On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria
Abstract
:1. Introduction
Aim of the Paper and Research Questions
- What do we know about the LDCs’ attendance of NCDFs in different spatial settings?
- What kinds of (spatial-related) factors determine the LDCs’ use of NCDFs?
- Do present NCDFs meet the requirements of LDCs and what can be done to increase the attractiveness of this health promotion measure for this target group?
2. Literature Review: Nursing Care Discussion Forums and Long-Distance Caregiving
2.1. Nursing Care Discussion Forums as a Support Measure for Informal Caregivers
2.2. Long-Distance Caregiving Family Members—A Particular Target Group in Health Promotion
3. Materials and Methods
- An existing dataset that originates from an explorative-qualitative written survey of group leaders of the Upper Austrian NCFDs conducted in 2017.
- Secondary and statistical data comprising (1) a summary list of all NCDFs in Upper Austrian NCDFs, including information on location municipalities, provided by the provincial administration of Upper Austria, (2) statistical data on care allowance recipients in Upper Austria, provided by the provincial administration of Upper Austria and (3) the official dataset on the spatial types of the Austrian municipalities, namely the Urban-Rural-Typology of the Austrian municipalities, provided by Statistics Austria [51].
3.1. Information Sources, Handling of Data and Data Analysis
3.1.1. Information Source 1: Results of a Written Survey of Group Leaders of the Upper Austrian NCDFs Conducted in 2017
- The actual catchment area of the NCDFs.
- The target group-specific (LDCs’) actual demand.
- Ideas on ideal health promotion for LDCs.
- The suitability of NCDFs for LDCs.
3.1.2. Information Source 2: Summary List of Upper Austrian NCDFs
3.1.3. Information Source 3: Urban-Rural-Typology of Statistics Austria
3.2. Mapping the NCDFs’ Coverage and Catchment Areas
3.3. Assessment of the Current NCDF-Offer for LDCs and Implications
4. Results
- With the exception of NCDFs located in regional centers, all other spatial types of NCDF-municipalities were covered by the expert survey, namely 50 % of the urban NCDFs, 75% of the suburban NCDFs and 60% of the rural NCDFs (see Table 2).
- Out of all Upper Austrian municipalities, 57% were eponymous municipalities or partner municipalities, that built a Nursing Care Discussion Cluster (see Figure 2).
- The coverage related to the theoretical catchment area of the NCDFs referring to domestically cared-for older persons: 70% of the theoretical catchment could be recorded (see Figure 2).
- From the written expert survey, information on 61% out of all 77 Upper Austrian NCDFs could be obtained (see Table 2).
4.1. Result 1: Catchment and Reachabilityof NCDFs
4.1.1. A Portrait of NCDFs
4.1.2. NCDFs’ Catchment Areas
4.1.3. Profile of NCDF-Participants
4.1.4. Advertising Channels and Reachability of LDCs
- Advertisement channels of local scope.
- Advertisement channels of regional scope.
- Directly addressing of caregiving relatives.
- Unspecified advertisement channels in terms of both, their (spatial) scope and contact building with caregiving relatives.
- Promotion activities on the part of the NCDF-municipalities themselves.
- Insertion of flyers in medical practices or pharmacies.
- Promotion activities by nursing homes and day care centers.
4.2. Result 2: Knowledge on LDCs Strains and Assessment of LDCs’ Demand for NCDFs
- The necessity to overcome distances leads to time constraints and a state of emotional disorder (mentioned three times in total, including one urban and two rural NCDF-group leaders).
- Geographical distance creates uncertainty about the actual physical and psychological condition of the cared-for older parent(s) (mentioned two times in total, comprising one group leader each from a suburban and a rural NCDF-municipality).
- LDCs have more efforts with regard to the organization of care within the family [55] (two mentions in total, including one urban and one suburban NCDF-group leader).
- LDCs are plagued by ambivalent feelings [56]: on the one hand, geographical distance leads to an increase of emotional distance; on the other hand, geographical distance causes more worries (mentioned by a group leader of a rural NCDF-municipality).
- Travel expenses are a burden, especially in winter (mentioned by a group leader of a rural NCDF-municipality).
- One group leader of a rural NCDF-municipality is of the opinion that geographical distance furthermore makes it easier to talk about one’s (LDC-related) problems.
