Voices of those receiving care: An interpretative phenomenological study of client experiences in Flanders’ primary care system

Introduction: This study explores the lived experiences of individuals receiving paid home care in Flanders, Belgium. It considers how identity, health uncertainty, and systemic barriers shape opportunities for participation. Reablement is positioned as a conceptual lens through which these experiences are interpreted, offering insight into how person-centered approaches may be meaningfully adapted within the Flemish primary care context. Method: An interpretative phenomenological analysis (IPA) was used and semi-structured interviews were conducted until saturation of the data. In line with the hermeneutic circle, participants’ were informed about reablement as an alternative model of care before the interviews took place. Subsequently, their experiences of their current paid home care were captured. Finally, the team engaged in ongoing reflexive dialogue to critically examine the results and interpreted them in relation to the principles of reablement to explore its potential as an alternative model of care. Findings: Six participants were included. Thirty-six experiential themes were identified and refined into three overarching group experiential themes. Participants described the experiences of their care as the unpredictability of daily life, the centrality of their activities to identity, and limitations imposed by rigid care systems. The analysis generated the following themes: (1) I Am What I Do: Preserving identity through engagement in meaningful activities, (2) I Live with Uncertainty: Continual negotiation of possibilities amidst changing health, and (3) The System Decides, Not Me: Experiencing powerlessness within institutional decision-making. The interpretation of these experiences in relation to reablement suggested a strong alignment between participants’ needs for autonomy, meaningful occupation, flexibility, and participation, and the core principles underpinning reablement. Conclusion: Reablement offers a promising framework for enabling participation, but must be context-sensitive and co-produced with those receiving care. Occupational therapists could challenge ableist assumptions and advocate for flexible, personalized care. Lived experience should guide innovation and implementation to reduce care poverty and support meaningful occupation.