Morning Routines of Adults With Chronic Disabilities and Without Disabilities

PURPOSE: This research was done for the purpose of examining morning routines of adults with chronic disabilities. The research question was, What are the morning routines of adults with chronic disabilities? Occupational therapy has long expressed the potential value of habits and routines in maintaining a healthy lifestyle for persons with disabilities. Routines allow for predictability, as well as having symbolic meaning, thereby enhancing the individual’s quality of life. They are particularly important to people with chronic disability and influence ability to function on a daily basis. Morning routines of adults without disabilities have been found to be a collection of occupations with temporal sequence, occurring in different contexts, and including use of objects. However, a review of literature found little information on morning routines of adults with disabilities.

DESIGN: A qualitative, grounded theory design with cross-case analysis was used to explore morning routines of adults with chronic disabilities conducted over a 3-yr period. In Year 3, data were collected from individuals without chronic disabilities across a similar age range (age 20–90 yr) to explore possible unique characteristics emerging from the data. Twenty-one participants in total were recruited by student researchers. Participants were purposefully recruited in Years 1 and 2 because they were known to have a chronic disability and in Year 3 because they had no known chronic disability. Eight participants were male; one participant was African-American, and the rest were White. Participants included students, workers, and retirees.

METHOD: After written consent, participants were asked to take digital photographs of their morning routines. Using photography enables the brain to be engaged in a different way than it is in written or spoken language and helped participants better see their routines. Participant-generated photographs were used to guide interviews and to confirm statements made during interviews. Year 1 participants were involved in unstructured interviews using photo elicitation in order to describe their morning routines. In Years 2 and 3, semistructured interviews with questions developed from emerging themes were conducted along with participant-generated photographs. After transcription, interviews were read and coded for significant statements. Memoing was used during coding to make note of important impressions. Codes were reviewed across cases by the research team. HyperRESEARCH (ResearchWare, Randolph, MA) assisted in analysis across cases. Secondary categories were developed based on comparison of codes, and emergent themes were examined.

RESULTS: Current results found that morning routines included activities of daily living, instrumental activities of daily living, objects, temporal and social context, physical environment, motivations, and pleasurable additions. The drive to live a normal life and self-developed routines to adapt to changes in chronic disability were additional themes in Year 2. Year 3 led to the finding that all retirees without disabilities reported doing volunteer work as part of their morning routines, while none of the retirees with disabilities did so. Other results found increasing use of technology and importance of social context.

CONCLUSION: Morning routines show similar components regardless of disability. Adults with disabilities may need more time and objects than others, and routines need to change over time as disability changes. In particular, retired adults with disabilities may be missing an important occupation—volunteering. It is vital for occupational therapists to understand components of morning routines as related to adults with chronic disabilities and to advocate for treatment outside traditional models of short-term rehabilitation during acute phases of disability. This study relates to the research priority of health behaviors to prevent and manage chronic conditions.

References

Christiansen, C. H., & Townsend, E. A. (2010). Introduction to occupation: The art and science of living (2nd ed.). Upper Saddle River: Pearson Education.

Clark, F. A. (2000). The concepts of habit and routine: A preliminary theoretical synthesis. OTJR: Occupation, Participation and Health, 20(1 Suppl.), 123S–137S. https://doi.org/10.1177/15394492000200S114

Royeen, C. B. (2010). Research article: Towards an emerging understanding of morning routines: A preliminary study using developing methods in art-based inquiry. Irish Journal of Occupational Therapy, 38(1), 30–42.