- Again, the reasons for the little information on this issue are that LCDs are out of the NCDF-group leaders’ sight.
4.3. Result 3: On the Potential of NCDFs as a Health Promotion Measure for LDCs
4.3.1. Suggestions on Suitable Health Promotion or Support Measures for LDCs
- Support measures that are linked with active involvement of LDCs. This includes the creation of a balanced care support mix, consisting of informal neighborhood assistance and professional care, mainly through mobile social and care services (mentioned three times in total, one from a group leader of an urban and two from group leaders of rural NCDFs); the willingness of LDCs to make use of existing offers (mentioned four times in total, all from group leaders of rural NCDFs); trying to organize care while the NCDF is taking place (mentioned by a group leader of a rural NCDF); the reduction of working time and claiming for more support from the social environment of the cared-for person (mentioned by a group leader from a rural NCDF).
- Concessions from outside by taking into account the specific situation and strains of LDCs, e.g., in the context of medical appointments in order to save time (mentioned by two group leaders of each one suburban and rural NCDF).
- The development of a particular telephone counseling offer (suggestions from two NCDF-group leaders, one suburban and one rural).
4.3.2. Considerations on the Ideal Location for LDCs’ Nursing Discussion Forums
5. Discussion
5.1. Appropriateness of Study Design, Representativenes and Reliability of Empirical Findings
5.2. Interrelations between the Profile and Advertisment of the Current NCDF-Offer and the Lack of Reachability of LDCs
5.3. On the Potential of NCDFs as a Health Promotion Measure and Requirements for a LDC-Suitable NCDF-Offer
- Where should NCDFs be located in order to save time?
- To what extent and at which locations could a handful of LDCs be brought together?
- What are the requirements for tailor-made NCDFs in terms of organization and scope?
- The profile of the NCDF-participants is as follows: women and men in midlife, of different marital status.
- LDCs living in cities or towns with older parent(s) in need of care living in rural municipalities are not likely to make us of NCDFs located in their parents’ rural residential municipality. This may be due to the “fact” that LDCs only come for caregiving reasons and exclusively dedicate each minute to their parent(s). NCDFs are to be designed as a location-based offer in the residence municipalities or (urban) working places of LDCs.
- Urban NCDFs might have a larger catchment area of LDCs and a larger number of (potentially interested) LDCs in comparison to NCDFs in rural municipalities.
- At the moment, we can only speculate about the scope of tailor-made NCDFs for LDCs. Basing on evidence on the burdens and strains of LDCs, dealing with guilt and responsibility may be focal issues.
- LDCs approach to NCDFS with different concerns in comparison to local caregivers. That is why it should be considered to offer target-group-specific and LDC-specialized NCDF-offers regardless of the spatial setting.
6. Conclusions
- The target group of LDCs must be made visible to public. Thereby, NCDF-group leaders can act as multipliers.
- LDCs must be given time to develop self-awareness as a target group of health promotion measures. For that reason, NCDFs can serve as on-site platforms for the development of mindfulness, health literacy and community building. In turn, all three are important prerequisites for making use of health promotion measures [64].
- Pilot projects (“NCDFs for LDCs”) should be initiated in different spatial settings and accordingly advertised in order to make LDCs aware of this kind of support or health promotion offer [58]. As a first step, it would be interesting to explore what (currently) is being debated in the NCDFs of other provinces of Austria, in order to identify the support needs of LDCs and to be able to sharpen ideas on the demand, organization and scope of (future) suitable offers. It should to be kept in mind that NCDFs cannot eliminate distress and burdens that directly are related to overcoming extensive geographical distances, but nevertheless may improve quality of life [60].
- After running for a reasonable period, NCDFs need to be evaluated and linked to basic research on intervention programs for informal caregivers [55]. Only then it will become apparent whether NCDFs may be a suitable health promotion measure for LDCs and may exist alongside web-based offers.
