title: Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research.
abstract: BACKGROUND
  Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult.
  
  
  OBJECTIVE
  This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease.
  
  
  METHODS
  Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes.
  
  
  RESULTS
  For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments.
  
  
  CONCLUSIONS
  Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.
authors.affiliation: Queen's University, Kingston, ON, Canada. handc@mcmaster.ca
authors.forename: Carri L
authors.initials: CL
authors.lastname: Hand
authors.affiliation: School of Rehabilitation Sciences, MsMaster University, Hamilton, ON, Canada.
authors.forename: Seanne
authors.initials: S
authors.lastname: Wilkins
authors.affiliation: School of Rehabilitation Sciences, MsMaster University, Hamilton, ON, Canada.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Letts
authors.affiliation: School of Rehabilitation Sciences, MsMaster University, Hamilton, ON, Canada.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Law
mesh_terms: D002908:Chronic Disease / Q000534:rehabilitation*; D003299:Cooperative Behavior; D004777:Environment; D006801:Humans; D017008:Negotiating; D009788:Occupational Therapy / Q000458:organization & administration*; D036301:Qualitative Research; D058992:Social Participation; D012944:Social Support