Community-Driven Health: Advancing Indigenous Well-Being and Workforce

Background: Loneliness in older adults is a global public health problem. Although robust evidence exists regarding its consequences, the evidence base is marked by a bias towards high-income countries and urban contexts. The rural Peruvian Amazon is a territory virtually absent from the scientific literature on ageing and loneliness. Methods: We conducted a descriptive–interpretive qualitative study based on 34 semi-structured interviews with adults aged 60 years and over, recruited through Cáritas-Requena. Analysis followed the reflexive thematic analysis framework. Purposive sampling with maximum variation criteria was employed. The study was complemented by a quantitative characterisation using the Barthel Index, the LSNS-6 scale, and the DUKE-UNC-11 questionnaire. Results: Four themes emerged: (1) structural and functional conditions as the substrate of loneliness; (2) family reconfiguration driven by internal migration, with notable prominence of skipped-generation households (grandparents caring for grandchildren); (3) lived experiences of emotional and social loneliness, including a contextual pattern of feeling lonely despite the physical presence of others, which we descriptively label “paradoxical loneliness”; and (4) coping resources, including faith, work, neighbourhood networks, non-human companionship, and habituation. The descriptive relational measures showed different distributions: objective social isolation (LSNS-6 < 12) was observed in 12.5% of participants, whereas low perceived functional social support (DUKE-UNC-11 < 32) was observed in 68.8%; these measures assess distinct constructs and were used solely to contextualise the qualitative findings. Conclusions: Among the service-connected older adults included in this study, loneliness was shaped by the interaction of family reconfiguration, material and health-related conditions, and locally available coping resources. The experience of feeling lonely despite the physical presence of others was compatible with Perlman and Peplau’s cognitive discrepancy model and is presented here as a context-specific interpretive pattern rather than as an independent dimension of loneliness. Full article

Background/Objectives: Occupational therapy theories, models, and frameworks appear to be developed in Western countries. The philosophical framework for occupational therapy in South Africa appears to have relied upon various models, predominantly stemming from Western and European origins, with vague and fleeting references to African knowledge systems and philosophies. The objectives of the study were to explore how service users understand occupational therapy following their engagement in occupational therapy services; service users’ perceptions of the activities used during occupational therapy; and service users’ participation in decisions regarding the selection of activities during occupational therapy. Methods: This study used an interpretive qualitative design. Purposive sampling was used to select participants. A total of 21 participants were interviewed before reaching data saturation; 30 min semi structured interviews were conducted. Data were collected by the research assistant. Data were analysed using inductive thematic analysis at the latent level. Findings: Four themes were derived from the data, which are misconceptions and vagueness, impact yet optimism, limited meaningful activities, and mostly therapist-directed activity choice. Conclusions: The findings highlight systemic barriers such as language of communication in occupational therapy practice and education. They also suggest ambiguity in the understanding of therapeutic goals by service users. In the findings of this study, it is also indicated that there seems to be a lack of meaningful activities selected for therapy. This is shown by the activities, such as the exercises, in which the participants expressed their participation during occupational therapy. The power dynamics, knowledge, and use of technology in occupational therapy practice were also highlighted in the findings. Full article