Why Hlutverkasetur?

WHY HLUTVERKASETUR?:
A FOCUS GROUP INTERVIEW

Aidan Wawchuk, BSc, University of Alberta, Edmonton, Alberta, Canada
Patricia Huld Ryan, University of Akureyri, Akureyri, Iceland

INTRODUCTION & BACKGROUND

Hlutverkasetur, literally “Role Centre” is an activity centre in Reykjavik, Iceland for people with mental health issues. It was founded in 2007 and has been running successfully since. Clients that attend Hlutverkasetur were contacted and asked to participate in a focus group interview. A focus group interview is a type of qualitative research, which allows us to understand the experience from the point of view of the consumer. “Focus groups are generally used to gather in-depth knowledge about attitudes, perceptions, beliefs and opinions of individuals regarding a specific topic. In understanding what people think about a topic, their views and experience help inform health care providers in general but, more specifically, can inform practice.” (Then, Rankin, & Ali, 2014, p. 16). This focus group was conducted to explore why clients come to Hlutverkasetur, what clients think are the positive aspects of the program and what they think can be improved, and what benefit clients receive from attending the centre. The results will be used to improve the current services and programs being offered at Hlutverkasetur and to inform the development of other activity centres for persons with mental health issues.
METHODS & PARTICIPANTS

A focus group interview was conducted at Hlutverkasetur in August 2014. The interview was conducted in English by Aidan Wawchuk, an occupational therapy student from the University of Alberta in Edmonton, Alberta, Canada. Patricia Huld Ryan, an occupational therapy student from the University of Akureyri in Akureyri, Iceland, acted as observer and translator. Both students worked together to analyze and synthesize the data. The interview lasted approximately eighty minutes with a ten minute break halfway through. Individual follow-up interviews were conducted with the participants in the two weeks following the focus group interview. These interviews lasted approximately 15 to 30 minutes per person. There were six participants, 4 women and 2 men, which included clients, volunteers and both past and present staff members of Hlutverkasetur. The age of participants ranged from 30 to 52 with a mean age of 41 years. The length of time they had been attending Hlutverkasetur ranged from 11 months to 4 years with a mean time of 22.5 months. There were a variety of diagnoses in this group including depression, anxiety, PTSD, bipolar disorder, and schizophrenia. Three of the participants were single, two were divorced and one was living with a common-law partner. Half of the participants were employed, the other half were unemployed, retired and/or volunteering.

The participants described their participation at Hlutverkasetur as partaking in activities, volunteering to help with and lead activities and helping with the daily processes of the centre. If they were not involved in any of the activities they participated by socializing and interacting with the clients and staff at Hlutverkasetur.

RESULTS

A number of themes were discovered through the progression of the focus group. Hlutverkasetur was found to be a successful program because of the peer support and socialization, the activities: purpose, contribution and acceptance of new ideas; and the informal and welcoming atmosphere.

Peer Support and Socialization

All of the participants stated that the people at Hlutverkasetur contributed to the positive aspects of the program, and was one of the main reasons that they have continued to attend the centre. Specifically, socialization and support from both clients and staff added to the value of the program. Participating in listening and talking with other people, socializing, and meeting new people is an important part of Hlutverkasetur. Clients gain support from other clients and from the staff in personal problems, and in navigating the healthcare, insurance, and social support systems. They are also able to share their positive experiences and celebrate these with the people at Hlutverkasetur. As participant 5 stated: “In Hlutverkasetur, [clients] are helping each other also.”

The role of staff was described as mediating clients who are displaying challenging behaviors, encouraging clients to speak and talk about how they are doing, providing a sense of security for clients – knowing that staff are there to help them if they need it, and following up with clients regarding past conversations and issues. Participant 1 described this well: “There is no staff here that hasn’t shown interest in what’s going on with my life, and if there is anything I need to talk to someone [about], they are all here, and they encourage me to come and speak to them.” Staff members themselves were described as always smiling, outgoing, outspoken, relaxed, encouraging, patient, showing interest in the clients and displaying active listening. Participant 4 stated: “They really take care of us… they really care.”

