The jigsaw puzzle of activities for mastering daily life; service recipients and professionals' perceptions of gains and changes attributed to reablement - A qualitative meta-synthesis.

BACKGROUND: Reablement services are intended to make a difference in the daily lives of older adults. Outcomes are often described in terms of independence, improving quality of life, improving ADL functioning, or reducing services. However, little is known if the older adults or next-of-kin experience these outcomes when talking about participating in reablement services. AIM: This study aims to explore how older adults, next-of-kin, and professionals narrate the reablement recipients' possible outcomes as gains and changes in everyday life during and after the reablement period. MATERIALS AND METHODS: This meta-synthesis included 13 studies. Data were analyzed with a meta-ethnographic approach, searching for overarching metaphors, in three stages. RESULTS: The metaphor 'the jigsaw puzzle of activities for mastering daily life again' illustrates that re-assembling everyday life after reablement is not a straightforward process of gains and changes but includes several daily activities that must be organized and fit together. To obtain a deeper understanding of the participants' gains, and changes after reablement, we use the theoretical framework of 'doing, being, becoming, and belonging'. CONCLUSION: The findings indicate the complexity of reablement services as well as the need for a holistic approach. SIGNIFICANCE: Outcome measures should be meaningful for reablement recipients.

Discourses of service recipients in the context of reablement in Norway.

BACKGROUND: Reablement is a shift from reactive home care to a more preventive model based on active engagement. In this shift, it is interesting to uncover and understand potential discourses that may exist amongst service providers regarding their views of service recipients. AIM: to explore and describe discourses of the view of service recipients in the context of reablement, from the service providers' perspective. METHOD: Participants were service providers working in reablement, with the analysis being retrieved from 13 focus groups. A critical discourse analysis was used in order to gain a broader understanding and to capture service providers' views. FINDINGS: Five discourses were constructed. Three discourses indicated the way participants perceived service recipients included in reablement, namely the competent service recipient, the conventional service recipient, and the perfect service recipient. Two discourses categorised recipients related to whether or not they were included in reablement: the suitable service recipient who was excluded and the unsuitable service recipient who was included. CONCLUSION: Service providers use a variety of different discourses when they talk about service recipients. SIGNIFICANCE: Service providers, including occupational therapists, must be aware of how unconscious discourses can affect those to whom they provide services.

Promoting Participation in Daily Activities Through Reablement: A Qualitative Study.

A well-known prediction is that the growing elderly population will place a strain on our healthcare systems. At the same time, healthcare is becoming increasingly patient-centered and individualized, with the patient becoming an active participant rather than a mere object of healthcare. The need for change may be met by using a reablement service, utilizing the rehabilitation mindset through home-based services. Rehabilitation and reablement aim to provide opportunities for individuals to participate to a maximum of their potential. This study is part of a larger research project exploring different aspects of reablement in municipalities. It aims to describe how older adults engage in daily activities within the context of reablement and to explore participation in daily activities. A qualitative design was chosen, and the study is explorative in nature due to limited research on participants' experience with reablement. Ten older adults age 70 to 94 years old were recruited and interviewed. The interviews were transcribed verbatim and analyzed using systematic text condensation (STC) strategies. This study provides insights on how older adults experience participation in daily activities and important aspects for performing these activities and living independently as long as possible. Based on the older adults' experiences, three main themes were identified when receiving reablement. First, what to achieve with reablement and feeling a sense of security to participate in daily activities. Second, how to carry out wanted activities using different skills and last, how the social network is important for enabling active living. This calls for healthcare workers to address and facilitate these in reablement. Our findings show the importance of collaborating with the social network and strengthening participation in daily activities to establish and develop existing reablement services.

Becoming an enabler of everyday activity: Health professionals in home care services experiences of working with reablement.

BACKGROUND: Reablement services aim at improving participation in everyday activities at home and in the local community for older adults, focusing on the older adults' resources and goal for participation. Reablement services have been implemented in a number of municipalities in Scandinavia. To our knowledge, there are a few studies focusing on home care service providers experience working within the frame of reablement. AIM: To provide knowledge regarding how home care service providers working with reablement in the home care setting describe their experiences. METHODS: The study had a qualitative design and included five focus group discussions with 25 healthcare professionals working in community health care in two municipalities. The data were analysed using a grounded theory approach. RESULT: The analysis illustrated how the participants experienced both engagement and challenges working with reablement. This was identified by the two categories: creating sustainable change and negotiating the line between helping and enabling. The first described how increased focus on enabling participation among the service recipients created sustainable changes for the older adults and was considered a positive change for both the recipients and the health professionals. The latter showed how the participants found working with reablement as a process of negotiation. This was what the health professionals found most challenging with reablement. CONCLUSION: Working within the frame of reablement offered the service providers, a framework for being more flexible in meeting the fluctuating needs of the older adults. This was done by increasingly utilise ones' clinical skills and changing from providing passive care to working on increasing the older persons' participation in everyday activities. Working with reablement also created challenges. This was related to the health professionals perceived expectations of what some of the older adults expected home care to be and caused ambivalence. IMPLICATIONS FOR PRACTICE: Nurses and healthcare workers should focus on older adults' resources and goals in order to give services that enhance participation in daily activities.

