Outcomes of the Active in My Home (AiMH) intervention for people with psychiatric disabilities in supported housing: A longitudinal pilot and feasibility study

Abstract

Introduction

Facilitating occupational engagement in residents with psychiatric disabilities living in supported housing is important, because meaningful occupation is closely related to wellbeing. The aim was to explore whether residents taking part in the intervention Active in My Home (AiMH) made any changes in activity and recovery from baseline to completed AiMH; whether satisfaction with AiMH was related to any changes; and if changes between baseline and completed AiMH were stable at follow-up.

Method

AiMH consists of eight sessions for residents and includes workshops for staff. This no-control study involved seven supported housing units and 29 residents who took part in data collection at the start and completion of AiMH and at follow-up after 6–9 months. Outcomes concerned occupational engagement, the unit’s provision of meaningful activity, personal recovery, psychosocial functioning and symptom severity.

Findings

Improvements occurred in the AiMH participants’ occupational engagement (Z = −2.63, p = 0.008) and personal recovery (Z = −1.98, p = 0.048) from start to completion of AiMH. The improvement on occupational engagement was stable at follow-up (Z = −3.01, p = 0.005), when also psychosocial functioning (Z = −2.39, p = 0.017) and psychiatric symptoms (Z = −2.42, p = 0.016) had improved.

Conclusion

This study could not show whether the improvements were due to AiMH or other factors. The findings are still promising, however, and encourage further development and testing of AiMH.

Keywords

Supported housing mental illness occupational engagement satisfaction occupational therapy

Introduction

Supported housing (SH) is a congregate housing facility that is the home context for many people with psychiatric disabilities who cannot manage to live in ordinary housing, even with outreach support. There are many types of SH, and McPherson et al. (2018) propose a classification based on variation in four characteristics – staff location, level of support, emphasis on move-on and physical setting. A common feature of SH units is that they provide shelter in a congregate setting and the role of the staff there not only includes assistance in performing home chores and self-care but also stimulating and supporting the residents to become more active and engaged in their everyday life (Brunt and Rask, 2018). This is an important aspect of the support, because meaningful activity has been shown to be closely related to wellbeing (Eklund and Leufstadius, 2007; Nagle et al., 2002) and recovery (Borg and Davidson, 2008; Sutton et al., 2012) among people with psychiatric disabilities. Research indicates that people who reside in SH often report being under-occupied and have a low activity level (Eklund et al., 2017a). The fact that residents in SH tend to feel under-occupied warrants attention being given to alternatives for enhancing their possibilities for participating in meaningful and engaging activities that are in line with their needs and capacities (Bejerholm and Eklund, 2004). This was the incentive for developing an occupational therapy intervention aimed for the SH context – Active in My Home (AiMH). It is based on a number of principles: meaningful activity (Hammell, 2004), occupational engagement (Bejerholm and Eklund, 2006), personal recovery (Leamy et al., 2011), sensory modulation (Champagne, 2011) and remotivation (de las Heras et al., 2003), which together form the theoretical frame of reference. These principles have guided the content of the AiMH sessions, further described below. AiMH has similarities to other activity-based interventions such as Action Over Inertia (Edgelow and Krupa, 2011) and Balancing Everyday Life (Eklund et al., 2017b). These have been constructed for people with mental illness living in their own accommodation in the community, while AiMH was developed for people with psychiatric disabilities in need of a congregate living environment (SH). The initial feasibility of AiMH was explored in a recent small-scale pilot study, and both residents, staff and managers found it useful and promising, but suggested a stronger emphasis on individual sessions and a somewhat simplified content (Tjörnstrand et al., 2017). The current study continues the development of the AiMH intervention and constitutes a second pilot and feasibility study in which resident-reported outcomes are in focus.

Housing satisfaction in the SH context has been researched quite extensively; for example, residents have reported greater satisfaction in terms of the social life but less satisfaction with the support provided in the SH units in comparison with the satisfaction of residents living in their own homes receiving individual support from outreach services (Brolin et al., 2015). Moreover, satisfaction with services is often associated with outcomes of interventions (Holcomb et al., 1998) and satisfaction with the AiMH intervention may play a role for the outcomes. Thus, even if logically related, investigating the correlation between satisfaction and outcomes can be a way of indicating a treatment effect.

