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Harnessing togetherness: perceptions of loneliness and promotion of social participation in the home care context
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.ORCID iD: 0000-0002-0729-5361
2023 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Att fånga känslan av gemenskap : uppfattningar av ensamhet och främjande av social delaktighet i hemtjänstkontext (Swedish)
Abstract [en]

Introduction: It is well known that older adults have a higher risk for loneliness, which is detrimental to health. Home care in Sweden has a responsibility to address social needs, but systematic approaches are lacking and there is a know–do gap. The overall aim of this thesis was to develop knowledge about older home care recipients’ and home care providers' perceptions of loneliness and social participation among older adults, and furthermore, to develop a work model for supporting social participation in home care and explore that process.

Methods: Four studies were included. In the first study, care recipient interviews explored perceptions of social participation. In the second, a total population survey investigated the association between perceived care quality and loneliness. The third study used individual and group interviews with home care providers to explore discourses on loneliness and social support. The fourth applied a participatory action research(PAR) process with care workers to develop strategies to alleviate care recipients’ loneliness.

Findings: Enjoying personally relevant occupations, both in solitude and with others, was found to be important for satisfactory social participation. Low perceived quality in home care quality was statistically associated with loneliness. Two discourses, one in which care recipients were described as valued but vulnerable “others”, and another in which they were described as competent peers, were identified. A work model facilitating social participation was created, and the process was applied to a “framework for occupational enablement for change in community practice”.

Conclusion: The understanding of loneliness and social participation in the complex home care context has been nuanced, as have discourses that affect home care practice. The work model itself could become a first step towards systematically addressing loneliness and social needs, and the application of an occupational enablement framework onto the PAR process ties the methodologies together and facilitates participatory research for occupational therapy and science.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2023. , p. 100
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2236
Keywords [en]
Loneliness, Older adults, Home care services, Home care delivery, Social participation
National Category
Social Work Occupational Therapy Nursing
Research subject
Occupational therapy
Identifiers
URN: urn:nbn:se:umu:diva-206318ISBN: 978-91-8070-043-6 (print)ISBN: 978-91-8070-044-3 (electronic)OAI: oai:DiVA.org:umu-206318DiVA, id: diva2:1748528
Public defence
2023-04-28, Rotundan, Universumhuset, Universums gränd 8, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07089Available from: 2023-04-06 Created: 2023-04-03 Last updated: 2023-04-04Bibliographically approved
List of papers
1. Personhood in aloneness and in affinity: satisfactory social participation among home care recipients
Open this publication in new window or tab >>Personhood in aloneness and in affinity: satisfactory social participation among home care recipients
2022 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 29, no 7, p. 563-577Article in journal (Refereed) Published
Abstract [en]

Background: Social participation can be described as engaging in activities that provide interaction with others, and support for social participation may reduce loneliness and improve health. However, there is limited knowledge about social participation in a home care context.

Aim: To explore the perceptions and experiences of community-dwelling older adults with regard to aspects related to social participation in a home care context.

Materials and methods: Seven home care recipients, aged 79-94 years, from two Swedish municipalities participated in semi-structured interviews. The interviews were analyzed using qualitative content analysis.

Results: The study identified the central theme, Personhood in aloneness and in affinity, as important in accomplishing satisfactory social participation. The results incorporated cultivating personal interests and navigating occupations, as well as having one's needs seen and experiencing mutuality in social encounters.

Conclusions: The study nuances existing knowledge about social participation among older home care recipients, and the findings strengthen the importance of framing a home care environment where recipients can cultivate personhood and be recognized as valuable individuals with relevant needs.

Significance: This study extends current understandings of the variety and richness of the social participation and occupational engagement enjoyed by older home care recipients, to be considered in research and practice.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Older adults, togetherness, agency, community dwelling older adults, social participation, loneliness, home care services, occupational identity, interdependence
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-177736 (URN)10.1080/11038128.2020.1849394 (DOI)000593095300001 ()33245667 (PubMedID)2-s2.0-85096836015 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07089
Available from: 2020-12-18 Created: 2020-12-18 Last updated: 2023-04-03Bibliographically approved
2. Cumulative consequences for loneliness? A total population survey on relationships between perceived home care quality and loneliness among older home care recipients in Sweden
Open this publication in new window or tab >>Cumulative consequences for loneliness? A total population survey on relationships between perceived home care quality and loneliness among older home care recipients in Sweden
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206317 (URN)
Available from: 2023-04-03 Created: 2023-04-03 Last updated: 2023-04-03
3. Constructing loneliness: home care providers' notions of older adults' social needs and the possibilities of the home care profession to support social participation
Open this publication in new window or tab >>Constructing loneliness: home care providers' notions of older adults' social needs and the possibilities of the home care profession to support social participation
2023 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 65, article id 101130Article in journal (Refereed) Published
Abstract [en]

