk support to function); 2-
Moderately Interferes With Adaptation (conditions that limit function); 1- Totally Interferes With Adaptation (major obstacles to
function)
Environment Past Present
Environmental Influences of the human
Influences environment 5 4 3 2 ') 4 3 2
Influences of the nonhuman
environment ') 4 3 2 5 4 :I 2

Figure 1. Occupational Performance History Rating Scale

The American/ournal of Occupational 7hl!rapJ' 491

Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms

 Table 1
Diagnostic Characteristics of Subjects (N = 153)
Adult Psychiatry Adolescent Psychiatry Physical Disabilities Gerontology
(n = 44) (n = 28) (n = 33) (n = 48)

Depression 19 (43) Depression 14 (50) CVA 7 (21) CVA 13 (27)

Schizophrenia 19 (43) Character 3 (11) Spinal cord 7 (21) Arthritis 6 (13)
disorder injury Depression 6 (13)
Substance 3 (7) Schizophrenia 2 (7) Fractures 5 (16) Amputation 5(11)
abuse
Other 3 (7) Learning 2 (7) Muscle/nerve 3 (9) Fractures 4 (8)
disability injury
Other 7 (25) Pain 3 (9) Parkinson's 3 (6)
disease
Multiple 2 (6) Spinal cord 3 (6)
sclerosis injury
Brain injury/ 2 (6) Multiple sclerosis 2 (4)
head trauma
Other 4 (12) Muscle or nerve 2 (4)
injury
Other 4 (8)
Note Numbers in parentheses are percentages.

scores can be summed to obtain a total score. Separate
ratings and scores are obtained for the past and for the
present. To make these ratings the therapist must es-
tablish a demarcation period between present and
past functioning. This is determined individually for
each interviewee and is based on such events as onset
of disability, major change in life roles, or change in
living situations.
In addition to the narrative form used to report
qualitative data, a five-item nominal scale called the
Life History Pattern is llsed to characterize the individ-
ual's overall history. The therapist is asked to identify
which of five life history patterns listed on the scale
most characterizes the patient/client. The five life his-
tory patterns are (a) history of chronic maladaptation,
(b) history of adaptation recently interrupted by acute

Table 2
Demographic Characteristics of Subjects (N = 153)
Adult Psychiatry Physical
Psychiatry Adolescent Disabilities Gerontology
(n = 44) (n = 28) (n = 33) (n = 48)

Age
Mean 336 17.0 44.2 75.9
Range 20-58 13-18 23-66 65-93
Occupation
Worker 16 (36) 21 (64) 3 (6)
Unemployed 15 (34) 1 (4) 4 (12)
Student 4 (9) 27 (96) 1(3)
Retired 1 (2) 1(3) 36 (75)
Homemaker 6 (14) 5 (15)
Other 2 (5) 1(3)

living situation
Alone 11 (25) 6 (18) 15 (32)
Head of household 11 (25) 18 (55) 21 (44)
Dependent on family 6 (14) 28 (100) 3 (9) 4 (8)
Institutional 8 (18) 1(3) 3 (6)
Roommate 8 (18) 4 (12) 2 (4)
Other 1 (3) 3 (6)

Education
Less than high school 6 (14) 17 (61) 4 (12) 14 (29)
High school 25 (57) 11 (39) 19 (58) 22 (46)
College 10 (22) 5 (15) 11 (23)
Beyond college 3 (7) 5 (15) 1 (2)

Sex
Male 22 (50) 21 (75) 17 (52) 16 (33)
Female 22 (50) 7 (25) 16 (48) 32 (67)
Note. Numbers in parentheses are percentages.