The aim of this pilot and feasibility study was to explore if residents taking part in AiMH showed any changes in outcomes – in terms of occupational engagement, the housing unit’s provision of meaningful activity, personal recovery, psychosocial functioning and symptom severity – from baseline to completed AiMH, and whether satisfaction with AiMH at completion was related to any changes. A 6- to 9-month follow-up was included to see if possible changes between baseline and completed AiMH were stable in a follow-up perspective.

Methods

The AiMH intervention

AiMH is led by an occupational therapist. The intervention was developed in collaboration with the authors; the last author having the leading role. The aforementioned theoretical principles were chosen based on research exploring the difficulties people living in SH present with regarding everyday occupations (Eklund et al., 2017a). Two previous interventions served as inspiration – a staff-oriented programme to enrich day centres for people with psychiatric disabilities with meaningful activities (Eklund et al., 2014) and an activity-based lifestyle intervention to support occupational engagement and occupational balance among people with mental disorders (Eklund et al., 2017b). AiMH starts with two workshops for staff, in which the intervention is outlined and the roles for the staff are particularly addressed. In a third staff workshop, halfway through the programme, the underpinning principles mentioned above are introduced and elaborated on. One staff member per AiMH participant has the role of an AiMH supporter, entailing responsibilities further described below.

AiMH consists of eight sessions for the residents, five individual and three group sessions, some of which also include the SH staff. This is consistent for all participants. Two initial individual meetings aim at forming the contact between the participant and the occupational therapist and establishing the participant’s level and direction of motivation for activity. Each session has a specific theme: ‘my motivators for feeling well’, ‘my senses – learning to know myself and how to cope with stress’, ‘what I do in one day’, ‘activity and health’, ‘which are my dreams – and how can I realize them?’ As in the individual sessions, the group sessions focused on each participant’s needs while using the group to facilitate and reinforce processes, and took 30–45 minutes. All sessions include psychoeducational elements, exercises and testing of activities. Each participant receives a sum corresponding to about €20 to spend on activities between the sessions. In the final session, the participant sums up what he/she has learnt and experienced and plans how to continue. The staff workshops and the eight sessions with residents are distributed over a period of 12 weeks.

The role of the AiMH supporter is to encourage the participant to keep on trying the strategies developed during the occupational therapy sessions, to support activity in general between sessions, particularly outside the SH premises, and to participate in two of the AiMH sessions, which focus on individual planning for the participants and how to move on to remain active after completing AiMH. Each time the occupational therapist attended the SH unit to meet participants, individually or in groups, it was possible for the AiMH supporter to consult the occupational therapist face to face. At other times, they communicated through phone or email. The supporters were also asked to keep a brief, structured log of what they did related to the AiMH intervention in between the sessions.

The initial pilot version of the intervention (AiMH 1.0), used in Tjörnstrand et al. (2017), had a stronger emphasis on groups (three individual sessions and five group sessions), compared to the further developed version (AiMH 2.0) in which five of the sessions were individual. The session themes were the same for both versions, but the contents were somewhat expanded in AiMH 2.0 to include both simpler and more advanced material, that could be modified depending on the participants’ capacities. The staff workshops were extended accordingly.

The occupational therapists who led the AiMH intervention in this study, including the workshops for staff, the individual sessions and the group meetings, were an external resource employed by but not part of the research team. This was because the municipality-employed occupational therapists in the included municipalities did not work directly with SH residents, and only had a consultative role.

