Qualitative realist evaluation of an occupation-based occupational therapy intervention programme (ABLE 2.0)

Background: ABLE 2.0 is a complex occupational therapy intervention, applying occupation-focused and occupation-based approaches, aiming to enhance the ability to perform activities of daily living (ADL) tasks among people with chronic conditions. It was feasibility and pilot tested; and proved effectiveness in improving observed ADL motor ability. To investigate the functioning of ABLE 2.0 a programme theory was developed. Objective: Evaluate how ABLE 2.0 worked in terms of interactions between context, mechanisms, and outcomes. Methods: Based on the programme theory, qualitative realist interviews were conducted among receivers and deliverers of ABLE 2.0 in a Danish municipality. Transcripts were coded, and contextmechanism-outcome configurations (CMOCs) were extracted and grouped into contiguous themes including patterns of the interactions between context, mechanisms, and outcomes. Results: Eight clients and three occupational therapists were included. Four themes were identified including a total of n=28 CMOCs: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and reevaluating ADL ability to finalise intervention. Conclusion: Overall, the programme theory was confirmed. Several required contextual factors and core mechanisms, leading to the desired changes, were revealed. The results will inform future implementation in community-based rehabilitation settings.