Electronic medication administration record (eMAR) in Swedish home healthcare-Implications for Nurses' and nurse Assistants' Work environment: A qualitative study.

BACKGROUND: The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. AIM: The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. METHOD: We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. RESULTS: NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. CONCLUSION: Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare.

Taking control of one's everyday life - a qualitative study of experiences described by participants in an occupational intervention.

BACKGROUND: Sick leave due to stress-related ill-health is increasing and is often caused by occupational imbalance. These types of issues tend to affect both the ability to work and cope with everyday life, as well as the overall experience of health, negatively. There is still little knowledge on how to prepare people and workplaces for the return-to-work process after participation in a work rehabilitation program due to stress and occupational ill-health. Therefore, this study aimed to describe what is needed to achieve a balanced everyday life that includes paid work as experienced by individuals who had participated in a ReDO® intervention due to occupational imbalance and ill-health. METHODS: The concluding notes from 54 informants' medical records were used for qualitative content analysis. The informants had participated in an occupational therapy group intervention to promote occupational health and regain full work capacity. RESULTS: The analysis resulted in one major theme and four categories describing how the informants perceive that they must take control of their everyday life as a whole. By doing so, they need to work with structurization and prioritization, social interaction, boundary setting, and occupational meaningfulness. CONCLUSION: The study indicates a highly relational process, where it is impossible to divide life into private and work, and presupposes balance in everyday life in multiple dimensions. Its contribution includes the formulation of perceived needs in the transition between intervention and return to work and could, through further research, be used to generate a more effective and sustainable return- and rehabilitation models.

Health transition after lung transplantation - a grounded theory study.

AIMS AND OBJECTIVES: To investigate lung recipients' process of transition from prior the transplantation to one year afterwards, as well as what their main concerns are and how they deal with these concerns. BACKGROUND: During the last three decades, lung transplantation has been established as an effective treatment for patients with end-stage pulmonary disease. Towards the end of the 20th century, the concept of survival expanded to also include improving health-related quality of life (HRQoL). Although many studies have been published regarding lung recipients' HRQoL, aspects of health and everyday life remain understudied. Lung transplantation demands some kind of transition. However, very little is known about this transitional process. DESIGN: A qualitative inductive approach using Grounded Theory (GT) was used. METHODS: A total of ten adult males and five adult females (n = 15) with a mean age of 55 years were included in the study and interviewed one year after transplantation. The open-ended interviews were digitally recorded and transcribed verbatim after each interview. The analysis of the material was performed consistent with Charmaz contructivistic approach of GT. RESULTS: The core category Reconstructing daily occupations summarises a process wherein the generated GT is present through four main categories: Restricting, Regaining, Reorganising and Enriching. The process of reconstructing daily occupations is necessary to regain health. CONCLUSIONS: A trajectory of health transition is evident, starting pretransplant with the lung disease and severe illness and proceeding at least up to one year after the transplantation with experienced health. RELEVANCE TO CLINICAL PRACTICE: The result enables a unique possibility to enhance the lung recipients' striving for everyday life and thereby promote health. There is a need for change in the existing multidisciplinary transplant team to also include an occupational therapist to support and guide the lung recipients in changing their occupational patterns.

A longitudinal study of the working relationship and return to work: perceptions by clients and occupational therapists in primary health care.

BACKGROUND: The working relationship between client and therapist can be important to enhance outcomes from vocational rehabilitation for women with stress-related disorders in primary health care. The aim was to investigate the working relationship, as perceived by clients and therapists in the Redesigning Daily Occupations (ReDO™) program, and its relationships to return to work and satisfaction with the rehabilitation. Another aim was to compare the ReDO™ group and a "care-as-usual" (CAU) group regarding perceptions of the working relationship with the social insurance officer. METHOD: Forty-two ReDO™ clients and 42 matched controls receiving CAU participated. The study included four measurements (baseline, after 16 weeks rehabilitation and follow-ups after 6 and 12 months). 37 + 37 clients completed. Return to work data was obtained from the Social Insurance Offices (SIO), and the working relationship and client satisfaction were assessed by self-report questionnaires. RESULTS: The clients rated the working relationship higher than the therapists (mean rating 101.1 vs. 93.9; p < 0.001). The therapists' rating showed a statistically significant association with return to work at the 12-month follow-up, and the clients' perceptions were statistically significantly related to how they rated satisfaction with the rehabilitation received. The ReDO™ and the CAU groups did not differ regarding how they rated the relationship with the SIO officer (mean ratings 83.9 vs. 77; p = 0.189). The working relationship with the SIO officer was not related to return to work, but an association (rs = 0.70, p < 0.001) to client satisfaction at 16 weeks appeared in the CAU group alone. CONCLUSION: The working relationship as perceived by clients and therapists seemed to be partly separate phenomena, the client perceptions being linked with satisfaction with the rehabilitation and the therapist perceptions with the clients' return to work. The relationship to the SIO officers was of no importance to return to work but was of some significance for satisfaction with the rehabilitation among the CAU clients. Therapists should strive to improve the relationship with clients to whom they feel the relationship is fragile since that might enhance the chances for those clients to return to work. TRIAL REGISTRATION: Registered at ClinicalTrials.gov (identifier NCT01234961) 2 November 2010.