Selection of settings and participants

SH units in a county in southern Sweden were invited to participate. Six municipalities were selected as suitable, as they represented a variation in desired characteristics. One was a larger city, one was a medium-sized city, two were smaller towns and two were larger villages. All of these municipalities also included rural areas. They also represented variation in terms of the socioeconomic situation of their population and the proportion of immigrants. First, the managers of the municipal social care services were approached and five of them agreed to participate. One of the smaller towns declined due to ongoing reorganisation. The next step was to invite specific SH units to information meetings about the AiMH project and to ask for their consent. Fifteen SH units were represented at those meetings and seven agreed to participate. Reasons for not participating at this level included mainly concerns that the AiMH intervention would be too demanding for the residents. These procedures resulted in four municipalities contributing with one unit each and the fifth (the medium-sized city) contributing with three. According to the classification system proposed by McPherson and colleagues (McPherson et al., 2018), the SH units approached for the present study can all be labelled as type 1, that is, characterised by staff on site, a high level of support, limited emphasis on move on to more independent living and built as a congregate setting.

Information meetings were then held for residents and staff at each of the eight participating units. Both oral and written information was provided, including details about the AiMH intervention, what participation in the research project would entail, and the right to withdraw at any time without explanation. Inclusion criteria were sufficient cognitive capacity and command of the Swedish language to complete the data collection, as assessed by the SH staff. Two to five residents from each unit agreed and a total of 29 participants provided their written informed consent. The project was approved by the regional ethical review board in Lund, reg. no. LU-2015/873.

Participants

Statistical power was an issue in this study, as it proved difficult to recruit SH units. To obtain as large a sample as possible, we included seven residents who had participated in the small-scale pilot study of AiMH 1.0 (Tjörnstrand et al., 2017), which had a stronger emphasis on groups, and a further 22 people who received the revised AiMH 2.0. As the revision to AiMH was minor and the session themes were the same for both versions, we assessed that the revisions were unlikely to affect the outcomes and therefore included all 29 participants in this study. Table 1 presents their sociodemographic characteristics. As seen there, the average person was in their mid-forties and there were more men than women. Very few were parents and none reported having a partner. Approximately half of the participants had met someone they saw as a friend in the past week. Very few had a university education. Most participants reported they had schizophrenia or other psychosis, while other self-reported diagnoses were, for example, borderline personality disorder or Asperger’s syndrome. The participants had lived in their current accommodation for more than 7 years on average, varying from having recently moved in to 26 years.

Table 1.

Characteristics of the 29 participants.

Characteristic	Mean (SD) or n
Age, mean (SD)	46.6 (12.6)
Gender, men/women (n)	18/11
Having children; yes/no (n)	3/26
Civil status, single/missing data (n)	27/2
Born in Sweden, yes/no (n)	25/4
Highest education level, 9-year school/high school/university (n)	11/15/3
Self-reported diagnosis, psychosis/other/missing data (n)	17/7/5
Seen a friend last week, yes/no (n)	16/13
Years in current accommodation, mean (SD)	7.6 (5.8)

The follow-up after 6–9 months only concerned the 22 participants who participated in AiMH 2.0, and four of them declined to participate in the data collection at follow-up, which was thus based on 18 participants.

Data collection

A background questionnaire was devised for this study to gather sociodemographic data, information about the participant’s daily routines, and self-reported diagnosis and any psychological and physical problems. The self-reported diagnoses and problems were subsequently coded according to the International Classification of Disease (ICD) classification (World Health Organization, 1993) by an experienced psychiatrist.

A set of rating scales was used to address the targeted outcomes and housing satisfaction, as detailed below. Brief versions were used when available, to avoid stress and discomfort among participants. Research assistants who were not part of the research team performed the data collection.

Profiles of occupational engagement in severe mental illness (POES) (Bejerholm et al., 2006; Bejerholm and Lundgren-Nilsson, 2015) was used to assess occupational engagement. It consists of a structured diary with five columns – time, the activity done, geographical location, social context and reflections/feelings. It covers the previous 24-hour day and is completed by the respondent, assisted if relevant by the data collector who can put prompting questions to help the participant remember. The data collector then rates the participant’s degree of occupational engagement, in dialogue with the participant, according to nine items by following a manual that details and exemplifies how the scoring should be made. The scoring alternatives have descriptors but are also combined with a numerical rating from 1 to 4, in which the higher score indicates a higher level of occupational engagement. The POES has shown a high degree of inter-rater agreement and good fit to the Rasch model (Bejerholm et al., 2006; Bejerholm and Lundgren-Nilsson, 2015).

