Navigating a Middle Ground - Exploring Health Professionals’ Experiences and Perceptions of Providing Rehabilitation in Outdoor Community Settings

Abstract

Contemporary practice has started to rethink use of outdoor and community environments for advancing comprehensive rehabilitation outcomes. The aim is to examine health professionals’ experiences and perceptions of providing rehabilitation in outdoor community settings. The purpose is to use these experiences to generate practice-based knowledge in using the outdoors as a means to guide community-based rehabilitation. The Interpretive Description methodology was accompanied by social practice theory. Fieldwork was conducted utilizing participant observation, photovoice, and focus-group interviews. Included were 27 health professionals. The analysis revealed how “naturalistic learning opportunities” offered health professionals strategies to empower activity and participation levels and yet invoked “rehabilitation setting tensions.” A continuum was engaged in the theme “navigating a middle ground,” representing an integrated environment approach; rehabilitation in conventional indoor and outdoor community settings. Development of a sustainable concept for outdoor community-based rehabilitation involves strengthening health professionals’ competencies and skills for providing outdoor and community work.

“It Was Definitely an Eye-Opener to Me”—People with Disabilities’ and Health Professionals’ Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context

“…Interpretive description was used to generate practice-based knowledge on rehabilitation practices in collaboration with and to the benefit of people with disabilities and health professionals [ 36 ]. Interpretive description provided an organising logic throughout the study by asking questions based in practice and guided by research results from the same practice field, namely those of a previous ethnographic fieldwork embedded in the developing SPARK park [ 18 , 24 ]. Interpretive description differs from other methodologies by drawing on a variety of already known research traditions and methods, thus allowing for a pragmatic approach to the research aim in question [ 36 ].…”

“…The MarselisborgCentre is a national centre for rehabilitation, organised as a cluster organisation with approximately 20 rehabilitation centres [ 25 , 40 ]. With the establishment of a SPARK park, the outdoor surroundings of the MarselisborgCentre are being transformed to a 7.2-hectare urban green space combining rehabilitation facilities, climate adaptation and health promotion [ 18 , 24 , 25 ].…”

“…The sample included 14 participants representing people with disabilities ( n = 4) and health professionals ( n = 10). A purposive sampling strategy [ 36 ] was chosen to select key informants from the original sample from an ethnographic fieldwork in connection with the SPARK park [ 18 , 24 ]. We aimed for a heterogeneous group composition [ 41 ] with different backgrounds, work experiences and types of disability.…”

“…To address contemporary needs for developing urban green spaces for rehabilitation activities [ 2 , 19 ] and encourage inclusive community development of people with disabilities [ 22 , 23 ], the SPARK (Sound Park Activities, Rehabilitation and Climate) park will be established in Aarhus, the second-largest city in Denmark [ 18 , 24 , 25 ]. The SPARK park has the contextual surroundings to be a potential unique example of an urban green space intervention for an innovative rehabilitation solution [ 18 , 24 , 25 ]. Based on the increasing evidence on the positive link between health and nature [ 26 , 27 ], urban green spaces have grown into an important public health initiative, which has been conceptualised in political documents by the World Health Organization and the European Commission [ 21 , 28 , 29 , 30 ].…”

“…Practice changes are known to be challenging, as the process often encompasses a change in roles, attitudes and behaviours by the individuals and groups involved [ 33 , 34 ]. More studies indicate the complexity of including urban green spaces in established health system services [ 24 , 33 , 35 ]. An understanding of challenges related to rehabilitation in urban green spaces remains unaddressed.…”