Effect of an occupation-focused family intervention on change in parents' time use and children's body mass index.

OBJECTIVE. This study explored factors related to changes in the time parents spent with their children with obesity and associated decreases in children's body mass index (BMI) z-scores after an occupation-focused intervention. METHOD. Parents participated in a 1-yr occupation-focused intervention to promote healthy family lifestyles. Data on 40 parents of 22 children with obesity ages 4-6 yr were collected before and after intervention and analyzed using linear and multiple regression methods. RESULTS. Parents increased time spent with their children by an average of 91 min/day. Parents' finances, perceived satisfaction in daily occupations, low BMI, and mastery at inclusion were associated with increased time spent with their children. Mothers' subjective health and high mastery and fathers' perceived occupational value and education explained 67% of the variance in children's BMI z-scores. CONCLUSION. The results indicate important factors to consider in developing interventions that facilitate occupational engagement and health among children with obesity and their families.

Changes in parents' time use and its relationship to child obesity.

OBJECTIVE: The aim was to explore any change in parents' time use together with their children, changes in their perceived occupational value, and its relationship to children's body mass index (BMI) over the course of a one-year occupation-focused family intervention. METHOD: The study sample consisted of participants in one arm of a randomized controlled trial, involving mothers and fathers (n = 30) of 17 children aged 4-6 years who were considered obese. Data were collected by time-geographical diaries during the intervention and by measuring the parents' occupational value and the children's BMI before and after the intervention. RESULTS: At the end of the intervention, an increase was shown in the amount of time parents spent together with their children during weekdays (p = .042) and the parents perceived occupational value (p = .013). Children's BMI z-score changed with -0.11 units. CONCLUSION: Collaboration with parents may be useful in interventions aiming at facilitating a normal weight development among children.

Changes in self-perceived performance and satisfaction with performance of daily activities following interdisciplinary rehabilitation in people with late effects of polio.

BACKGROUND: People with late effects of polio (LEoP) may need rehabilitation to manage everyday life but knowledge of the benefits of interdisciplinary rehabilitation is limited. OBJECTIVE: To evaluate changes in performance and satisfaction with performance of activities among people with LEoP following interdisciplinary rehabilitation. METHODS: A pre-post retrospective study based on data on 102 participants with LEoP from a rehabilitation clinic. Changes in performance and satisfaction with performance of daily activities before and after interdisciplinary rehabilitation were assessed with the Canadian Occupational Performance Measure (COPM). RESULTS: There were statistically significant increases in the mean performance and mean satisfaction with performance COPM scores from admission to discharge. Twenty-three percent and 19% of the participants, respectively, had improved their performance and satisfaction with performance, 25% and 26% of the participants had no changes, and 19% and 22% of the participants, respectively, rated their performance and satisfaction lower at discharge compared to admission. CONCLUSION: Interdisciplinary rehabilitation can enhance self-rated performance and satisfaction with performance of daily activities among people with LEoP. Future studies of rehabilitation for people with LEoP should use a prospective design and capture the participants' process of change related to their rehabilitation period.

Challenges, strategies, and gender relations among parents of children recently diagnosed with type 1 diabetes.

This study explored (a) parents' process of changes and challenges in their patterns of daily activities after the onset of diabetes in their children; and (b) how personal gender relations can restrain or create functional strategies for managing the changes and challenges of illness. Interviews were conducted with 21 mothers and 15 fathers of 23 children with type 1 diabetes 8 to 10 months after onset. Using a constant comparative analysis method, the core category depicts how the illness forced parents to reconstruct their family project with respect to patterns of daily activities and gender structures. The emerging subcategories of reinforced mothering and adjusted fathering illustrate the parents' effort to handle contemporary and contradictory demands. With increased knowledge of the dynamics of gender relations of families in the context of a child's illness, health care professionals can assist in promoting well-being and functional strategies in families when a child is newly diagnosed with diabetes.

