Evolving reablement through occupational perspectives and welfare technology in home care

Abstract

Rationale: Sweden is encountering dual societal challenges characterised by a rapidly ageing population and a diminishing home care workforce, leading to strained resources, which potentially can impact the quality of care. This situation poses a considerable risk to the health and overall well-being of older adults and home care staff. Innovative strategies are necessary to restructure the provision of home care services that promote healthy ageing and enable older adults to age in place. Reablement, as a rehabilitation approach, is recognized in other countries but is relatively new in Sweden. However, despite increased research, knowledge gaps and ambiguities persist regarding reablement’s theoretical foundation and key components. This knowledge is needed to increase transferability and facilitate successful implementations, thereby advancing the evolution of reablement.

Aim: This thesis aims to contribute to the evolution of reablement in home care, using theory, occupational perspectives, and welfare technology to promote healthy ageing in place.

Method: The four studies included in this thesis applied various methods to gain knowledge about different perspectives and prerequisites for reablement to evolve. Study I applied a quantitative approach where a questionnaire was sent out to 467 home care staff containing questions about their perceived psychosocial work environment and job strain. Data was analysed with descriptive and inferential statistics. Study II is a quasi-experimental, mixedmethod feasibility study of the reablement program ASSIST 1.0. Seven older adults and three home care staff participated in the program, and ten older adults participated in the control group and received ordinary home care. Quantitative data from clinical outcome measures were analysed with descriptive and inferential statistics, and interviews and field notes were transcribed and analysed according to a qualitative content analysis. Study III is a qualitative study containing nine interviews conducted with the three home care staff involved in ASSIST 1.0 to explore how theories and concepts can evolve the understanding of reablement. The interviews were analysed with Braun & Clarke’s reflexive thematic analysis. Study IV applies a mixed-method design to evaluate the usability and user experience of an information and communication technology system within a home care organization. Quantitative data consisted of test-based usability assessments and self-reported questionnaires, analysed with descriptive statistics. Qualitative data consisted of transcribed material from one focus group interview with six home care staff and three individual interviews with managers from the home care agency.

Conclusion: The outcomes from the four studies lay the foundation for the discussion of this thesis, focusing on current reablement discourses and delving into three areas contributing to the evolution of reablement. The first two areas critically reflect on theories that can underpin reablement, strengthen the person-centred and holistic approach, and discuss why and how occupational perspectives can provide new outlooks for reablement. Combined, these two areas contribute to an evolved definition of reablement. The third area addresses why welfare technology is essential for enhancing the interprofessional and person-centred approach in reablement. Finally, it is proposed why reablement should be implemented in Sweden, advocating for a change in policies and guidelines for how home care can be reconstructed to facilitate healthy ageing in place.