Striving for meaning in a diminishing world : Older persons’ experiences of reflective STRENGTH-giving dialogues including a digital tool

The Reflective STRENGTH-Giving Dialogue (STRENGTH) method was developed, grounded in a lifeworld perspective, with a focus on identifying and meeting older persons’ needs for the promotion of health and well-being. In this thesis, STRENGTH, including the digital tool SelfSTRENGTH, was tested in the context of community-dwelling older persons living with long-term health problems. The overall aim was to describe how life with long-term health problems is experienced and influenced by the Reflective STRENGTH-Giving Dialogue intervention, including the SelfSTRENGTH app, by community-dwelling older persons. The research was conducted based on a reflective lifeworld approach, through qualitative and quantitative method studies. Three of the studies had a qualitative, descriptive, and inductive design based on individual interviews and reflection notes with the older persons in the intervention group (Papers I–III). Analysis was conducted using phenomenology (Papers I–II), and phenomenography (Paper III). One study had a quasi-experimental pretest-posttest no-treatment control group design (Paper IV), and was analyzed using nonparametric paired statistics. Altogether, 60 older persons in the fourth age participated in the studies. The finding showed, according to self-reports, that STRENGTH immediately and significantly reduced the impact of health problems on daily life, and increased well-being after each single dialogue. The content and outcome of the dialogues are affected by intersubjectivity, which is influenced by the healthcare professional (HCP) and the older person’s ability, as well as the relationship between them. STRENGTH dialogues that have an existential dimension are described as a starting point to provide a “push” toward joy and meaning. When the understanding of an older person’s holistic situation, including the past, present, and future, is tactfully and sensitively challenged with reflection and an emphasis on possibilities, the dialogues support joy and meaning in life. Dialogues of this nature have been lacking, as older persons may choose not to have that conversation with their family or HCPs, and HCPs may not attend to the older person’s existential needs and concerns. It is important when living in the feeling of a diminishing world for older persons to be involved in decisions that concern their lives and care, and to engage in life projects that improve well-being. This is made possible through the dialogues and use of the SelfSTRENGTH app. However, use of the app is hindered by resistance to digital technology and the occurrence of health problems. To foster healthy ageing, HCPs need increased knowledge and favorable conditions for caring conversations and provision of digital support that older persons with long-term health problems need for participation in a digital society