Arbeidsforberedende trening på gård for mennesker utefor arbeidslivet : perspektiver fra selvbestemmelsesteorien

Background and aim. There is a concern in Norway that a large part of the population is out of work. Having the possibility to participate in working life, is important for ensuring good health, well-being and an acceptable standard of living. The two most commonly reported diagnoses for long-term sick-leave and disability pension in Norway are related to musculoskeletal and psychological subjective health complaints. People that have been outside the workforce for a long time, is one of the groups with the absolute highest number of subjective health complaints. A high degree of such complaints, may lead to low function and health related problems. According to the World Health Organization, health promotion should enable people to increase control over their own health. Prevocational training specifically aims to help people that have been outside the workforce for a long time return to work. In Norway, several care farms offer prevocational training as a health promoting service based on normal farming activity. However, there is little systematic knowledge about possible health promoting elements in the prevocational training context on care farms. In addition, there is a need for research that describes clients participating in prevocational training on care farms, and that give a better understanding of how subjective health complaints may be related to satisfaction with life for these individuals. New insight about the clients and possible health promoting elements in the prevocational training context, could contribute to the development of these services, which essentially also could facilitate return to work for the clients. The self-determination theory describes underlying psychological mechanisms important for motivation, function and well-being. This theoretical framework therefore, can give useful insight for understanding the relationship between subjective health complaints and satisfaction with life, and for understanding possible health promoting elements in the prevocational care farm context. The main aim of the thesis therefore, was to gain a better understanding of clients in prevocational training on care farms and of the possible health promoting elements in the care farm context by using the self-determination theory. Methods. A mixed method design was used. First, a national cross-sectional study, was conducted where 201 adult participants in prevocational training on care farms answered a questionnaire including questions providing demographic and background information, questions about the stay on the care farm, perception of being a useful colleague, the social community on the farm, experiencing nature and animals, and standardised instruments on subjective health complaints, basic psychological need satisfaction, and satisfaction with life. Structural equation models were constructed to investigate relationships between variables. Next, ten semi structured qualitative interviews with adult participants attending prevocational training on care farms were conducted. Transcripts were analysed using a modified version of systematic text condensation. Results. Results showed that participants in prevocational training on care farms were relatively young, most were unmarried, had a low level of education and had been out of work for a long time. They had a high prevalence of subjective health complaints and a low level of satisfaction with life. Further, the results showed that experiencing psychological health complains was negatively associated with satisfaction with life, and basic psychological need satisfaction was found to be one important mediator in this relationship. Next, the combination of findings presented in Paper II (including 194 participants answering the survey), and Paper III (including 10 interviews), showed that feeling like a useful colleague, was positively associated with satisfaction of the basic psychological need for competence. Working with animals was the most commonly performed task on the farm for the majority of participants, and both working with animals and being in nature were described as activities that decreased stress and offered a sense of peace for the participants in the qualitative interviews. However, working with animals and being in nature was unrelated to any of the three basic psychological needs in the structural equation model. Further, results showed that client group belonging was positively associated with the basic psychological needs for relatedness and autonomy. The qualitative study showed that participants experiences of receiving understanding and being acknowledged, as well as having the possibility to support others, was described as important in the relationship amongst the clients. Last, support from the farmer was positively associated with the satisfaction of all three basic psychological needs, and the farmer was also described in the qualitative study as a person who provided understanding, acknowledgement, guidance, and positive feedback to the participants. Conclusion. Participants in prevocational training on care farms seem to be a vulnerable group that may have a challenging return to work process ahead of them. In addition, their high degree of psychological health complaints influence basic psychological need satisfaction negatively, which was positively associated with satisfaction with life. Based on the theoretical understanding of SDT, enhancing basic psychological need satisfaction could therefore, be important for counteracting some of the negative consequences related to having a high degree of psychological health complaints for the clients. Further, it appears that a supportive farmer may hold an autonomy supportive role for the clients, which implies that the farmer may be the most important element in the prevocational training context supporting basic psychological need satisfaction for the clients. From a theoretical standpoint, experiencing satisfaction of basic psychological needs not only has the potential to facilitate function and well-being for the clients, but can also lead to a more autonomous motivation towards resuming work. Further, basic psychological need satisfaction may create opportunities for clients to engage freely in activities enabling them to follow interest, grow and develop. Overall, experiencing basic psychological need satisfaction therefore reflect resources that may enable clients to have a higher degree of control over their own health, which is the main aim of health promotion. Therefore, strengthening elements in the prevocational training context that are positively associated with basic psychological need satisfaction, may be important to facilitate health promotion for the clients, thereby also aiding the possibly challenging return to work process for these individuals.Bakgrunn og formål. Det er