The resident’s opinion of the housing units’ provision of meaningful activity was assessed by the perceived meaning in activity – housing (PMA-H) questionnaire (Eklund and Brunt, 2019a). A brief seven-item version was used, found to have good internal consistency and to show evidence of construct validity (Eklund and Brunt, 2019b). PMA-H-7 consists of items such as ‘My housing contributes so that I can do activities that are good for me’. A five-point response scale is applied, in which a higher score denotes perceptions of more meaningful activities.

Personal recovery was assessed by the self-reported questionnaire about the process of recovery (QPR) (Argentzell et al., 2017; Law et al., 2014). Items address, for example, the ability to assert oneself, feeling one’s life has a purpose, and the ability to develop positive relations to others. A five-point rating scale from 1 to 5 is used, in which a higher rating denotes greater personal recovery. A brief seven-item Swedish version (QPR-Swe-7) was used for the present study, shown to have good internal consistency and construct validity in various samples with mental illness (Eklund et al., 2019c).

Global assessment of functioning (GAF) (Endicott et al., 1976) was used to address the participants’ level of psychosocial functioning and severity of psychiatric symptoms. A scale scored from 1 to 100 is used, in which 100 indicates an optimal state reached by practically nobody. A score of 80 or greater is considered to denote a healthy state. GAF is rated by an interviewer, who may provide either two separate ratings, one for psychosocial functioning and one for symptoms, or a combined rating. The option of two separate ratings was used for this study. GAF has been found to have good inter-rater reliability if the data collectors get basic training in performing the ratings (Startup et al., 2002). The data collectors for the present study thus first participated in training sessions based on filmed fictitious cases and calibration against an experienced clinician.

Satisfaction with AiMH was estimated by a housing satisfaction questionnaire (HSQ), which has been found to be useful in research on supported housing and has shown high internal consistency (Eklund et al., 2017a). The HSQ consists of eight items addressing general aspects of the housing and the support received, such as ‘Do you have the type of housing you want?’ and ‘How satisfied are you with the housing support you get?’ A four-point rating scale is used, in which a higher rating indicates greater satisfaction. Satisfaction with AiMH was assessed by seven of the HSQ questions, reformulated in relation to the intervention, such as ‘Did you get the type of activity support you wanted?’ and ‘How satisfied are you with the AiMH?’ Internal consistency reliability of this satisfaction scale, based on the current sample, was α = 0.93.

Data analysis

Non-parametric statistics were used because the data collection was based on instruments with ordinal scales (Altman, 1993). Differences between two measurement points were analysed by Wilcoxon’s test and correlations between variables by Spearman correlations. Change scores were calculated as the baseline value subtracted from the value obtained at the AiMH end measurement and the follow-up measurement, respectively. Strengths of correlations were estimated in accordance with Cohen (1988), recommending that correlations less than 0.30 should be considered as weak, between 0.30 and 0.50 as moderate, and over 0.50 as strong. Intention to treat was not applied, and the dropouts (two after completing the intervention and a further four at the follow-up) were excluded from the analyses. SPSS 24 software (IBM, 2017) was used for all analyses and p < 0.05 was considered statistically significant.

Results

Outcomes after completed AiMH and the follow-up

Descriptive statistics regarding the outcome variables at baseline and completed AiMH, as well as the situation at the follow-up, are presented in Table 2.

Table 2.

Mean ratings (SD) on outcome variables at the three measurement points.

Outcome variables	Baseline, mean (SD), n = 29	AiMH completion, mean (SD), n = 27^a	Follow-up, mean (SD), n = 18^b
Occupational engagement (POES)	21.9 (4.3)	24.6 (4.8)	27.1 (5.2)
The housing unit’s provision of meaningful activity (PMA-H-7)	24.2 (5.9)	23.6 (6.4)	23.5 (5.1)
Personal recovery (QPR-Swe-7)	25.7 (5.8)	27.6 (5.4)	27.6 (5.4)
Psychosocial functioning (GAF)	47.6 (8.5)	49.1 (9.4)	57.7 (10.0)
Psychiatric symptoms (GAF)	45.6 (11.5)	48.5 (11.3)	57.0 (7.8)

^aTwo of the initial 29 participants dropped out.