Work outcomes and their predictors in the Redesigning Daily Occupations (ReDO) rehabilitation programme for women with stress-related disorders.

BACKGROUND/AIM: Previous research has shown that the Redesigning Daily Occupations programme reduced the degree of sick leave and increased return to work rates among women on sick leave for stress-related disorders when compared with "care as usual". To further investigate the Redesigning Daily Occupations intervention, this study explored changes in the work situation from baseline to a 12-month follow-up in the Redesigning Daily Occupations group compared with the "care as usual" group and analysed any predictors of change. METHODS: A matched-control design was used and 84 women were recruited. Objective (return to work and sick leave) and subjective work outcomes (perceptions of the worker role and the work environment) were explored. Potential predictors were clinical and demographic variables and an anxiety-depression factor. RESULTS: In both groups, large positive effect sizes from baseline to follow-up were found regarding the objective outcomes, a moderate positive effect size was found for perceived work environment, whereas perceived worker role remained unaffected. Previous work rehabilitation predicted objective work outcomes in both groups. Higher education and older age were predictors of subjective outcomes in the Redesigning Daily Occupations group, whereas a more severe anxiety-depression rating was negative for work environment ratings in the "care as usual" group. CONCLUSIONS: Return to work seemed possible without a change in the women's perceptions of the worker role; rather they renegotiated their view of the work environment. The Redesigning Daily Occupations programme was found to be promising, with a positive effect on return to work and sick leave reduction. It seemed more suitable for the higher educated and older women.

A family-based intervention targeting parents of preschool children with overweight and obesity: conceptual framework and study design of LOOPS- Lund overweight and obesity preschool study.

BACKGROUND: As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score. METHODS/DESIGN: The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress. DISCUSSION: The LOOPS project will provide valuable information on how to build effective interventions to influence an unhealthy weight development to prevent the negative long-term effects of childhood obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT00916318.

Psychometric properties of a Swedish version of the Pearlin Mastery Scale in people with mental illness and healthy people.

BACKGROUND: Mastery refers to the degree to which people perceive that they can control factors that influence their life situation, and has been found important for people's quality of life and well-being. It is thus essential to be able to measure mastery in a valid and reliable way. AIM: This study aimed at using the Rasch measurement model to investigate the psychometric properties of a Swedish version of the Pearlin Mastery Scale (Mastery-S). METHODS: A sample of 300 healthy individuals and 278 persons with mental illness responded to the Mastery-S. Item responses were Rasch analysed regarding model fit, response category functioning, differential item functioning (DIF) and targeting, using the partial credit model. RESULTS: The Mastery-S items represented a logical continuum of the measured construct but one item displayed misfit. Reliability (Person Separation Index) was 0.7. The response categories did not work as expected in three items, which could be corrected for by collapsing categories. Three items displayed DIF between the two subsamples, which caused a bias when comparing mastery levels between subsamples, suggesting the Mastery-S is not truly generic. CONCLUSIONS: The Mastery-S may be used to obtain valid and reliable data, but some precautions should be made. If used to compare groups, new analyses of DIF should first be made. Users of the scale should also consider exempting item 6 from the scale and analyse it as a separate item. Finally, rewording of response categories should be considered in order to make them more distinct and thereby improve score reliability.

How does ReDO®-10 work? Understanding the mechanisms of action of an intervention focused on daily activities and health from the perspective of participants.

Evaluation of a complex healthcare intervention should include careful exploration of the mechanisms through which it brings about change. This paper describes a qualitative evaluation of the Redesigning Daily Occupations (ReDO®-10) programme as it was implemented for the first time with women with stress-related issues in a primary care setting in Ireland. The ReDO®-10 is a 10-week group intervention designed to support participants make changes to their daily activity patterns to have a more satisfying and balanced daily life. Fourteen women were interviewed after completing the programme. The aim was to explore changes that participants perceived they experienced and to understand how the content of ReDO®-10 was thought to bring about this change (if it did). Directed content analysis was used to analyse the qualitative data using the Behaviour Change Wheel and Theoretical Domains Framework as a coding framework. Overall, four BCW functions of ReDO® -10 were identified: Education, Persuasion, Modelling and Enablement. Participants described improved belief in their own capabilities, knowledge and goals around life changes. Many behaviour changes were also described, particularly in relation to doing more restorative activities in daily life. Behaviour change techniques that were identified as important for change were practicing new, restorative occupations in group sessions and as homework and the use of self-analysis activities to understand the relationship between activities and health for these participants. Modelling, support and other effects of group dynamics were also vital in changes that occurred.