The art of maintaining everyday life: collaboration among older parents, their adult children, and health care professionals in reablement.

Background: A shift in the work-divide among generations and an ageing population have altered the balance of care and support between families and welfare states. Although state policy has increasingly acknowledged that older adults ageing in place receive support from family members, how adult children perceive their collaboration with their parents and health care professionals in reablement services remains unclear. The aim of this study is to identify how adult children perceive the collaboration between older parents, family members, and health care professionals in reablement services. Methods: This study has a qualitative research design with a constructivist grounded theory approach. In total, 15 adult children - 6 sons, 8 daughters, and a daughter-in-law, aged 47-64 years - whose parents had received reablement services, participated in in-depth interviews. Results: Our findings clarify how children and their older parents' reablement services can collaborate to support how the adult children manage and maintain both their own and their parents' everyday lives. The core category derived from our data analysis was the art of maintaining everyday life, with four subcategories indicating the different dimensions of that process: doing what is best for one's parents, negotiating the dilemmas of everyday life, managing parents' reablement, and ensuring the flow of everyday life. Conclusion: To promote collaboration among older adults, their children, and health care professionals in reablement, health care professionals need to proactively involve older adults' family members in the reablement processes, particularly because older adults and their children do not always express all of their care-related needs to reablement services.

Health professionals' perspectives of next of kin in the context of reablement.

Aim: To describe health professionals' perspectives of next of kin in the context of reablement. Methods: A total of 49 health professionals from different organizational levels participated. Their ages, genders, experiences, and professions varied. A total of 10 focus group discussions were held in two municipalities. The data analysis was conducted using a constructivist grounded theory approach. Results: The core category was identified as negotiating between themselves. Two categories captured the different dimensions of the core category: facing a dilemma with next of kin in reablement and ambiguous motives for collaborating with next of kin. Conclusion: In collaboration with next of kin, it is important for health professionals to be aware of and manage the possible differences in expectations and opinions concerning reablement. Health professionals need to acknowledge that next of kin can be a source of support for older adults. They also need to take into consideration that next of kin may need support, information, and education associated with their roles as next of kin to older adults. Implications for rehabilitation Health professionals need to be aware of how they collaborate with next of kin and what they expect of them. There is a need for health professionals to find a routine in how next of kin can become partners in reablement without compromising the older adult's autonomy. This study contributes to further awareness of the different roles of health professionals and next of kin regarding expectations of reablement. Health professionals may benefit from providing a more family-centred approach by taking into account that next of kin can be a resource in reablement. In addition, they need to take into consideration that next of kin also have their own needs and must be respected.

Challenges and motivators to physical activity faced by retired men when ageing: a qualitative study.

BACKGROUND: Active ageing reflects the message from World Health Organisation about addressing the challenge faced by the rapidly ageing population. Knowledge about barriers and facilitators to an active lifestyle must be given more attention. In addition, men seem to participate less in cultural activities and less in fall-prevention groups than women do. When mostly women work with the elderly in primary care, one might question whether the activities offered to older men meet their activity preferences. The aim of this study is to provide new knowledge about challenges and motivators encountered by retired men in maintaining physical activity when ageing. METHODS: Nine retired men, aged between 66 and 83, wrote a Time Geographic Diary for 7 days each. Two focus group discussions with the men were held. A Systemic Text Condensation was used to analyse the data. RESULTS: The analyses identified three categories to describe challenges in being physical active: differences between men and women; meaningful physical activity; and environmental - especially socio-cultural - constraints. Motivating conditions were seen as: new activities to get younger friends, and more information about how to cope. CONCLUSIONS: To achieve the aim of active ageing, service providers as well as local authorities need to have a better understanding of the challenges retired men encounter when ageing. This study highlights vital aspects of the challenges faced by retired men in maintaining their physical activity level.

Importance of participation in major life areas matters for return to work.

INTRODUCTION: The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation. METHODS: This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6-12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression. RESULTS: The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model. CONCLUSION: To identify individuals' subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual's needs.

Older adults who receive home-based services, on the verge of passivity: the perspective of service providers.

