Understanding the relationships between the activities and occupations, and health and well-being, of adults living with ongoing health conditions.

This thesis presents a theory that describes the complex relationships between the activities and occupations, and health and well-being, of adults living with multiple health conditions. Ongoing health conditions affect over 75% of Australians and are a leading cause of disability. Understanding the relationships between what people do and their health and well-being is necessary to inform person-centred, occupation-based health care that facilitates the participation and health and well-being of people with ongoing health conditions.
   This study used a qualitatively-driven, mixed methods design and grounded theory methodology to investigate the relationships between activities and occupations, and health and well-being. Sixteen adults with multiple ongoing health conditions were recruited and selected (using theoretical sampling), from hospital outpatient and community health settings. Each participant completed two in-depth interviews, and one self-report questionnaire that included the Short Form 36v2 Health Survey and Personal Wellbeing Index - Adult. Grounded theory methods were used to analyse qualitative data and integrate the findings with quantitative measures of health and well-being, and relevant literature.
   A substantive, middle-range theory of the relationships between the activities and occupations, and health and well-being, of adults living with multiple health conditions was constructed. The theory describes the complex interrelationships between activities and occupation, and health and well-being experienced by people living with ongoing illness. Living with ongoing illness was a complex process that involved four interrelated experiences: (a) recognising something is not right, (b) working out what is wrong, (c) getting things under control, and (d) getting on with life. Throughout the process of living with ongoing illness, participants managed the state of their health and well-being using their everyday activities and occupations. The participants transitioned between engaging in activities and occupations that focused on their health (the functioning of the person’s body and mind) and those that focused on their well-being (the functioning of the person in the context of their environment). The participants also transitioned between different occupational experiences: disruption, loss, adaptation and engagement. Their changing ability to perform or participate in valued activities altered how the participants perceived their health and well-being. Those participants who were able to engage in valued activities despite their health conditions experienced better subjective health and well-being.
   This thesis provides insights into the multiple, dynamic inter-relationships between occupation, health, and well-being based on the experiences of adults with ongoing health conditions. Further understanding the process of living with ongoing illness and the relationships between what people do and their health and well-being informs person-centred health care, assisting health professionals to enable adults to manage their ongoing health conditions, participate in life, and experience health and well-being by continuing to engage in valued activities.