bekymringsfullt at en stor andel av den norske befolkningen står utenfor arbeidslivet. Muligheten til å delta i arbeidslivet er viktig for å sikre god helse, livskvalitet og gode levekår. De to vanligst diagnosene som fører til langtidssykefravær og uførhet i Norge er relatert til de subjektive helseplagene muskel- og skjelettplager og psykologiske plager. Mennesker som har vært lenge utenfor arbeidslivet og som er avhengige av trygdeytelser, er en av gruppene med høyest forekomst av symptomer i befolkningen. En høy forekomst av slike plager kan lede til dårlig funksjon og livskvalitet. I følge Verdens Helseorganisasjon er helsefremming prosessen som gjør folk i stand til å bedre og bevare sin egen helse. Arbeidsforberedende trening har som målsetting å hjelpe mennesker som har vært lenge ute av arbeidslivet med å komme tilbake i arbeid. I Norge er det en rekke gårder som tilbyr arbeidsforberedende trening som et helsefremmende tiltak, basert på deltakelse i vanlige gårdsaktiviteter. Imidlertid er det i dag lite systematisk kunnskap om mulige helsefremmende elementer i den arbeidsforberedende treningskonteksten på gård. I tillegg er det et behov for forskning som beskriver brukerne som deltar i arbeidsforberedende trening på gård, og som kan gi en bedre forståelse av forholdet mellom subjektive helseplager og tilfredshet med livet. Ny innsikt om brukerne og mulige helsefremmende elementer i den arbeidsforberedende konteksten, kan bidra til en videre utvikling av disse tilbudene, som også kan være viktig for å fremme tilbakeføring til arbeidslivet for brukerne. Selvbestemmelsesteorien beskriver viktige underliggende psykologiske mekanismer for motivasjon, funksjon og livskvalitet (well-being). Dette teoretiske rammeverket kan derfor gi nyttig innsikt for å forstå forholdet mellom subjektive helseplager og tilfredshet med livet, og for å forstå mulige helsefremmende elementer i den arbeidsforberedende konteksten på gård. Formålet med denne forskningen var derfor å få en bedre forståelse av brukerne i arbeidsforberedende trening på gård og av de mulige helsefremmende elementene i gårdskonteksten ved å bruke selvbestemmelsesteorien. Metode. En kombinasjon av metoder (mixed methods) ble benyttet. Først ble en nasjonal tverrsnittstudie gjennomført, der 201 deltakere i arbeidsforberedende trening på gård besvarte et spørreskjema med spørsmål som omfattet demografisk og bakgrunnsinformasjon, spørsmål om deltakelsen på gården, opplevelsen av å være en nyttig arbeidskollega, de sosiale relasjonene, og opplevelsen av natur og dyr, i tillegg til standardiserte instrumenter for å måle subjektive helseplager, tilfredstillelse av grunnleggende psykologiske behov og tilfredshet med livet. Strukturelle ligningsmodeller ble benyttet for å undersøke sammenhenger mellom variabler. Videre ble det også gjennomført ti semistrukturerte intervjuer med voksne deltakere i arbeidsforberedende trening på gård. Transkripsjonene ble analysert med en modifisert versjon av systematisk tekstkondensering. Resultater. Resultatene viste at brukere i arbeidsforberedende trening på gård er relativt unge, flesteparten var ugifte, hadde et lavt utdanningsnivå og hadde vært ute av arbeidslivet i en lang periode. De hadde en høy prevalens av subjektive helseplager og et lavt nivå av tilfredshet med livet. Videre, viste resultatene at det å ha psykologiske helseplager var negativt assosiert med tilfredshet med live og at tilfredsstillelse av grunnleggende psykologiske behov var en viktig mediator i dette forholdet. Videre, viste de kombinerte resultatene presentert i Artikkel II (basert på 194 besvarelser på spørreundersøkelsen) og artikkel III (basert på 10 intervjuer), at opplevelsen av å være en nyttig kollega var positivt relatert til tilfredstillelse av det grunnleggende psykologiske behovet for kompetanse. Arbeid med dyr var den vanligste arbeidsoppgaven for flesteparten av brukerne, og både arbeidet med dyr og å oppleve naturen ble beskrevet som stressreduserende og beroligende i de kvalitative intervjuene. Men, arbeid med dyr og opplevelse av nature var ikke assosiert med tilfredstillelse av noen av de grunnleggende psykologiske behovene i den strukturelle ligningsmodellen. Resultatene viste også at opplevelsen av tilhørighet til gruppen av andre brukere på gården var positivt relater til tilfredstillelse av de grunnleggende psykologiske behovene for tilhørighet og autonomi. Den kvalitative studien viset også at forholdet brukerne imellom var basert både på å kunne gi, og å kunne få, forståelse og anerkjennelse av andre. Støtte fra gårdbrukeren var positivt relatert til behovstilfredsstillelse av alle de tre grunnleggende psykologiske behovene kompetanse, tilhørighet og autonomi, og gårdbrukeren ble også beskrevet som en person som ga forståelse, anerkjennelse, veiledning og positive tilbakemeldinger til brukerne i den kvalitative studien. Konklusjon. Brukere i arbeidsforberedende trening på gård virker å være en sårbar gruppe som kan ha en utfordrende tilbakeføringsprosess til arbeidslivet foran seg. I tillegg virker det som deres høye forekomst av psykologiske helseplager påvirker tilfredstillelse av de grunnleggende psykologiske behovene negativt, som igjen var positivt assosiert med tilfredshet med livet. Basert på selvbestemmelsesteorien, kan derfor en økt tilfredstillelse av de grunnleggende psykologiske behovene være viktig for å motvirke noen av de negative konsekvensen en høy forekomst av psykologiske helseplager medfører for brukerne. Videre, kan det virke som en støttende gårdbruker kan være en autonomistøttende person for brukerne, som også indikerer at gårdbrukeren kan være det viktigste elementet i den arbeidsforberedende treingskonteksten på gården for å støtte tilfredstillelse av de grunnleggende psykologiske behovene for brukerne. Fra et teoretisk ståsted, vil tilfredstillelse av de grunnleggende psykologiske behovene ikke bare kunne lede til funksjon og livskvalitet for brukerne, men kan også lede til en mer autonom motivasjon for å komme tilbake i arbeid. I tillegg kan tilfredstillelse av grunnleggende psykologiske behov kunne gjøre det mulig for brukerne å engasjere seg fritt i aktiviteter der de kan følge sine interesser, vokse og utvikle seg. Å oppleve grunnleggende psykologisk behovstilfredstillelse reflektere derfor ressurser som kan gjør folk i stand til å bedre og bevare sin egen helse, som er målet med helsefremming. Å styrker elementer i den arbeidsforberedende treningskonteksten som er positivt assosiert med grunnleggende psykologisk behovstilfredstillelse, kan derfor være viktig for at brukerne skal oppleve helsefremming, som igjen kan hjelpe brukerne i den vanskelige veien tilbake til arbeidslivet.The project was founded by the Research Council of Norway, the Agricultural Agreement, The Farmers’ Union (Bondelaget), the Norwegian Farmers’ and Smallholders’ Union (Norsk Bonde- og Småbrukarlag, Hedmark) and the Norwegian Labour and Welfare Administration (NAV)

