Targeting belongingness among older people through engagement in senior centres: intervention development study in Denmark.

Adults often experience a loss of social relations and sense of belonging in later life, leading to the risk of social isolation. Municipal senior centres offer a potential site for intervention, as they provide social communities targeting older people. However, not all older people find it easy to access these social communities due to experiencing physical and/or psychosocial frailties and could therefore continue to experience a decline in social relations and sense of belonging, which potentiates poor physical and psychosocial health and well-being. To date, there are limited evidence-based interventions in Denmark. The present article describes the development of an intervention to increase belongingness and decrease social isolation among older people with frailties who attend Danish municipal senior centres. The development process was conducted with reference to the INDEX (IdentifyiNg and assessing different approaches to DEveloping compleX intervention) guidance. The development process resulted in a 6-month supportive intervention, consisting of four elements: skills development workshops for all staff members; a start conversation including frailty screening; allocation of a 'buddy' among existing service users; and monthly follow-up conversations with staff members. This theory-informed approach can progress to feasibility testing and outcome evaluation in order to generate an evidence base. Concurrently, the article reflects on current guidance for intervention development and how it may be used and optimized to strengthen developmental processes in the future.

Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives.

PURPOSE: Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS: Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS: In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION: From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.

The lived experiences of endometriosis in adolescence-A critical hermeneutic perspective.

BACKGROUND: Endometriosis is a condition that worldwide affects 10% of all women of childbearing age. Despite the large prevalence, it takes 4-11 years from the first onset of symptoms until the time of diagnosis, and the majority experience symptoms debut in adolescence. Endometriosis affects women's lives both physically, psychologically, socially and a lack of recognition from society causes the pain the women experience to be neglected, hidden and normalised. Preventative measures targeting endometriosis in adolescence are limited and there is a need to change the way these symptoms are viewed and affected by society at large. AIM: The aim of this qualitative study was to explore the lived experiences of endometriosis in adolescence and the social reactions impact on the illness experience and quality of life. METHOD: With a critical hermeneutic approach, individual interviews were conducted with women diagnosed with endometriosis. The analysis and interpretation were conducted inspired by Pedersen and Dreyer's (2018) method which is based on Ricoeur's critical theory. RESULTS: The structural analysis shows that women experience a struggle for recognition of symptoms from their immediate surroundings including family, friends, schools and health professionals, as symptoms considered linked to menstruation are deemed to be normal for women to experience. The women's narratives are characterised into a before and after diagnosis. Therefore, the diagnosis is found to be important for the meaning that the women attach to their experiences in adolescence. CONCLUSION: Social experiences have a substantial impact on women's illness experience and quality of life and affect how women perceive themselves and their symptoms. Through interventions at the social level, it might be possible to change the existing societal discourses surrounding women's menstruation pain to raise the awareness of endometriosis.

Return-to-work intervention while undergoing cancer treatment: Female cancer survivors' experiences.

BACKGROUND: This qualitative study followed participants enrolled in a return to work (RTW) intervention, aiming to address individual physical, psychological and work-related challenges. OBJECTIVE: To explore cancer survivors' experiences of receiving a tailored RTW intervention initiated parallel with chemotherapy and/or radiotherapy. METHODS: Two semi-structured interviews of eight female cancer survivors in treatment for breast cancer (n = 7) or ovaria cancer (n = 1) were conducted prior or close to their RTW and 3-5 months later. Inspired by Margrit Schreier's inductive analysis coding and identification of themes guided the analysis. RESULTS: Participants expressed satisfaction with the RTW intervention, which helped them to cope during the RTW process. Three themes with corresponding subthemes dominated the participants' experience of the RTW intervention. 1) Social workers made participants feel individually coached, 2) Collaboration with social workers helped over time to manage RTW, and 3) Social workers supported participants to conduct and adjust the RTW plan. CONCLUSION: This study shows how the interaction with social workers were based on mutual trust and sense of being cared for, which seems to have a positive impact on how participants managed their RTW. Future research needs to address the long-term challenges in cancer survivors' RTW.

The added value and unintended negative consequences of public involvement processes in the planning, development and implementation of community health services: Results from a thematic synthesis.

