Framing Facets of Social Participation: Older Adults' Experiences of "Social Online Meetings".

Changing demographics with an increased proportion of older adults indicate the need to develop new health-promoting interventions where the potential of digitization is considered. The aim was to explore and create an understanding of how social online meetings are experienced by older adults. Interviews with older adults generated data that were analyzed using a grounded theory approach. The participants were interviewed after participating in a digital health promotion group initiative provided in a municipality context. A core conceptual category and three subcategories reflected an intertwined process of discovering facets of social participation where internal reflections on personal values and needs were nurtured by an external driven process of becoming part of a group in an online context. Occupational therapists and other health and social care professionals need to consider the various facets of social participation when supporting older adults active and healthy aging.

Older Adults' Experiences of "Social Online Meetings"Promoting health among older adults is an important societal issue. Changing demographics with an increased proportion of older adults indicate the need to develop new health-promoting interventions. However, it is important to explore how such interventions in municipal settings meet the needs of older adults and the circumstances that influence their participation. Therefore, this study aimed to understand how older adults experience social online meetings. Seven older adults who had participated in an intervention called "social online meetings" were interviewed about their experiences. The findings demonstrate how older adults come to explore various dimensions of social participation and the value it holds for their everyday life. This gave rise to achieving new perspectives on everyday activities and encouraged personal development, and generated ideas for change. Occupational therapists and other health and social care professionals should consider how older adults' social participation can be promoted when designing health-promoting interventions online.

Fostering social participation among older adults: Perspectives of stakeholders.

BACKGROUND: Fostering social participation for active and healthy ageing among older adults is an urgent issue in a changing society that requires new approaches from occupational therapists as well as from society at large. AIM: To explore possibilities to foster social participation for older adults in society from the perspective of stakeholders. MATERIAL AND METHODS: A qualitative design was applied. 18 key informants, engaged in supporting older adults in their organisational roles as either professionals or volunteers, participated in five different focus groups discussions. RESULTS: The results involved two overarching themes that reflects different perspectives on key informants' possibilities to foster social participation for older adults. The first theme describes how they direct their attention towards their roles within the organisations to foster social participation in their own context. The second theme describes the broader societal perspectives that they address to establish a common ground for collaboration and knowledge-sharing among different stakeholders. CONCLUSIONS: The findings emphasise how addressing common challenges and developing collaboration are essential to foster older adults' social participation. It is therefore necessary to involve policy-makers and decision-makers. Occupational therapists and researchers should consider the value of occupational justice to drive collective and social approaches.

Information and communication technology in home-based rehabilitation - a discussion of possibilities and challenges.

Background: Information and communication technology (ICT) has been proven to have effect in terms of providing alternative ways to deliver rehabilitation services. The intention with this paper is to serve as a foundation for discussions regarding the future development, design, and delivery of home-based rehabilitation, including ICT.Aim: To reflect on and discuss the possibilities and challenges of using ICT in home-based rehabilitation services.Method and material: We use experiences and results from various projects to reflect on and discuss possibilities and challenges related to the use of ICT in home-based rehabilitation.Findings and discussion: We exemplify how ICT present new possibilities that can increase the quality of the rehabilitation process and improve access to services. We reflect on some challenges in the use of ICT, related to non-user-friendly solutions, to the specific rehabilitation situation, and a lack of technical support. At an organisational level, readiness to use ICT can impact the extent to which new solutions are integrated into practice.Conclusion: We emphasise that ICT has the potential to develop and improve service delivery and contribute to increased quality and accessibility of home-based rehabilitation.

Developing and testing the feasibility of a new internet-based intervention-A case study of people with stroke and occupational therapists.