There is a vast majority of female staff members at Hlurverkasetur, and a few of the focus group participants commented on this by conveying that additional male staff members would be a positive change and is wanted by some of the clients at the centre.

Activities: Purpose, Contribution and Acceptance of New Ideas

Another common theme was the satisfaction with the activities offered at Hlutverkasetur. There is a diversity of activities to attend at the centre, and they change every few months. There is also flexibility to allow for spontaneous activities, to take advantage of good weather or special events. Participants did express a desire for more special occasions, and more consistent meet-ups outside of Hlutverkasetur’s hours of operation. They suggested additional meet-ups, as often as 2-4 times a month, to socialize in other settings such as a café or the bowling alley.

The clients shape the variety of activities offered at Hlutverkasetur, as they are encouraged to share their ideas. Participant 5 explained: “If you have some ideas… you are encouraged to add something to Hlutverkasetur, put your mark on it.” Furthermore, clients are challenged to be involved in activity facilitation, organization and/or leadership when they bring forward new ideas. This builds skills, confidence and a sense of accountability as the clients become responsible for activity facilitation, and allows them to use their strengths and talents. The participants also described the appreciation shown by the staff when they contributed and volunteered to help with the activities or daily processes at the centre. Participant 4 stated: “[the staff] are so grateful when we give something back.”

The activities and the centre itself were described as a place that gives meaning to a client’s day. Clients are able to describe and share the different things they did at the centre when they spend the evening with their family members or friends. Participant 5 explained: “Coming here, meeting people, my spirit was uplifted just for that day because I have been interacting with people and doing something and creating something… at home I started being more active also.”

When the participants were asked what they gained from coming to Hlutverkasetur, their responses included: self confidence, friends, something to occupy your mind, a sense of purpose, improvement in well-being, and a chance to discover and practice their strengths.

Informal and Welcoming Atmosphere

Hlutverkasetur was described as very welcoming, accepting, non-judgmental, and that no one is made to feel different at the centre. Participant 6 stated: “I can be here like I am, I don’t have to be fake… and I love it.” The atmosphere was also described as being very relaxed, non-restrictive, and free or flexible. Participant 5 explained: “You don’t actually know who is a staff here and who is a [client] because they kind of blend in.” There are minimal rules and Hlutverkasetur was described as having a less rigid structure than other activity centres. This lack of structure was also observed as being a bit too relaxed at times, in terms of not being able to mediate challenging clients and that the lack of rules can lead to uncertain behavioral expectations for some clients.

Clients are encouraged to become involved in the centre in whatever way they choose, and at their own pace. The centre is adaptable to every person’s needs because there is no schedule that needs to be followed, or timelines that have to be achieved. Clients can also remain involved in Hlutverkasetur for as long as they wish, as there is no pressure to discharge clients from the program. As long as clients are still gaining some benefit from coming to the centre, they are welcome to continue attending. All of the participants expressed appreciation for the flexibility to decide their level of involvement in the activities offered at the centre.

The shape of the building, the physical environment, was also described as welcoming. The centre is in a circular building, which participants explained reduces the corners in which to hide, and makes everyone feel welcome. The location is close to the main bus station and easily accessible from many parts of Reykjavik, which is a positive aspect of the physical building and location of Hlutverkasetur. Many participants commented that with the growth of clients attending the centre, the space might be too small. They commented that another toilet would be ideal, as well as more space and more rooms to run all of the activities that are offered, especially in the busier winter months.

CONCLUSION

As evidenced above, there is no single one reason that explains the success of Hlutverkasetur. There is an important interaction of the people, the environment and the occupations offered here that contribute to its success as an activity centre and encourage clients to keep coming back and participate in their own way. The results of this focus group interview can be expanded upon to create a questionnaire to gather data from a larger group of clients that are attending the centre, or used to inform future changes to the programs and services of Hlutverkasetur. This has been a valuable inquiry to gain a better understanding of the experiences of the clients who are using this centre.
References
Then, K., L., Rankin, J., A., & Ali, E. (2014). Focus group research: What is it and how can it be used? Canadian Journal of Cardiovascular Nursing, 24(1), 16-22.