PURPOSE: Public involvement is widely considered a means to improve health and quality of health services. The research literature reveals ambiguities concerning added value and unintended negative consequences of public involvement processes. The aim of this study is to identify, synthesise and present an overview of added value and unintended negative consequences of public involvement processes in the planning, development and implementation of community health services. METHODS: Data from 36 peer-reviewed articles retrieved from a systematic search in the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, ProQuest, and Scopus databases in October 2019 and updated in April 2021 were extracted. A three-step thematic synthesis was conducted involving (1) line-by-line text coding, (2) developing descriptive themes and (3) generating analytical themes. RESULTS: Two main themes along with their corresponding themes provided an overview of the added value of public involvement processes at the individual, service and political levels. Unintended negative consequences concerning individual resources, uncertainty about the effect of involvement and power differences were revealed. CONCLUSION: Added value of public involvement processes is primarily reported on an individual and service level. The added value seems to be accompanied by unintended negative consequences. Training of professional facilitators and recruitment of participants that come from vulnerable groups could help promote equality in public involvement. Unintended negative consequences need to be further explored in future evaluations in order to achieve the desired goals of public involvement.

An Overwhelming Burden of Psychosocial Stress: Life With Ischemic Heart Disease for Midlife Patients With Low Socioeconomic Status and Lack of Flexible Resources.

The largest social inequalities in ischemic heart disease are found in the midlife population. These inequalities are often explained by lifestyle factors, while the role of structural factors and psychosocial stress are generally less acknowledged. In this study, we explore the influence of psychosocial stress on life with ischemic heart disease for midlife patients with low socioeconomic status and lack of flexible resources. In-depth interviews were conducted with 18 participants, and a critical hermeneutic approach was used to analyze and interpret data. We found that the participants were exposed to several external psychosocial stressors related to their family relationships, employment conditions, and experiences of stigmatization. These stressors reinforced each other and created an overwhelming burden of psychosocial stress. Our findings call for supportive interventions that target external psychosocial stressors and stressful feelings among this vulnerable group of patients.

Towards person-centred rehabilitation in dementia - a narrative synthesis.

PURPOSE: The aim of this study was to identify and synthesize person-centred principles and components as described in rehabilitation intervention studies which target home dwelling people with mild to moderate dementia. MATERIALS AND METHODS: A narrative synthesis was carried out which included 19 rehabilitation intervention studies targeting people with mild to moderate dementia. The analysis was guided by an initial program theory about person-centredness in rehabilitation, which was developed for this purpose. RESULTS: Person-centred principles and components were identified and synthesised. Person-centred rehabilitation practice in dementia includes: (1) a focus on the needs, preferences and cultural values of the individual and consideration of his/her life history and biography; (2) the cooperation of professionals and people with dementia, including specific tools and methods such as goal-setting, holistic assessment and methods to activate and empower the individual, and building relationships; (3) organisation and structure. CONCLUSION: Compared to the principles of Kitwood, person-centredness in rehabilitation for people living with dementia also includes goal-setting and empowering principles. There is a need for developing the theoretical and philosophical foundation for person-centredness in rehabilitation in relation to people with dementia.IMPLICATION FOR REHABILITATIONPerson-centredness is a key feature in rehabilitation for people living with dementia.In rehabilitation, person-centredness may entail other principles and components than in dementia care in general.There is a need for developing person-centredness in rehabilitation, both in theory and in practice.

Participants' lived experience of pursuing personal goals in the Illness Management and Recovery program.

BACKGROUND: The Illness Management and Recovery (IMR) program is designed to support people diagnosed with severe mental illness in developing tailored illness-management skills and to pursue personal goals. Although IMR is a goal-oriented program, little is know about the participants' experience of goal-setting as part of IMR. AIM: To describe participants' lived experience of personal goal-setting as part of the Illness Management and Recovery program (IMR). METHOD: A descriptive, phenomenological research design was employed with individual interviews. RESULTS: IMR helped the participants break down their personal goals into manageable short-term goals. The main themes were as follows: 'We were guided to set clearer and specific goals in IMR', 'We were encouraged to pursue our personal goals in IMR' and 'We were encouraged and supported to resume work on our goals when we stopped making progress'. The findings emphasise goal-setting in IMR as a means to instilling hope for the future and work on goals. CONCLUSIONS: The participants learned to identify, articulate and initiate work towards short- and long-term goals when guided by the instructor and supported by peers in the IMR group. Goal-setting is a useful method for breaking down personal recovery goals into a practical short-term goals and motivating participants to pursue them. The findings indicate goal-setting is an important part of the IMR-program, but suggest that flexibility in goal-setting is needed, especially in the time required to achieve personal goals.