INTRODUCTION: Internet-based interventions are called for within rehabilitation to meet the limited access to support for self-management after stroke. Therefore, a new intervention program, "Strategies for Empowering activities in Everyday life" (SEE) was developed. The aim of this study was to explore and describe how clients with stroke and their occupational therapists experienced the SEE intervention process and whether SEE has the potential to promote an active everyday life. METHODS: A qualitative descriptive case study was designed. Four people with stroke (two of each sex, mean age 66,5 years) and their two occupational therapists (one of each sex) were included. A mix of data collection methods as interviews, assessments, registration forms and fieldnotes was used to uncover the participants' experiences and potential changes. Data were analysed with pattern matching. FINDINGS: The analysed data formed three categories: "Not being able to take on the internet-based intervention", "Being facilitated in the change process of everyday life through the internet-based intervention", and "Providing a new internet-based intervention is a transition from ordinary practice". These categories included two to four subcategories that reflected aspects of SEE feasibility and acceptability with a focus on content and delivery. CONCLUSION: The first test of the intervention indicates that the content and delivery of SEE can be feasible and acceptable both for clients and occupational therapists. The findings suggest that SEE has the potential to support clients' self-reflections and their adoption of strategies that influence engagement in daily activities and satisfaction with life in various ways. Further research with large-scale studies is needed.

Optimising the development of sustainable internet-based occupational therapy interventions: Important key actions and perspectives to consider.

BACKGROUND: By examining the health needs of the general population and utilising the potential of digitalisation as a driving force, new internet-based services need to be developed in occupational therapy. However, existing guidelines for the development of complex interventions provide scant information on how to develop internet-based interventions. AIM: The aim of this paper is to share experiences and illustrate important key actions and new perspectives to consider during the innovation process of developing and designing an internet-based occupational therapy intervention. METHOD AND MATERIALS: International guidelines for intervention development was reviewed to add important perspectives in the innovation process. RESULTS: The illustration focuses on five key actions in the development phase to highlight new perspectives and questions important to consider when designing new internet-based occupational therapy interventions. CONCLUSION: The new perspectives can complement existing guidelines to enhance the development of more effective and sustainable internet-based interventions. SIGNIFICANCE: The illustration provided has potential to improve the sustainability in innovation processes of new internet-based occupational therapy interventions.

Older adults' experiences of maintaining social participation: Creating opportunities and striving to adapt to changing situations.

BACKGROUND: Social participation concerns the possibility of engaging in activities in interaction with others or society at large and contributes to the health and well-being of older adults. In contrast, a lack of social participation is associated with loneliness. It is, therefore, important to understand what strategies older adults use to maintain social participation. AIM: To explore and describe older adults' experiences of maintaining social participation. MATERIALS AND METHODS: Nine older adults, aged 69-92 years, participated in interviews that were analysed through qualitative content analysis. RESULTS: The overall findings reflect how older adults create opportunities for social participation by developing strategies and striving to adapt to changing situations, emphasizing how maintaining social participation is an active process. Preserving social participation requires motivation and an effort to take initiative to cultivate social relations, maintain community bonds, engage in social events and activities and stay connected with society. CONCLUSIONS AND SIGNIFICANCE: These results may extend our understanding of strategies that older adults use, as well as the challenges they face when striving to adapt to new circumstances. This study may have implications for the practice of how to support older adults' social participation.

Enacted togetherness - A concept to understand occupation as socio-culturally situated.

Background: This paper is in line with the on-going discussion of a theoretical re-orientation towards acknowledging the socio-cultural dimensions of occupation.Aim: To define enacted togetherness as a concept and share our understandings of how this concept can add to the understanding of occupation as socio-culturally situated.Method and material: The concept enacted togetherness emerged from empirical findings of a larger research project with older adults living with late-life depression. Informed by a transactional understanding of occupation and a narrative approach, the concept emerged as a contextually situated process holding qualities and potential as a source of meaning-making.Findings: Enacted togetherness as described herein has a clear association to occupation in terms of doing activities together. We reflect on enacted togetherness as a process of meaning-making, connecting people and places through unfolding stories; as an arena where togetherness and belonging can be created; and as a space for interpretation, providing opportunities to negotiate issues of meaning that can lead to possibilities for change.Conclusion: The concept of enacted togetherness can contribute to the ongoing discussion of a theoretical reorientation towards understanding socio-cultural dimensions of occupation.Significance: Enacted togetherness is a concept that can contribute to occupational therapy and occupational science as it adds to an understanding of the qualities and potentials inherent in engagement in occupations with others.

