What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives

The Use of Digital Technologies in the Promotion of Health Literacy and Empowerment of Informal Caregivers: Scoping Review

BACKGROUND

Informal caregivers (IC) play an important role in the community as health care providers for people who are dependent on self-care. Health literacy contributes to empowerment, better care, and self-management of one's own health and can be developed using digital technologies.

OBJECTIVE

This study aims to map scientific evidence about the use of digital technologies to promote health literacy and the empowerment of ICs.

METHODS

We conducted a scoping review following the Joanna Briggs Institute methodology. The CINAHL, MEDLINE, Scopus, and PubMed databases were searched to find primary studies on the theme. Inclusion criteria were based on the Population, Concept, and Context logic. To be selected for analysis, studies must have involved informal or family caregivers aged ≥18 years who provide care to dependent persons and who have access to the internet and digital devices (computer, smartphone, and tablet). A total of 2 independent researchers (SS and LVH) performed the screening process. This study is part of a main project that was approved by the Ethics Committee for Health of the Regional Health Administration of Lisbon and Tagus Valley (reference 058/CES/INV/2022).

RESULTS

A total of 9 studies were included in the review. The analysis of the studies showed that ICs use digital tools, such as computers and smartphones, with smartphones being the preferred tool. ICs use the internet to access information; manage home tasks; communicate with relatives, their peers, and health care professionals; and take part in forums. Due to difficulties in leaving their houses, forums are highly valued to preserve human connections.

CONCLUSIONS

The use of digital technologies to convey clear, objective, reliable, and accessible information is a strategic action for promoting health literacy and for contemplating the variable care needs of ICs. By working with ICs in the development of new technologies, researchers are building a new tool that meets ICs' needs.

A systematic review of gerontechnologies to support aging in place among community-dwelling older adults and their family caregivers

Objective

Paucity of information concerning the efficacy of gerontechnologies to support aging in place among community-dwelling older adults prevents potential users, healthcare professionals, and policymakers from making informed decisions on their use. The goal of this study was to identify gerontechnologies tested for home support in dyads of community-dwelling older adults with unimpaired cognition and their family caregivers, including their benefits and challenges. We also provide the level of evidence of the studies and recommendations to address the specific challenges preventing their use, dissemination, and implementation.

Methods

We conducted a systematic review of the literature published between 2016 and 2021 on gerontechnologies tested for home support in dyads. Two independent reviewers screened the abstracts according to the inclusion/exclusion criteria. A third reviewer resolved eligibility discrepancies. Data extraction was conducted by two independent reviewers.

Results

Of 1,441 articles screened, only 13 studies met the inclusion criteria with studies of moderate quality. Mostly, these gerontechnologies were used to monitor the older adult or the environment, to increase communication with family caregivers, to assist in daily living activities, and to provide health information. Benefits included facilitating communication, increasing safety, and reducing stress. Common challenges included difficulties using the technologies, technical problems, privacy issues, increased stress and dissatisfaction, and a mismatch between values and needs.

Conclusion

Only a few gerontechnologies have proven efficacy in supporting community-dwelling older adults and their family caregivers. The inclusion of values and preferences, co-creation with end users, designing easy-to-use technologies, and assuring training are strongly recommended to increase acceptability and dissemination.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=310803, identifier CRD42022310803.

Exploring Differences in Caregiver Communication in Serious Illness

Background: Demographic factors, such as disease context and family relationships, are communication mediators and moderators; however, little is known about how understanding these factors can improve caregiver communication with providers. Recognition of communication differences among caregivers may aid the development of approaches to improve serious illness communication. Objective: To explore whether caregiver communication differs by disease context (cancer vs. dementia) and caregiver communication type (Manager, Carrier, Partner, and Lone). Caregiver communication type is based on communication patterns between the care recipient and caregiver. Design and Measurements: Caregivers of persons with cancer and/or dementia were surveyed from a U.S. national research registry website. Measures of caregiver communication included information needs, communication confidence, perception of provider understanding of the caregiver, perceived frequency of caregiver assessment, and caregiver stress. Analysis of variance (ANOVA) determined significant differences between caregiver communication (p < 0.05) based on disease context and caregiver communication type. Results: Cancer caregivers reported higher unrecognized-demanded information states (i.e., not recognizing information was needed), more communication confidence, and more frequent caregiver assessment compared to dementia caregivers. Among caregiver communication types, Manager caregiver types were more confident communicating than other caregiver types and perceived greater understanding by providers than the Lone caregiver type. Manager caregivers reported significantly less stress than other caregiver communication types. Conclusions: Understanding disease context and caregiver communication type may help improve caregiver communication with health care providers.

Caregivers to older adults require support: A scoping review of their priorities

The vast majority of older adults who are chronically ill rely on informal caregivers for support. Caregivers often require additional support to facilitate their role. To the best of our knowledge, there has yet to be a collation of caregiver-identified priorities for support. Using existing research, this scoping review provides a comprehensive picture of what caregivers have indicated as priorities for support. Arksey and O'Malley's scoping review framework guides this review. We searched MEDLINE, CINAHL and PsycINFO databases on July 2, 2021. We selected databases based on their relevance to nursing, health and social science. Inclusion criteria were peer-reviewed research of any design, a sample population of caregivers to older adults (>55 years), manuscripts published in English and the priorities for caregiver support identified by caregivers themselves. We screened a total of 3591 records, and 33 articles met the inclusion criteria. These studies were from geographic settings across the globe and used various quantitative, qualitative and mixed-method study designs. In our synthesis, we quantified the identified priorities within the studies using coding and content analysis. We present the following list of caregiver-identified priorities: (1) orientation to the caregiving role; (2) self-care and respite; (3) adapting healthcare; (4) improved supports; (5) information needs; (6) access to resources; (7) financial assistance. Policymakers, healthcare professionals and non-profit organisations can use evidence from this review to guide decisions when developing support services and interventions for caregivers.

The information trust formation process for informal caregivers of people with dementia: a qualitative study

Purpose

This paper provides new insights on trust formation during information-seeking processes of informal caregivers of people with dementia and identifies the sources of information deemed as trustworthy by caregivers.

Design/methodology/approach

The study adopts a phenomenological qualitative approach in the form of in-depth, semi-structured interviews with a sample of 20 informal caregivers.

Findings

Caregivers trust sources that are perceived as authoritative and particularly value the information and advice provided by other caregivers. Trust in information can be divided into subjective and objective, but both are important precursors to the actual use of the information. The information available to caregivers is sufficient in quantity but inadequate in terms of ease of use, clarity and usefulness. Often, some key information needs remain unsatisfied due to the lack of timeliness, relevance and personalisation of the information.

Practical implications

This paper provides recommendations for information and healthcare providers on how to improve communication and information relevance for informal caregivers of people with dementia.

Originality/value

This paper contributes to a more comprehensive perspective on caregivers’ information trust formation processes, which takes into account both the characteristics of the information and caregivers’ individual factors.