Returning to everyday life after discharge from a short-stay unit at the Emergency Department-a qualitative study of elderly patients' experiences.

INTRODUCTION: Elderly patients often receive care and rehabilitation from different providers across healthcare settings. Collaboration between hospital and primary care providers is therefore essential to ensure that the discharge and transition of rehabilitation is coherent. However, research that focuses on elderly patients' experiences of the discharge, and their everyday lives after, has attracted little attention. PURPOSE: This study explores elderly patients' experiences of being discharged and returning to everyday lives after discharge from a short-stay unit at the Emergency Department. METHODS: Eleven qualitative interviews with elderly patients were conducted two weeks after their discharge. The transcribed interviews were analysed using systematic text condensation. RESULTS: The study identified four themes related to the participants experiences. In the participants perspective it was difficult, due to fatigue and pain, to perform daily activities after discharge. Participants who experienced not being prepared and clarified in relation to their discharge continued to have concerns for the future. They also experienced some challenges related to lack of being involved and lack of receiving the information needed. CONCLUSION: The findings contribute with impotant knowledge about elderly patients' experiences and concerns which should be taken into consideration in the discharge planning process .

Intensive client-centred occupational therapy in the home improves older adults' occupational performance. Results from a Danish randomized controlled trial.

BACKGROUND: There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. METHODS: An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). RESULTS: No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. CONCLUSIONS: ICC-OT improved older adults' occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.

Living with a partner with dementia: a systematic review and thematic synthesis of spouses' lived experiences of changes in their everyday lives.

OBJECTIVES: Dementia causes dramatic changes in everyday-living for spouses. Occured changes in marital relationship, force spouses to perform more both mentally and physically. Leading to a spousal perceived burden. To improve understanding of spouses' needs, spouses lived experiences is needed. The aim was to identify and synthesise qualitative studies on spouses' lived experiences of living with a partner with dementia. METHODS: A systematic search was undertaken in January 2017. Six databases (CINAHL, Cochrane Library, Embase, PubMed, PsycINFO and Sociological Abstracts) were searched, using search terms in accordance with PICo. A descriptive synthesis and a thematic synthesis were undertaken. FINDINGS: Fifteen studies met the inclusion criteria. Three themes derived from the analysis 1) Noticing changes in everyday life 2) Transformation to a new marital relation in everyday life, with corresponding sub-themes; changes in marital relationship, management of the transitioned marital relation in everyday life 3) Planning the future. CONCLUSION: Findings provide an overview of how spouses notice changes and transform their marital relationships in everyday-life. Findings offer a deeper understanding of changes that occurs over time while the partner is living at home. Findings contribute with knowledge on spouses' experiences of changes in early-stages of dementia. Interventions supporting spouses are needed.

The Adult Sensory Profile™ in Care Homes Targeting People Diagnosed with Dementia: A Qualitative Study from the Care Provider Perspective.

INTRODUCTION: The background of this study is the pilot testing of the Adolescent /Adult Sensory Profile (A/ASP) in dementia units at municipal nursing homes. Based on the results from therapists' A/ASP assessment, recommendations are made according to individual needs and forwarded to the health care providers. This study looks into the health care providers' perspective on the usability of these recommendations. AIM: The aim of this qualitative study is to explore the health care providers' perspective on the usability of recommendations derived from the A/ASP during a pilot testing of the profile in dementia units for people living with severe dementia. METHODS: Participant observations and informal and formal interviews with health care providers at five municipal dementia units during the pilot testing of the A/ASP. RESULTS: In the health care provider perspective, the A/ASP is a relevant and useful tool to use when behavioural challenges among residents living with dementia occur. However, in their opinion, it requires time, adjustment, and further education if recommendations are to be fully implemented in everyday practice at the dementia units.

Effectiveness of the "Elderly Activity Performance Intervention" on elderly patients' discharge from a short-stay unit at the emergency department: a quasi-experimental trial.

