| 1. |
- Carlsson, Gunilla, et al.
(författare)
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A hundred days in confinement : Doing, being, becoming, and belonging among older people in Sweden during the COVID-19 pandemic
- 2022
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Ingår i: Journal of Occupational Science. - : Informa UK Limited. - 1442-7591 .- 2158-1576. ; 29:3, s. 402-416
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Tidskriftsartikel (refereegranskat)abstract
- Background: When and how people were able to engage in everyday occupations changed suddenly with the coronavirus pandemic. Defined as a risk group due to their age, people 70 years and older in Sweden experienced confinement, as did older adults globally. Aim: To explore how doing, being, becoming, and belonging as dimensions of occupation were manifested in the lives of Swedish people 70 years or older, 100 days into the coronavirus pandemic. Method: Data were elicited through semi-structured interviews with 17 participants (11 women, 6 six men, mean age 76 years), living in ordinary housing in Sweden. Interviews were conducted in June 2020 as part of a larger longitudinal research project. A directed content analysis approach was used to analyse the data based on the occupational dimensions of doing, being, becoming, and belonging. Results: After 100 days of confinement, daily occupations had been changed, and habits and routines disrupted. However, the need to engage in occupations was strong. Participants expressed how they adapted their occupations to the restrictions, but also how their doing affected their well-being, further development, and opportunities for social interactions. Conclusion: The participants, who were older people without any specific diagnosis, reflected upon their daily occupations during an unrehearsed natural experiment when, more than anything else, the social environmental circumstances changed. The analysis elucidates how doing, being, becoming, and belonging is embedded in people’s lives. The study can serve as a foundation to further research on understanding people’s individual needs as occupational beings.
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| 2. |
- Elf, Marie, 1962-, et al.
(författare)
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A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings
- 2024
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112.
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.
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| 3. |
- Elf, Marie, 1962-, et al.
(författare)
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Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke : An Explorative Study
- 2023
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 18:3, s. 237-237
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke.BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse.METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis.RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings.CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.
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| 4. |
- Elf, Marie, 1962-, et al.
(författare)
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Rehabilitation at Home With the Development of a Sustainable Model Placing the Person's Needs and Environment at Heart : Protocol for a Multimethod Project
- 2024
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Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person's physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person's home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting.OBJECTIVE: The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered.METHODS: The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model.RESULTS: This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026.CONCLUSIONS: The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56996.
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| 5. |
- Elf, Marie, 1962-, et al.
(författare)
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Tailoring and Evaluating an Intervention to Support Self-management After Stroke : Protocol for a Multi-case, Mixed Methods Comparison Study
- 2022
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Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.OBJECTIVE: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.METHODS: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.RESULTS: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.CONCLUSIONS: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.
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| 6. |
- Elf, Marie, 1962-, et al.
(författare)
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The Home as a Place for Rehabilitation After Stroke : Emerging Empirical Findings
- 2023
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Ingår i: (Re)designing the Continuum of Care for Older Adults : The Future of Long-Term Care Settings - The Future of Long-Term Care Settings. - Cham : Springer International Publishing. - 9783031209697 - 9783031209703 ; , s. 37-51
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Bokkapitel (populärvet., debatt m.m.)abstract
- Health care is moving toward integrated services where care and rehabilitation are provided at home rather than in institutions. This, together with the requirement that care must be person-centered, has proven to be a considerable challenge. Older adults living with complex health conditions such as stroke are vulnerable to change when their responsibility for care and rehabilitation becomes extensive. Health care tends to be governed by quick fixes rather than taking people’s own goals, resources, and life situations. Factors in the environment that can affect a person’s health and social, emotional, and physical aspects of daily life are crucial to consider in person-centered care. Nevertheless, the environment is often neglected in both research and clinical practice. This chapter addresses findings within the REARCH (Rehabilitation and Architecture) project. The project was initiated in response to Swedish law in 2018, making it more common for older adults with stroke to be rehabilitated at home rather than in a hospital. The purpose was to explore environmental factors to fulfill person-centered rehabilitation. The results are based on qualitative and quantitative data collected from patients and interdisciplinary care staff. We describe the challenges for people with stroke during rehabilitation and how their possibilities to engage in everyday life in their homes and immediate surroundings are influenced by environmental factors. Our contribution will improve the understanding of how environmental factors relate to everyday life and recovery at home. The discussion aims to guide evidence-based care models for rehabilitation at home.
