Promoting health through yarncraft: Experiences of an online knitting group living with mental illness

ABSTRACT

This study explored how people living with mental illness describe their experiences of knitting as a leisure occupation and whether knitting can create value and meaning and promote well-being. A qualitative design was used, based on the netnographic LiLEDDA method. Data, consisting of 600 posts, were collected from the internet, cleaned according to the LiLEDDA method, and analyzed using qualitative content analysis. The findings showed that knitting is ‘A way towards health’, indicating that knitting is a way to feel better and achieve a sense of competence; ‘A way to slow down’, indicating that knitting is a way to focus; and ‘A way of being occupied’, indicating that knitting affects the structure and balance of daily life and can be performed socially as well as non-socially. The knitters perceived knitting as a highly valued occupation that promotes health in both the short and long-term. Knitting contributed to an occupational identity and a sense of belonging, and the knitted products were rewarding for the knitter. Further studies about these transformative experiences and meanings for other people, and whether other creative occupations can generate the same experiences, is warranted.

RESUME

Cette étude a exploré la manière dont les personnes vivant avec un trouble mental décrivent leurs expériences du tricot en tant qu'occupation de loisir et a cherché à savoir si le tricot peut créer de la valeur et du sens ainsi que promouvoir le bien-être. Un devis qualitatif a été utilisé, basé sur la méthode netnographique « LiLEDDA ». Les données, composées de 600 publications, ont été collectées sur Internet, nettoyées selon la méthode LiLEDDA et analysées à l'aide d'une analyse de contenu qualitative. Les résultats ont montré que le tricot est « une voie vers la santé », indiquant que le tricot est un moyen de se sentir mieux et d'atteindre un sentiment de compétence ; « une voie pour ralentir », indiquant que le tricot est un moyen de se recentrer ; et « une voie pour occuper son temps », indiquant que le tricot affecte la structure et l'équilibre de la vie quotidienne et peut être pratiqué socialement et non socialement. Les personnes qui tricote accordent une grande valeur à cette occupation qui favorise la santé, à court et à long terme. Le tricot a contribué à une identité occupationnelle et à un sentiment d'appartenance chez les personnes participantes, et les produits tricotés étaient gratifiants pour elles. D'autres études approfondies sur ces expériences transformatrices et leur sens auprès d'autres groupes de personnes sont justifiées, afin de savoir si d'autres occupations créatives peuvent générer des expériences similaires.

KEYWORDS:

• Occupational science
• craft
• netnography
• health
• social media

MOTS CLÉS:

• Science de l'occupation
• artisanat
• netnographie
• santé
• médias sociaux

Knowledge about how people occupy themselves and adapt to challenges in daily life is needed. Such knowledge can be obtained by studying the occupations in which people engage in their natural environment (Yerxa, 2000). Occupations such as knitting, which can be both productive and enjoyable, are thought to have potential to enhance health and quality of life (Corkhill et al., 2014; Riley et al., 2013), with people who knit reporting it to be meaningful, and to enhance mood, bestow a sense of calm, improve cognitive ability (Riley et al., 2013), and reduce stress (Utsch, 2007). Engagement in goal-directed and meaningful occupations, such as knitting (Riley, 2013), is also seen to be vital to human development and lived experiences in ways that positively impact health and well-being (Christiansen & Townsend, 2004). This tacit knowledge warrants examination to understand knitting in relation to daily life and health.

Knitting as a Creative Occupation

Knitting is a commonly performed occupation that encompasses a great variety of experiences (Corkhill et al., 2014) and provides an occupational identity for knitters (Brooks et al., 2019). The knitter uses needles as tools and yarn as a material to produce textiles that range from fabric to works of art. Both hands are used in a rhythmic, repetitive, and often automatic movement and a meditative state of mind can be stimulated (Corkhill et al., 2014). Occupations closely connected to and conditional on knitting include producing or otherwise acquiring yarn, planning what to knit, and reading patterns. Knitting was historically something that women were mainly occupied with at home. They also met and socialized while at the same time producing comfortable warm clothes (McGregor, 1984; Wahlund-Lundquister, 1945; Wallin, 2016). In the present day, women might meet in knitting cafés for the same purpose (Corkhill et al., 2014). Group knitting can be a place for learning and creativity, and can influence individuals’ sense of belonging, increase self-efficacy, and provide group members with an opportunity to socialize without any demands in an environment characterized by acceptance, humour, inclusion, and friendship (Palmer & Kawakami, 2014; Potter, 2016; Prigoda & McKenzie, 2007).

