A process evaluation of everyday life rehabilitation: a critical discourse analysis of housing staff perspectives

Residents in supported accommodation often lead lonely and sedentary lives, with limited influence on everyday decisions. In addition, long-term outreach-based rehabilitative efforts and integrated care remain uncommon in this setting. The intervention, Everyday Life Rehabilitation (ELR), was developed specifically for this setting and has demonstrated robust effectiveness in an experimental trial. Yet implementation of similar interventions often meets resistance. This study examines how organisational discourse and contextual determinants shape the implementation of recovery-oriented interventions in supported accommodation.

This is an embedded process evaluation following a randomised controlled trial of ELR in Sweden. Focus group interviews were conducted with housing staff (n = 23) across seven supported accommodation units. Transcribed interviews were analysed using critical discourse analysis to examine how language, power relations, and organisational context shaped staff's understandings of the implementation process.

Our interpretation is that the core discourses among housing staff revealed how they diminished the intervention's perceived novelty and legitimised existing practices to cope with change. The discourses often constrained resident's potential to maintain control over collective resources in accordance with organisational norms. Across the corpus, staff discourses protected the boundary between insiders and outsiders, potentially generating tensions regarding collaboration, ownership, and power. Finally, vague leadership often blurred the lines of accountability, requiring staff and occupational therapists to negotiate responsibilities within organisational constraints.

Discourse analysis can be a valuable methodology for understanding how implementation barriers emerge and are sustained in supported accommodation. We argue that the identified barriers did not reflect staff resistance to the intervention but rather how the implementation process was framed within the organisation. Our interpretation is that structural limitations, including vague leadership and unclear accountability for implementation, constrained staff agency and contributed to discursive strategies that legitimised resistance and gatekeeping.