^bFour of the 22 participants who were eligible for follow-up dropped out.

AiMH: Active in My Home; POES: profiles of occupational engagement in severe mental illness; PMA-H-7: 7-item perceived meaning in activity – housing; QPR-Swe-7: 7-item Swedish version of the questionnaire about the process of recovery; GAF: global assessment of functioning.

There were statistically significant improvements in occupational engagement (Z = –2.63, p = 0.008) and personal recovery (Z = –.98, p = 0.048) from baseline to completed AiMH, but not regarding the participants’ opinions about the housing units’ provision of meaningful activity (p = 0.663). There was also a statistically significant increment between baseline and the follow-up (6–9 months after completed AiMH, based on the subgroup of 18 participants) for occupational engagement (Z = –3.01, p = 0.005). The difference between baseline and follow-up was not statistically significant for personal recovery at follow-up (p = 0.061) and remained non-significant for the housing units’ provision of meaningful activity (p = 0.522). Analyses of changes between the completion of AiMH and the follow-up resulted in non-significant findings for all of these three outcomes (P values ranging between 0.125 and 0.955).

No statistically significant change was found between baseline and the completion of AiMH for symptom severity (p = 0.979) or psychosocial functioning (p = 0.312) in the GAF ratings, assessed by a research assistant. Improvements were found, however, for both psychosocial functioning (Z = –2.39, p = 0.017) and symptom severity (Z = –2.42, p = 0.016) between baseline and follow-up. There was also a statistically significant improvement between completed AiMH and the follow-up for both psychosocial functioning (Z = –4.46, p < 0.001) and symptom severity (Z = –2.24, p = 0.025).

Relationships between satisfaction with AiMH and outcomes

The participants rated their satisfaction with AiMH at on average 3.0 (SD 2.0). This satisfaction rating was not significantly related to change in any of the outcomes, neither at the completion of AiMH nor at the follow-up (see Table 3). The correlation between satisfaction with AiMH and change in opinion on the housing unit’s provision of meaningful activity was in the realm of moderate in strength, although non-significant (r_s = 0.37, p = 0.142).

Table 3.

Correlations between satisfaction with the AiMH intervention and change in the outcome variables at the intervention end and the follow-up.

Change variable	AiMH completion, mean (SD), n = 27	Follow-up, mean (SD), n = 18
Occupational engagement (POES)	r_s = −0.04, p = 0.861	r_s = −0.15, p = 0.551
The housing unit’s provision of meaningful activity (PMA-H-7)	r_s = −0.13, p = 0.524	r_s = 0.37, p = 0.142
Personal recovery (QPR-Swe-7)	r_s = 0.02, p = 0.921	r_s = −0.18, p = 0.462
Psychosocial functioning (GAF)	r_s = −0.24, p = 0.242	r_s = 0.09, p = 0.736
Psychiatric symptoms (GAF)	r_s = 0.16, p = 0.427	r_s = 0.11, p = 0.668

Discussion

The findings indicate that participants in AiMH increased their levels of occupational engagement and personal recovery from baseline to completed AiMH. This is in line with the intentions with the AiMH and the frame of reference outlined in the introduction. The improvement in occupational engagement was maintained at the follow-up and indicates, for example, a more positive daily rhythm, enriched variation in activities, progression to productive activities, and expanded social and geographical environments (Bejerholm et al., 2006). The participants’ opinions on the SH unit’s provision of meaningful activity did not change between any of the measurement points, which suggests that the changes in occupational engagement and personal recovery were not a result of amendments in the SH support per se. The fact that a small amount of money to spend on activities, about €20, was part of the intervention deserves some attention. A study offering about €50 per month to people with mental illness receiving care as usual found that the participants improved on variables such as social networks and sense of self compared with a group receiving only care as usual (Ljungqvist et al., 2016). Given these findings, it is reasonable to assume that facilitating activity financially, as in the current study, may contribute in some way to positive outcomes. Whether the identified changes were due to the AiMH intervention cannot, however, be established by the no-control design of this study.