Knitting can be a highly creative occupation, where creativity is defined as thinking and acting in original ways. People throughout history have created objects and expressed a need to be creative, irrespective of culture or ethnicity (Winther Hansen et al., 2021), thus creativity is assumed to be an innate capacity through which people can be inventive, imaginative, and find new solutions to needs and problems. Creative processes, Schmid (2005) asserted, can be used in all occupations, with both the process and outcomes generating positive feelings and being meaningful.

Creative occupations are also a way to express and communicate experiences of joy as well as pain (Perruzza & Kinsella, 2010). Expressing oneself through creative occupations has a strong occupational and social value that supports the person’s occupational identity (Winther Hansen et al., 2022). For instance, textile art makers preserved a positive identity, made new social contacts, and developed new skills through their textile art, which not only promoted well-being but also assisted them to cope with illness (Reynolds, 2004). This association supports the assumption of a close relationship between occupational value, perceived meaning, and subjective health (Eklund et al., 2017).

There is some evidence that knitting in a group has positive impacts on mood, coping ability, and social interactions with others (Brooks et al., 2019). Therapeutic use of knitting has also been researched in psychological (Utsch, 2007), rehabilitation (Duffy, 2007), and occupational therapy contexts (Corkhill et al., 2014; Riley et al., 2013). For instance, knitting was shown to have a positive impact for women with drug and alcohol addiction in a rehabilitation programme where, in addition to providing an outlet for creativity, knitting in a group generated hope and increased self-esteem (Duffy, 2007). Knowledge is warranted about how knitting is experienced by people living with mental illness (McGregor, 1984; Wahlund-Lundquister, 1945; Wallin, 2016), which can affect thoughts and behaviour, resulting in an inability to cope with daily occupations (Steel et al., 2014) or maintain occupational balance in daily life.

Aim

In the present study, we wanted to explore how knitters with mental illness communicated their experiences of being occupied with knitting in a social community context, in the company of other knitters.

Material and Methods

Because people share their experiences, thoughts, and reflections via online communities, which can function as a diary or written dialogue, these can be a valuable forum for gaining access to such insights. We accessed data on knitting as a health-related occupation among people living with a mental illness in such a digital community. Netnography is used for data collection on the internet (Kozinets, 2010), and has been found to be appropriate for sensitive data where the researcher will not affect the data collection through their involvement or presence (Salzmann-Eriksson & Eriksson, 2012). A qualitative design with an inductive analysis approach was used according to the forum-based netnographic LiLEDDA method (Salzmann-Eriksson & Eriksson, 2012). LiLEDDA is an abbreviation of the six steps of the method; 1. Literature review and Identifying the research question(s), 2. Locating the field(s) online, 3. Ethical considerations, 4. Data gathering, 5. Data analysis and interpretation, and 6. Abstraction and trustworthiness.

Literature review and identifying the research question

The existing field of knowledge was investigated and is presented above. There was an identified gap in the knowledge of how knitting is perceived as an occupation. Based on the findings from the literature review, the research question emerged as follows: How do people living with mental illness experience knitting as an occupation?

