Balancing Everyday Life. Exploring change following an activity-based lifestyle intervention for mental health service users.

Research output: ThesisDoctoral Thesis (compilation)


There is limited research that evaluates occupational therapy and lifestyle interventions, especially for mental health service users. This thesis provides increased knowledge and understanding of the processes and factors that led to better quality of everyday life, engagement in meaningful activities, and balance for participants who took part in the Balancing Everyday Life (BEL) intervention. BEL was implemented in 2012-2015 as part of a larger research project, of which this dissertation is part. BEL is a group-based occupational therapy intervention that aims to support overall well-being and recovery through finding a personalized balance of meaningful activities and relationships.

Study I investigated whether socio-demographic, care context, clinical and self-related factors could predict clinically important improvements in the outcomes mentioned above. Data collection took place with 133 participants at baseline, and then again at BEL end and six months following. Bi-variate analyses and then multivariate regression analyses were performed. Though many associations were found, few factors were identified as predictors in the regression analyses. The strongest predictors of belonging to the improved groups for occupational balance included having a friend for the leisure domain of occupational balance and female gender for the self-care domain. Having children was found to be a predictor for improved occupational engagement.

Studies II-IV used a qualitative Grounded Theory approach. Nineteen participants were interviewed after BEL, and some were interviewed mid-intervention and 1.5-2 years after BEL. Study II focused on the meaning of the group for the BEL participants, and a process of meaning-making through group participation was constructed of three categories: Joining with others, Sense of belonging, and Re-valuing Self. Those who experienced the most meaning reported feeling less lonely, more connected, as well as respected and worthy.

Study III focused on the processes at work that supported making lifestyle changes. A process of making changes was constructed, consisting of five categories: Going at it gently: change is an on-going process; Support for progress, permission to fail; Prioritizing and setting boundaries; Adjusting for a sustainable balance; and Caring for a valued Self. Each category included a strategy for change as well as a related inner change. A more self-compassionate approach seemed to be a key for caring for Self and making sustainable changes.

Study IV focused on perceptions of the BEL format and content and included focus group and/or individual interviews with 12 group leaders and 19 participants. Both parties felt that they had benefited from BEL’s structure and manual, yet flexibility was desired. BEL appeared to create bridges - to other people, to society at large, and to a future version of everyday life. BEL’s occupation- and person-focused approach was appreciated. Group leaders experienced BEL as easy to implement and some felt it strengthened their professional role. Participants appreciated feeling respected and listened to by the group leaders, and appreciated them maintaining structure in the group. Regarding hindering factors, group leaders mentioned mainly material obstacles, such as the lack of suitable group rooms or projector. Participants felt that too different functional levels between the group participants could be an obstacle.

As similar research and interventions are lacking, this dissertation provides an important contribution to the knowledge base for occupational therapeutic interventions in the psychiatric field.


Research areas and keywords


  • Lifestyle, Lifestyle intervention, Mental Health, Mental illness, Occupational Therapy, Quality of life, Change Process, meaning, Grounded theory, Recovery
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
Award date2019 Mar 22
Place of PublicationLund
  • Lund University, Faculty of Medicine
Print ISBNs978-91-7619-754-7
Publication statusPublished - 2019
Publication categoryResearch

Bibliographic note

Defence details Date: 2019-03-22 Time: 13:00 Place: Health Science Centre, Baravägen 3 i Lund External reviewer(s) Name: Killapsy, Helen Title: professor Affiliation: University College London (UCL)

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