Strategies for Empowering activities in Everyday life (SEE 1.0): study protocol for a feasibility study of an Internet-based occupational therapy intervention for people with stroke.

BACKGROUND: Rehabilitation after stroke seldom focuses on needs related to an active everyday life and the process of change that people must undergo to adapt to an altered capacity and life situation. In particular, occupational therapy in the late phase needs to support clients in adopting sustainable self-initiated management strategies to regain daily activities and an active everyday life. To improve access to rehabilitation, the use of digital solutions has been suggested. This study aims to evaluate the feasibility of the Internet-based occupational therapy intervention "Strategies for Empowering activities in Everyday life" (SEE, version 1.0). We will investigate the feasibility of the intervention process in terms of acceptability and adherence as well as the most suitable outcome measures to evaluate SEE and improve the knowledge about the potential changes and outcomes of SEE for clients with stroke. METHODS: This feasibility study is based on a pretest posttest design without a control group. Quantitative and qualitative data will be collected from clients and staff concurrently embedded in a mixed-method design during the entire study. DISCUSSION: The project is a first test of a novel Internet-based occupational therapy intervention, and the research will contribute to the continued development and evaluation of the SEE programme. SEE can provide people with strategies in daily activities that can support them to live an active everyday life despite changed capacity and to improve access to rehabilitation interventions. TRIAL REGISTRATION: NCT04588116 . Name of the registry: Strategies Empowering Activities in Everyday Life (SEE 1.0). A Web-based Occupational Therapy Intervention. URL of trial registry record. Date of registry: Trial first posted: October 19, 2020; first submitted: October 2, 2020.

Perceived occupational balance in people with stroke.

BACKGROUND: The balance of activities in daily life can become disrupted after a stroke; however, previous research has mainly focused on the performance of daily activities. Therefore, it is important to understand the impact that stroke has on various aspects of balance in activities for working-age people. PURPOSE: To describe how persons with stroke perceived their occupational balance and to explore whether occupational balance was associated with the severity of disability, fatigue and sociodemographic characteristics. METHODS: This cross-sectional study included 63 working-age persons with stroke. The Occupational Balance Questionnaire, Glasgow Outcome Scale and Fatigue Severity Scale were used and analyzed statistically. RESULTS: The majority of participants disagreed or strongly disagreed that they perceived occupational balance in most of the investigated aspects. Moreover, few significant associations were found between total summed occupational balance and injury and sociodemographic characteristics. CONCLUSION: These results demonstrate the importance of considering occupational balance in the rehabilitation of persons with stroke to support their engagement in a variety of meaningful activities that contribute to health.IMPLICATIONS FOR REHABILITATIONRehabilitation need to support persons with stroke to monitor their entire patterns of activities and perceived balance to support wider engagement in meaningful activities and promote health.Balance between all kinds of activities in daily life besides work, needs to be considered in the later phase of rehabilitation in persons with stroke.A majority of the participants with stroke in this study disagreed that they had a satisfying level of occupational balance.Perceived balance between all activities in daily life can together with performance of activities add to the understanding of consequences after stroke.

Perceived occupational value in people with acquired brain injury.

BACKGROUND: It is well known that engagement in occupations becomes restricted after acquired brain injury (ABI), but little is known about how this influences occupational values and occupational balance. AIM: To describe the extent to which persons with ABI perceived occupational value; to explore whether occupational value and occupational balance were associated with life satisfaction, and to explore how occupational value, occupational balance, the severity of disability, fatigue and sociodemographic characteristics influenced life satisfaction. MATERIALS AND METHODS: A cross-sectional study was undertaken with 75 participants of working age with ABI who responded to questionnaires on occupational value, occupational balance, and life satisfaction. Additionally, instruments covering fatigue and severity of disability were administered. Data were analyzed by means of comparisons, correlations and logistic regression. RESULTS: A high perceived occupational value and a high perceived occupational balance were significantly associated with satisfaction with life as a whole, psychological health and somatic health. The logistic regression showed that occupational value, occupational balance and severity of disability significantly impacted satisfaction with life as a whole.Conclusions and significance: Occupational value and occupational balance together with severity of disability, are important areas of focus in the later phase of rehabilitation after ABI to promote satisfaction with life as a whole.