Locating the field(s) online

We used Google as the online forum where the topic of research is discussed and searched for the terms knitting and forum. The inclusion criteria were; a forum that was considered active, that is had posts from the last month, had over 100 members, used the English language, and the topics were about knitting and mental illness in combination. We found Ravelry (2007b), which is a knitting community with over seven million members from all over the world. The main language used on Ravelry is English. It has over 38,400 groups, and each one has a discussion forum. We identified Knitherapy after a process of familiarizing with the different groups. The description of the group was “This is a group for people who use knitting, crochet or spinning to help cope with mental disorders. Any and all mental disorders are welcome, and the goal of this group is to share the tips and tricks of coping through yarncraft” (Ravelry, 2007a). We chose to focus on the people talking about knitting, and not crochet or spinning. Depression, anxiety disorders, bipolar personality disorder, and neuropsychiatric disabilities are some of the self-declared mental health problems the knitters in the group stated. The presumptive user has to have an account on Ravelry to join the group, and the person has to state where they live, date of birth (not the year of birth) and choose an alias when signing up. All other personal information is optional. The majority of the members of the group were from the US, Canada, or northern Europe and judging from the names and pictures the majority were women. The group started in October 2007 and in April 2017 had 872 members. The group forum was considered active, with the topic ‘introduce yourself!’ having over 600 posts from over 300 individual ‘voices’. More than 100 posts remained after the cleaning of the data, which is considered sufficient for data collection according to LiLEDDA (Salzmann-Eriksson & Eriksson, 2012). The first author joined the Ravelry community but did not join the Knitherapy group and did not post any posts. The site was scanned to become familiar with the forum.

Ethical considerations

The authors chose a covert strategy to avoid contaminating the field. The data used in this study were archive data (Salzmann-Eriksson & Eriksson, 2012), that is, data collected from previous conversations in which the authors of this study were not involved. A high level of cloaking was used. That is, how well one disguises the posters who participated in the Knitherapy group. No real names or aliases were used in order to increase the integrity of the posters and their posts. We decided to use direct quotes to illustrate the findings, recognizing both that posters join groups with the knowledge that other people will read what they write and that the purpose of a group of this nature is to spread the members’ stories to others, to share; yet also aware that quotes could be traced with a search engine. An evaluation of the risks and benefits for the posters was made. A decision was made to include as few quotes as possible and yet still answer the research question in order to follow the LiLEDDA method and take ethical aspects in consideration. It was not possible to gain informed consent or to provide information about this study in line with the principles of Good Research Practice (Swedish Research Council, 2018) as stipulated by the Swedish Research Council.

Data collection

A systematic gathering of posts was performed on April 13, 2017. All posts (pages 1-27) in the introduce yourself! topic were copy/pasted from the screen and dumped to a text file. This resulted in 370 pages of raw text written in Calibri, 11 point, single spaced and containing 83,009 words. The text was then ‘raw-peeled’. That is, logotypes, pictures, and other debris were deleted, which resulted in 122 pages and 65,478 words remaining. In the next step, the text was changed to Times 12 point, 1.38 spacing, which resulted in 150 pages. After reading all the posts, those not related to knitting and not answering the present study’s research question were deleted. Forty pages of data remained and constituted the data for analysis.

Data analysis and interpretation

Qualitative content analysis, as described by Graneheim and Lundman (2004), guided the data analysis. The process involved considering text in its context, before dividing it into condensed meaning units, which were then abstracted and coded. Comparison of apparent differences and similarities then led to an iterative process of sorting the codes into categories and sub-categories. A process of reflection and discussion between the two researchers, until agreement was reached about how to sort the codes, resulted in revision of the initial categories. The first and third authors read and discussed the findings throughout the analysis process, and the second author took part in the iterative process. The authors are all occupational therapists with long experience of mental health care, where they have used creative activities therapeutically, individually, and in groups. The first author has a long experience of knitting while the second and third authors have less experience. The authors are experienced in research based on qualitative design.

Findings

Three major categories, each with three to five different subcategories of experience of knitting, were found: A way towards health, A way to slow down, and A way of being occupied (Table 1).

Table 1. The ways in which people with mental illness experienced knitting in daily life.

