‘Add info and stir’: an institutional ethnographic scoping review of family care-givers’ information work

Explaining the unmet information needs of family carers of people with dementia: a theoretical model of information behaviour

BACKGROUND

Family carers of people with dementia often report unmet information needs, despite policy emphasis on the provision of information as key to enabling good care and empowering carers in their role. Although the consequences of unmet information needs are detrimental to both the person being cared for and the carer, a systematic understanding of the causes of unmet information needs is lacking. To address this gap, this article presents a theoretical framework centred on the concept of information behaviour and integrating the information seeking and communication model, candidacy theory, and discrepancy theory. The framework maps information behaviour across six phases (from the identification of an information need to its satisfaction) and three levels (individual, service, system) at which explanatory factors may be observed.

METHODS

The framework was tested on data collected from 24 in-depth interviews and two focus groups with people with dementia and family carers of someone living with dementia in the North-East of England (UK). Data were analysed thematically to map the factors at play at each phase of the framework that might explain whether needs were met.

RESULTS

Unmet information needs are not always the result of a lack of information. Issues such as inadequate support for the user in identifying the need, problems in finding information, the timing of information provision, the amount of information provided, the credibility of the information source, and the relevance of the information (given care needs, preferences, personal, and family circumstances) can all contribute to unmet information needs. This work shows that meeting an information need ultimately requires progress through the different stages of information behaviour, each of which is influenced by the interplay of individual-, service-, and system-level factors, and depends on both users and providers.

CONCLUSIONS

This work challenges the rational paradigm in health and care information, which assumes that more information will lead to better care, and contributes to a critical perspective on health and care information that reframes successful information behaviour as a set of complex activities that are relational, emotionally charged, contextually embedded, and require (and produce) situated knowledge.

TRIAL REGISTRATION

Not applicable.

Emotion work and emotional labour, neglected facets of parental health information work. Analysing mothers of neurodivergent children

The neoliberal and biomedical 'good caregiver' discourse neglects the many facets of everyday information work that parents of children with special needs are required to do as they seek, receive and share information concerning their children's health and wellbeing. Along with time and skills, one such neglected facet is emotion work, the management of feelings in relation to societal norms. The purpose of this article is to explore emotion work, as a facet in parental health information work in the care and education sector, among mothers of neurodivergent children. Our analysis draws on interviews with 50 Swedish mothers of neurodivergent children. We present three primary insights. 1. Emotion work, on the self as well as on others, is pivotal to the information work that the mothers carry out in the education and care sector as they strive to ameliorate their children's situation. 2. Contested diagnoses, such as diagnoses associated with neurodivergent conditions, result in intense parental information and emotion work. 3. Fragmented and complex education and care systems, alongside traditional gender structures, compel mothers to undertake extensive information and emotion work.

Navigating Community-Based Aged Care Services From the Consumer Perspective: A Scoping Review

BACKGROUND AND OBJECTIVES

The shift to consumer-directed aged care means that older adults need to play a more active role in navigating the complex aged care system for adequate health and social services. Challenges in the navigation process result in unmet needs and difficulty accessing available resources. This scoping review investigates how aged care navigation is conceptualized in literature and interrogates research on the experiences of older adults navigating community-based aged care services with or without support from their informal carers.

RESEARCH DESIGN AND METHODS

This review follows the Joanna Briggs Institute methodological guidelines. PubMed, Scopus, and ProQuest were searched for relevant literature published from 2008 to 2021, supplemented by grey literature and manual reference list searching. Data were extracted using a predefined data-extraction table and synthesized with an inductive thematic analysis.

RESULTS

The current conceptualization of aged care navigation focuses on the support provided to older adults, rather than actions taken by older adults themselves. Thematic analysis from the included studies (n = 26) revealed shared themes (lack of knowledge, social networks as information providers, complex care systems) among older adults and informal carers; unique challenges faced by older adults (difficulties with technology, waiting game), and informal carers (structural burden) in aged care navigation.

DISCUSSION AND IMPLICATIONS

Findings suggest the need to comprehensively assess individual circumstances including social networks and access to informal carers as predictors of successful navigation. Changes that reduce the complexity of the aged care system and improve coordination will relieve the structural burden experienced by consumers.

Animal sheltering: A scoping literature review grounded in institutional ethnography

A diverse research literature now exists on the animals, staff and organisations involved in animal sheltering. We reviewed this research through the lens of institutional ethnography, a method of inquiry that focuses on the actual work that people do within institutions. The main topics, identified through a larger ethnographic study of animal sheltering, were: (i) research about shelter staff and officers; (ii) the relinquishment of animals to shelters; and (iii) animals' length of stay in shelters. After reviewing the literature, we held focus groups with shelter personnel to explore how their work experiences are or are not represented in the research. The review showed that stress caused by performing euthanasia has attracted much research, but the decision-making that leads to euthanasia, which may involve multiple staff and potential conflict, has received little attention. Research on 'compassion fatigue' has also tended to focus on euthanasia but a granular description about the practical and emotional work that personnel undertake that generates such fatigue is missing. Published research on both relinquishment and length of stay is dominated by metrics (questionnaires) and often relies upon shelter records, despite their limitations. Less research has examined the actual work processes involved in managing relinquishment as well as monitoring and reducing animals' length of stay. Institutional ethnography's focus on people's work activities can provide a different and more nuanced understanding of what is happening in animal sheltering and how it might better serve the needs of the animals and staff.

