The digital society: Occupational therapists need to act proactively to meet the growing demands of digital competence

Digitalization and digital competence in relation to the core concerns of occupational therapy

Digitalization in society with the subsequent increased use of everyday technology (ET: the technical artefacts and services used on a daily basis (Hagberg, 2008)), has rapidly influenced our engagement in occupations at home, work, and in public places (Bühler et al., 2011; Emiliani, 2006). Currently, people cannot work, shop, use public transportation or stay in contact with friends without the use of ET, such as mobile phones and internet-based services. The competence needed to live an active independent life in society and the conditions for participation have changed with digitalization. People often share experiences of how their digital competence is challenged in occupations. For example, a woman visiting an unfamiliar city might say she needed to ask how to use her phone to buy a bus ticket, or a man taking part in a live chat that didn't work might not be able to understand the explanation of how to report the error.

According to the European Commission (2017), digitalization leads to the need for every citizen to have at least basic digital competence in order to live, work, learn and participate in society. Digital competence includes not only the abilities and skills to use different ET for various purposes but also the knowledge, understanding and attitudes that are called for as changes occur (SOU [the Swedish Government Official Investigations], 2015: 91). The five recently defined key components of digital competence (Vuorikari et al., 2016) are (a) information and data literacy, (b) communication and collaboration through digital technologies, (c) digital content creation, (d) safety and (e) problem solving. Aspects of these components include (the component from which the aspects derived is given in brackets):

Participate in society through public and private digital services and participatory citizenship (b),

A number of these aspects relate directly to occupation, participation, health and wellbeing, and all are core concerns of occupational therapy.

Digital competence varies between people and is related to aspects such as a person's interests, belief in their own ability, actual ability, and access to social support or other resources when needed. Those who have insufficient digital competence are at risk for exclusion from important occupations. Therefore, bridging the digital divide (European Parliamentary Research Service, 2015), that is, the gap between individuals with regard to both their access to and use of technologies for a variety of tasks, is important. Until recently, societal efforts have focused on improving access to technology and, to a large extent, have taken for granted the ability to use the technology. Consequently, the need to focus on peoples’ ability to benefit from digitalization in meaningful ways is important.

The digital transformation in society: Advancing the role of occupational therapy

In occupational therapy, the development of a digital society has commonly focused on practical issues involving how to make use of technology advancements in assistive devices and, to a lesser extent, on the growing demand for digital competence. Occupational therapists need to become active players in enabling digital competence, by adopting a perspective that acknowledges the wider impact of the digital transformation in society on peoples’ occupational lives. In relation to assistive devices, occupational therapists have a central role, but their role in relation to digitalization and the increased need for digital competence needs to be defined. Occupational therapists have the knowledge and skills to become leaders in supporting digital competence in occupations and, thereby, promoting participation, health and wellbeing. The knowledge and skills that occupational therapists possess can, for example, be used to support policy makers in issues of digital participation and usability of new digital services or lead to new jobs, such as software development. Consequently, it is important to outline potential new roles of occupational therapy and how these roles can be achieved.

Because equal opportunities and resources to engage in occupations are a matter of social justice (Townsend and Wilcock, 2004), it is important to adopt an occupational justice perspective on digital transformation. Digitalization can empower people to do more and enhance participation in society where opportunities to participate did not exist before. But, on the other hand, it is possible that digitalization and automation can reduce opportunities for vulnerable individuals to participate in society. Accommodations necessary to enable their participation may be so extraordinary that it becomes too complicated or costly to engage. Consequently, when the use of ET is too demanding for peoples’ competencies, digitalization may lead to occupational injustice in the form of decreased participation in society. Such situations, in turn, can result in occupational marginalization, occupational alienation and/or occupational deprivation. Therefore, the occupational justice issues related to digitalization need to be monitored and debated in terms of concerns such as equality in the conditions for occupations, accessibility and usability disparities, and disparate conditions for participation. In this regard, occupational therapy has an important role in leading the way to ensure that opportunities that are critical to health and wellbeing continue to be fostered.

