“I’m my own boss” – a qualitative study with people receiving adult day services in Germany about their understanding of leisure

Introduction: Community-based care such as adult day services (ADS) are preferred by people with dementia. ADS offers the opportunity to support the health and social needs of their clients and provide respite to family members, contributing to a stable care situation at home. The psychological needs of humans according to the self-determination-theory (SDT) (autonomy, competence, and relatedness) can be fulfilled by leisure activities and thus improve well-being and quality of life. The implementation of leisure activities that reflect individual preferences support active participation, preserve autonomy, improve satisfaction with care and consequently can be understood as a core aspect of person-centered care. However, it is currently unknown how people receiving ADS understand leisure and which leisure activities they prefer.

Method: To gain insight, a qualitative design was chosen. We conducted semi-structure interviews with 15 people receiving ADS in Germany. Participants were recruited from three different ADS in one state in Germany. Interviews were recorded, transcribed verbatim and analyzed using reflexive thematic analysis and categories of the SDT.

Results: The results show that over 90 % of participants were diagnosed with dementia and we identified two different themes. The first theme, the sweet bitter symphony, emphasizes the positive (sweet tones: autonomy, competence, and relatedness) and negative (bitter tones: incompetence, unrelatedness, and heteronomy) sensations and feelings that shape interviewees’ understanding of leisure. The second theme, young, wild & free!, describes the different preferred leisure activities. 

Conclusion: The results indicate the importance of preference-based service design in ADS to meet clients’ psychological needs and thus provide person-centered care to improve well-being and quality of life. These results can be used to develop an item-based assessment tool to assess the preferences of people with care needs regarding leisure activities in ADS.