The context matters for understanding why the researchers undertook this work. Supported housing in Sweden, particularly the type classified as Type 1 in the Simple Taxonomy for Supported Accommodation, offers residents a room or small flat of their own alongside common areas for meals and socialising, with staff support available between twelve and twenty-four hours a day. Yet previous research has consistently shown that residents in these settings report feeling neglected, at risk of leading passive and isolated lives, and in need of encouragement to engage in meaningful activity. Occupational therapy expertise is rarely available in these facilities, and none of the six municipalities involved in the study, four urban and two rural in southern Sweden, had an occupational therapist working directly with supported housing residents. Tailored, activity-based and recovery-oriented interventions of this kind remain rare in Swedish supported housing, which the researchers describe as making their development and evaluation an urgent matter.

The AiMH intervention rests on four theoretical cornerstones drawn from occupational therapy research: engagement in meaningful everyday activities as a fundamental human need essential for health and well-being; the re-motivation process, which addresses how to encourage and sustain an individual’s motivation to engage in occupations; the principles of personal recovery, understood as a process through which a person works to regain a meaningful life despite the challenges of mental illness; and sensory modulation, which focuses on how sensory experiences can either calm or stimulate a person, allowing adjustments that enable engagement. The intervention was developed collaboratively, incorporating the views of service users, staff and relatives, and was pilot tested and revised through co-production before the main study. It was delivered by an occupational therapist who received two days of training and ongoing supervision, and it followed a manualised structure of eight biweekly sessions over twelve weeks, five of them individual and three group-based, each lasting roughly thirty to forty-five minutes.

A distinctive feature of the design was the involvement of the housing staff themselves. All staff were invited to workshops built around short pre-recorded digital lectures of about fifteen minutes each, with attendance mandatory for designated support staff. The first workshop addressed meaningful occupations, recovery and re-motivation; the second covered sensory stimuli and modulation; and a third, held halfway through the intervention, assessed the housing context and considered changes that could benefit residents’ occupational engagement. Each participant was also assigned a staff member as an AiMH supporter, who worked with the resident on a shared worksheet between sessions and encouraged the use of newly learned strategies both within the housing setting and in the wider community. Session themes included topics such as getting to know one’s own senses and stress management, and finding inspiration and setting goals, with practical exercises such as drawing an activity circle to visualise the variety of daily occupations. Each participant also received a sum corresponding to twenty euros, specifically allocated to facilitate engagement in a desired occupation, creating what the researchers describe as an incentive to plan and carry out meaningful activities.

Twenty-nine residents took part in the intervention across seven housing units, and twenty agreed to be interviewed, of whom sixteen completed at least one of the two interview occasions, producing twenty-three interviews in total. The interviews were semi-structured and open-ended, guided by the intervention’s structure, and were conducted by occupational therapists with clinical and research experience of the target group. Particular ethical care was taken given the mental vulnerability of participants, who could have a support person present and could divide the interview into several sessions if needed. The researchers analysed the material using manifest content analysis, staying close to the informants’ actual statements, and distilled the findings into one overarching theme and four categories.

The main theme that emerged was described as boosting personal recovery by discovering new capacities and activity opportunities. Participants reported feeling valued simply by being offered a course, with one informant, Karin, saying that it showed that people cared, and another, Petra, describing how she was positively affected by all the opportunities that had opened up. The positive impact appeared to endure over time, with some participants continuing to feel more seen and acknowledged months after completing the programme. This sense of being noticed and invested in was, for many, a novel experience within the housing setting and appeared to act as a catalyst for broader change in how they managed everyday life.

The first of the four categories concerned a stimulating change in the approaches and interaction of the staff. Residents perceived that staff had come to know them better, showed more respect for personal choice, and were more responsive and encouraging, which fostered self-confidence and independence. Staff applied new knowledge about sensory modulation by organising so-called sensory days, during which participants made rice pads for weighted stimulation or used warmth and rhythmic movement. Structured support through the course material helped residents reflect on life goals and establish daily routines, even though some found the early stages of change messy and difficult. Notably, several participants reported needing less staff support over time as they benefited from new strategies and newfound friendships, describing greater control over daily life and reduced sensitivity to stressors such as loud noise.