PURPOSE: To examine the effectiveness of the Elderly Activity Performance Intervention on reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. PATIENTS AND METHODS: The study was conducted as a nonrandomized, quasi-experimental trial. Three hundred and seventy-five elderly patients were included and allocated to the Elderly Activity Performance Intervention (n=144) or usual practice (n=231). The intervention consisted of 1) assessment of the patients' performance of daily activities, 2) referral to further rehabilitation, and 3) follow-up visit the day after discharge. Primary outcome was readmission (yes/no) within 26 weeks. The study was registered in ClinicalTrial.gov (NCT02078466). RESULTS: No between-group differences were found in readmission. Overall, 44% of the patients in the intervention group and 42% in the usual practice group were readmitted within 26 weeks (risk difference=0.02, 95% CI: [-0.08; 0.12] and risk ratio=1.05, 95% CI: [0.83; 1.33]). No between-group differences were found in any of the secondary outcomes. CONCLUSION: The Elderly Activity Performance Intervention showed no effectiveness in reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. The study revealed that 60% of the elderly patients had a need for further rehabilitation after discharge.

What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults' occupational performance? A systematic review.

BACKGROUND: There is a lack of evidence-based knowledge about the effectiveness of home-based OT for older adults aimed at improving occupational performance by practicing activities and tasks. AIM: This review synthesizes and discusses evidence for the effectiveness of occupation-focused and occupation-based OT for older adults at home. MATERIAL AND METHODS: Peer-reviewed quantitative papers were included. PARTICIPANTS: ≥ 60-year-old adults with functional limitations. INTERVENTION: OT aiming at improving occupational performance, primarily through the practice of activities and tasks. OUTCOME: Occupational performance. CONTEXT: Home. Three reviewers critically appraised 13 of 995 detected papers. Extracted data were presented and summarized descriptively. RESULTS: Eight high-quality papers showed that occupation-focused and occupation-based OT using cognitive, behavioral and environmental strategies may significantly improve occupational performance in older, home-dwelling adults with physical health problems. Maintaining achieved improvements was a consistent challenge. CONCLUSIONS AND SIGNIFICANCE: Evidence suggests that older adults' occupational performance can be significantly improved through low-intensity occupation-focused and occupation-based intervention. It is recommended to develop and test high-intensity OT programs and maintenance programs.

Work reintegration after long-term sick leave: domains of influence on co-workers' ability to be supportive.

PURPOSE: The purpose of the study is to identify domains of influence on co-workers' ability to be supportive of returning worker during the work reintegration (WR) process. METHODS: An ethnographic study design was chosen involving fieldwork at four different workplaces, at an emergency care service, a waste disposal company and at two nursing homes. Qualitative methods for inquiry were used including participant observation, individual- and group interviews of 30 participants. Data were coded and analysed according to a grounded theory approach. RESULTS: Four themes were identified related to domains of influence on co-workers' ability to be supportive of returning worker during the WR process: (1) organisation of work and level of interaction; (2) disruption of work routines, (3) relationship with returning worker and (4) attitudes towards sick leave. CONCLUSION: The WR process after long-term sick leave is not only influenced by the WR's arrangements made, but also by the co-workers' responses to the process. Work arrangements not only affect the returning worker's ability to return-to-work (RTW) successfully, but also the co-workers' ability to be supportive and their ability to take active part in the process. Implications for Rehabilitation The process of WR after long-term sick leave involves interaction with co-workers. Domains of influence is in the co-workers' perspective influencing their ability to be supportive during reintegration of a returning worker. Future WR management could benefit from integrating the conditions for co-worker support. We encourage co-workers to be involved in the RTW planning, monitoring and evaluation with particular focus on how the WR arrangements are influencing their work and their ability to be supportive.

Recovery from mental illness: a service user perspective on facilitators and barriers.

Mental health services strive to implement a recovery-oriented approach to rehabilitation. Little is known about service users' perception of the recovery approach. The aim is to explore the service user's perspectives on facilitators and barriers associated with recovery. Twelve residents living in supported housing services are interviewed. The analysis is guided by a phenomenological-hermeneutic approach and the interpretation involves theories from critical theory, sociology, and learning. Learning, social relations, and willpower are identified as having an impact on recovery. Stigmatization and social barriers occurred. Social relations to peer residents and staff were reported as potentially having a positive and negative impact on recovery. Studies have explored the user's perspectives on recovery but this study contributes with knowledge on how recovery-oriented services have an impact on recovery.

[Rehabilitation to people with mental disorders].

The Danish Government Committee on Psychiatry states that recovery-oriented rehabilitation is an important framework and direction in psychiatry. Recovery-oriented rehabilitation means that the intervention is based on best practice. It is also based on four values: self-determination, person involvement, self-determination/choice and growth potential. A comprehensive national plan of action on how to develop a recovery-oriented rehabilitation to Danish citizens with mental disorders is recommended.