492 August 1988, Volume 42, Number 8

Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
 Table 3 reliability worked in pairs. The first therapist made
Item Correlations Between Two Administrations of the sure that the patient could respond to an interview,
Occupational Performance History Interview (N = 153)
obtained consent, and interviewed the subject, re-
Item Past Present cording the interview on a tape recorder. When at
Maintenance of organized least 5, but no more than 12 days had passed. the
routines 62 .40 subject was reinterviewed by the second therapiSt.
Acievement of balance in
work, play, and daily Each therapist completed the Rating and Narrative
living tasks .57 .47 Forms immediately after the interview Therapists
Maintenance of were instructed to take turns doing the first interview
involvement in life roles 68 39
Fulfillment of role to counterbalance the effects of order. After the thera-
expectations .65 .33 pists had finished collecting data, they completed a
Identification of interests, feedback/demographic questionnaire giving infor·
values, goals .63 .42
Enactment of interests, mation about themselves and their assessments of the
values, goals 56 35 instru ment.
Acknowledgment of To examine interrater reliability, we duplicated
abilities and limitations .62 .48
Assumption of the taped interviews done by the first therapist during
responsibility 68 .49 the test-retest phase and sent them to two indepen-
Human environment .62 36 dent therapists who listened to the interview once and
Nonhuman environment 55 31
then completed the Rating and Narrative Form. Thes.e
Note. p = .001 for all correlations,
therapists were prOVided with basic demographic in-
formation on the subject. These raters were also asked
to respond to a feedback/demographic questionnaire.
onset of maladaptation, (c) history of variable periods
of both adaptation and maladaptation, (d) history of
adaptation followed by gradual, progressive maladap- Results
tation, and (e) other. To assess test-retest reliability, data across two admin-
Both test-retest and interrater reliability data istrations of the interview were obtained for 153 sub-
were collected by therapists selected from a variety of jects. Interrater data were collected for 129 of these
settings in the United States and Canada. Although the subjects Table 1 presents subjects' diagnoses for each
composition of this sample was determined by the of the four subsamples in the study, Subjects' demo-
therapists' willingness to make a substantial commit- graphic traits are noted in Table 2, A total of 201 thera-
ment of time and effort, we sought to maximize vari- pists helped collect clata or make ratings of the sub-
ability in the types of settings and therapists repre- jects, The therapists' mean age was 32.3 years, and the
sented. Recruitment of therapists was also done so as average number of years of experience was 7.2. Thera-
to assure four categories of subjects adolescent psy- pists' frames of reference were primarily eclectic
chiatry, adult psychiatry, physical dysfunction, and (40%), occupational behavior/model of human occu-
gerontology. Therapists collecting data for test-retest pation (33%), and developmental (10%)

Table 4
Correlations Between Two Administrations of the Interview (N = 153)
Adolescent Physical
Psychiatry Adult Psychiatry Disabil ities Gerontology Total Group
Variable Past Present Past Present Past Present Past Present Past Present
Organization
of routines .55" .44' , .46' , .4}>' .65' , .52" .44" .. 54" ,63'" .49'"
Life roles .57" .25' .46' , .49" .64" .47" .69" .34' • 71**· .39" ,
Interests,
values, goals .66" .45' , .44" .44" .40" .25' .67" .49" .63'" .4 5'"
Perception of
ability and
responsibility .49" .59" .51' , 31* .55' , .55' , .63" .56" 71**· .55" ,
Environmental
influences 33' .18" 18" .49' , ,71' , .37' .55' , .27' .63' " .35" •
Individual total ,64" .51*' .53' , .45' , .63" ,SO" .69" .57' • .73" • .54" ,
Scale total ,60" .47' , .47' , .52' , ,68' , ,47" .69" .54' , ,73" , .53' "
, Not significant,
, p-5. ,05. "'p-5. ,01 ",p-5. 001

The American.!ournal oj'Occupational Tberapy 493

Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
 Table 5
Correlations Between Two Administrations When Therapists' Frames of Reference Were Matched
Matched Frame of Occupational Behavior
Reference (n = 91) EcleClic (n = 38) (n = 24)

Variable Past' , Present' , Past' , Present' , Past' , Present

Organization of
routines 68 45 72 46 75 36'
Life roles 79 34 .84 40 .88 .19'
Interests, values,
goals 71 52 84 57 71 .38'
Perception of ability
and responsibility .81 55 .87 59 87 .66'
Environmental
infiuence 68 41 .74 45 59 .34'
Individual total .82 .51 .86 55 .92 45'
Scale tOtal .82 52 85 53 91 48'
aNot significant.
'p:o;.05."p:o; .01

