Municipal Health Systems Unprepared to Deliver Health-Promoting Care for Older Adults, Study Warns

An ambitious shift in Swedish elder care toward prevention rather than reaction is colliding with the everyday reality of the professionals expected to deliver it, according to new research published in the Scandinavian Journal of Occupational Therapy. A qualitative study led by Linnea Körlof of Luleå University of Technology, together with Anneli Nyman, Ellinor Larsson, and Gunilla Isaksson, finds that municipal health and social care organizations currently lack the structural, cultural, and practical conditions needed for health-promoting interventions targeting older adults to take root in routine practice. Crucially, however, the study concludes that this readiness is not a fixed shortage but something that can be actively created, provided that coordinated, long-term efforts span the entire organization rather than resting on individual, already overloaded professionals.

The context for the study is a demographic and policy pressure cooker. Societies and healthcare systems worldwide are confronting the demands of an aging population, and the European Commission has emphasized cross-sector collaboration to build sustainable, health-promoting solutions that support active and healthy ageing. In Sweden, healthcare is undergoing a deliberate transition toward person-centered and integrated care, with proactive, health-promoting approaches and digital solutions intended to deliver more equal, efficient, and accessible services. Municipal healthcare, provided in people’s homes or in specialized housing, serves a population in which up to 83 percent of recipients in 2023 were aged 65 or older, and many of these individuals also receive municipal social services such as home care. Staff in these services frequently perform delegated healthcare tasks, blurring the boundaries between sectors and making shared, collaborative perspectives essential to any preventive shift.

The scientific rationale is compelling. Cohort studies suggest that today’s older adults generally show higher levels of physical and mental functioning than previous generations, and Swedish data report improvements in health, longevity, and activity performance among people up to 80 years of age. Health promotion, defined as the process of enabling people to increase control over the determinants of their health, offers a way to consolidate those gains. Interventions that target key health determinants among community-dwelling older adults before they enter municipal care could help maintain health, delay the onset of care needs, and reduce future demand on strained health and social care systems. Within occupational therapy, engagement in meaningful everyday activities is considered a key determinant of health, and prior evidence supports both group-based formats and digital delivery, suggesting that combining the two could offer promising, resource-efficient routes to supporting healthy ageing.

To understand the organizational ground truth before any large-scale implementation, the researchers turned to the people who run and staff municipal services. Using a qualitative focus group design, they recruited 22 participants from seven municipalities in northern Sweden, including occupational therapists, development managers, area managers, operations managers, and case managers. The participants were purposively sampled across professional roles and organizational levels, and grouped with others in similar positions to reduce the distorting effects of hierarchy on candid discussion. Five focus groups were held over five months, three digitally because of the long distances between workplaces and two in person. To anchor the conversation, the researchers presented a shared case: a web-based, group-delivered occupational therapy intervention called Health Web, which their team had previously developed and piloted. The case was not being evaluated; it served as a concrete stimulus for broader reflection on what health-promoting work would demand of the organization. Discussions, lasting between 56 minutes and one hour and 50 minutes, were audio recorded, verbatim transcribed, and analyzed inductively using a structured focus group analysis approach.

The analysis converged on a single overarching theme: creating organizational readiness for health-promoting interventions. This theme was supported by three interrelated subthemes: supportive structures for health-promoting work are needed within the organization; a shared health-promoting focus and new collaborations are required; and new working methods are necessary to facilitate health promotion. The researchers found that these subthemes do not operate as isolated barriers or facilitators but interact dynamically in everyday practice, collectively shaping whether preventive ambitions can actually be realized. Every focus group judged current readiness to be insufficient, yet participants also expressed a clear sense that health-promoting interventions are essential as the organization aligns with person-centered and integrated care.

The first subtheme exposed a structural paradox. Participants described legal agreements, frameworks, and priority orders that govern municipal work as failing to stipulate health-promoting activity. Development managers explained that the home care agreement, for example, directs effort almost entirely toward technical aids and reactive, treatment-focused care, leaving professionals who are trained to work preventively feeling actively hindered. In their words, staff are left to put out fires without ever being able to prevent the fires from starting. The absence of supportive structures led to a shared perception of health promotion as optional work, something to be attempted only when time and resources allowed. Participants called for revised agreements, clearer interpretation of the new social services act, explicit direction on resource allocation and competence use, and political and managerial leadership to initiate the change, emphasizing that long-term sustainability requires extra resources during a transition period rather than short-term projects vulnerable to annual budget cuts.

The second subtheme revealed a cultural trap: daily practice is dominated by reactive, compensatory interventions. Occupational therapists are mainly contacted for acute needs following hospital discharge and are often perceived as an overburdened group with few staff, so managers hesitate to add anything beyond ordinary tasks. Interventions in older adults’ daily activities are frequently delegated to home care staff who lack formal competence and face language barriers, leading to deprioritization in favor of basic care. Collaboration between health and social care typically emerges only late, when complex needs have already arisen, and is further restricted by secrecy regulations. Participants proposed earlier, closer collaboration, tools such as life story forms used proactively to map health determinants, and outreach into society, including associations, libraries, and digital platforms, to reach resourceful older adults whose changing life circumstances make them ideal candidates for preventive intervention before poor health takes hold.

The third subtheme highlighted new working methods, particularly digital and group-based formats. Participants viewed digital solutions as a way to reach older adults who have difficulty leaving home, including informal caregivers and those with limited energy or mobility, and to build digital competence, itself a health-promoting skill in modern society. Yet current municipal digital use is largely one-way, covering security alarms and camera surveillance rather than mutual communication. Group formats were judged inherently health-promoting: shared activities foster mutual encouragement, social learning, empowerment, cognitive and physical stimulation, and a sense of purpose, right down to the motivation to look presentable for a meeting. Flexible design was seen as important, since combining an initial physical meeting with later digital sessions could lower the threshold for isolated older adults, while for others a screen feels safer as a first step out of isolation.

Interpreted through Weiner’s theory of organizational readiness for change and the Consolidated Framework for Implementation Research, the findings suggest low change efficacy and fragmented change commitment among staff, but also extend those frameworks by showing that readiness is continuously negotiated through structural conditions, shared views, and everyday collaborative practices rather than being a static psychological state. The authors argue that the study provides a foundation for structured dialogue between policymakers, managers, and professionals, ideally within collaborative co-creation processes, and call on the occupational therapy profession to engage across organizational levels in deciding how its competencies can shift from reactive, compensatory roles toward proactive, health-promoting practice. For a system facing an ever-growing older population, the message is stark but constructive: the potential for prevention already exists within municipal organizations, but it must be deliberately built, resourced, and led from the top if health promotion is ever to move from aspiration to everyday routine.

Subject of Research: A qualitative focus group study exploring organizational opportunities and challenges for delivering health-promoting interventions to older adults within municipal health and social care in Sweden.

Article Title: Opportunities and Challenges for Health-Promoting Interventions for Older Adults: A Focus Group Study with Professionals in Municipal Health and Social Care

Article References: Körlof, L., Nyman, A., Larsson, E., & Isaksson, G. (2026). Opportunities and Challenges for Health-Promoting Interventions for Older Adults: A Focus Group Study with Professionals in Municipal Health and Social Care. Scandinavian Journal of Occupational Therapy, 33(1), Article 6. https://doi.org/10.1007/s44474-026-00008-0

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00008-0

Keywords: health promotion, older adults, occupational therapy, organizational readiness, municipal health care, social care, person-centered care, integrated care, digital interventions, group-based interventions, healthy ageing, qualitative research