Category	Subcategory
A way towards health	Self-medicating by oneself Leaning on the king pin Developing self-efficacy Making choices depending on the day
A way to slow down	Calming down Regulating one’s focus Frogging it
A way of being occupied	Constructing everyday life Keeping a knitting diary Socializing behind the needles Enabling creativity and opening for possibilities Enjoying knitting with one’s senses

A way towards health

Self-medicating

The knitters had learned that knitting may have a similar effect to that of medication. They preferred knitting to taking pharmaceutical substances, which might cause negative side effects: “The nurses were wanting to give me [an antianxiety medication] until I told them that I preferred knitting for the anxiety. She stopped, looked at me, and said, ‘That’s much healthier than drugs.’ Ya think?”

The knitters saw it as a way of coping with or reducing symptoms such as anxiety, depression, and pain. It had a calming effect for some of them and having one’s hands and mind occupied was the crucial aspect for others. When their hands were busy with knitting, they did not tend to wander off and start pulling out their hair or the knitters did not feel the need to control their anxiety by eating or harming themselves. They experienced a strong link between knitting and a sense of relief from the symptoms. The knitters also used knitting as a preventive measure; for example, when they felt they were on a downward spiral, they used their knitting as a way to stop it from deteriorating. They experienced knitting as a form of therapy, and as something that “keeps them sane”.

Leaning on the king pin

Knitters used metaphors. They talked about “pouring their pain into the knitting”, and that knitting was “something that can harbor their pain”. Knitting gave a sense of relief and support and was experienced as a king pin, something stable. The king pin could also be knitting and was experienced as helpful when they had to deal with difficult situations in daily life. The knitting had been there when they had to cope with the loss of family and friends and to go through hardship. They found knitting to be supportive when it generated a feeling of helpfulness. It was perceived as something the knitter could trust, something stable that they could fall back onto, and something that they could make sense of. That meant that when people around them did not understand, there was always some knitting to lean on. It stood for security, safety, assurance, strength, and stability, according to the knitters, even though it could also be described as a “force”. Some knitters felt that it had been the only thing worth living for, and some even said that they would be dead if it was not for their knitting. They experienced knitting as the one and only thing that gave meaning, and that had a value. It could be actively used in a preventive way. They brought their knitting with them to potentially stressful places or stressful situations. It was portable, could often fit in their bag and was also easy to store away. They knitted on the bus or the subway, in supermarket queues, in class, in the waiting room and many other places where they needed to cope with stress.

When my parents convinced me to go to the walk-in center at the hospital, I was knitting while I sat crying next to my mother in the waiting room. I carried on knitting all the way through the entire hour I spent being interviewed and assessed by the nurse. Now that I’m more stable on my meds, knitting is still one of my biggest stress relievers and coping tools (a fact my family, friends and therapist are all well aware of!).

Developing self-efficacy

The experience of knitting enhanced the knitter’s self-efficacy. Knitting was something that the knitter could control in life even when other things seemed unfair and out of control. The feeling of being good at something can be rare among people with mental illness. Experiencing an occupation that they could feel good at, or even excel at, boosted their confidence. Having an illness often went hand in hand with a loss of roles in life (e.g., that of an employee or a student) or with feelings of not living up to their own or other people’s expectations of their remaining roles. When they knitted and became a knitter they could be a part of the knitting community, which gave them a new role in life. It could be an accomplishment to produce something, but it could also be an accomplishment to be able to learn a new skill. The experience of starting an occupation, doing it, and completing it was an important experience, expressed as “and it has also given me a great sense of accomplishment to be able to teach myself this new skill and to finish a few small projects”. They wrote about being productive, that they felt that it was positive to be able to produce something, which they meant was unusual for them and gave them a sense of gratification.

Making choices depending on the day

The knitters could do a great deal by just using the knit-stitch and the purl-stitch, but there were many different knitting techniques to learn if they wanted to; fair-isle, lace, cable-knitting, etc. The skills needed for knitting differed greatly and there was a wide choice of levels with varying degrees of difficulty to choose from when it came to the techniques and skills required and just as many choices when projects were concerned. The knitters took these choices into account when they selected what to knit. They often had a number of different ongoing projects, and they made their choice depending on how they felt or what they wanted from the knitting at any particular time: “I knit various things depending on how my brain is functioning, i.e., a simple stocking stitch through to lace”.