For each of the 20 items on the rating scale as- compared with 57 (p = ,01) and ,2] (p = nonSignifi-
sessing the individual's past and present adaptive cant) for the subjects with low honesty ratings. Con-
status (see Figure]), the distribution of ratings across tent area and individual item correlations were also
the 5-point scale was about equal with the exception generally lower for the low-honesty subjects,
of the totally maladaptive rating, which was used The effect of therapists's agreement on the de-
about 10% of the time Correlations between past and marcation of past and present was similarly examined,
present item ratings were generally low (ranging Therapists who agreed on demarcation pOints within
from .13 to A1), indicating that the two sets of ratings 3 months of each other yielded total correlations of
were relatively independent. .76 (p =01) for the past and 55 (p = .01) for the
present whereas therapists who disagreed by more
Reliability Across Two Administrations of the than 3 months yielded a total past correlation of .68
Interview (p = .01) and a total present correlation of AO (p =
Table 3 gives Pearson correlations for individual .01), The item and individual toral correlations
items across the two administrations of the interview showed the same pattern of lower correlations when
for the toral group. These ranged from .55 to .68 for therapists did not agree on the demarcation.
past ratings and from .31 to .49 for present ratings.
Overall the correlations were higher for the past than
for the present. Correlations for the content area Table 6
scores and total scores across two administrations of Item Correlations Between Two Interraters for the Total
the assessment are shown in Table 4. As expected, Group (N = 129)
these correlations appear higher than those for the Item Past Present
individual items. Table 4 also presents correlations Maintenance of organized
for ratings across each of the four subgroups in the routines .52 40
study. These correlations are somewhat lower on the Achievement of balance in
work, play, and daily
whole. The past ratings of physical disabilities and Jiving tasks 51 40
gerontology appear more stable than the adolescent Maintenance of involvement
psychiatry and adult psychiatry ratings Although the in life roles .50 38
Fulfillment of role
present ratings are lower overall, there does not ap- expectations .52 46
pear to be the same pattern of the psychiatry rating Identification of intereSts,
being less stable than the other two groups' ratings. values, goals 38 23
Enactment of interests,
The effect of the subject's honesty on stability values, goals 48 40
was examined by dividing the sample into two sub- Acknowledgment of abilities
groups: those whose therapists gave ratings of 3 or and limitations 53 29
Assumption of responSibility 55 42
above on a 5-poinr rating of honesty (n = 132) and Human environment 54 32
those with ratings of 2 or 1 (n = 21), The correlation Nonhuman environment 45 -08
for the total score in the honest group was 75 <p = Note. Interrater data were collected for only 129 of the 153 subjects.
01) for the past and 54 (p = ,01) for the present p:o; .001 for all correlations.

494 August 1988, Votume 42, Number 8

Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
 Table 7
Variable and Total Correlations Between Two Interraters of the Interview for the Four Subgroups (N = 129)
Adolescent Physical
Psychiatry Adult Psychiatry Disabilities Gerontology Total Group
Variable Past Present Past Present Past Present Past Present Past Present
Organization of
routines .46' , .57*' .21' .52' , .27" .12" .61' , .4 5" .56" , .45" ,
Life roles .53' , .2S' 23' .53' , .19' 22' 30' .49'" '" .55" , .44" ,
Interests,
values, goals 39' .54' , .24" .45' , .21' 17" .29' .42' , .4S" , .3S" ,
Perception of
ability and
responSibility .46' , .56' , .19" 12" .4 7" .42' .41' , .48' , .58" , .44" ,
Environmental
influences .30" .04" .40' 11" IS" .07" .30' 02' .57' " .13" •
Individual total .53' • .55' • 23' .54' , .30" .26" .49' , .55" .60'" .50" ,
Scale lOtal .53' , .45' .29' .55' , 32" .21 ' .50' , .52' , .63" , .48" •
Note. Interrater data were collected for only 129 of the 153 subjects.
, Not significant.
'p,,; .05. "p,,;Ol "'p,,; .001

