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

The scientific significance of the study lies in its deductive design. Rather than letting themes emerge freely from interview data, the researchers deliberately mapped participants’ narratives onto the CHIME framework, a widely accepted conceptual model of personal recovery developed through systematic review. CHIME stands for Connectedness, Hope and optimism, Identity, Meaning and purpose, and Empowerment, and it has become something of a gold standard for characterising what recovery from mental health problems actually involves. By testing whether the experiences of Balancing Everyday Life participants fit this established framework, the investigators could determine both whether the intervention promotes recovery in the sense that the field recognises and whether it offers anything the framework itself has overlooked.

The data came from a re-analysis of in-depth qualitative interviews originally collected during and after a randomised controlled trial of the intervention. From nineteen original interviewees, the researchers purposefully selected eleven information-rich cases: nine women and two men aged between thirty and sixty-three, with an average age of forty-six. Their diagnoses spanned bipolar disorder, psychosis, emotionally unstable personality disorder, ADHD, PTSD, eating disorders, panic disorder, depression, stress-related problems and previous substance abuse. Crucially, all had been interviewed at the completion of the intervention, allowing the researchers to capture recovery reflections at a consistent point in time. Semi-structured interviews lasting between thirty minutes and two and a half hours were transcribed verbatim and then analysed using the three phases of deductive content analysis: preparation, organising and reporting.

The results were striking in their breadth. Every one of the five CHIME categories was represented in the participants’ accounts, and most of the framework’s subcategories appeared as well. Two categories dominated the narratives, however: Connectedness and Empowerment. Participants repeatedly described how the safe, accepting climate of the group allowed them to open up to others, share experiences, exchange tips and support each other’s goals. One participant described recognising fellow group members as comrades in a shared fight, even when their specific goals differed. Another explained that the group was the first place she felt able to talk with people who had also been through hardship, expanding a social network she had not previously had and breaking a cycle of isolation that many mental health service users know intimately.

The importance of trusting relationships extended beyond the peer group to the healthcare staff who led the sessions. Participants emphasised that group leaders who listened without rushing, who radiated calmness and who responded to missed sessions with empathy rather than critique strengthened their confidence in the care system and in themselves. Support from family, friends and even new acquaintances made through the intervention also featured prominently, with one participant describing how a friend introduced through a fellow group member helped her get to a gym activity and became a source of mutual inspiration. These findings align with a substantial body of occupational therapy research showing that group-based activity interventions carry therapeutic value precisely because belonging and shared occupation reinforce one another.

The Empowerment category proved equally central. Participants spoke about personal responsibility in their own care, including having a voice in decisions about medication, and about regaining control over daily life through concrete strategies. One participant set a goal of reducing his sleeping pills and valued the freedom to experiment with his doctor rather than simply following a prescription. Others described learning to set limits, to tell an employment agency when they could not cope with too many changes, to break housework into manageable half-hour segments, and to let go of activities that drained them, such as one participant who abandoned a photography hobby when the fear of failure outweighed the joy. Balancing rest and activity, setting realistic goals matched to one’s abilities, and pacing oneself step by step emerged as practical recovery tools that participants carried into their everyday lives.

Beyond confirming the CHIME categories, the study made a discovery with potentially broader implications: two recovery experiences that the framework does not cover appeared consistently in the data. The first was occupational balance, the sense that daily activities are satisfyingly mixed, aligned with personal values and matched to one’s abilities. Because Balancing Everyday Life is explicitly built around learning about and self-analysing occupational balance, its prominence among participants’ recovery experiences may reflect what is distinctive about occupational therapy as a discipline. The second was self-esteem and self-confidence, which participants reported had grown through the course and which the researchers suggest could be added to CHIME’s Identity category. These additions hint that recovery frameworks developed in psychology and psychiatry may benefit from incorporating occupational science concepts that capture how people structure and experience their daily doing.