A way to slow down

Calming down

The knitters used many different words that related to the different states of mind they were in while knitting. It could be calming, soothing, relaxing, meditative, unwinding, feelings of peace, feeling at ease, feeling normal, and getting tension out of the system. They experienced the rhythmic motion of knitting as soothing. Even performing the motion with their hands, without having any knitting, could have the same effect. It could be a form of meditation when the person found it difficult to meditate in the more traditional way: “I have always used knitting or crocheting or some other form of needle craft to relax me and kind of ‘take everything away’”.

Regulating one’s focus

Regulating one’s focus was when knitting helped them to feel focused. Knitting provided a gentler pace when they felt stressed and was perceived as a way to slow down and sort out the thoughts in one’s head and make life more manageable. Some of the knitters experienced a difference in their thinking when they knitted, compared to when they were not doing it. They experienced that their thoughts were clearer and more manageable when knitting: “While my hands are busy doing something, my mind slows to a crawl, and I am actually able to think about one thing at a time … rather than having 20-30 threads all going at once”. Knitters experienced that being active with their hands helped them to be focused and remember what they saw or heard. It was perceived as a way to distract thoughts when negative sentiments threatened to take over. By concentrating on the stitches and the movement of the needles in, over and out, the knitters were brought back from spending too much time with their own thoughts. There was no room for negative thoughts when you had to focus on knitting.

Frogging it

Frogging was a term the knitters used when ripping out a project. It referred to the sound frogs make, that is, “rip it, rip it … ”. It could be challenging to follow a new complicated pattern or to keep a focus on the knitting and it was important that the demands were suitable for the knitter. It could become a negative experience and could cause frustration if it was not suitable. Furthermore, knitting could be too demanding when they were unfamiliar with a new pattern or a new technique, which could entail them having to focus on the instructions and being able to take in and interpret instructions and then put them into practice: “My anxiety does rule my life a lot at times but knitting at least helps to keep me focused until I end up throwing it across the room in frustration from a mistake”. Just as finishing a project could make the knitters feel great about themselves, not being able to finish could have the opposite effect. The mistake one made became one more failure to cope with.

A way of being occupied

Constructing everyday life

Being occupied during the daytime helped the knitter to gain structure, as well as when they were inactive. They knitted when they had a need to occupy themselves; for example, if they did not have a job to go to or other organized regular occupations during the daytime. Their occupational balance in everyday life was affected by knitting both in positive and negative ways. Knitting could be a strong motivator. To reward yourself with some knitting, could motivate the knitter to do other less meaningful or enjoyable tasks beforehand. It helped to maintain an occupational balance for some of them but could lead to an occupational imbalance for others: “It’s all I want to do right now. To the point when my hubby said I was getting lax on housework. Don’t want him to be disappointed with me. Need to keep a balance”.

Keeping a knitting diary

Some of the knitters explained how they could recall how they felt when working on previous projects and what mood they had been in by looking at their previous work or yarn stash or also reading notes in an old diary. Some of the knitters knitted something every day, it could be a square for a blanket or a stripe in a scarf, and used designated colors as codes for the different moods they were in: “I can gauge my moods by how much, how fast, etc that I’m knitting and completing the project”.

Socializing behind the needles

Knitting was an occupation that the knitters practiced both on their own and in the company of others, for example in knitting cafés, and there was also a large knitting community on the internet. Knitting was something that connected people through their common interest. It was also a way to block people out or a legitimate reason to have some time on your own. Knitters at organized knitting events were often welcoming and friendly, and sharing new ideas and giving and receiving input from other people could be very important. Knitting in public could often generate interaction with others and start conversations, and it could be a way to make new friends. Alternatively, some knitters used knitting as a way of avoiding contact with others. It could be an attempt to gain some time for themselves or it could be a way to avoid a difficult situation. Knitting was also used as a way to not have to talk to other people. Sometimes, knitting became a wall or a barrier and the knitters occupied themselves with the knitting so that other people did not get a chance to talk to them.