Understanding the relationship between subjective health complaints and satisfaction with life for people in prevocational training in Norway

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Understanding the relationship between subjective health complaints and satisfaction with life for people in prevocational training in Norway

Background and aim: In Norway, a large part of the population is dependent on disability benefits. The main reasons for this are related to long-term musculoskeletal pain and psychological complaints. Prevocational rehabilitation, aimed at increasing participation in working life, targets people in need of a sheltered vocational environment. This group has been found to report a very high level of health complaints. Therefore, a better understanding of the psychological mechanisms affecting satisfaction with life for people who experience subjective health complaints could be important for tailoring more optimal vocational rehabilitation initiatives for these individuals. This study aimed to investigate the possible mediator role of basic psychological need satisfaction, described in self-determination theory, in the relationship between subjective health complaints and satisfaction with life. Methods: A total of 201 adult participants attending prevocational training on care farms in Norway answered a questionnaire, including demographic questions and standardised instruments on subjective health complaints, basic psychological need satisfaction and satisfaction with life. Analyses were conducted using a structural equation model. Results: Most of the participants had been out of work for more than one year, had a high prevalence of subjective health complaints and a low level of satisfaction with life. The structural equation model showed that basic psychological need satisfaction mediated the negative association between psychological health complaints and satisfaction with life. Conclusion: The results indicate that even though health complaints remain, prevocational programs can counteract some of the negative associations between subjective health complaints and satisfaction with life by creating contexts that support basic psychological needs that are important for well-being and functioning. Providing clients with understanding, guidance, positive feedback, meaningful tasks and a close, supportive social community, has been found to facilitate satisfaction of basic psychological needs in prevocational training on care farmspublishedVersio