More than a visitor? Rethinking metaphors for family care in long-term care homes

Recent public and policy interventions aim to recognise formally the contributions of family care-givers to long-term residential care in Canada, with some arguing family carers are more than visitors and should be recognised as essential care-givers. These developments call for reconsidering how family care roles are understood and operationalised. Drawing on ethnographic research conducted in three care homes in Ontario, Canada, we present an in-depth feminist rhetorical analysis of the narrated lives and work practices of 12 unpaid family carers. Specifically, we explore how unpaid family carers themselves draw on broader discursive ‘ruling metaphors’ to interpret their roles and activities (e.g. as essential care-givers, visitors, team members), and how these metaphors invoke, organise and/or give rise to particular practices, responsibilities and relations. We contrast the stories of a family member who positioned herself as an essential care-giver and expressed a more onerous sense of individual responsibility with the stories of people who enjoyed the pleasures of visiting, who contributed as team members in ways that went beyond caring for their own relatives' care needs, and who embraced the possibilities that came with volunteering and with being able to influence change. Our analysis situates and contextualises participants' stories of their involvement and unpaid work in relation to their everyday material conditions and circumstances. We elaborate how different ways of understanding caring roles shape the nature of carers' unpaid work, as well as their options to share responsibility or set limits on that work. We also raise questions about the organisational conditions needed to help enact care as a shared collective responsibility.

The experience of structural burden for culturally and linguistically diverse family carers of people living with dementia in Australia

Evidence suggests that family carers of culturally and linguistically diverse (CALD) people living with dementia experience higher stress and unmet need than the general Australian population. These disparities are often framed as the result of CALD communities failing to seek formal support. Challenging this, we draw on the concept of 'structural burden' to explore how the complexity of health and aged systems contribute to the burden that CALD carers experience. We conducted semi-structured interviews with 104 family carers for CALD people with dementia in Australia, followed by thematic analysis of transcripts. Additional to structural burdens encountered by the general older population, CALD carers faced challenges understanding Australia's Anglo-centric aged care system, locating culturally appropriate care and were required to translate the languages and operations of health and aged care systems into terms their family members understood. This burden was mitigated by the presence of ethno-specific organisations and other navigation support. Australia's aged care system has moved towards centralised governance and consumer-directed care provision. This system involves a confusing array of different programmes and levels, bureaucratic applications and long waiting times. Carers' encounters with these systems demonstrates how some CALD people are being left behind by the current aged care system. While ethno-specific services can reduce this burden, not all CALD groups are represented. Consequently, improving access to dementia care among CALD populations requires entry point and navigation support that is culturally appropriate and linguistically accessible.

Information work of hospital librarians: Making the invisible visible

The aim of this paper is to explore and to make visible how the information work of hospital librarians is enacted in key practices where services of the hospital library are employed to support evidence-based practice. The empirical material was produced at three hospital libraries in three different regions in Sweden between January and March 2020. A practice-oriented approach using the theoretical lens information work is employed to analyze nine semi-structured interviews with hospital librarians and hospital library managers, together with field notes from observations of interactions between hospital librarians and healthcare practitioners. The analysis investigates the conditions for information work performed by hospital librarians as they participate in three key practices: clinical practices, information seeking practices, and HTA-practices. The results of the analysis are related to four categories of invisible information work, and the nature of the information work done to counter different types of invisibilities within the key practices is discussed. The findings suggest that a substantial amount of the information work of hospital librarians is invisible to clinicians. At the same time, considerable efforts are made by hospital librarians to counter different types of invisibility, for example through building relationships with healthcare staff and to develop and make specialized competencies visible. In particular, the importance assigned to evidence-based practice in healthcare allows for the librarians to be regarded by clinicians as legitimate partners with clearly defined competencies in specific situations.

Effectiveness-implementation hybrid type 2 study evaluating an intervention to support 'information work' in dementia care: an implementation study protocol

INTRODUCTION

Patients with long-term conditions consistently report a lack of information around services and support available to them. This unmet need for information is significant among people with dementia and family carers. A quality improvement intervention is being carried out to tackle this issue as part of a co-creation initiative in the North East of England (UK). The intervention consists of the dissemination (via the local Community Mental Health Services for Older People) of a leaflet about services available to people with dementia and their family carers in the study site. This protocol is reported in accordance with the Standards for Reporting Implementation Studies.