The influence of digitalization on occupations and occupational patterns

Digitalization changes individuals’ occupations in many ways. What people do has changed and will continue to change; some tasks no longer exist, while a number of new tasks have arisen (for example, charging devices and checking short messages). Increased access by the use of mobile devices might increase the number of unexpected activities people engage in, changing the available time for, or sequence of, tasks. It has been suggested that technological developments influence people of all ages to become less physically active. Especially with regard to work, physically demanding tasks have been reduced, and cognitive demands have increased (Arbetsmiljöverket, 2015: 17; Sellberg and Susi, 2014) through multi-tasking and increased information flow. In addition, when tasks are carried out and for how long that task is carried out has changed. ET makes it possible to initiate and carry out more tasks at the same time, such as washing clothes at the same time as you cook food and read emails. Where tasks are carried out has also changed, as many tasks including ET are not necessarily bound to a certain place or time. A common example is the flexibility to carry out work tasks at home or while travelling. How tasks are performed can be different from before digitalization, and this continually changes due to updates and new ET artefacts and services. This aspect requires flexibility and the ability to learn and establish new habits and ways of performance. In this, an optimal match between the users’ ability and the demand for ET will be important to facilitate performance.

The above-mentioned changes in occupations are simply examples, reflecting how the complexity between tasks is different compared to previously, in that occupational patterns have changed as well as the performance ‘per se’ of many tasks. People who are able to adapt to these changes may perceive that their lives are easier and may experience improved participation, health and wellbeing. However, the changes in occupations can also be a risk for participation restriction and ill health. There is a urgent need to identify citizens who are more vulnerable with regard to adapting to the digitalization’s requirement for digital competence. Recent research confirms that users with disabilities can have a decreased ability to use ET compared with healthy people (Fallahpour et al., 2014; Malinowsky et al., 2014), which can influence activities in daily life, work and participation negatively (Fallahpour et al., 2015; Larsson Lund et al., 2014; Malinowsky et al., 2014). However, knowledge regarding the impact of the increased need for digital competence in occupations is still rather limited. Therefore, the influence of digitalization on health and wellbeing from an occupational perspective is important to analyse from both a person-centred and a group and societal perspective.

Occupational therapy responses to ongoing changes in the digitalized society

The digital transformation has been described as much more radical than previous developments in society (SOU (the Swedish Government Official Investigations), 2015: 91) and is characterized by high speed cataclysmic changes that involve all sectors of society. This implies that occupational therapy is similarly in a phase that involves a much greater number of changes than in its previous development. Occupational therapy practice, research and education each need to identify directions necessary not only to participate but also to take a leading position. Practitioners need to discuss and identify how they can act proactively rather than responding to the ongoing changes in peoples’ occupations to promote engagement in occupations, participation, health and wellbeing. Action plans need to be developed so that occupational therapists can ensure the possibilities that digitalization offers can be maximized and also that digital health services and new ET can be used to prevent ill health and exclusion. This development needs to occur within an evidence-based framework, and will add to the ongoing lifelong learning in our professional role. In turn, this requires that researchers develop new knowledge about peoples’ occupational engagements as well as new evidence-based assessments, actions and intervention protocols. A revision of existing models of practice needs to be considered, such as whether the digital environment needs to be included and whether digital places, digital occupations and digital skills need to be more clearly outlined. The changes also call for educators to develop occupational therapist educational programmes, and students need to be prepared for lifelong learning supported by digital professional/personal-learning networks. Individual occupational therapists, professional organisations and other institutions can also contribute by taking part in or organising local, national or global initiatives to discuss, plan projects or develop guidance documents. The development of digital academic communities can be an important resource to advance discussions and initiatives between practitioners, researchers, educators, students and other interested parties. In conclusion, as digitalization has a tremendous impact on peoples’ occupations, it is time for occupational therapy to build capacity and for us to advance our discussion and position in order to meet the new health-related needs of our citizens.