Occupational challenges in a digital society: A discussion inspiring occupational therapy to cross thresholds and embrace possibilities.

The digital transformation of society and the increased need for digital competence implies extensive changes in peoples' everyday lives and occupations. Heretofore, the discussion in the field of occupational therapy about the consequences of digitalisation has been vague. The aim of this discussion paper is to outline some reflections and to offer some arguments on how to meet the changes following digitalisation and its impact on occupational therapy. The discussion focuses on three issues: the new conditions for participation in a digital society and the role of occupational therapy and occupational therapists in the evolving digital society as well as what occupational therapists need to be pro-active and to embrace the ongoing changes in a digital society. In conclusion, occupational therapy needs to advance its position and become pro-active to cross the threshold and to embrace the possibilities that digitalisation holds for peoples' everyday lives to support occupational justice and health.

Everyday activities outside the home are a struggle: Narratives from two persons with acquired brain injury.

Background: Participation restriction is a common consequence after acquired brain injury (ABI).Aim: To explore and identify problematic situations in everyday activities outside the home for persons with acquired brain injury.Material and Method: Two persons of working age with ABI were included. Data were generated through repeated semi-structured interviews and participant observations. Narrative analysis was used to capture ongoing processes related to problematic situations during engagement in everyday activities outside the home.Results: The narratives reflect how places, everyday activities and social relations were closely connected and influenced engagement in everyday activities outside the home. The participants visited fewer places and performed more of their everyday activities alone in their homes after the injury compared to before. They were struggling to create meaning in their lives and trying to reformulate their identity. Problematic situations often occurred outside the home as a result of unexpected events. The narratives indicate a struggle to find new routines to handle challenging situations.Conclusions: The results provide an understanding of how problematic situations occurred and were managed in different ways. By observing everyday situations professionals can gain access to how persons with ABI act in and reflect upon problematic situations which can eventually improve the design of individually tailored interventions.

Patterns of participation: Facilitating and hindering aspects related to places for activities outside the home after stroke.

Background: Being engaged in activities in places outside the home after a stroke can be challenging. Knowledge about what characterize places outside the home is important to support participation.Objectives: To explore patterns of participation in places for activities outside the home after stroke and whether these patterns were associated with personal and environmental aspects.Material and methods: Sixty-three people with stroke were interviewed using the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire. A two-step cluster analysis was used to identify patterns of participation and non-parametric test was used to explore potential associations to the patterns of participation.Results: Four clusters of patterns of participation, based on frequency, familiarity of the place/the way to the place and perceived distance, were identified. The patterns were significantly associated with type of place, activity domain, retained or abandoned participation, transportation and being accompanied by someone. The severity of disability was significantly associated with groups of individuals with different patterns of participation.Conclusions: Different combinations of aspects facilitated and hindered whether or not participation changed. To support people with stroke in their endeavour to retain or recapture participation, social support is important to consider in relation to transportation, activities and places outside the home.

Influences of the social environment on engagement in occupations: the experience of persons with rheumatoid arthritis.

The aim of this explorative study was to describe and enhance the understanding of how persons with rheumatoid arthritis (RA) experience the influence of the social environment on their engagement in occupations. Nine persons were interviewed and the data obtained were analysed using a comparative method. The findings revealed that other persons in the social environment influenced informants' experiences of engaging in occupations in two ways, which formed the categories: "Constructive collaboration" and "Insufficient collaboration". These categories had certain properties related to the actions the others undertook to assist the informants during their collaboration. These assisting actions influenced the informants' possibilities to engage in occupations, and also their experience of engagement. The findings also showed that the "Conditions for collaboration" varied and influenced their collaboration, which thereby constituted a third category. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.

Participation and occupation in occupational therapy models of practice: A discussion of possibilities and challenges.