Nurses' Perspectives on an Electronic Medication Administration Record in Home Health Care: Qualitative Interview Study.

BACKGROUND: eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. OBJECTIVE: The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. METHODS: This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. RESULTS: Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses' superior position. The experience of the eMAR was regarded as transitioning the nurses' professional role-away from the point of care and toward more administration-and further strengthened the way of managing work through delegation to health care assistants. CONCLUSIONS: Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals' work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.

A feasibility study of the Redesigning Daily Occupations (ReDOTM-10) programme in an Irish context.

BACKGROUND: Despite high demand, mental health services in primary care in Ireland are underdeveloped. People with mild/moderate anxiety, depression and unspecified psychological distress are frequently seen in primary care settings, mostly by general practitioners (GPs). Occupational therapists have the potential to contribute to service-provision with interventions specially designed for the targeted group e.g. the Redesigning Daily Occupations programme (ReDO-10). AIMS/OBJECTIVES: This study aimed to explore the feasibility of a future RCT of the ReDO-10 programme in Ireland and the contextual factors that would influence future implementation. MATERIAL AND METHODS: Using a multi-phase, mixed-method design, qualitative and quantitative data were gathered from key stakeholders: ReDO-10 participants (n = 10), GPs (n = 9) and occupational therapists (n = 2). Acceptability, satisfaction, cultural fit and demand were explored, as well as methodological issues such as appropriateness of recruitment methods, outcome measures and randomization. RESULTS: ReDO-10 was acceptable to participants who reported improvements in their occupational patterns and valued the group-based format. GPs and occupational therapists welcomed the intervention, but acknowledged the limitations of time and resources in the Irish primary care context. CONCLUSIONS: ReDO-10 is feasible to explore in a future RCT in Ireland and this study provides important context for future implementation and/or research.

Assessing the use of a portable time-geographic diary for detecting patterns of daily occupations.

BACKGROUND: A time-geographic diary approach is of interest in occupational therapy due to the inclusion of the diarist's subjective experiences. There are several methods for detecting doing in time, but details needed for analysis are still lacking. The smartphone application POrtable Diary Data collector (PODD), a 24-hr diary based on the time-geographic diary has recently been introduced. AIM: To test the usability of PODD as a tool for diary data collection to detect and visualize sequences of daily activities. MATERIAL AND METHODS: An exploratory sequential design was used, where diary data was first collected and then followed by a questionnaire assessing usefulness. Thirty-one occupational therapy students participated. Usability testing was applied, exploring how participants experienced the use of the device. Data was analysed qualitatively and quantitatively. RESULTS: The PODD visually presents activity sequences and thus assists in detecting patterns of daily occupations (PDO). The students agreed on the supportive statements concerning learnability, efficiency and memorability. Regarding errors and satisfaction, participants agreed that the device was easy to use. CONCLUSIONS: Using a mobile application to collect data about students' daily activities was effective. However, the PODD needs to be further evaluated among other groups and contexts as well as for its usefulness for PDO analyses.

Exploring risk factors for developing occupational ill health - departing from an occupational perspective.

BACKGROUND: Sick leave due to stress-related mental ill health increases in society. In occupational therapy, occupational balance is considered important for experiencing health and well-being. Thus, knowledge regarding occupational balance and occupational value constitute essential parts of occupational therapists' work with people suffering from occupational ill health. OBJECTIVE: The aim of this study is to analyse the relationships between sociodemographic factors, occupational value, occupational balance and perceived health in people suffering from occupational ill health. METHODS: In a quantitative cross-sectional study data from a total of 218 individuals were included, 192 women, 22 men and 4 individuals who did not specify their gender. Data were collected by means of surveys prior to an occupational therapy intervention. The instruments used included OVal-pd, OBQ, EQ5D and a sociodemographic questionnaire. Data were analysed using regression and decision tree analysis. RESULTS: The results show that individuals who experience an imbalance in their everyday life and who have few or no experiences of daily occupations imprinted by socio-symbolic occupational value experienced lower perceived health. CONCLUSIONS: Low level of experiences of balance in daily life and occupational value seems to be the main risk factors for the development of occupational ill health, rather than sociodemographic factors.

Return to work outcomes of the Redesigning Daily Occupations (ReDO) program for women with stress-related disorders--a comparative study.

