Synneve Dahlin Ivanoff

Understanding the multiple realities of everyday life: Basic assumptions in focus-group methodology

In recent years, there has been a notable growth in the use of focus groups within occupational therapy. It is important to understand what kind of knowledge focus-group methodology is meant to acquire. The purpose of this article is to create an understanding of the basic assumptions within focus-group methodology from a theory of science perspective in order to elucidate and encourage reflection on the paradigm. This will be done based on a study of contemporary literature. To further the knowledge of basic assumptions the article will focus on the following themes: the focus-group research arena, the foundation and its core components; subjects, the role of the researcher and the participants; activities, the specific tasks and procedures. Focus-group methodology can be regarded as a specific research method within qualitative methodology with its own form of methodological criteria, as well as its own research procedures. Participants construct a framework to make sense of their experiences, and in interaction with others these experiences will be modified, leading to the construction of new knowledge. The role of the group leader is to facilitate a fruitful environment for the meaning to emerge and to ensure that the understanding of the meaning emerges independently of the interpreter. Focus-group methodology thus shares, in the authors’ view, some basic assumptions with social constructivism.

Home as a signification of independence and autonomy: Experiences among very old Swedish people

The aim of this study was to explore independence in the home as experienced by very old single-living people in Sweden. A grounded theory approach was used and interviews were conducted with 40 men and women aged 80–89. Data analysis revealed the core category “Home as a signification of independence” with two main categories: “Struggle for independence” and “Governing daily life”. The findings showed that home is strongly linked to independence, and being independent is extremely valued. Explicit descriptions of the ageing process as an individual process of changing living conditions within the home emerged from the findings. Hence, the ageing process influences the participants’ perception of themselves as independent persons. Along the ageing process the participants’ view of independence changed from being independent in activity performance without help from others to experiencing independence in being able to make autonomous decisions concerning daily life at home. Consequently, there is a need to develop strategies to support very old people in staying as active and independent as possible in their own homes. In addition, since the findings highlight that independence is a complex construct, there is a need for conceptual differentiation between independence and a construct often used synonymously, namely autonomy.

Women on sickness absence—views of possibilities and obstacles for returning to work. A focus group study

Purpose: The aim was to learn how women on sickness absence due to work related strain perceive and describe their possibilities and obstacles for returning to work. Method: The focus group method was used. Five groups were conducted and each group met at one occasion. Twenty women participated in total. Results: Three different themes were found. In ‘The process of losing control’ the participants describe the process from controlling every day living, to total loss of control of private and working life. The second theme, ‘Not finding alternatives’, deals with the difficulties of finding an alternative way back to work. ‘Mastering life as a whole’ contains strategies for regaining control over daily activities and life as a whole. The results show that personal as well as environmental factors have an impact for returning to work. Conclusions: In this study we have received an understanding of the complex situation of being on sickness absence due to work related strain. We have learned the importance of recognizing the context of the individual and understanding the interplay between the person and the environment. As professionals in rehabilitation we can use this knowledge to create a rehabilitation programme supporting people back to work.

Home as the locus and origin for participation: Experiences among very old Swedish people

Using a grounded theory perspective, this article focuses on experiences of participation in relation to home among very old people who are living alone. Eight people selected from the larger ENABLE-AGE Project were interviewed. Data analysis identified the core category as “home as the locus and origin for participation” with two main categories (“performance-oriented participation” and “togetherness-oriented participation”). The findings indicate that the home is the origin for participation both out of the home and within the home. However, as older peoples health declines, the home becomes the explicit locus for participation. Participation successively changes from taking part in more physically demanding activities out of the home to participation by means of watching others from within the home (i.e., by being a spectator). In appreciating self-defined goals for a meaningful life, thus enabling the experience of participation in very old age (age 80 to 89 years), this study contributes to the knowledge about relationships between participation and home in very old age.

Supervisors’ Views on Employer Responsibility in the Return to Work Process. A Focus Group Study

Background: Supervisors’ attitudes and measures have been pointed out by employees to influence the return to work process. The purpose of this study was to explore supervisors’ views on employer responsibility in the return to work process and factors influencing the support of sick-listed employees. Method: The focus group method was used. Six groups were conducted and each group met on one occasion. Twenty-three supervisors experienced in managing sick-listed employees participated. Result: Two different themes emerged; In “The Supervisor is the Key Person” the participants found themselves as being key persons, carrying the main responsibility for the rehabilitation of the sick-listed employees and for creating a good working environment, thus preventing ill health and sick-listing among the employees. In the second theme “Influential Factors in Rehabilitation Work” the participants described the rehabilitation work as a part of a greater whole influenced by society, demands and resources of the workplace and the interplay between all parties involved. Conclusion: The study gives us the supervisors’ perspective on the complexity of the return to work rehabilitation. This knowledge could be invaluable and be used to improve the possibilities for developing successful collaboration in occupational rehabilitation.