METHODS AND ANALYSIS

This effectiveness-implementation hybrid type 2 study aims at understanding (1) the unfolding and outcomes of the implementation strategy, (2) the outcomes of the intervention (for people with dementia and family carers, staff implementing the intervention and local service providers) and (3) the contribution of co-creation to the design and implementation of the intervention and its outcomes. The prospective theory of change of the intervention articulated by local stakeholders is used as a reference framework against which to assess the implementation and outcomes of the intervention. Evaluation data will be collected through in-depth interviews with people with dementia and family carers receiving the intervention, staff implementing the intervention and managers from local service providers. Referral data from local service providers will be collected to triangulate the interview data. A focus group with key stakeholders will support the sense-making of findings. The realist configuration of mechanism-context-outcome, operationalised using an information behaviour model, will inform data analysis and interpretation.

ETHICS AND DISSEMINATION

Ethical and research governance approvals have been obtained from the West Midlands-South Birmingham Research Ethics Committee. The results of the study will be submitted for publication in peer-reviewed journals and disseminated through conferences.

Exploring interface design to support caregivers' needs and feelings of trust in online content

INTRODUCTION

Family caregivers of people living with dementia require a range of accurate, current, and reliable information throughout the care trajectory. Much of this information is available online, however it can be difficult for caregivers to identify and decide what content is relevant to them. Little is known about how online design cues impact family caregivers' decision to assess how trustworthy information is and whether to engage with it.

METHODS

Our exploratory research focused on the interface design of CARE-RATE, an online search tool intended to support more effective information searches for family caregivers seeking dementia care-related resources. Data from focus groups were coupled with design literature to inform the development of three mockups that were evaluated by seven dementia caregiver experts.

RESULTS

Participants preferred a search bar design because of its simplicity, familiarity, and functionality. Design elements that impact trust included logos from reputable organizations, transparency of content author, and ratings from other caregivers.

CONCLUSION

Feelings of trust regarding information, including the ability to ascertain trustworthiness, is a major aspect of caregivers' willingness to engage with online content. Transparency and familiarity appear to be key elements that impact caregivers' trust in online information, which agrees with current web design research.

Considering the local and the translocal

Purpose

Institutional ethnography is a method of inquiry that brings attention to people’s everyday work while simultaneously highlighting broader sites of administration and governance that may be organising that work. The purpose of this paper is to argue that the integration of institutional ethnography in health information practice research represents an important shift in the way that Library and Information Science professionals and researchers study and understand these practices.

Design/methodology/approach

This paper first explores the key tenets and conceptual underpinnings of Dorothy Smith’s institutional ethnography, illuminating the importance of moving between translocal and the local contexts and identifying ruling relations. Drawing from a library and information science study that combined interviews and textual analyses to examine the social organisation of family caregivers’ health-related information work, the paper then explores the affordances of starting in the local particularities and then moving outwards to the translocal.

Findings

The paper concludes with an overall assessment of what institutional ethnography can contribute to investigations of health information practices. By pushing from the local to the translocal, institutional ethnography enables a questioning of existing library and information science conceptualisations of context and of reappraising the everyday-life information seeking work/non-work dichotomy. Ultimately, in considering both the local and the translocal, institutional ethnography casts a wider net on understanding individuals’ health information practices.

Originality/value

With only two retrieved studies that combine institutional ethnography with the study of health information practices, this paper offers health information practice researchers a new method of inquiry in which to reframe the application of methods used.

Context, mechanisms and outcomes in end-of-life care for people with advanced dementia: family carers perspective

Background

Keeping people living with advanced dementia in their usual place of residence is becoming a key governmental goal but to achieve this, family carers and health care professionals must negotiate how to provide optimal care. Previously, we reported a realist analysis of the health care professional perspective. Here, we report on family carer perspectives. We aimed to understand the similarities and differences between the two perspectives, gain insights into how the interdependent roles of family carers and HCPs can be optimised, and make recommendations for policy and practice.

Method

Qualitative study using a realist approach in which we used the criteria from guidance on optimal palliative care in advanced dementia to examine key contexts, mechanisms and outcomes highlighted by family carers.

Results

The themes and views of family caregivers resonate with those of health care professionals. Their overlapping anxieties related to business-driven care homes, uncertainty of families when making EOL decisions and the importance of symptom management referring to contexts, mechanisms and outcomes, respectively. Contexts specific to family carers were ad hoc information about services, dementia progression and access to funding. Not all family carers identified dementia as terminal, but many recognised the importance of continuity of care and knowing the wishes of the person with dementia. New mechanisms included specific resources for improving EOL care and barriers to discussing and planning for future care. Family carers identified the importance of comfort, being present, the meeting of basic care needs and feeling the right decisions have been made as good outcomes of care.

Conclusions

Family carers and health care professionals share similar concerns about the challenges to good EOL dementia care. Better understanding of the effects of dementia at the advanced stages would improve confidence in EOL care and reduce uncertainty in decision making for family carers and health care professionals.