Stress-related disorders are a frequent cause for sick leave, with consequences such as great distress and adverse economic effects for the affected person and substantial costs for society. Identifying effective interventions that facilitate return to work is thus important. The aim of this study was to evaluate the effectiveness of the 16-week Redesigning Daily Occupations program as a work rehabilitation method for Swedish women with stress-related disorders. The authors of this study hypothesized that, compared to women who got Care as Usual, 12 months after completed rehabilitation a larger proportion of the Redesigning Daily Occupations women would have returned to work, and they would have less sick leave, perceive less stress, and have greater self-esteem. Forty-two women entered the Redesigning Daily Occupations intervention and a matched comparison group received Care as Usual. The data, collected between 2007 and 2010, consisted of registry information and questionnaires targeting socio-demographics, perceived stress, and self-esteem. The findings partly verified the hypotheses. A larger proportion of the Redesigning Daily Occupations women returned to work and they decreased their sick leave and increased their self-esteem more than the Care as Usual group, but the groups did not differ in stress reduction. Thus, the Redesigning Daily Occupations seems to be a promising work rehabilitation method for women with stress-related disorders.

A concept analysis of creative activities as intervention in occupational therapy.

Background: This article is based on a common understanding of the concept of creative activities as intervention, as described in occupational therapy literature. Historically, creative activities have been used as intervention in occupational therapy. There is, however, a lack of clarity in descriptions of the concept.Aims/Objectives: To investigate and clarify the concept of creative activities as intervention (CaI) and to validate the findings in occupational therapy practice.Material and methods: A selection of articles according to PRISMA resulted in 15 articles, analysed with concept analysis. The results were validated by a reference panel of seven occupational therapists using a questionnaire and data was analysed by descriptive statistics.Results: Five attributes defined CaI: (1) Often consisting of elements of art and craft using mind and body, (2) Being experienced as meaningful, (3) Creating creative processes, (4) Developing skills, enhancing occupational performance and managing everyday life, and (5) Being easy to modify individually or in groups with different approaches. Three cases were generated from the attributes to illustrate the integrity of the analysis.Conclusions and significance: The results led to a description of CaI that could facilitate future research communication and common definition in occupational therapy practice.

The BELE program: The development of a holistic interdisciplinary health-promoting program enhancing work-life balance among female employees working in human service organizations in Sweden.

BACKGROUND: Despite an increase in work-life balance literature, the development of successful support to help employees manage their work -life balance is slow. Moreover, there are few interventions with a comprehensive approach to workplace health promotion focusing on work-life balance. OBJECTIVE: This paper aims to present the development and building blocks of a holistic interdisciplinary health-promoting program, the BELE program, to enhance female employees working in human service organizations health and well-being with a focus on work-life balance. METHODS: The planning and development of the program was done through an intervention mapping and research circles methodology. RESULTS: The planning- and development process of the program resulted in a theoretical framework, and a program structure with a program content. The intervention program was named "The Balance in Everyday Life Empowerment program" (BELE program). CONCLUSIONS: The BELE program adds to the existing body of work-life balance knowledge, so far often based on a conflict approach. Interventions focusing on a comprehensive approach to health and work-life balance with a salutogenic approach are rare. Furthermore, the integration with occupational therapy and health promotion in a workplace health promotion framework is innovative. In a previous study, the BELE program has shown that it enhances women's well-being and balance in their everyday life.

The occupation-based intervention REDO™-10: Long-term impact on work ability for women at risk for or on sick leave.

Background: Stress-related disorders are increasing in western societies and are the main reason for sick-leave in Sweden. Previous research justifies occupation-based interventions to increase health and work ability.Aim: To investigate if the occupation-based intervention ReDO™-10 predicts work ability for women at risk for or on sick-leave.Material and Methods: A longitudinal cohort study design including the REDOTM-10. The participants answered a questionnaire about their perceptions of health, work ability, occupational balance, occupational values and mastery at baseline, after intervention and at 12 months follow-up. Differences before and after the intervention as well as at 12 months follow-up and possible predictors of work ability were analyzed.Results: Eighty-six women (response rate 70%) answered the questionnaire at follow-up. Perceived health, occupational balance, occupational value, mastery and work ability were improved after intervention. Perceived health, mastery and socio-symbolic value predicted work ability.Conclusion: The intervention increased perceived health and perceived health predicted work ability. However, the occupational aspects in the intervention did not predict work ability. For the intervention to predict work ability, the work placement might be necessary.Significance: The results of the present study add to earlier evidence that a work focus is of importance both in prevention of sick leave and in return to work interventions.