Exploring Family Support for Older Chinese Singaporean Women in a Confucian Society

Exploring the lived experience of Chinese family caregivers caring for end-of-life cancer patients at home: a phenomenological study in Singapore

PURPOSE

The Chinese community constitutes the largest demographic and faces the highest rates of cancer incidence in Singapore. Given this, palliative care plays a crucial role in supporting individuals, particularly those nearing the end of life, with family serving as their primary source of support. Many Chinese family caregivers in Singapore reported significant unmet needs in cancer care provision, with studies indicating that they often bear the brunt of caregiving responsibilities. Despite this, there has been a lack of research exploring the needs and perspectives of Chinese Singaporean family caregivers caring for terminally ill cancer patients at home. Thus, this study seeks to address this gap by investigating the lived experiences of Chinese Singaporean family caregivers providing end-of-life cancer care in a home setting.

METHODS

This study employed a hermeneutic phenomenological approach, guided by the framework developed by van Manen (1990), to uncover the essential meaning of each participant's lived experience. In-depth, semi-structured virtual interviews were conducted face-to-face with ten Chinese Singaporean family caregivers. These caregivers shared their personal journeys of caring for a loved one with advanced cancer during their final stage of life at home. The interviews were audio recorded, and open-ended questions were used to facilitate discussion. Each interview lasted between 30 and 60 min. The principal investigator manually transcribed all audio recordings. Additionally, an external transcriber translated the interviews into written form to ensure accuracy and authenticity. The interview texts were then analyzed and interpreted using the philosophical underpinnings rooted in phenomenology.

RESULTS

The attempts to identify meanings and make sense of the Chinese Singaporean's lived experience led to the development of two main themes and eight sub-themes. Under the primary theme of "experiences from caregiving" comprises the sub-themes "being a caregiver," "suffering," and "well-being," and the major theme of "expectations in caregiving" encompasses the sub-themes "caregiving support," "decision-making," "communication," "spirituality," and "being a Chinese Singaporean".

CONCLUSION

In conclusion, addressing family caregivers' needs requires culturally sensitive nursing education, peer support initiatives, public awareness campaigns, and enhanced training for domestic helpers. These measures, coupled with further research into diverse cultural caregiving needs and male caregivers' experiences, will improve support systems and empower caregivers in their essential roles.

The relationship among pregnancy-related anxiety, perceived social support, family function and resilience in Chinese pregnant women: a structural equation modeling analysis

BACKGROUND

Accumulating evidence suggests that pregnancy-related anxiety (PRA) has adverse impacts on maternity health and infant development. A substantial body of literature has documented the important influence of family function, perceived social support and resilience on PRA. However, research identifying the mediating mechanisms underlying this relationship in China are still lacking. Therefore, the current study aimed to investigate the prevalence of PRA under the three-child policy in China, and also explore the interrelationships among perceived social support, family function, resilience, and PRA.

METHODS

In this cross-sectional study, a convenient sampling method was used to select 579 pregnant women who underwent prenatal examination at the maternity outpatient departments of the First Affiliated Hospital of Chongqing Medical University in China from December 2021 to April 2022. Participants were required to complete the following questionnaires: the demographic form, the Chinese Pregnancy-related Anxiety scale, the 10-item Connor-Davidson Resilience Scale, the APGAR Family Care Index Scale, and Multidimensional Scale of Perceived Social Support. Pearson correlation analysis was utilized to examine the rudimentary relationship among the study variables. Bootstrapping analyses in the structural equation modeling were applied to identify the significance of indirect effects.

RESULTS

There were 41.4% of pregnant Chinese women indicating PRA. Correlational analyses indicated that perceived social support, family function and resilience were negatively associated with PRA (r = - 0.47, P < 0.01; r = - 0.43, P < 0.01; r = - 0.37, P < 0.01, respectively). The results of bootstrapping analyses demonstrated significant indirect effects of perceived social support (β = - 0.098, 95% CI [- 0.184, - 0.021]) and family function (β = - 0.049, 95% CI [- 0.103, - 0.011]) on PRA via resilience.

CONCLUSIONS

Chinese pregnant women are suffering from high levels of PRA. Better family function and perceived social support might reduce the occurrence of PRA, as well as by the mediating effects of resilience. Healthcare providers must be concerned about PRA and perform corresponding actions to reduce it. By strengthening social support and improving family function, antenatal care providers could effectively reduce or prevent PRA. And more importantly, implementing resilience-promoting measures are also essential to relieve anxiety and support mental health in pregnant women.