No statistically significant change had been found at completed AiMH for both psychosocial functioning and symptom severity, which had improved at the follow-up. As seen in Table 2, the greater amount of that improvement occurred from completed AiMH to the follow-up. This was an unexpected result pattern, and the research assistant was contacted to gain more knowledge about the participants’ situation at the follow-up. A few of them had started studying or received an internship, some had started to attend a course and others performed more activities in the home context. As work is one of the parameters on which the GAF ratings are based (Endicott et al., 1976), this change in the residents’ situation entailed higher ratings on both psychosocial functioning and symptom severity, while not being reflected so clearly in the residents’ self-reports. Work and other productive activities are not part of the AiMH, but are reflected in the POES instrument. The fact that significant increases in occupational engagement were found at both completed AiMH and the follow-up thus indicates progression towards productivity/productive activities. The observations emanating from this study therefore indicate that data on work-related activities should be included in the data collection when studying outcomes in relation to AiMH.

The outcomes of AiMH are somewhat comparable with those from the BEL intervention, in which improved occupational engagement was one of the main findings (Eklund et al., 2017b), and Action Over Inertia, where a healthier use of time (less sleep) was found (Edgelow and Krupa, 2011).

The participants’ average rating on satisfaction with AiMH was 75% of the maximum score (3 out 4). This is a positive finding, which is in line with results from other studies on housing satisfaction in the SH context (Eklund et al., 2017a; Killaspy et al., 2016) in which residents generally report high levels of satisfaction. Such positive findings can, however, be tempered by studies that have shown that previous experience of psychiatric care settings may lead to low expectations and feelings of gratitude and thus satisfaction with a situation not acceptable to others in the community (Brolin et al., 2015; Walker and Seasons, 2002). No relationship could be established between AiMH satisfaction and any of the change scores. This is possibly due to the small sample size and the findings may be flawed with type 2 errors, as indicated by the medium-sized correlation that became statistically non-significant.

Although this study could not show any definite trends regarding the effects of AiMH on outcomes, in terms of occupational engagement, personal recovery and the unit’s provision of activity, the findings encourage further development of AiMH, which in its present form is led by an occupational therapist. The occupational therapist was employed by the research team, but ideally, and to enable implementation of AiMH as routine support, staff employed in the organisation who run the SH units are best positioned to lead AiMH. One option would be to revise AiMH in such a way that it can be led by the SH staff. Training nursing staff to support activity among service users has not been shown to be successful, however, as shown in two randomised controlled trials (RCTs). One was performed in rehabilitation hospitals in the United Kingdom, and staff in the intervention units received training and supervision from occupational therapists and service users on how to encourage and support activity engagement among service users in mental health rehabilitation hospitals (Killaspy et al., 2015). Service users in the intervention units did not improve their activity engagement more than users in the control units. The reasons for that were external (such as limited economic resources), organisational (such as lack of senior leadership) and related to limitations of the intervention per se (Lean et al., 2015). The other RCT was performed in Sweden and the care context was community-based activity centres for people with psychiatric disabilities. The staff received training on rehabilitation and occupational therapy principles and developed a plan for how to enrich the centres with more meaningful activities. No differences were found between service users in the intervention and control units as to activity engagement or satisfaction (Eklund et al., 2014). Based on these studies, it is recommended that the AiMH intervention is led by an occupational therapist, in collaboration with the SH staff, particularly the AiMH supporters who play a vital role in the intervention. Occupational therapists are generally employed in community-based mental health services. In the current study, the occupational therapists employed in the municipalities did not have direct contact with residents, only with day centres and people living in ordinary housing with support. This is a matter of priority, however, and an eight-session intervention spread over 12 weeks does not take a huge amount of resources. It would thus be feasible to allocate occupational therapy resources to enable AiMH in the SH context. In future research regarding AiMH, the intervention should ideally be led by occupational therapists employed in the organisations running the SH settings.