The second and third categories highlighted the inner work that the intervention made possible. Residents described that opportunities to reflect on personal recovery were essential: learning sensory strategies helped some see paths to well-being beyond medication, with Karin likening the effect to receiving an injection of kindness in the psyche, while others valued practical tools such as breathing techniques and crisis-management strategies. Reflecting on activity timelines evoked memories that created renewed purpose, and participants spoke of discovering goals and dreams, from getting out of bed more often to training as a hairdresser or applying for a job at a second-hand store. Reflection combined with exploration of new activities appeared to initiate a positive cycle of change: visual tools such as activity pie charts helped residents identify imbalances in how they spent their time, and many began dancing, exercising, baking or walking to the forest and the sea. One participant enrolled in a nursing assistant programme, while another performed publicly as a musician.

The fourth category concerned the power of the group format itself. Interacting with fellow participants and staff fostered trust, motivation and a sense of community, with structured, well-prepared sessions experienced as far more meaningful than the informal kitchen gatherings that had preceded them. Listening to others’ experiences deepened mutual understanding, and new friendships emerged that reduced dependence on staff; two participants who had initially been sceptical of group settings developed a close friendship and used their intervention money to attend a social event together. The researchers conclude that AiMH filled a gap in occupational therapy provision in Swedish supported housing, contributed to a more supportive housing climate, increased residents’ sense of security and connectedness, and has potential to shift the caregiving culture toward recovery-oriented support. They acknowledge limitations, including incomplete longitudinal data and the brevity of some interviews with a cognitively vulnerable group, but argue that continued access to tailored occupational therapy interventions in supported housing should be prioritised, since residents remain a low-priority group for rehabilitation and staff training internationally.

Subject of Research: Occupational therapy intervention for personal recovery and occupational engagement among residents of supported housing for people with severe mental illness

Article Title: Supportive housing residents’ experiences of the intervention active in my home

Article References: Tjörnstrand, C., Brunt, D., Bejerholm, U., Eklund, M., & Argentzell, E. (2025). Supportive housing residents’ experiences of the intervention active in my home. Scandinavian Journal of Occupational Therapy, 32(1), Article 2528803. https://doi.org/10.1080/11038128.2025.2528803

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2528803

Keywords: supported housing, occupational therapy, mental illness, personal recovery, occupational engagement, sensory modulation, re-motivation, qualitative research, Sweden, staff support, peer support, psychiatric disabilities

The methodological approach was deliberately intimate. The researchers used semi-structured interviews with open-ended questions, allowing participants to describe their days, their meals, their bodies and their frustrations in their own words. Interviews, which lasted between 25 and 47 minutes, mostly took place in residents’ own living rooms and were audio-recorded and transcribed verbatim. The team then applied a phenomenological analysis method developed by Amedeo Giorgi, a framework designed to distil the essential structure of lived experience from first-person accounts. The analysis moved iteratively through four steps, from an initial holistic reading to coding with participants’ own phrases, such as the study’s evocative title phrase about swapping cake for crispbread, and finally to consensus themes agreed between two researchers.

The eleven participants, six men and five women aged 69 to 87, had body mass indices ranging from 31 to 61. Their marital histories varied widely: one was married, three widowed, three divorced and four had never married. From the transcripts, three themes emerged that the researchers say encapsulate the essence of daily life with obesity in an institutional setting: living and coping with an oversized body, wanting to keep going, and navigating the possibilities and barriers of the nursing home’s social and institutional environment.

The first theme reveals how profoundly body and self are intertwined. Every participant described being intensely aware of their body, and that awareness shaped their actions throughout the day. Some used gentle euphemisms such as being well-fed or horizontally challenged, while others were blunter. Crucially, residents tended to describe their bodies not in abstract terms but through function: what they could do and what they could not. One participant, given the fictional name Richard, framed his bodily experience entirely through mobility. How do I see my body? Well, one part of it is that I cannot walk, you know, I’m just sitting in this chair, he told the researchers. In contrast, Adam described himself as overweight but said his body felt good because it did not restrict him from being physically active.

Weight loss emerged as a powerful lens through which residents re-experienced their bodies. Paul, who lost 40 kilograms around the time he moved into the nursing home, described the change in purely physical terms: you can feel it in the legs, you can feel that there is less to drag along. Helen, who cared about dressing neatly, felt her size acutely when her clothes grew tight, saying she did not feel comfortable in clothes she otherwise liked. For several residents, the move into the nursing home itself triggered weight loss and improved function, which in turn became an incentive to continue the positive changes. All eleven participants expressed a desire to lose or maintain weight, and each had developed personal strategies: replacing cake with crispbread or fruit, arranging controlled portions with staff, monitoring what went onto their plates, or, in one case, skipping lunch entirely. Peter, who lost 30 kilograms after moving in, even traded one of his two daily slices of rye bread for a hot dish when meatballs appeared on the lunch trolley, a kind of informal calorie arithmetic conducted meal by meal.