BACKGROUND: The increasing number of older adults will put pressure on health care services in the community. It is thus critical to ensure that services promote healthy ageing and participation.The aim of the study was to explore service providers' perception and understanding of the conditions for participation among older adults who receive home-based care. METHODS: The study design was a grounded theory, with six focus groups representing different parts of home-based care in two different municipalities. The data were analysed by a constant comparative method following the guidelines from grounded theory. RESULTS: The findings showed how four different conditions influenced the opportunity for participation or could give a push towards passivity. Firstly, the timing of applications for services. Secondly, the older adults and their family's expectations about participation. Thirdly, external factors such as adequate housing and assistive devices. Finally, the service delivery per se could constitute a barrier for participation, because the services often focused on passive help and 'standard packages'. CONCLUSION: The findings show how factors at the system level, the execution of services and characteristics among older adults and their family may contribute to the individual service recipient being on the verge of being passive.

Understanding experiences of participation among men and women with chronic musculoskeletal pain in vocational rehabilitation.

OBJECTIVE: The objective of this study was to provide knowledge about participation and change in participation among men and women experiencing chronic musculoskeletal pain and undergoing multidisciplinary vocational rehabilitation. PARTICIPANTS: Six women and four men participating in a vocational rehabilitation intervention. METHOD: Data were collected through semi-structured in-depth interviews. The participants were encouraged to talk about their experiences and thoughts regarding participation in different life areas using previous, present, and future expectations. The analysis performed was constant comparative and inspired by grounded theory. RESULTS: The core category was identified as "goal-oriented participation" which represented participation as intentional and situated. Three categories, "participating as before," "participation constantly changing," and "participating in work on hold," were used, taking into account gender-influenced trajectories and understandings of participation before, during, and after sick leave and rehabilitation. CONCLUSION: The different trajectories of participation seemed to be gender specific and were connected to broader societal and environmental factors. These combined aspects seemed to affect values, motivation, and understanding of important goals while experiencing chronic pain. Examining goal-oriented participation may add to the understanding of gender differences in the rehabilitation process and thereby have implications for rehabilitation interventions.

Activity as a tool in language training for immigrants and refugees.

OBJECTIVE: The focus of this study is how skills acquired from everyday life in one's native country can represent a resource in language training and work for immigrants and refugees. The specific aim is to explore what significance activity and participation in activity have on language training. METHODS: This qualitative study is based on fieldwork carried out in relation to a group of illiterate immigrants at a centre for adult education. The sample consists of 11 adult immigrants and refugees, male and female, between the ages of 20 and 65. The interviews with all the participants were carried out with the help of an interpreter. RESULTS: The main findings were that the individual immigrant's history of activities received little attention during the language training. There was hardly any mention of previous experience from everyday life and work. By relying on different activities in the language training, the resources and background of the individual immigrant would have become more visible. Familiar activities from one's own culture enable communication when language skills are limited.

The exhausting dilemmas faced by home-care service providers when enhancing participation among older adults receiving home care.

Older adults wish to stay at home, participate in society and manage on their own as long as possible. Many older adults will, however, eventually become dependent on care and help to maintain their daily living. Thus, to enhance activity and participation also among older adults that receive home-based services, there is a strong need for development of knowledge-based practice regarding participation. The specific aim of this study is to explore how service providers perceive that their working conditions influence on their possibilities to promote participation among older adults, and more specifically, how they perceive the influence of their working conditions. A purposeful sampling strategy was applied, and six focus groups with professionals in two municipalities were conducted. The focus groups comprised four and six participants of varying ages, length of working experience and professions. A total of 30 service providers participated. The data were analysed by a constant comparative method following the guidelines from Grounded Theory. The analysis identified the categories 'encountering needs that cannot be met', 'expectations about participation', 'organisation of services' and 'professional standards' influencing the service delivery. During this analytical process, 'being on the verge' emerged as a core category that describes the service providers' experience of a stressful workday, i.e. when they had the feeling of working against their own professional standards and being pushed to their limits. The findings indicate how the professional standards of service providers on the whole are in line with health policy for in-home services. Policy objectives are, however, not always followed owing to different constraints at the level of service delivery. Along the path from political ideals to the practical execution of services, external circumstances related to the organisation of services are perceived as crucial.

The ups and downs of social participation: experiences of wheelchair users in Norway.

PURPOSE: The primary aim of the study was to explore how people with a disability experience participation in society. A secondary aim was to contribute to the understanding of the concept of participation in terms of the International Classification of Functioning, Disability and Health (ICF). METHOD: Six people with disabilities participated in focus group discussions. The data were analysed following the guidelines for the constant comparative method. RESULTS: Three main categories emerged with regard to the participants' experiences of participation in society. These included: (1) being engaged, (2) being a member of society and (3) interacting as a citizen. Furthermore, a sense of 'climbing up and sliding down the participation ladder' emerged as a core category of participation. This image reflected the dynamic interaction between individual and society; between, on one hand, an individual' attitude, engagement, motivation, interest and capacity, as well as their sense of responsibility vis-a-vis an activity or a social group; and, on the other hand, the opportunities that society and their immediate social worlds offer them. CONCLUSIONS: The fact that participants experience social participation as 'climbing up and sliding down the participation ladder' is important as it enables service providers, managers and policy makers to identify which intrapersonal and environmental factors operate together to limit or enhance the social participation of people with disabilities. This also implies that there is a need for a committed relationship in issues concerning participation for all in society, between people with disabilities and urban planners, and service providers. Findings also imply that participation means being autonomous and making decisions about one's own life and that the subjective dimension of participation must be considered in the revision of the ICF model. Another consideration is to separate activity and participation into two dimensions; i.e. to render more visible the fact that participation is related to environmental, as well as to personal, factors.

