There is a national call for digital health innovations in the provision of health and social care, especially for older adults in the context of home. The Reflective STRENGTH-Giving Dialogue (STRENGTH) method is used to provide individual and holistic care using recurrent dialogues. The SelfSTRENGTH application (app) was developed to support reflection and stimulate activity that enables achievement of meaningful life projects. The objective of the study was to describe how the use of the SelfSTRENGTH app is perceived by older adults living with long-term health problems. A qualitative, descriptive and inductive design. Data, analyzed using a phenomenographic approach, consisted of individual qualitative interviews with older adults (age range = 74-96) conducted before (n = 34) and after (n = 27) participation in the STRENGTH intervention. The results consist of five categories of description: Resistance to use apps and digital tools; Health problems hinder its usefulness; Need of assistance is a prerequisite to be able to use the app; the app supports memory and reflection; and Using the app disperses thoughts and creates motivation. The outcome space thus contains descriptions of both barriers and possibilities regarding how the use of the SelfSTRENGTH app is perceived. The potential of using technology such as applications in health care is immense. However, long-term health problems in older adults, along with care providers' attitudes and opportunities to support, must be taken into consideration when implementing apps in health and social care.

The Reflective STRENGTH-Giving Dialogue (STRENGTH) method was developed, grounded in a lifeworld perspective, with a focus on identifying and meeting older persons’ needs for the promotion of health and well-being. In this thesis, STRENGTH, including the digital tool SelfSTRENGTH, was tested in the context of community-dwelling older persons living with long-term health problems.

The overall aim was to describe how life with long-term health problems is experienced and influenced by the Reflective STRENGTH-Giving Dialogue intervention, including the SelfSTRENGTH app, by community-dwelling older persons.

The research was conducted based on a reflective lifeworld approach, through qualitative and quantitative method studies. Three of the studies had a qualitative, descriptive, and inductive design based on individual interviews and reflection notes with the older persons in the intervention group (Papers I–III). Analysis was conducted using phenomenology (Papers I–II), and phenomenography (Paper III). One study had a quasi-experimental pretest-posttest no-treatment control group design (Paper IV), and was analyzed using nonparametric paired statistics. Altogether, 60 older persons in the fourth age participated in the studies.

The finding showed, according to self-reports, that STRENGTH immediately and significantly reduced the impact of health problems on daily life, and increased well-being after each single dialogue. The content and outcome of the dialogues are affected by intersubjectivity, which is influenced by the healthcare professional (HCP) and the older person’s ability, as well as the relationship between them. STRENGTH dialogues that have an existential dimension are described as a starting point to provide a “push” toward joy and meaning. When the understanding of an older person’s holistic situation, including the past, present, and future, is tactfully and sensitively challenged with reflection and an emphasis on possibilities, the dialogues support joy and meaning in life. Dialogues of this nature have been lacking, as older persons may choose not to have that conversation with their family or HCPs, and HCPs may not attend to the older person’s existential needs and concerns. It is important when living in the feeling of a diminishing world for older persons to be involved in decisions that concern their lives and care, and to engage in life projects that improve well-being. This is made possible through the dialogues and use of the SelfSTRENGTH app. However, use of the app is hindered by resistance to digital technology and the occurrence of health problems.

To foster healthy ageing, HCPs need increased knowledge and favorable conditions for caring conversations and provision of digital support that older persons with long-term health problems need for participation in a digital society.

Rationale: Experiences of the innovative method Reflective STRENGTH-Giving Dialogue (STRENGTH), which is grounded in a lifeworld perspective and developed to improve quality of care, is described in this study. Innovative thinking in developing health and social care, which may include digital solutions, is required to ensure a meaningful and dignified life in old age.

Aim: The aim of this study was to describe experiences of the intervention Reflective STRENGTH-Giving Dialogue from the perspective of older persons living with long-term health problems.

Method: Individual qualitative interviews were conducted with 27 older persons who participated in the intervention. The older persons wrote notes from each dialogue in booklets, and the booklets became part of the study data, analysed with a Reflective Lifeworld Research approach.

Results: STRENGTH is experienced as an opportunity to reflect upon life and identify small and large life projects. Dialogues that lead to change in thoughts and actions influence the older persons' well-being, sense of balance, joy and meaning in life. There is an experience of STRENGTH as a starting point and a push to move forward in an effort to experience joy and meaning in life when living with long-term health problems.

Conclusions: STRENGTH has the potential to contribute to quality improvement in person-centred care and enhance meaning in life for older persons living with long-term health problems. However, the use of a digital tool in this particular context poses challenges that must be considered.

Introduction: Ageing is often associated with multiple long-term health problems influencing older persons’ well-being in daily living. It is not unusual that the point of interest in research is often on the management of the actual health problem instead of being holistic and person-centred. Purpose: To describe the phenomenon of living with long-term health problems that influence daily living, from the older persons’ perspective. Methods: Qualitative individual interviews were conducted with 34 older persons living with long-term health problems. The data were analysed using a Reflected Lifeworld Research (RLR) approach, grounded in phenomenology. Results: Life with long-term health problems entails living in a diminishing world. It entails living in uncertainty, not being able to trust one’s own ability. The freedom to make decisions of your own is deprived by relatives and health-care providers. Living with long-term health problems entails being dependent on support in daily life and a strive to maintain meaningfulness in daily living. Conclusions: The results address a need for extended individual and holistic guidance and support in living with long-term health problems to increase the older person’s sense of well-being and meaning in life.