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Structure of Questionnaire | Subjects |
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thematic block no. 1: demographic profile of NCDF-group leaders |
|
thematic block no. 2: organization and catchment area of NCDFs |
|
thematic block no. 3: demographic profile of participants places of residence of participating caregiving relative and cared-for person |
|
thematic block no. 4: NCDF-group leaders‘ assessment of the NCDFs‘ health-promoting effects |
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thematic block no. 5: knowledge on burdens related to long-distance caregiving and considerations related to target-group-specific support and relief measures (including NCDFs) |
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Spatial Typology of Upper Austria’s NCDF-Municipalities | In Total | Covered in the Written Survey [%] |
---|---|---|
urban centers | 10 | 5 [50%] |
regional centers | 2 | 0 [0%] |
suburban municipalities | 20 | 15 [75%] |
rural municipalities | 45 | 27 [60%] |
in total | 77 | 47 [61%] |
Basic Information on Group Leaders and Organization of NCDFs | In Urban Centers | In Suburban Municipalities | In Rural Municipalities |
---|---|---|---|
age of group leaders | aged 43–58 | aged 33–62 | aged 42–68 |
sex of group leaders | entirely women | entirely women | mainly women (24 out of 27) |
sharing their function as group leaders | mainly yes (4 out of 5) | no | mainly not (22 out of 27) |
frequency of place-taking | mostly once a month (4 out of 5) in one case: twice a month | mostly once a month (12 out of 15) in one case: twice a month in two further cases: bimonthly | mostly once a month (26 out of 27) in one case: twice a month |
day of the week | during the week (Mon, Tue or Thu) | during the week (Mon, Tue, Wed or Thu) | during the week (Mon, Tue, Wed or Thu) |
start time | between 6 and 7 p.m. | mostly between 7 and 8 p.m. (13 out of 15) in one case: 2 p.m. in one further case: between 5 and 7 p.m. | between 7 and 8 p.m. |
duration | 2 h | 0.5–2 h | 2–2.5 h |
NCDFs’ Catchment Area | Spatial Type of NCDF Eponymous Municipality | Number of NCDFs | Theoretical Catchment Area of NCDFs Related to Domestic Cared-for Older Persons *) | Actual Catchment Area of NCDFs Related to Domestic Cared-for Older Persons *) | Relation between Theoretical and Actual Catchment Area [in %] |
---|---|---|---|---|---|
limited to eponymous municipality | urban centers suburban municipalities rural municipalities | 4 5 9 | 9300 500 1300 | 9300 500 1300 | 100% 100% 100% |
comprising partner municipalities | urban centers suburban municipalities rural municipalities | 1 10 18 | 200 2600 4700 | <100 1800 2100 | 10% 69% 44% |
related to all NDFs | urban centers suburban municipalities rural municipalities | 5 15 27 | 9500 3100 6100 | 9200 2300 3400 | 98% 74% 56% |
in total | 47 | 18,700 | 15,000 | 80% |
Profile of Participants | NCDFs in Urban Centers | NCDFs in Suburban Municipalities | NCDFs in Rural Municipalities |
---|---|---|---|
participants per NCDF | 4–5 (5 out of 5) | 4–8 (15 out of 15) | 3–15 (25 out of 27) |
development of NCDF-attendance | trending downwards (3 out of 5) | trending downwards (8 out of 15) | trending downwards (12 out of 27) |
age of participants | aged 50–60 (5 out of 5) | aged 50–70 (15 out of 15) | aged 45–70 (27 out of 27) |
sex of participants | mainly women (4 out of 5) | mainly women (13 out of 15) | mainly women (24 out of 27) |
relationship of places of residence of participants and their cared-for older relative/s | mostly living in the same municipality (3 out of 5) | mostly living in the same municipality (11 out of 15) | mostly living in the same municipality (22 out of 27) |
kinship of participants and older cared-for person/s | daughter > daughter-in-law (5 out of 5) | daughter > daughter-in-law (15 out of 15) | daughter > daughter-in-law (27 out of 27) |
older cared for person/s | mother > father > parent-in-law (5 out of 5) | mother > parent-in-law > father (15 out of 15) | mother > mother-in-law > father/father-in-law (27 out of 27) |
NCDFs in Urban Centers | NCDFs in Suburban Municipalities | NCDFs in Rural Municipalities | Number of Advertisement Channels in Total | |
---|---|---|---|---|
being advertised (information provided: 44 out of 47 NCDF-group leaders) | yes: 5 out of 5 | yes: 14 no, no longer: 1 | yes: 25 no, no longer: 2 | |
most relevant advertisement channels of local scope (number of channels) | organized by municipality (municipal newspapers, homepage) > leaflets (community physician, pharmacy) > information provided by hospital (5 cases) | municipal newspapers > community physician/pharmacy > announcements of the church (10 cases) | community physician/pharmacy > nursing homes/day-care centers for elderly people > leaflets of the municipality > announcements of the church (10 cases) | 11 in total |