Professional carers' perspectives on participation for older adults living in place.

PURPOSE: The purpose of this study was to provide knowledge about professional carers' subjective descriptions and understanding of older adults' participation in everyday life, when living in place and depending on home-based service delivery. METHOD: Thirty professionals from different organisational levels were selected, allowing for differences in ages, gender, length of working experience, and profession or education. Six focus group discussions were held. A grounded theory approach was used to analyse the data. RESULTS: The core category was identified as 'participation in one's own life'. Two categories included the care providers' descriptions and understanding of participation in the life of older adults; 'carrying out tasks in everyday-life' and 'interaction during service delivery'. Participation as carrying out tasks was related to the contexts inside and outside the house. The professional carers' understandings of older adults' participation in interaction during service delivery included three categories; 'Being included and taking part in decision-making', 'socialising during service delivery' and 'collaboration in keeping up or regaining functions'. CONCLUSIONS: To promote participation for older adults living in place and in the context of service delivery, the findings suggest that the professional carers must extend their focus on participation as socialising and its significance for older adults. At a system level there is a need to focus on how the professional role in home-based service delivery can be adjusted and developed to promote collaboration about participation in older adults.

Encountering staff in the home: three older adults' experience during six months of home-based rehabilitation.

PURPOSE: The purpose of the present study was to explore and describe how older adults who received home-based rehabilitation perceived the staff during a period of 6 months when they received rehabilitation. Specifically, the study focused on how the participants collaborated with and made use of the services from the staff. METHOD: In this case-oriented study, three older adults were interviewed continuously during the 6-month period they received home-based rehabilitation. The interviews were analysed continuously using a grounded theory approach. RESULTS: Five different modes of perceiving the staff were identified among the participants: as small talk persons, as discussions partners, as instructors and advisors, as teachers and as persons who carry out tasks efficiently. The three conditions that most came to influence the way the participants perceived collaborated with the staff were as follows: 'experience and encounters with the staff', 'expectations for the future daily life', and 'the participants' needs and tasks related to their disability'. CONCLUSIONS: To achieve collaboration and user involvement, the staff have to encounter each client differently in accordance with the various tasks that must be carried out during rehabilitation. Our findings indicate that this is particularly important for older adults during home-based rehabilitation, since older adults often have changing needs because of comorbidity.

Agency and engagement: older adults' experiences of participation in occupation during home-based rehabilitation.

BACKGROUND: Participation is considered the main goal of rehabilitation and occupational therapy intervention. This study focuses on older adults'participation in occupations in daily life when receiving home-based rehabilitation. PURPOSE: To explore how older adults with disabilities participate in daily life subsequent to hospitalization. METHODS: A prospective case-orientated design was used, with repeated interviews with three older adults and a constant comparative method of analysis. FINDINGS: Two main categories emerged as the participants' experience of participation: "Continuing to be an agent in daily life"captured the participants' decision making, choosing, and acting in daily life. "Life itself is the agent" identified how the participants, despite their strong wishes to be agents, also could let their participation be directed by their engagement in ongoing daily life. IMPLICATIONS: The findings identified participation as a dynamic engagement ranging from individual agency, including decision-making, choosing, and acting in daily life, to letting life itself be the agent. The emphasis on agency in the participants' experiences challenges rehabilitation professionals to find further means of facilitating the clients' possibilities of being agents in their daily lives.

The influence of the environment on participation subsequent to rehabilitation as experienced by elderly people in Norway.

The aim of this study was to illuminate how the environment may influence participation among elderly people who have undergone community-based rehabilitation in Norway, after an acute illness or accident. Fourteen persons over 65 years of age were selected with the specific intention of gaining a variety of ages, both genders, and people living in different kinds of housing. Three focus groups were established and repeated interviews were held with each group. A constant comparative analysis was used to analyse the data. The main finding was that the participants experienced pressure from their environment to concentrate on performing the most necessary daily activities rather than on participation. Three main encounters with environments seemed to be important for this: encountering people and society, encountering private and formal assistance, and encountering occupation. The support that the participants received from family and friends was more important for their participation than having accessible physical environments. The findings suggest that occupational therapists must consider themselves to be part of a societal environment that can hinder participation.