Another potential source of instability was the present rating whereas the present ratings of the three
difference in therapists' frames of reference. Since the other groups were similar
instrument was designed to be compatible with more By eliminating subjects whose raters disagreed
than one frame of reference, it follows that therapists on the event demarcating past from present and who
using different frames of reference might interview had received low ratings on honesty, higher correla-
subjects and interpret data differently Correlations tions were obtained for variable and total scores (see
(see Table 5) obtained for pairs of therapists who had Table 8) When selecting those G1SeS for whom both
matching frames of reference are notably elevated for raters held the same frame of reference (see Table 9),
the past ratings when compared with the total group; there was no increase in stability except for the occu-
present ratings appear unaffected. Correlations for pational be!-Jcwior present rating.
matched pairs of therapists holding an eclectic frame
of reference appeared similar to the total group of Therapists' Assessment of the Interview
matched pairs. Correlations for those who used the Therapists were asked for their assessment of the usa-
occupational behavior frame of reference appeared bility and utility of the instrument. The majority did
higher for the past ratings; correlarions for the present not find the interview, the rating scale, the life history
were somewhat lower in comparison with the others. pattern, or the narrative description difficult to do.
Numbers were too few for comparisons of therapists The entire procedure on the average takes about 1 Vz
who held other frames of reference. hours with an average of 47 minutes for the interview,
21 minutes for the rating, and 28 minutes for the nar-
Reliability Between Two Raters rative report The majority of therapists found the in-
terview helpful in establishing rapport, identifying pa-
Interrater reliability was examined in a fashion similar
to that described above Table 6 shows item correla-
tions between two interraters; they ranged from .38 to
.55 for the past and from a nonsignificant -08 to .46 Table 8
Variable and Total Correlations Between Interraters With
for the present. As shown in Table 7, past content area
Two Potential Sources of Error Eliminated (N = 45)
correlations ranged from .48 toS8; the individual
Variable Past Present
total was .60 and the scale total was .63. The present
correlations ranged from 13 to .45; the individual Organization of routines 67 51
Life roles .66 55
toral was .50 and the scale total was .48. As with reli- Interests, values, goals 74 49
ability ~1CrosS two administrations, present ratings Perception of ability and
were less stable than past ratings. The physical dis- responSibility 69 48
Environmental influences .64 .05"
abilities and adult psychiatry subgroups' past ratings Individual total 75 61
were the least stable whereas the past ratings of the Scale total 77 55
other tWO subgroups were similar The physical dis- Note. p < .0001 unless otherwise nored.
abilities subgroup had the lowest correlations for the , Not significant.

The American journal a/Occupational Therapy 495

Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
 Table 9
Correlations Between Two Interraters When Therapists' Frames of Reference Were Matched
Matched Frame of Occupational Behavior
Reference (11 = 38) Eclectic (n = 22) (n=12)

Variable Past Present Past Present Past Present

Organization of
romines .55' , .63" .25" .63" .57* 79"
Life roles .46' • .40' , 38' .50' , .23' .50'
Interests, val ues.
goals .37' , .37*' .14" 28' .34" .69"
Perception of ability
and responsibility .4 7*· .44' , .28" 38' .26' 60'
Environmemal
influences .23' -.12" .20" -31' .29" .46"
Individual total .53' • .54' , .33' .49" 39' 71*'
Scale total .50' • .49' , .31" .38' .43" .80"
, Not significant.
'p :0;05. "p:o; .01.