The second theme, wanting to keep going, captures a strikingly energetic stance toward life. Rather than resigning themselves to decline, residents expressed a strong desire for continuity, renewal and doing as much as possible, with or without assistance. Lis, who received help with personal hygiene but insisted on doing as much as she could herself, arranged with the night staff to have breakfast and medication delivered before dawn so she could begin crocheting at five in the morning. That craft, she explained, fills up her entire day. Henry, meanwhile, refused the easier option of using a bottle beside his bed, choosing instead to shuffle to the toilet three, four or five times a night, a decision he framed as refusing to take the easy way out.

Exercise was another expression of this drive. Peter, who uses a walker, took four walks a day around the nursing home, saying it keeps him in shape. Others used wall bars and double-pedal trainers. The desire for change extended beyond fitness: residents longed for more outdoor trips, with one, Mary, willing to leave at nine in the morning to visit a newly opened amusement park. Others wanted changes to the food selection, from traditional Danish dishes to ethnic cuisine, or the removal of ingredients they disliked. The researchers note that this keep-going attitude was not simply a byproduct of weight-loss efforts but seemed to be an inherent characteristic of the group, an eagerness to reshape their immediate circumstances rather than stagnate.

The third theme maps the institutional terrain on which these personal battles are fought, and it cuts both ways. On the positive side, the physical environment offered exercise opportunities residents had lacked in their previous homes, and supportive staff proved invaluable for weight management. Paul praised a staff member as the best at making him low-fat food, and others described staff serving oatmeal without raisins, helping with finances and encouraging outings. For residents who built such relationships, the staff became a lever for influencing the institutional framework itself, shaping when and what food was provided.

But the institutional setting also imposed barriers. Staff busyness and shortages meant some residents could not get the help they needed, one could not go to bed at her preferred time, and several could not go outdoors because the assistance required was unavailable. Social dynamics added another layer of difficulty. Participants described feeling different from residents with cognitive impairments, keeping to themselves, and in some cases using starkly distancing language, referring to other residents as them. Helen avoided communal cake touched by wandering residents with dementia. The researchers observe a painful paradox: being in the nursing home was partly a consequence of their oversized bodies, since they needed daily help, yet placement meant living among people from whom they felt estranged. Volunteers, by contrast, opened doors that routine staffing could not, taking residents rickshaw cycling, shopping and visiting, restoring access to the outdoors and to companionship.

The findings carry practical weight for occupational therapy and nursing care. Because routines, habit change and environmental adaptation are central to successful weight management, the authors argue that occupational therapists are well positioned to design interventions that support residents’ self-reliance, preserve preferred routines and embed physical and social cues that encourage weight loss where it is beneficial. They also caution that nutritional risk and malnutrition, including low protein intake, can be overlooked in older adults with overweight or obesity, underscoring the need for staff education. The study has limitations: participants were recruited by convenience sampling and were relatively well-functioning and articulate, so the findings may not transfer to all residents, and further research is needed on residents unable to verbally express their preferences. Still, as the first study of its kind, it replaces a one-dimensional picture of decline with something more nuanced: older people actively calculating, negotiating and striving, one slice of bread and one early-morning crochet session at a time, to keep going on their own terms.

Subject of Research: Everyday life experiences of nursing home residents living with obesity

Article Title: From cake to crispbread – giving voice to nursing home residents with obesity and their experiences of everyday life

Article References: Holt Bentz, H., Maersk, J. L., Dynesen, A. W., & Lindahl-Jacobsen, L. E. (2025). From cake to crispbread – giving voice to nursing home residents with obesity and their experiences of everyday life. Scandinavian Journal of Occupational Therapy, 32(1), Article 2577287. https://doi.org/10.1080/11038128.2025.2577287

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2577287

Keywords: obesity, nursing homes, older adults, occupational therapy, qualitative research, phenomenology, weight management, everyday life, geriatrics, Denmark, institutional care, staff support