一项加拿大的定性研究，从社会定位视角探索患有多种慢性病的老年人家庭照顾者经历的多样性。
A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective.
作者信息
Williams Allison, Sethi Bharati, Duggleby Wendy, Ploeg Jenny, Markle-Reid Maureen, Peacock Shelley, Ghosh Sunita
机构信息
McMaster University, School of Geography and Earth Sciences, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
University of Alberta, Faculty of Nursing, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada.
出版信息
Int J Equity Health. 2016 Mar 2;15:40. doi: 10.1186/s12939-016-0328-6.
BACKGROUND
A little-studied issue in the provision of care at home by informal caregivers is the increase in older adult patients with chronic illness, and more specifically, multiple chronic conditions (MCC). We know little about the caregiving experience for this population, particularly as it is affected by social location, which refers to either a group's or individual's place/location in society at a given time, based on their intersecting demographics (age, gender, education, race, immigration status, geography, etc.). We have yet to fully comprehend the combined influence of these intersecting axes on caregivers' health and wellbeing, and attempt to do this by using an intersectionality approach in answering the following research question: How does social location influence the experience of family caregivers of older adults with MCC?
METHODS
The data presented herein is a thematic analysis of a qualitative sub-set of a large two-province study conducted using a repeated-measures embedded mixed method design. A survey sub-set of 20 survey participants per province (n = 40 total) were invited to participate in a semi-structured interview. In the first stage of data analysis, Charmaz's (2006) Constructivist Grounded Theory Method (CGTM) was used to develop initial codes, focused codes, categories and descriptive themes. In the second and the third stages of analysis, intersectionality was used to develop final analytical themes.
RESULTS
The following four themes describe the overall study findings: (1) Caregiving Trajectory, where three caregiving phases were identified; (2) Work, Family, and Caregiving, where the impact of caregiving was discussed on other areas of caregivers' lives; (3) Personal and Structural Determinants of Caregiving, where caregiving sustainability and coping were deliberated, and; (4) Finding Meaning/Self in Caregiving, where meaning-making was highlighted.
CONCLUSIONS
The intersectionality approach presented a number of axes of diversity as comparatively more important than others; these included gender, age, education, employment status, ethnicity, and degree of social connectedness. This can inform caregiver policy and programs to sustain health and well-being.
背景
在非正式照料者提供家庭护理方面，一个研究较少的问题是患有慢性病的老年患者数量增加，更具体地说，是患有多种慢性病（MCC）的患者数量增加。我们对这一人群的护理经历知之甚少，尤其是当它受到社会位置影响时，社会位置指的是一个群体或个人在特定时间基于其交叉人口统计学特征（年龄、性别、教育程度、种族、移民身份、地理位置等）在社会中的位置。我们尚未充分理解这些交叉维度对照料者健康和福祉的综合影响，因此试图通过采用交叉性方法来回答以下研究问题：社会位置如何影响患有MCC的老年人的家庭照料者的经历？
方法
本文所呈现的数据是对一项在两个省份进行的大型研究的定性子样本进行的主题分析，该研究采用了重复测量嵌入式混合方法设计。每个省份邀请20名调查参与者（共40名）的调查子样本参与半结构化访谈。在数据分析的第一阶段，使用 Charmaz（2006）的建构主义扎根理论方法（CGTM）来开发初始代码、重点代码、类别和描述性主题。在分析的第二和第三阶段，使用交叉性来开发最终的分析主题。
结果
以下四个主题描述了总体研究结果：（1）照料轨迹，确定了三个照料阶段；（2）工作、家庭和照料，讨论了照料对照料者生活其他方面的影响；（3）照料的个人和结构决定因素，审议了照料的可持续性和应对方式；（4）在照料中寻找意义/自我，强调了意义的构建。
结论
交叉性方法呈现出一些多样性维度，其中一些维度比其他维度更为重要；这些维度包括性别、年龄、教育程度、就业状况、种族和社会联系程度。这可为照料者政策和项目提供参考，以维持健康和福祉。
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