tient problems, and setting treatment goals. Only
16.5% of therapists indicated they would not use the
interview, and over 40% indicated they would use it
regularly or for some patients. Nearly half of the thera·
pists said they would use the rating form for the meeii-
cal record, and about 80% said they would include it
in the occupmional therapy record
Discussion
The conditions under which the interview and rating
scale were examined in this study yielded a very con-
servative estimate of stability. When the interview was
administered to a patient by twO different therapists,
several sources of potential differences in scores ex·
isted. (a) respondent reliability from Interview 1 to
Interview 2, (b) differences in therapists' interview·
ing abilities and style, and (c) therapist judgment in
converting interview data to ratings. further differ·
ences are those creared by the research procedure:
(a) the presence of the audiotape machine in the first
interview but not in the second, (b) inHuence exerted
by the first interview on the information the respon·
dent gave in the second interview, and (c) the artifi-
ciality of being interviewed by a second therapist
using the same interview instrument. Additionally,
the large number of interviewers/raters who partici-
pated instead of the few ordinarily used to estimate
stability, all of whom had limited experience ,vith the
interview and were self-taught (via the manual) in its
use, may have accounted for some differences in
scores.
Data from the two administrations of the inter·
view indicated that for the total group the variable and
total past scores were fairly stable. All of the correla-
tions for past ratings exceeded Benson and Clark's
(1982) minimal criterion of .60 for test-retest reliabil-
ity. Ratings for the present fell short of reaching this
minimal criterion
It may be that present ratings were more difficult
to make because fewer dara were available to raters.
For example. the recently injured person may not
have had enough experience to relate, thus not giving
therapists a sound basis for a present rating. In a pre-
vious study of reliability in an occupational therapy
interview, stability of the rating of present adaptation
of patients was also lower than for the past (Kiel-
hofner, Harlan, Bauer, & Maurer, 1986). Another fae
tor that may have made these ratings marc difficult to
give was the way in which we instructed therapists to
do them (ie., to consider the present in terms of its
indications about the future direction of the patient's
adaptation) In another study (Kaplan, 1984), stability
for a rating of future adaptation was also low, indicat-
ing that this is a more difficult area of clinical judg-
ment. Finally, it may be that differences in the present
rating reflect some actual changes in the patient's
status between interviews.
It does appear that the present ratings are based
on different information than the past ratings, as is
indicated by the low correlations between past and
present ratings. The present ratings bear further at·
tention, and some revision of the procedure may be
warranted If it is determined that instability in ratings
was due to a lack of information about the present,
then the user might be given the option of not making
the present ratings or of indicating on the form that
they are based on limited information.
Therapists reported tinding it difficult to deter-
mine the demarcation of past and present on the basis
of the person's unique life history, and differences
between therapists' point of demarcation did have a
negative effect on stability. Similarly, subjects judged
to be low on honesty had a negative effect on stability.