Occupational Therapy Research on Assistive Technology and Physical Environmental Issues: A Literature Review

Background. To determine future directions for research in the area of assistive technology and physical environmental issues, it is important to have an understanding of prior research. Purpose. This literature review examined how assistive technology and physical environmental issues have been studied in the research published in international peer-reviewed occupational therapy journals. Method. Five recent volumes of nine journals were manually searched utilizing specific criteria. The publications were classified according to their perspective, application of the Person-Environment-Occupation (PEO) model, and the research design. Results. Both research fields demonstrated use of different research methods and they displayed equal needs with regard to improved research methodologies. Practice Implications. There are a lack of studies involving all three PEO components indicating a lack of research in occupational performance issues. Further research on occupational performance is important for developing occupational therapy practice in the area of assistive technology and physical environmental issues. Furthermore, study designs reflecting the societal level in all three PEO components are required. Finally, there is a strong need for conceptual and theoretical development in both fields.

Changes in the use of assistive devices among 90-year-old persons

Background and aims: The growing numbers of elderly people are expected to lead to an increasing demand for assistive devices. The purpose of this study was to examine changes in the use of assistive devices over time and their relation to dependence in daily activities among 90-year-old persons living at home. Methods: This retrospective longitudinal study examined the 90-year-old population at the ages of 85 and 90, and 195 persons participated. Results: 92% of the 90-year-old population used assistive devices at the age of 90, compared with 74% at the age of 85. Between this interval, 19% became new users, 73% were permanent users, and 7% did not make any use of assistive devices. There was a significantly higher proportion of device-users among those who were dependent in both personal daily activities (PADL) and instrumental activities of daily living (IADL) (98.5%, p<0.001) and among those who were dependent in IADL (94%, p<0.001) compared with those who were independent in ADL (72%). At the age of 90, bathing and mobility devices were the most frequently used. Mobility devices such as walking-frames and wheel-chairs were the most widely distributed devices in this group. Conclusions: The use of assistive devices increases with age, very few 90-year-olds remain non-users at age 90, and the multiple use of assistive devices at 90 years of age is very common. This complexity put great demands on health care services, and highly skilled professionals are needed to meet these demands.

Does informal support influence social participation of fractured elderly people

This population-based cross-sectional study describes social participation expressed as the accomplishment of social, cultural, and leisure activities resulting from informal support given by relatives or friends, formal support given by the municipality or county, or a combination of the two, among 452 individuals aged 60-93 years suffering from osteoporosis-related fractures. A fourth group of individuals with fractures without any support was used as a reference group. Fractures included were humeral, wrist, vertebral, hip, pelvic and ankle fractures. Questionnaires were used to collect sociodemographic data and information on social participation, social support, and covariates. The results showed that a smaller proportion of those with only formal support took part in social, cultural, or leisure activities, compared to participants with informal support alone, both informal and formal support or those without any kind of support. The associations between categories of activity and kind of support were further tested in a logistic regression model adjusting for possible confounders. Odds ratios (ORs) for taking part in social, cultural, and leisure activities were significantly lower for participants with formal support and a combination of informal and formal support, while participants receiving informal support did not show a significantly reduced OR for taking part in any category of activity, compared to the reference group. In conclusion; informal support of older people with fractures is an important means of facilitating social participation and an active lifestyle. Attention should be paid to the vulnerable situation of those who rely solely on formal support.

Integrating research into practice: A challenge for local authority occupational therapy

The aim of this qualitative study was to identify and analyse the experiences of Swedish local health authority occupational therapists with regard to their participation in, and the implementation of, research. Data were collected from three focus-group interviews, with five different occupational therapists in each. The interviews were taped and transcribed and thereafter analysed using broad coding. One core category—“feeling professionally competent”—emerged, comprising three subcategories: “perceiving congruence between research and practice”, “having the necessary skills”, and “making a contribution”. Feeling professionally competent embraces the occupational therapists’ definition and delimitation of their professional domain and the obligations related to this. It also embraces the perception of having the skills necessary for participating in research projects and implementing research findings in a scientific manner. The implementation of research was not only perceived as contributing to the knowledge base of the profession, but personal gains could also be made. The knowledge gained from this study can help in the development of strategies to promote the integration of research in local authority occupational therapy practice. This is necessary; otherwise the occupational therapy provided will be based on the knowledge and perceptions of individual professionals, rather than on state-of-the-art knowledge gained through research.

Development and Evaluation of a Health Education Programme for Elderly Persons with Age-Related Macular Degeneration

The overall aim of this thesis was to develop and evaluate a health education programme for elderly persons with age-related macular degeneration (AMD).