Date of Award


Document Type


Degree Name

Doctor of Occupational Therapy


Occupational Therapy

First Advisor

Rebecca Wolf, JD, MPH, OTR/L

Second Advisor

Brandi Fulwider, PhD, OTR/L


Health care in the United States has shifted over the past several decades, from an emphasis on addressing morbidity and mortality to health promotion and overall quality of life (Centers for Disease Control and Prevention [CDC], 2018a). As a result, clinicians in various fields have begun to incorporate considerations for wellness initiatives in addition to preventive strategies. The phrase health-related quality of life (HRQOL) refers to “an individual’s or group's perceived physical and mental health over time” (CDC, 2018a, p. 7). As specified in that definition, HRQOL can be viewed at an individual or community level. For individuals, this includes the physical and mental health perceptions, such as those about energy level or mood, and related factors including health risks, conditions, functional status, social support, and socioeconomic status (CDC, 2018a). For communities, this may include community-wide resources, environmental conditions, policies, and other practices that may influence a larger population’s perceptions of health and functional status (CDC, 2018a).

The World Health Organization (WHO) defines the quality of life (QOL) as “an individual’s perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” (WHO, 2012, p. 11). What is common between these definitions is a person-specific and context-based perception of health. It is important then to consider how QOL is experienced by different people or groups, and what factors support or hinder a person’s pursuit of their desired QOL.