496 Augus! 1988, Volume 42, Number 8

Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms

 Therapists' having the same frame of reference ap-
peared to increase some correlations. If therapists'
frame of reference does influence how they make
judgments when doing the ratings, then the question
must be raised whether a generic rating scale concor-
dant with different frames of reference is compatible
with the goal of achieving an optimally stable rating.
Overall, the correlations between two interraters
were unacceptably low. It was expected that these
correlations would be higher than the correlations
across two administrations, since the two administra-
tions included sources of error not present in the in-
terrating condition (ie., the effects of time and two
different interviewers). Since previous research on
psychosocial interviews indicated that audiotaped in-
terviews produced ratings as stable as when therapists
were present at the interviews (Fleiss et al., 1965), we
expected the ratings made from the audiotapes to be
more stable. Several factors may have contributed to
these lower correlations. The semistructured inter-
view permits therapists to use their own style of inter
viewing and to construct their own questions. It may
be that therapists condu([ed interviews differently
from the way raters listening to the tapes would have
and that the information obtained was not what the
listeners would have obtained to make their judg-
ments. In particular, a therapist listening to an inter-
view conducted by a therapist using another frame of
reference may have found it difficult to make ratings
from the interview.
Therapists commented on the difficulty of mak-
ing ratings from audiotapes. They identified several
factors that made for difficulty, including the auditory
quality of some tapes, the nature of the interview
done by the interviewer, and the lack of actual contact
with the patient. A therapist's knowledge of the pa-
tient'S personality and abilities (more readily avail-
able from direct observation) may have influenced
ratings, and the lack of this information may have
made ratings from audiotapes more prone to error.
Given the higher stability of the ratings across two
administrations, it would appear that the interrater
correlations are a result of such problems rather than
an accurate reflection of instability in the rating
process.
Recommendations
Given the apparent impact of frame of reference on
stability, it appears advisable that rating scales should
be based on a frame of reference. By creating rating
judgments that correspond to how therapists engage
in clinical reasoning from their frame of reference it
should be possible to improve the stability of
ratings.
The American Journal of Occupational Therapy
Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
In the present study over a third of the therapists
had never or seldom used interviews in their practice,
and all learned to use the Occupational Performance
History Interview only by reading a manual. However,
most did not use it or used it only a few times before
doing the interviews for this study. Thus, if therapists
received organized training and experience in the use
of the interview, higher reliability coefficients would
probably be obtained
Although we made efforts to assure content valid-
ity of the procedure, an empirical examination of the
validity of the history should be made in the future.
Specifically, the ability of the history to predict reha-
bilitation participation and success would be of both
theoretical and clinical interest.
Finally, direct observation or videotaped inter-
views along with the use of data from other charts may
prove to be a more effective method of examining
interrater agreement than the audiOtape method.
In summary, it appears fair to expect that if the
rating scale were revised and developed specific to a
frame of reference and if therapists trained in the use
of the Occupational Performance History Interview
gave the interview and did the ratings, evidence
of acceptable reliability and validity would be
forthcoming.
References
Babbie, E R. (1974). Sumey research melhods. Bel-
mont, CA: Wadsworth.
Benson, j., & Clark, F. (1982) A gUide for instrument
development and validation. American)oumal ofOccupa-
tional Therap)', 36, 789-800.
Carmines, E., & Zeiter, R. (1979) Reliahility and va-
lidityassessment Beverly Hills: Sage.
Clare, A. W, & Cariens, v. E (1978). Design, deveJop-
ment and use of a standardized interview to assess social
maladjustment and dysfunction in community studies. Psy-
cbological Medicine, 8, 589-604
Cynkin, S. (1979) Occupational therapy: Toward
health tbrougb activities Boston: Little, Brown.
Edgerton, R. 13., & Langness, L. L. (1974). Methods and
st)'les in the study of culture. San Francisco: Chandler &
Sharp
Fleiss, J. L., Spitzer, R. L., & Burdock, E. 1 (1965).
Estimating accuracy of judgment using recorded imerviews
Archives of General Ps)'chiatJ}', J2, 562-567.
Florey, L. L., & Michelman, S M. (982) Occupational
role history: A screening tool for psychiatric occupational
therapy. journal a/Occupational Tberapy, 36, 301-308.
Gurland, B. J., Yorkston, N. .J., Stone, A. R, Frank, J D,
& Fleiss,J. L. (1972). The structUred and scaled interview to
assess maladjustmem (SSIAM)· 1 Description, rationale,
and development. Archives 0/ General Psychiatr)', 27,
259-263
Helzer, J. E, Robins, L. N, Croughan,.J L., & Weiner,
A. (1981) Renard diagnostic interview Its reliability and
procedural vailidity with physicians and lay interviewers.
Archives of General Psychiatr)', 38, 393-398
497
 Helzer, ]., Robins, L., Taibleson, M., Woodruff, R.,
Reich, T., & Wish, E. (1977). Reliability of psychiatric diag-
nosis. Archives of General Psychiatry, 34, 129-133.
Kaplan, K. (1984). Short term assessment: The need
and a response. Occupational Therapy in Mental Health, 4,
29-45.
Kieihofner, G., Harlan, B., Bauer, D., & Maurer, P
(1986). The reliability of a historical interview with physi-
cally disabled respondents. American journal of Occupa-
tional Therapy, 40, 551-556
Melvin, ]. (1977) Rheumatic disease: Occupational
therapy and rehabilitation. Philadelphia: F. A. Davis.
Moorhead, L. C. (1969) The occupational history.
Americanjournal of Occupational Therapy, 23, 329-334.
Pedretti, L. (1981) Occupational therapy: Practice
skills for physical dysfunction. St. Louis: C. V. Mosby.
Pelto, P J., & Pelto, G. H. (1970). Anthropological re-
498
Downloaded from http://ajot.aota.org on 10/22/2020 Terms of use: http://AOTA.org/terms
search: The structure of inquiry (2nd ed.). New York: Cam-
bridge University Press.
Shontz, F. C, & Fink, S. L. (1961). A method for evalu-
ating psychosocial adjustment of the chronically ill. Ameri-
can journal of Physical Medicine, 40,63-69.
Smith, H. D., & Tiffany, E. G (1983) Assessment and
evaluation-An overview. In H. D. Smith & H. L. Hopkins
(Eds.), Willard and Spackman's Occupational Therapy
(6thecl) (pp 143-147) Philadelphia:] B. Lippincott.
Strauss,] S., Carpenter, W. T., & Nasrallah, A. T.
(1978). How reliable is the psychiatric history' Compre-
hensive Psychiatry, 19, 213-219.
Swanson-Fisher, R. W., & Martin, C. ]. (1981) Stan-
dardized interview in psychiatry: Issues of reliability. British
journal of Psychiatry, 139, 138-143
Trombly, C (Ed) (1983) Occupational therapy for
physical dysfunction. Baltimore: Williams & Wilkins.
August 1988, Volume 42, Number 8