most relevant promotion channels of regional scope (number of channels) | regional newspapers (1 case) | regional newspapers > health fairs/health days (3 cases) | regional newspapers > announcements of the initiative “healthy communities” (4 cases) | 4 in total |
directly contacting caregiving relatives (number of channels) | personal acquaintance/telephone contact, written invitation, word-of-mouth advertising (3 cases) | personal acquaintance/telephone contact, written invitation, word-of-mouth advertising (1 case) | personal acquaintance/telephone contact, written invitation, word-of-mouth advertising > SMS, Facebook, Whatsapp (2 cases) | 4 in total |
most relevant promotion channels not specified scope (number of channels) | none | posters, events (1 case) | posters, events (1 case) | 1 in total |
ranking of promotion channels related to relevance | information with local scope > direct contacts to caregiving relatives > information channels of regional scope | information with local scope > information channels of regional scope > direct contacts to caregiving relatives | information with local scope > direct contacts to caregiving relatives > information channels of regional scope |
Information Derived from Expert Survey and Literature | NCDFs for Long-Distance Caregiving Relatives | NCDFs for Local Caregiving Relatives |
---|---|---|
current demand of NCDFs | still unknown | to a limited extent |
relevance and further (quantitative) development of the target group | increasing | increasing |
further development of psychological burdens | rising | rising |
demand for professionally led-discussion groups | still unknown | to a limited extent |
relevance of web-based alternative services | probably relevant | increasing |
future demand for NCDFs | still unknown | unknown or in decline |
appropriate name of offer | “Supervised Discussion Forums for LDCs” | “Regular’s Tables for Caregiving Relatives” |
assumed motivation for participation | mutual exchange with similarly affected caregiving relatives supervised speaking-from-the-soul getting in touch with health and care professionals staying informed about support measures and developments in domestic care | time-outs / short breaks from domestic care gaining personal distance exchange with similarly affected caregiving relatives information and counseling |
demographic profile of (future) NCDF-participants | women (and men) caregiving relatives of the second generation (particularly daughters/sons) | women (and men) caregiving relatives of the first and second generation |
relation LDCs/local caregivers | solely LDCs | solely local caregiving relatives |
assumed number of participants per NCDF | a couple of people | as at present |
regularity of participation [57] | useful, but still unknown | useful, but still unknown |
appropriate advertising channels | word-of-mouth advertising information (leaflets) in medical practices directly being contacted by care and nursing professionals information channels with super-regional scope (e.g., newspapers, internet platforms) | as at present |
catchment area | local (residential municipalities of LDCs) | local (residential municipalities of local caregiving relatives) or small-scaled (neighbor municipalities) |
appropriate location municipality for NCDFs | residential municipality of the LDC: mostly in the urban or suburban | residential municipality of the local caregiving relative: urban, suburban, as well as rural |
location/meeting place | at the workplace attractive meeting places (e.g., cafes) | attractive meeting points (cafes) |
organization structure depending on location | on demand, during the week during lunch breaks, in the afternoon and (early) evening | on demand, during the week, in the (early) evening |
assumed scope of NCDFs (scope/discussed issues) | constructing identity as caregivers [55] developing mindfulness coping with guilt and feelings of obligation and responsibility | dealing with “unlimited” availability |
relevance and function of care and nursing expert (=NCDF-group leader) | Informant, counselor mediator trainer | link between oneself and the cared-for older parent(s) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Fischer, T.; Jobst, M. On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria. Healthcare 2019, 7, 139. https://doi.org/10.3390/healthcare7040139
Fischer T, Jobst M. On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria. Healthcare. 2019; 7(4):139. https://doi.org/10.3390/healthcare7040139
Chicago/Turabian StyleFischer, Tatjana, and Markus Jobst. 2019. "On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria" Healthcare 7, no. 4: 139. https://doi.org/10.3390/healthcare7040139