Balancing Everyday Life. Exploring change following an activity-based lifestyle intervention for mental health service users
Abstract: There is limited research that evaluates occupational therapy and lifestyle interventions,especially for mental health service users. This thesis provides increased knowledge and understanding of the processes and factors that led to betterquality of everyday life, engagement in meaningful activities, and balance forparticipants who took part in the Balancing Everyday Life (BEL) intervention.BEL was implemented in 2012-2015 as part of a larger research project, of whichthis dissertation is part. BEL is a group-based occupational therapyintervention that aims to support overall well-being and recovery throughfinding a personalized balance of meaningful activities and relationships.Study I investigated whether socio-demographic, care context, clinical and self-related factors could predict clinically important improvements in the outcomes mentioned above. Data collection took place with 133 participants at baseline, and thenagain at BEL end and six months following. Bi-variate analyses and thenmultivariate regression analyses were performed. Though many associations werefound, few factors were identified as predictors in the regression analyses.The strongest predictors of belonging to the improved groups for occupationalbalance included having a friend for the leisure domain of occupational balanceand female gender for the self-care domain. Having children was found to be apredictor for improved occupational engagement.Studies II-IV used aqualitative Grounded Theory approach. Nineteen participants were interviewedafter BEL, and some were interviewed mid-intervention and 1.5-2 years afterBEL. Study II focused on the meaning of the group for the BEL participants, anda process of meaning-making through group participation was constructed ofthree categories: Joining with others, Sense of belonging, and Re-valuing Self.Those who experienced the most meaning reported feeling less lonely, moreconnected, as well as respected and worthy.Study III focused onthe processes at work that supported making lifestyle changes. A process ofmaking changes was constructed, consisting of five categories: Going at itgently: change is an on-going process; Support for progress, permission tofail; Prioritizing and setting boundaries; Adjusting for a sustainable balance;and Caring for a valued Self. Each category included a strategy for change aswell as a related inner change. A more self-compassionate approach seemed to bea key for caring for Self and making sustainable changes.Study IV focused onperceptions of the BEL format and content and included focus group and/orindividual interviews with 12 group leaders and 19 participants. Both partiesfelt that they had benefited from BEL’s structure and manual, yet flexibilitywas desired. BEL appeared to create bridges - to other people, to society atlarge, and to a future version of everyday life. BEL’s occupation- andperson-focused approach was appreciated. Group leaders experienced BEL as easyto implement and some felt it strengthened their professional role.Participants appreciated feeling respected and listened to by the groupleaders, and appreciated them maintaining structure in the group. Regardinghindering factors, group leaders mentioned mainly material obstacles, such asthe lack of suitable group rooms or projector. Participants felt that toodifferent functional levels between the group participants could be anobstacle.As similar researchand interventions are lacking, this dissertation provides an importantcontribution to the knowledge base for occupational therapeutic interventionsin the psychiatric field.
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