Quality of care is determined not only by political decisions but also by how those policies are understood and managed by professionals when put into action. Home care services, the most common form of elder care in Sweden today, should include social support, which is very important for health and wellbeing. And yet, support for social participation seems to be lacking. Understanding prevalent social constructs and their possible impacts on focus and content of social practice in home care could reveal ways to address social support in home care. Therefore, this article highlights how professionals in home care provision talk about older home care recipients' loneliness and social needs, and how these repertoires are related to professionals' opportunities and obligations to support those social needs. The study included 22 persons from different professions in home care provision, from two municipalities in northern Sweden. Nine individual interviews and four group interviews were conducted, recorded, transcribed, and analyzed using a discourse psychology approach. The results show two interpretative repertoires in which notions of otherness and likeness guided definitions and support regarding loneliness, social needs, and social support. This study reveals assumptions that underpin and structure the practices of home care. As the interpretative repertoires provided differing and partly opposing views on how to provide social support and combat loneliness, it seems important to also address the broader issues of professional identities and how loneliness is defined and approached.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Home care services, Occupational therapy, Discourse analysis, Interpretative repertoire, Older adults, Aging
National Category
Occupational Therapy Ethnology Nursing
Research subject
Occupational therapy; Ethnology
Identifiers
urn:nbn:se:umu:diva-205993 (URN)10.1016/j.jaging.2023.101130 (DOI)000952643200001 ()2-s2.0-85150042171 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07089
Available from: 2023-03-26 Created: 2023-03-26 Last updated: 2023-09-05Bibliographically approved
4. Teaming up to traverse loneliness: a co-creative journey toward a home care work model for supporting social participation among older adults
Open this publication in new window or tab >>Teaming up to traverse loneliness: a co-creative journey toward a home care work model for supporting social participation among older adults
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1159Article in journal (Refereed) Published
Abstract [en]

Background: Participatory research is particularly suitable in adressing know-do gaps in health systems. There is a disparity between what is known about the benefits of social participation and home care’s responsibility to provide conditions amenable to older adults’ social participation, and what is accomplished in home care practice. Home care workers are a large, low-power group, whose competences should be better harnessed. We carried out a participatory action research (PAR) project with the goal of generating an improved structure for identifying and alleviating loneliness. This article aims to explore the co-creative process of designing a work model that guides home care workers in supporting social participation among older care recipients.

Methods: Multimodal data from 16 PAR workshops with 14 home care workers were described and explored through the ‘recursive PAR process’ and the ‘framework for occupational enablement for change in community practice”.

Results. The PAR process is outlined through the objectives, activities, and work model, as well as enablement strategies employed throughout the PAR process; as are its opportunities, challenges and implications. The work model describes how care workers can act as discoverers of care recipients’ unmet social needs, employ intentional communication, and link to relevant professions or community services to alleviate loneliness among older home care recipients.

Conclusions: This research process included opportunities of collaborating with enthusiastic and competent home care workers, but also challenges of moving between theory and practice and maintaining active participation between workshops. The resulting work model is in step with the requirements of elderly care, is unique in its field and could comprise a first step toward a more systematic approach of assessing and addressing loneliness. The vivid delineation of the PAR process provided in this paper can aid other researchers in navigating participatory research in home care contexts.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Home care services, Participatory action research, Older adults, Social participation, Togetherness, Occupational therapy, Elderly care
National Category
Nursing Occupational Therapy Social Work
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-199863 (URN)10.1186/s12913-022-08524-y (DOI)000855171800003 ()36104816 (PubMedID)2-s2.0-85137850818 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016- 07089
Available from: 2022-09-30 Created: 2022-09-30 Last updated: 2023-04-03Bibliographically approved

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