I was personally knitting and crocheting compulsively this past weekend in an effort to avoid my husband and our troubles. He’s so harsh and unsupportive that I’m too burned out to be there for him anymore. So, I hide behind my two beautiful children and my needles or hook.

The knitters experienced knitting as a socially acceptable occupation to be involved in among other people who needed something to do with their hands. A knitter did not have to have the same amount of eye contact as those who were not knitting. The knitter could be part of a group but without having to be involved in the conversation.

Enabling creativity by demands and opening for possibilities

Knitting was experienced as an occupation that allowed knitters to be creative, which was important for them and for some it was the only creative occupation they had. There were many aspects that were linked to this occupation, for example, selecting which needles to use, knitting in private or in the company of others, taking photos during the process, and whether to show it on social media or not. These were important aspects for some knitters, while for others it was just something to be occupied with to pass the time; occupation to do when they did not know what else to do. If they were not feeling motivated to start a new occupation, picking up their knitting could be an easier option. They also experienced that knitting was an outlet for energy, expression, and feelings, and they could channel these feelings into their knitting: “Knitting has been great - there’s knitting angrily, knitting to calm down, knitting in a tense manner … I could go on”. The knitter could meticulously follow a pattern or make their own version with the alterations they wanted, or they could invent their own pattern. It could be an outlet for creativity either way and could also be an outlet for opinions. The knitter could knit a blue and yellow world cup hat or a pink pussyhat, a symbol for women’s rights.

Indulging in knitting

Feeling the yarn, touching the different fabrics, looking at the colors, and sometimes smelling the yarn was experienced as an important aspect of knitting. There was a pleasure and delight in experiencing the yarn: “It satisfies my desire for both bright colors and soft textures. I’ve often said that it’s not the knitting I’m into, it’s the yarn”. The knitter experienced the yarn with its beautiful colors, its softness, fluffiness, or slipperiness, and also the tactile input that could be sensed with one’s hands and fingers when knitting. They did not have to see what they are doing, they could feel each stitch, where to put the needle in the next stich and how the yarn flew through their fingers. They spoke of knitting and things connected to knitting making them feel good, which was connected to a positive feeling. Knitting and the occupations connected to knitting, such as buying yarn, were some things that the knitter enjoyed, which could make the knitter happy.

Discussion

Knitting is shown in this study to be an occupation that, on the surface, appears to be simple, while the value and meaning of being engaged in knitting could vary from simple aspects to more complex ones. There are several reasons why people choose to knit instead of doing other creative occupations. One is that knitting is easy to bring along, while others are the natural, tactile element of the occupation, the rhythmic motion, the soft yarn, the nice colours, and the calmness of the repetitive movements. Moreover, knitting does not disturb people around you when bringing it, for example, to a lecture, and knitting is not dependent on time as it can be done for few minutes and up to several hours. These findings are in line with a previous study by Stitchlinks (2012). Moreover, the findings from this study showed that being engaged in knitting was perceived as creating daily life as well as concrete products, which could be related to the findings of Jones (2022), who saw knitting as a communicative practice, like writing and storytelling. Every knitted product is unique, even when the knitter has used a pattern for the product, and Jones claimed knitting is a meaning-making occupation on its own.

The effect on health was clearly stated by the knitters in this study, who described experiences of knitting as medication, reducing mental symptoms, which concurs with previous research showing that knitting put people in a better mood (Riley et al., 2013), made them happy (Brooks et al., 2019), and reduced experiences of stress (Riley et al., 2013; Utsch, 2007). Moreover, knitting could be perceived as an immunogenic occupation or ‘vaccine’ for knitters with mental illness, enabling them to gain control and improve health and well-being. This is similar to the findings concerning the way that physical occupation can promote health and decrease symptoms of depression (Danielsson et al., 2014).