BACKGROUND: Occupation has been the focus in occupational therapy practice to greater or lesser degrees from a historical viewpoint. This evokes a need to discuss whether concepts that are added to our field will enhance or blur our focus on occupation. AIM: To explore how the concept of participation in the International Classification of Functioning, Disability and Health (ICF) is related to the concept of occupation by reviewing and comparing its use in three models of practice within occupational therapy. The aim was also to generate discussion on possibilities and challenges concerning the relationship of participation and occupation. METHOD: The models reviewed were The Model of Human Occupation (MOHO), the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Occupational Therapy Intervention Process Model (OTIPM). RESULTS: The concept of participation was related to occupation in different ways in these models. Based on the review some challenges and considerations for occupational therapy were generated. CONCLUSION: Relating the concept of participation from the ICF to the concept of occupation in models of practice can be challenging. At the same time, relating the concepts can be a resource to develop occupational therapy and the understanding of occupational issues in society.

Togetherness in another way: Internet as a tool for togetherness in everyday occupations among older adults.

OBJECTIVE: This article explores and describes how the Internet was experienced as a tool for togetherness in everyday occupations among older adults. METHODS: Discussions with 12 older adults, divided into three focus groups, generated data that were analysed using a grounded theory approach. Six women and six men between 67 and 79 years of age were purposively selected and recruited from a retirement organization in northern Sweden. RESULTS: Findings reflect how online contexts generated new possibilities for togetherness in everyday occupations and created a sense of belonging with others and to society at large. However, togetherness through the Internet was also associated with ambiguity and uncertainty among older adults. The Internet provided opportunities for togetherness that were somehow different from togetherness derived from face-to-face contact, but it was also connected with a fear and a resistance. CONCLUSIONS: Findings from this research can extend our understanding of how online contexts have the possibility to promote togetherness in everyday occupations and what it means to be part of such a context among older adults. In light of these findings, the need is highlighted to consider the Internet as a tool for older adults to be socially engaged with the potential to reduce loneliness and isolation.

Being part of an unfolding story: togetherness in everyday occupations when ageing.

AIM: The aim of this study was to explore and enhance the understanding of how togetherness in everyday occupations is experienced and discussed among older adults. METHOD: Focus-group discussions generated the data and a total of 12 participants, including six women and six men, divided into three groups, participated in this study. Analysis was performed using a grounded theory approach. RESULTS: The findings reflect how togetherness in everyday occupations can be comprehended as multifold transactional processes, emphasizing how an acted belonging was a situated experience connecting people and places through unfolding stories. The findings suggest that the process of meaning-making in ongoing life was closely associated with togetherness and was negotiated with others through shared culture and experiences. Togetherness meant being part of something in which the persons involved were contributing to each other in various ways. However, being part of togetherness was complicated, especially when the person's life situation was challenged in some way. CONCLUSIONS: It was apparent from the analysis that togetherness could not be taken for granted. Rather, the findings reflect how togetherness was created and maintained through an ongoing process of nurturing established relationships as well as creating something new around occupations with others.

Being part of an enacted togetherness: narratives of elderly people with depression.

In this article, we explored how five elderly persons with depression engaged in everyday activities with others, over time, and how this was related to their experience of meaning. Repeated interviews and participant observations generated data that was analysed using a narrative approach. Analysis identified togetherness as an acted relation, "enacted togetherness", emphasising how the act of doing everyday activities with someone created togetherness and belonging, and being part of an enacted togetherness seemed to be a way for the participants to negotiate and construct meaning. Opportunities for doing things together with someone were closely associated to the place where the participants lived. Furthermore, engagement in activities together with others created hope and expectations of future acting. Findings from this research can extend our understanding of how participating in everyday activities is experienced as a social process including change over time, presenting the perspective of elderly people themselves. In light of these findings, we highlight the need to consider how opportunities to become part of an enacted togetherness can be created. Also, we aspire to contribute to the debate on how to understand the complexity related to social aspects of ageing and add to the emerging understanding of everyday activities as transactional, incorporating people and the environment in a dynamic process that goes beyond the individual.