Methodological considerations

As mentioned above, the small sample size may have inferred type 2 errors. That is, both correlations between variables and changes in outcomes, particularly analyses involving the follow-up in which fewer participants were included, may have gone undetected because of a lack of statistical power. Statistical power considerations were also the rationale behind including the seven participants from the first pilot study (Tjörnstrand et al., 2017) in the current one. A larger sample, based on power calculations from the current study, is thus an important next step in developing and evaluating AiMH.

Short forms of instruments were used to avoid stress and discomfort among participants. This is supported by several researchers, who argue that even one-item assessments tend to be valid and reliable (Bowling, 2005; Mausbach et al., 2009), but may still be debated because scales based on several items are seen as more robust and reliable (Altman, 1993). After careful reflection, we prioritised avoiding stress and exhaustion, and thus chose brief versions of the instruments for assessing personal recovery (QPR-Swe-7) and perceived meaning in activity in the housing context (PMA-H-7). A shortcoming regarding the instruments was, however, that the test–retest reliability was not known for the majority of them.

It should also be acknowledged that the follow-up period varied between 6 and 9 months. Six months was the default follow-up period, but was extended to 9 months for some of the units due to summer holidays intervening between the completion of AiMH and the follow-up. Finally, as some managers found the AiMH too challenging, there may have been a selection bias regarding included SH units.

Conclusion

This pilot and feasibility study showed that improvements occurred in the AiMH participants’ occupational engagement and personal recovery from start to completion of the AiMH intervention. The improvement on occupational engagement was stable at the follow-up, and at that point the findings also indicated improved psychosocial functioning and less severity in psychiatric symptoms. Importantly, this was a no-control study and it could not be established whether the improvements were due to AiMH or other factors. Satisfaction with AiMH was not related to change on any of the outcomes. Although this may have to do with the small sample size, and a possible type 2 error, no support for AiMH as the factor generating the improvements could be established. The findings are promising, however, and encourage further development and testing of AiMH. The intervention seems to have potential for application in societies and support systems similar to the current study context, which would include many western countries. Future research should include larger samples as well as some form of control condition, preferably randomisation to AiMH or a control group. Assuring staff at the SH unit level that AiMH is feasible in that context would be important in order to accomplish a larger randomised controlled study. Research on the implementation process and further feasibility would therefore be a logical and necessary next step in AiMH research, preferably including that the intervention is led by occupational therapists employed in the organisations running the SH settings.

Key findings

Occupational engagement and personal recovery improved among residents with psychiatric disabilities after a new intervention, Active in My Home, in the supported housing context.

Residents’ perceptions of the housing unit’s provision of meaningful activity remained unchanged, suggesting that the changes were not a result of amendments in the supported housing support per se.

Improvements in occupational engagement and recovery were not related to satisfaction with the intervention, possibly because of limited statistical power.

What the study has added

Active in My Home, a new intervention aimed for people with psychiatric disabilities living in supported housing where interventions are very rare, was shown to be promising, which encourages further development and evaluation of the intervention.

Footnotes

Acknowledgements

The authors are grateful to occupational therapists Milla Friis and Carina Tordai for facilitating the AiMH intervention.

Research ethics

The project was approved in 2015 by the regional ethical review board in Lund, reg. no. LU-2015/873.

Consent

All participants provided written informed consent to be interviewed for the study.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Swedish Research Council for Health, Working Life and Welfare under grant number 2014-4488.

Contributorship

Mona Eklund applied for funding and for ethical approval, and Mona Eklund and Carina Tjörnstrand researched the literature. Carina Tjörnstrand and Elisabeth Argentzell developed the AiMH manual and administered the data collection. All authors contributed to the methodology of the project, and the statistical analysis plan. Mona Eklund carried out the statistical analysis, and all authors interpreted the data. Mona Eklund wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version.

ORCID iD

Mona Eklund

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