Digital Group Therapy Aims to Keep Older Adults Connected and Active

Aging populations across the world are placing unprecedented pressure on health and social care systems, and researchers are increasingly turning to digital solutions to meet the challenge. A team of occupational therapy researchers at Luleå University of Technology in Sweden has now published a detailed study protocol for testing a new web-based group intervention, called Health Web 1.0, designed to help older adults maintain social participation and meaningful daily activities. The protocol, published in the Scandinavian Journal of Occupational Therapy, describes a feasibility study that will be conducted in municipal primary healthcare settings in northern Sweden, with occupational therapists delivering the intervention remotely through a digital communication platform while older adults participate from their own homes.

The scientific rationale behind the intervention rests on a growing body of evidence linking social participation to health in later life. Studies have shown that staying socially engaged protects against the onset or progression of chronic conditions, slows declines in the ability to perform everyday activities, and reduces the risk of physical frailty. The World Health Organization emphasizes social participation and the ability to create and maintain relationships as central pillars of healthy aging. Yet despite this evidence, social participation is rarely the primary focus of interventions targeting older adults, and even less attention has been paid to the concrete strategies older people use in their daily lives to stay engaged with their communities.

Social participation is a complex concept. According to the widely cited definition by Levasseur and colleagues, it describes a person’s involvement in activities that provide interactions with others in community life and in important shared spaces, shaped by the societal context and by what the individual finds meaningful. Participation exists on a spectrum of engagement, from simply interacting with others, to doing activities together, to contributing to other people and to society at large. Life events such as the loss of friends or family members, or the need to relocate, can threaten these connections and become risk factors for loneliness. Environmental barriers, including a lack of accessible social meeting places, further complicate the picture. Research also shows that maintaining social participation in old age is an active, ongoing process that requires commitment, initiative, and the development of personal strategies to adapt to new circumstances.

It is precisely these strategies that the Health Web intervention targets. A key psychological ingredient is self-efficacy, the belief in one’s own ability to plan and carry out the actions needed to achieve specific goals. A systematic meta-synthesis of qualitative studies previously conducted by the research group revealed that older adults use a variety of inward-looking and outward-looking strategies to build routines within daily activities that support their social participation. That systematic review was integrated into the theoretical framework of the new intervention, alongside occupational therapy theory. The ValMO model describes how different values attached to daily activities generate meaning in everyday life, while the transactional model of occupation focuses on the situations in which activities take place, treating digital tools and digital environments as part of the whole that shapes opportunities for participation.

Because Health Web 1.0 is designed as a group intervention, its developers also built the programme on established theories of group dynamics. Cole’s seven steps for group intervention guide the occupational therapist on how to structure each group meeting, which is considered important both for the group process and for the outcomes achieved. The purpose of the group format is to help participants gain new perspectives on their own situation by reflecting and sharing experiences with one another. In addition, the programme borrows pedagogical principles from the flipped classroom. Participants prepare for each group meeting by watching short recorded educational videos and completing reflection assignments on their own, which frees the occupational therapist to spend the live sessions supporting participants in becoming aware of, reflecting on, and developing their own strategies for social participation, rather than simply delivering information.

The structure of the intervention is carefully specified. It begins with two introductory sessions, followed by five themed sessions spread over seven weeks, and concludes with a follow-up session one month after the last themed meeting. Each themed session consists of a short educational video of five to ten minutes, a reflection assignment, and a group meeting of approximately ninety minutes moderated by an occupational therapist. Before the programme starts, participants receive a binder containing an intervention guide that presents the theme sessions and reflection assignments, along with study-specific registration forms. The occupational therapists delivering the intervention complete a dedicated education programme beforehand, including recorded videos on the theoretical foundation and an example of how a themed session can be conducted, and they receive ongoing support from the research group throughout the delivery period.

The feasibility study itself follows the Medical Research Council framework for developing and evaluating complex interventions and uses a pre-test and post-test design without a control group. Qualitative and quantitative data will be collected concurrently in a convergent mixed-methods design. After each themed session, older adults will complete registration forms rating, on five-point Likert scales, their agreement with statements about the knowledge gained, the value of the reflection assignments, the value of and engagement in group discussions, and their use of the digital platform. The occupational therapists will complete parallel forms rating their compliance with the intervention guide, their confidence as group leaders, and the management of the digital platform. Semi-structured interviews with both groups, conducted before, during, and after the programme, will probe expectations, experiences, perceived benefits, harms, and unintended consequences.

Potential outcomes will be measured with standardized self-assessment tools administered before the intervention, immediately after, and three months later. The Occupational Balance Questionnaire, an eleven-item instrument with good confirmed validity, captures satisfaction with and variation in daily activities, with higher scores indicating better occupational balance, a quality previously linked to health and quality of life in older adults. The General Self-Efficacy scale measures self-perceived ability to cope with life’s demands across ten items. A newly developed twenty-four-item measure of strategies for social participation, based directly on the research group’s meta-synthesis, will capture how frequently participants use specific strategies in daily life. Baseline sociodemographic data will be collected, and perceived loneliness will be assessed with the twenty-item UCLA Loneliness Scale, which covers emotional, social, and existential dimensions of loneliness.

The study will enroll approximately twelve older adults and two occupational therapists, a sample size considered appropriate for an early-stage feasibility study where the goal is to gather detailed information rather than statistical power. Participants must be sixty-five or older, living in ordinary housing, experiencing a changed life situation that affects their possibilities for social participation, and have access to a computer or tablet along with experience using the internet and email. Recruitment began in autumn 2024 and was completed in spring 2025, drawing participants through occupational therapists, advertisements, and local retirement organizations, with screening conducted during home visits. The study has been approved by the Swedish Ethical Review Authority and will be conducted in accordance with the Helsinki declaration and the GDPR.

The researchers acknowledge that several uncertainties remain before Health Web can move to larger-scale testing. Clinical uncertainties concern whether a web-based format suits older adults who may be hindered in using technology, and both digital delivery and flipped-classroom pedagogy represent new ways of working for many occupational therapists. Methodological uncertainties around the research design and the chosen outcome measures also need to be resolved. If the feasibility evaluation succeeds, however, the long-term potential is considerable. The intervention could help occupational therapists adopt a more proactive role in supporting meaningful everyday lives in old age, while the group format and digital delivery promise more efficient use of scarce professional resources and greater accessibility to services, particularly for older adults in sparsely populated regions of northern Sweden and beyond.

Subject of Research: A web-based occupational therapy group intervention to support social participation and healthy aging in older adults

Article Title: Health Web 1.0, a web-based occupational therapy group intervention for older adults: A study protocol for a feasibility study

Article References: Health Web 1.0, a web-based occupational therapy group intervention for older adults: A study protocol for a feasibility study. (n.d.). https://doi.org/10.1080/11038128.2025.2590725

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2590725

Keywords: occupational therapy, older adults, social participation, digital health, healthy aging, feasibility study, e-health, loneliness, self-efficacy, group intervention, flipped classroom, primary healthcare