This study also showed that the knitters use knitting in daily life as a form of self-help to prevent mental illness. Engagement in knitting led to calmness, and a feeling of satisfaction when thoughts and tensions decreased while knitting. This is in line with Hörberg et al. (2020), who showed that the ability to rest in a creative occupation enhanced well-being, by allowing thoughts and emotions to disappear. This is also similar to the findings by Ruud (2002, 2013), who described the concept of ‘musicking’, encompassing all kinds of musical occupations as a form of cultural immunogen that promotes health and well-being. Furthermore Reynolds (2004), when reporting on textile art making, stated that engagement in this form of occupation could serve as occupational resistance to illness. Knitting was used in this study as a form of coping strategy when managing stressful situations in daily life, which could be linked to other research (Corkhill et al., 2014; Riley et al., 2013). According to Iwasaki (2003), people use leisure-coping strategies intentionally or unintentionally to cope with stress as a health-promoting resource (Iwasaki, 2007; Iwasaki et al., 2005). This preventive aspect of the occupation is interesting, that is, how knitters put a lot of trust in the knitting when managing stressful situations, almost as though the knitting was a person, which is similar to how von Kürthy (2022) described textile craft as a companion.

The perceived occupational value of knitting was described in this study as giving meaning in daily life, which seemed to have an impact on perceived health and well-being. Knitting stands for something that is secure, even though at the same time it could be described as powerful. There were knitters who claimed that knitting was the only reason to live, that they might be dead if it was not for knitting. Needleworkers similarly expressed strong emotions about their craft in a study about embroidering (von Kürthy et al., 2022), but they express them in terms of passion. This is also in line with Hasselkus (2002) and the relationship Erlandsson et al. (2011) proposed between occupational value, perceived meaning, and subjective health and well-being. Winther Hansen et al. (2022) also showed in their study an association between doing creative occupations and mental health recovery in an intervention for people with mental illness, which we interpret as them experiencing a high degree of occupational value.

Knitting was perceived in this study as helping to maintain occupational balance, which was defined by Wagman et al. (2012) as “having the right amount of occupation and the right variation between occupations” (p. 324). In the subcategory Constructing everyday life, knitting was perceived as an alternative occupation in the knitters’ daily occupational repertoire, aiming to attain an occupational balance and a variation in daily life. Furthermore, knitting was sometimes seen as a motivator to complete occupations by balancing between fewer or more tempting and valued occupations. Eklund et al. (2017) emphasized the importance of congruence between a person’s occupations and their values and personal meanings. Occupational balance is affected when a feeling of meaningfulness is perceived. Knitting was, in this study, found to support occupational balance, but might also be a reason for occupational imbalance, such as when the knitter spent too much time knitting. The knitters also asked themselves if there was any risk of developing an addiction when they jokingly talked about their knitting. They found it hard to put the needles down, they had to knit “just one more row”. Support for this experience comes from Croghan (2013), who maintained that knitting alters the chemistry of the brain and has an addictive quality, while Shin and Ha (2011) reported people admitting to being addicted to knitting in their study. Griffith (2017), however, pointed out that knitting can be a constructive addiction that can be a healthier alternative to other addictions.

Furthermore, it was found that knitting may generate challenges in a way that the knitters could identify as an unhealthy occupation. Such situations could emerge when the challenge was too great, implying that the knitters gave up and were left with feelings of failure. This was also discussed by von Kürthy (2022), who maintained that frustration can be related to the actual physical collaboration of the body and material (the yarn and needle) while doing textile work. Knitting can also elicit challenging emotions and sensations, such as pain and/or isolation (Jones, 2022). However, a challenge may not be a negative experience; it can also lead to progress and entail satisfaction in performing occupations, as explained in the theory of flow (Csikszentmihalyi, 2008). An occupational challenge can be a well-needed mental challenge, keeping the brain engaged, learning new techniques and problem solving (Brooks et al., 2019). This was experienced by the knitters in this study, when their choice of what to knit depended on how they felt that day, and how much of a challenge the knitting should be. These deliberate choices are something Pöllänen (2015) found when exploring how women used textile crafts as a stress-reducing occupation. Even though those women experienced stressful situations in daily life, they continued with projects that were more difficult to perform, aiming to become truly captivated by the occupation. Handicraft occupations thus need to correspond to the right type of challenge for each individual.

