Patient Involvement During a Pathway of Home-Based Reablement for Older Persons: A Longitudinal Single-Case Study

Abstract

Background: In recent years, home-based reablement has become an increasingly popular way to provide rehabilitation services. This health care service aims to enable older persons to live longer at home while reducing the need for institutionalization. To ensure the provision of high-quality services, there is a continual need for research on issues of user involvement and co-creation during the pathway of the reablement process. Purpose: This study focused on user involvement and participation with health care professionals during the reablement process. Methods: This was a longitudinal, instrumental single-case study, in which one 85-year-old female patient was followed over the pathway of a six-week reablement process. Data were collected at three stages, including the goal-mapping phase, evaluation phase, and three weeks after completing reablement. Results: Our analyses revealed two themes for the goal-mapping phase (dialogue led by the care provider and main goal), three themes for the implementation phase (the home as the preferred setting, little influence on organizational factors, and participation, influence, and motivation), and three themes for the evaluation phase (patient understanding as a precondition, motivated by weak paternalism, and self-determination requires clear communication). Conclusion:The patient becomes involved through a partly co-creation process. During this time, they are involved, motivated, and influenced over the pathway of reablement. Health care providers must avoid implementing too much control during the pathway of home-based reablement, as patients have contextual knowledge that care providers do not possess.

Factors Impacting User Engagement in Reablement: A Qualitative Study of User, Family Member and Practitioners’ Views

“…Furthermore, and again unusual in much existing work on engagement, reablement happens in people’s homes as opposed to the clinic. 5 , 8 The time-limited nature of reablement means services have little time to overcome resistance or retrieve disengagement, unlike many other healthcare interventions. However, the level of intensity is potentially much higher with possibly multiple visits from staff in a single day which, intuitively, would appear to support engagement.…”

“… 23 This is because existing research suggests that the degree to which an individual engages with reablement is a key factor impacting reablement outcomes. 5 , 8 , 16 , 20 , 24–31 This is not surprising given the substantial body of evidence across multiple sectors (eg healthcare, education, work/management, community development) on the critical importance of user engagement with an intervention in securing intended outcomes. 32–39 …”

“… 13 , 16 , 24 , 54–56 The need for effective information and communication strategies has therefore been highlighted both by research and implementation guidance. 8 , 22 , 25 , 27 , 29 , 30 , 55 , 57 , 58 However, less is understood about what those information and communication strategies need to look like.…”

“…4 , 7 , 20 , 25 , 59 , 61 , 63 , 64 Finally, existing work indicates that reablement staff’s understanding of, and adherence to, reablement principles, communication and motivational skills, and duration of reablement visits may impact engagement. 8 , 10 , 13 , 20 , 21 , 26 , 30 , 59 , 64 , 65 …”

Shared decision making in sarcopenia treatment

“…The family is often an extension of the patient and ensures that the patient processes and understands the information. Additionally, community-based rehabilitation, as an extension of hospital and post-hospital rehabilitation ( 41 ), has gained importance with continuous government investment in older adults care service facilities, particularly in community-based workouts and rehabilitation equipment. In pursuit of this goal, healthcare teams should be encouraged to conduct regular visits and maintain close communication with the families of patients who choose home-based rehabilitation services and nutritional interventions.…”