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| 7. |
- Elf, Marie, 1962-, et al.
(författare)
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The home as a place for rehabilitation-What is needed?
- 2020
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Ingår i: Architecture for Residential Care and Ageing Communities: Spaces for Dwelling and Healthcare. - New York, NY : Routledge, 2021. : Routledge. - 9780367358730 ; , s. 252-266, s. 252-266
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- This chapter aims to contribute to an understanding of the physical environment as an important part of the rehabilitation process for patients recovering from a stroke who rehabilitate at home. To further develop evidence-based care models for rehabilitation at home and incorporate person-environment dynamics, an understanding of how environmental factors relate to everyday life and recovering at home is crucial, especially for persons with long-term conditions, such as stroke survivors. Along with highlighting the challenges for the stroke survivors when rehabilitated at home, we discuss initiatives and intervention needed. We also present important theories that can be used in research in order to increase the knowledge of the person-environment interaction from a societal perspective vital to increase our knowledge of home and health dynamics in this context.
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| 8. |
- Elf, Marie, 1962-, et al.
(författare)
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The importance of context : a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke
- 2023
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.METHODS: Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.RESULTS: The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.CONCLUSIONS: Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.
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| 9. |
- Elf, Marie, et al.
(författare)
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The Importance of the Physical Environment to Support Person-Centered Rehabilitation in the Home
- 2020
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Ingår i: Architecture for Residential Care and Ageing Communities : Spaces for Dwelling and Healthcare - Spaces for Dwelling and Healthcare. - New York, NY : Routledge, 2021. : Routledge. - 9780367358730 - 9781000202236 ; , s. 252-266
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Bokkapitel (refereegranskat)abstract
- This chapter aims to contribute to an understanding of the physical environment as an important part of the rehabilitation process for patients recovering from a stroke who rehabilitate at home. To further develop evidence-based care models for rehabilitation at home and incorporate person-environment dynamics, an understanding of how environmental factors relate to everyday life and recovering at home is crucial, especially for persons with long-term conditions, such as stroke survivors. Along with highlighting the challenges for the stroke survivors when rehabilitated at home, we discuss initiatives and intervention needed. We also present important theories that can be used in research in order to increase the knowledge of the person-environment interaction from a societal perspective vital to increase our knowledge of home and health dynamics in this context.
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| 10. |
- Eriksson, Erik, et al.
(författare)
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Perceived Housing in Relation to Retirement and Relocation : A Qualitative Interview Study among Older Adults
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:20
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Tidskriftsartikel (refereegranskat)abstract
- As people age the home environment becomes increasingly important. Retirement commonly leads to spending more time in one’s home, and relocating from your own home in older age could be associated with reduced health or wellbeing. The relationship between home and person is complex and perceived aspects of one’s housing such as social, emotional and cognitive ties are considered important factors for health and wellbeing. However, little is known about how perceived aspects of the home change in relation to retirement and relocation. This paper used Situational Analysis to explore, via situational mapping, how community dwelling older adults (aged 60–75) perceived their housing situation in relation to retirement and relocation. The results suggest complex relations between relocation/retirement and perceived housing, and between different aspects of perceived housing. Furthermore, the results suggest that the relationship between life transitions and perceived housing can be seen as bi-directional, where different life transitions affect aspects of perceived housing, and that perceived housing affects (decisions for) relocation. The results suggest complex relations between retirement and relocation, as well as other life transitions, and perceived aspects of one’s housing. It is important to consider these interactions to understand factors that affect health and wellbeing in older adults.
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