Methodological considerations

Trustworthiness needs to be considered in qualitative research (Graneheim & Lundman, 2004). Credibility was strengthened by the amount of data with posts from experienced knitters from an online community, which was deemed sufficient to answer the research question. This entailed, however, a limitation in that there was no way of gathering any sociodemographic information. Moreover, the fact that we used data from an online community may also be an ethical issue as the knitters could not give their informed consent to participate. We dealt with this issue by following the guidelines for Good Research Practice (Swedish Research Council, 2018). On the assumption that the knitters, by joining an online community, would have known that other people could read what they wrote, we treated the data so that we could obtain meaning for the findings without any single person being identifiable. All the authors took part in the analysis process to ensure the credibility of the findings and that the categories and subcategories cover the data. Quotes representing the findings were used in order to strengthen credibility.

Dependability was strengthened by comprehensively following the LiLEDDA method (Saltzmann-Eriksson & Eriksson, 2012) and the different steps of qualitative content analysis (Graneheim & Lundman, 2004). It was an asset to get data from social media that is not affected by a researcher as a present observer or as an interviewer. We needed a systematic method to be able to use the data we extracted from social media in a scientific way. The LiLEDDA method offered such a structure.

Furthermore, Graneheim and Lundman (2004) suggested a non-present observation in order to attain a distance. Confidentiality was strengthened, and the ethical aspects concerning confidentiality were taken in consideration when a test search was made using Google with three exact quotes from the study and none of them were found to be traceable back to its origin. The authors were not present in any way in terms of the conversations in the community forum, but this could also be seen as a limitation, as there was thus no opportunity to pose any follow-up questions. A suggestion for further research is to recruit members in community groups for in-depth interviews.

Trustworthiness also concerns transferability of the findings. The focus was on the experiences of people who were already knitters and were also familiar with using social media. By selecting the sample from social media, we were able to reach a larger survey group who report their lived experiences from knitting as an occupation. Several studies examine knitting from a qualitative perspective, but with few participants included in the studies. Their knitting experiences could range from being a novice to becoming an expert, all of them were knowledgeable about how to knit, and engaged in knitting regularly. We do not know whether the findings would be different if the participants did not identify themselves as a person with mental illness, or whether other occupations can generate these experiences for people with mental illness. However, the findings can be useful for health professionals when reflecting on which occupations an individual experiences as useful and meaningful in everyday life.

Conclusion

This study provides knowledge about knitting as experienced by people with mental illness participating in a digital online community. The findings indicated that the form and meaning making of knitting, that is, the art of knitting, was experienced and used in different ways. Engaging in knitting was perceived as meaningful, sometimes challenging, and facilitating and balancing daily life. Knitting could support an occupational identity in terms of being part of a digital online community, and a creative occupation such as knitting may prevent illness, as well as promote health in its own way. For those for whom knitting is regarded as a valued occupation, this study presents important tacit knowledge that needs to be taken into consideration in person-centered interventions. This study also showed a need for further studies to be able to understand more clearly the critical components of engagement in knitting, such as how and why knitting as a meaningful occupation is inherent to promoting health and well-being, and to be useful when providing evidence for health-promotive and occupational-based interventions.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Acknowledgements

The present project received financial support from the Research and Development Primary Health Care, Gothenburg, Sweden, Grant Number RHS 2022-00237, and the Kronoberg County Health Authority, Grant Number RK-992075. The funders are not involved in the design of the study, collection, analysis, interpretation of data or in writing the manuscript.

Thanks to all the anonymous members of the Ravelry knitting group who have shared their experiences of the importance of knitting to sustaining their mental health.