The study’s findings also illuminate the temporal nature of recovery. Categories such as Hope and optimism, Identity and Meaning and purpose appeared in the narratives but less prominently, and not all of their subcategories were identified. The researchers propose a plausible explanation: participants were interviewed shortly after completing the intervention, at a relatively early stage of what is often a long, multi-phase recovery journey. People earlier in that journey may experience belonging and connection most vividly, while hope, a redefined identity and a rebuilt sense of meaning may consolidate later. This interpretation is supported by the intervention’s randomised trial data, which showed that quality-of-life improvements among Balancing Everyday Life participants emerged only at a six-month follow-up rather than immediately after completion. The authors therefore call for follow-up studies that track recovery after occupational therapy interventions over longer horizons.

Methodologically, the researchers took deliberate steps to ensure trustworthiness. Two occupational therapy students coded transcripts independently and reached consensus under supervision, while one author independently re-analysed an entire interview, with discrepancies resolved through iterative discussion at the subcategory level. The selection of participants across different regions, group leaders, genders, ages and service contexts strengthened dependability, and illustrative participant quotes bolstered credibility. The authors acknowledge that the interview data was originally collected for earlier inductive studies and that the interview guide did not probe recovery specifically, but they argue that this openness was actually a strength, since questions framed around CHIME would have led participants toward the framework’s own concepts rather than testing whether those concepts genuinely fit their experience.

The clinical implications are concrete. The study concludes that Balancing Everyday Life supports recovery in the way the field has conceptualised it, providing evidence that practitioners can use when encouraging service users to enrol. Perhaps more importantly, it demonstrates that an occupational therapy intervention, grounded in everyday activity rather than symptom management, can foster the connectedness, hope, identity, meaning and empowerment that define personal recovery. For a population that research consistently shows to be under-occupied, isolated at home and struggling with imbalanced daily routines, the message is quietly radical: recovery can be built through the ordinary architecture of daily life, one goal, one homework assignment and one shared group session at a time. As mental health systems worldwide search for recovery-oriented services, this Swedish study suggests that the humble tools of occupational therapy, goal setting, self-reflection, activity strategies and peer belonging, deserve a central place in that conversation.

The broader context of the study’s intervention is worth noting. Balancing Everyday Life was evaluated in a randomised controlled trial across community-based and specialist psychiatry units in southern and western Sweden, where it demonstrated significant gains in occupational engagement, activity level and occupational balance compared with standardised treatment. The intervention itself unfolds over sixteen weeks through fourteen themed group sessions covering topics such as meaning and motivation, daily habits and social activities. Between sessions, participants pursue individually chosen homework activities, a structure rooted in self-reflection, goal setting and the testing of activity strategies in real-world settings.

The concept of personal recovery that anchors the analysis has its own history. Established during the 1990s as an alternative to purely biomedical notions of clinical recovery, it emphasises that individuals can experience health and well-being despite persisting symptoms, regaining control over their lives and participating more actively in meaningful activity. The CHIME framework was developed to bring clarity to this process and is now used in both research and clinical practice internationally.

The study also situates itself within a documented problem: mental health service users tend to live low-active lives, spending much of their time on sleep, meals, self-care and quiet pursuits, with isolation at home common and under-occupation far more frequent than overload. Occupational balance, defined as a subjectively satisfying mix of work, leisure, housework and rest aligned with personal values, has been shown to link with well-being and recovery, making it a natural target for therapeutic attention. The study was approved by the ethical review board in Lund and conducted in accordance with the Declaration of Helsinki.

Subject of Research: Recovery experiences of mental health service users participating in the Balancing Everyday Life occupational therapy intervention, analysed with the CHIME recovery framework

Article Title: Recovery experiences among mental health service users going through the Balancing Everyday Life™ intervention – A deductive qualitative study

Article References: Eklund, M., & Argentzell, E. (2025). Recovery experiences among mental health service users going through the Balancing Everyday Life ™ intervention – A deductive qualitative study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2451267. https://doi.org/10.1080/11038128.2025.2451267

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2451267

Keywords: occupational therapy, mental health recovery, Balancing Everyday Life, CHIME framework, personal recovery, occupational balance, empowerment, connectedness, qualitative research, group intervention, mental illness, Lund University