Background. Occupational therapists practicing hand therapy are challenged to implement occupation-based practices (OBPs) due to the strong influence of the medical model. Purpose. To explore hand therapists' perceptions of OBP and describe occupation-based interventions (OBIs) in hand therapy. Method. Qualitative content analysis (QCA) was used to analyze semi-structured interviews with seven hand therapists. Findings. Six themes emerged: (1) OBP denotes treatment that is customized to ensure individual meaningfulness to each client; (2) the client-therapist relationship is a foundational element central to OBP in hand therapy; (3) goal setting serves as an important link between biomechanics and occupation; (4) OBP in hand therapy encompasses a spectrum of both OB and non-OB interventions; (5) various contextual factors influence OBI; (6) advanced experience in hand therapy facilitates enactment of tailored OBI. Implications. Comprehension of multiple aspects of occupation-based methods in hand therapy exemplifies best practices for clinicians to benefit clients and the profession's identity.