Immigrant and ethnic minority patients` reported experiences in psychiatric care in Europe – a scoping review

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Farm-based day care services – a prospective study protocol on health benefits for people with dementia and next of kin

Introduction: The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin. Methods and design: The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016–2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon. Discussion: Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin.publishedVersio

Prevocational training on care farms for people outside the work force : the self-determination theory perspective

Background and aim. There is a concern in Norway that a large part of the population is out of work. Having the possibility to participate in working life, is important for ensuring good health, well-being and an acceptable standard of living. The two most commonly reported diagnoses for long-term sick-leave and disability pension in Norway are related to musculoskeletal and psychological subjective health complaints. People that have been outside the workforce for a long time, is one of the groups with the absolute highest number of subjective health complaints. A high degree of such complaints, may lead to low function and health related problems. According to the World Health Organization, health promotion should enable people to increase control over their own health. Prevocational training specifically aims to help people that have been outside the workforce for a long time return to work. In Norway, several care farms offer prevocational training as a health promoting service based on normal farming activity. However, there is little systematic knowledge about possible health promoting elements in the prevocational training context on care farms. In addition, there is a need for research that describes clients participating in prevocational training on care farms, and that give a better understanding of how subjective health complaints may be related to satisfaction with life for these individuals. New insight about the clients and possible health promoting elements in the prevocational training context, could contribute to the development of these services, which essentially also could facilitate return to work for the clients. The self-determination theory describes underlying psychological mechanisms important for motivation, function and well-being. This theoretical framework therefore, can give useful insight for understanding the relationship between subjective health complaints and satisfaction with life, and for understanding possible health promoting elements in the prevocational care farm context. The main aim of the thesis therefore, was to gain a better understanding of clients in prevocational training on care farms and of the possible health promoting elements in the care farm context by using the self-determination theory. Methods. A mixed method design was used. First, a national cross-sectional study, was conducted where 201 adult participants in prevocational training on care farms answered a questionnaire including questions providing demographic and background information, questions about the stay on the care farm, perception of being a useful colleague, the social community on the farm, experiencing nature and animals, and standardised instruments on subjective health complaints, basic psychological need satisfaction, and satisfaction with life. Structural equation models were constructed to investigate relationships between variables. Next, ten semi structured qualitative interviews with adult participants attending prevocational training on care farms were conducted. Transcripts were analysed using a modified version of systematic text condensation. Results. Results showed that participants in prevocational training on care farms were relatively young, most were unmarried, had a low level of education and had been out of work for a long time. They had a high prevalence of subjective health complaints and a low level of satisfaction with life. Further, the results showed that experiencing psychological health complains was negatively associated with satisfaction with life, and basic psychological need satisfaction was found to be one important mediator in this relationship. Next, the combination of findings presented in Paper II (including 194 participants answering the survey), and Paper III (including 10 interviews), showed that feeling like a useful colleague, was positively associated with satisfaction of the basic psychological need for competence. Working with animals was the most commonly performed task on the farm for the majority of participants, and both working with animals and being in nature were described as activities that decreased stress and offered a sense of peace for the participants in the qualitative interviews. However, working with animals and being in nature was unrelated to any of the three basic psychological needs in the structural equation model. Further, results showed that client group belonging was positively associated with the basic psychological needs for relatedness and autonomy. The qualitative study showed that participants experiences of receiving understanding and being acknowledged, as well as having the possibility to support others, was described as important in the relationship amongst the clients. Last, support from the farmer was positively associated with the satisfaction of all three basic psychological needs, and the farmer was also described in the qualitative study as a person who provided understanding, acknowledgement, guidance, and positive feedback to the participants. Conclusion. Participants in prevocational training on care farms seem to be a vulnerable group that may have a challenging return to work process ahead of them. In addition, their high degree of psychological health complaints influence basic psychological need satisfaction negatively, which was positively associated with satisfaction with life. Based on the theoretical understanding of SDT, enhancing basic psychological need satisfaction could therefore, be important for counteracting some of the negative consequences related to having a high degree of psychological health complaints for the clients. Further, it appears that a supportive farmer may hold an autonomy supportive role for the clients, which implies that the farmer may be the most important element in the prevocational training context supporting basic psychological need satisfaction for the clients. From a theoretical standpoint, experiencing satisfaction of basic psychological needs not only has the potential to facilitate function and well-being for the clients, but can also lead to a more autonomous motivation towards resuming work. Further, basic psychological need satisfaction may create opportunities for clients to engage freely in activities enabling them to follow interest, grow and develop. Overall, experiencing basic psychological need satisfaction therefore reflect resources that may enable clients to have a higher degree of control over their own health, which is the main aim of health promotion. Therefore, strengthening elements in the prevocational training context that are positively associated with basic psychological need satisfaction, may be important to facilitate health promotion for the clients, thereby also aiding the possibly challenging return to work process for these individuals

