A qualitative exploration of engagement in daily activity programs among adults with mild intellectual disability and severe challenging behaviors in a residential care setting

Objectives This qualitative study explored engagement in daily activities among adults with mild intellectual disability or borderline intellectual functioning and severe challenging behaviors in a Dutch residential care setting.Methods Semi-structured interviews with seven residents and five staff members were analyzed using framework analysis to identify barriers and facilitators to engagement. The Inpatient Daily Activities Inventory (IDAI) informed the interviews, and its five dimensions (Structure, Contact and Support, Recovery, Learning and Meaning, and Autonomy) guided the a priori coding framework while allowing additional themes to emerge.Results Residents’ and staff accounts reflected all five IDAI dimensions, including benefits of daily routine, social interaction, learning opportunities, and autonomy. Barriers included disruptive peer interactions, interruptions to routine, activities not perceived as real work, and social stigma. Inadequate staff coordination emerged as an overarching service-level factor affecting engagement.Conclusion These findings indicate the need for individualized activity programs embedded within coordinated service delivery across residential and work settings.