Physical activity in people with dementia attending farm-based dementia day care – a comparative actigraphy study

Background Despite public focus on the importance of physical activity and findings showing the benefits of such activity, research has shown that people with dementia are less physically active and have more sedentary behaviour compared to others in similar age groups. In Norway, there is a focus on day care services as a means to allow people with dementia to experience social, physical and cultural activities. Farm based services have been highlighted as an innovative and customized day care service, but little research has been done on physical activity and such services. This study therefor aims to investigate the potential of farm-based day care services as services that can promote physical activity for people with dementia. Methods Actigraphy data from people with dementia attending farm-based day care services (n = 29) and people with dementia attending regular day care services (n = 107) was used to assess levels of physical activity in each group and to compare the two groups. Results People attending farm-based day care had significantly higher levels of moderate activity, approximately 23 min each day, compared with persons attending ordinary day care (p = 0.048). Time spent in sedentary or light activity were similar for both groups. For the group attending farm-based day care services, days at the service, were significantly associated with less time spent in sedentary activity (p = 0.012) and more time spent in light (p < 0.001) and moderate activity (p = 0.032), and in taking more steps (p = 0.005) compared to days not at the service. Conclusion The findings indicate that participants in farm-based day care for people with dementia have higher levels of physical activity compared to ordinary day care and that farm-based day care increases levels of physical activity for its attendees. Farm based day care services has the potential to help their participants reach or maintain recommended levels of physical activity. Further research is needed to investigate what facilitates this increase in activity and how such knowledge could be used in all types of day care services.publishedVersio

Comparing the care environment at farm-based and regular day care for people with dementia in Norway — An observational study

publishedVersio

Physical activity in people with dementia attending farm-based dementia day care – a comparative actigraphy study

Background Despite public focus on the importance of physical activity and findings showing the benefits of such activity, research has shown that people with dementia are less physically active and have more sedentary behaviour compared to others in similar age groups. In Norway, there is a focus on day care services as a means to allow people with dementia to experience social, physical and cultural activities. Farm based services have been highlighted as an innovative and customized day care service, but little research has been done on physical activity and such services. This study therefor aims to investigate the potential of farm-based day care services as services that can promote physical activity for people with dementia. Methods Actigraphy data from people with dementia attending farm-based day care services (n = 29) and people with dementia attending regular day care services (n = 107) was used to assess levels of physical activity in each group and to compare the two groups. Results People attending farm-based day care had significantly higher levels of moderate activity, approximately 23 min each day, compared with persons attending ordinary day care (p = 0.048). Time spent in sedentary or light activity were similar for both groups. For the group attending farm-based day care services, days at the service, were significantly associated with less time spent in sedentary activity (p = 0.012) and more time spent in light (p < 0.001) and moderate activity (p = 0.032), and in taking more steps (p = 0.005) compared to days not at the service. Conclusion The findings indicate that participants in farm-based day care for people with dementia have higher levels of physical activity compared to ordinary day care and that farm-based day care increases levels of physical activity for its attendees. Farm based day care services has the potential to help their participants reach or maintain recommended levels of physical activity. Further research is needed to investigate what facilitates this increase in activity and how such knowledge could be used in all types of day care services