How Does Confucianism Influence Health Behaviors, Health Outcomes and Medical Decisions? A Scoping Review

The aim of this study is to analyze the influence of Confucianism on health behaviors, health outcomes and medical decisions. The research was conducted using the following databases: PubMed, Scopus, CINHAL, PsycINFO and Web of Science, without restrictions of language and year of publication. The search process identified 833 publications matching the search criteria, and after the review process, 40 articles were included. Family is a central aspect of Confucianism, and it seems to affect participation in medical decisions, taking care of relatives, ethical dilemmas and mental health problems. Although most Confucianist influence seems to be positive, some ways of thinking could increase suffering, burnout and a delay in healthcare seeking. Understanding these values could help health professionals to deal with the growing contingent of patients with different cultures and religious beliefs.

Perceptions of pelvic floor dysfunction and rehabilitation care amongst women in southeast China after radical hysterectomy: a qualitative study

Objective

To investigate the perceptions of pelvic floor dysfunction (PFD) and rehabilitation care amongst women after radical hysterectomy and to explore ways to improve quality of care.

Methods

Thirty-six women who underwent radical hysterectomy at a hospital in southeast China were enrolled via purposive sampling. Semi-structured in-depth interviews were conducted. The texts were analysed via qualitative content analysis.

Results

Four themes were obtained: serious lack of knowledge, heavy psychological burden, different coping strategies and great eagerness to receive multiparty support on PFD rehabilitation care.

Conclusion

The society and professional staff should strengthen health education on PFD. Professionals should offer education before and after surgery and actively provide rehabilitation consultation to promote the availability of rehabilitation to support women with PFD rehabilitation care. In addition, family-centred care is an important way to support women to return to normal life, and women's need for family support should be more actively expressed. Moreover, knowledge of medical insurance should be popularised, especially in rural areas in China.

Review and Implications of Intergenerational Communication and Social Support in Chronic Disease Care and Participation in Health Research of Low-Income, Minority Older Adults in the United States

Background: Health disparities disproportionally affect Black and Hispanic older US adults. Health research is needed to understand and eliminate these disparities; however, older adults, and particularly Black and Hispanic/Latino older adults are underrepresented in health research. Adult children have influenced health behavior and health outcomes of their older parents in several demographics in the US. Analysis of these studies can lead to a model for the development of interventions aimed at improving health and healthcare participation of older Black and Hispanic US adults. Objectives: To review the role of intergenerational communication and social support in health behavior, health research, and health outcomes for older adults and to apply these findings toward a model for health interventions for Black and Hispanic US older adults. Methods: An analytical narrative review and application toward an intervention model. Results: Key topic areas were reviewed and analyzed by examining studies that applied forms of intergenerational communication and/or intergenerational social support with the goal of either improving health, disease management and/or participation in health research in populations world-wide. Next, a model for providing health interventions in older Black and Hispanic US adults was developed using strategies gleaned from the findings. Conclusion: A model for health intervention for Black and Hispanic/Latino US older adults was presented based on an analytical review and intergenerational communication and/or social support. Qualitative data are necessary to understand the enablers and barriers of intergenerational communication and social support to improve health outcomes in these populations.

Tensions in support for family caregivers of people with dementia in Singapore: A qualitative study

BACKGROUND

Family members as informal caregivers are considered the first line of support for people with dementia across the world. In Singapore, caregiving expectations revolve around the cultural expectations of providing care in the home environment. However, studies in Singapore have identified a lack of family support for primary caregivers. Family support has been discussed in the literature as the provision of care for people with dementia, and rarely as a resource for family caregivers.

METHOD

To understand family support among primary caregivers in Singapore, 24 semi-structured interviews were conducted. Thematic analysis found four themes: excuses for lack of physical support for the caregiver, tensions between cultural expectations of caregiving and the provision of support, unmet emotional support, and lack of awareness of dementia and caregiving needs.

FINDINGS

Caregivers rationalized and forgave the absence of physical support but were frustrated when the lack of support impacted people with dementia. This was seen as a lack of fulfilling cultural obligations of caring for elderly parents. The caregivers also felt frustrated with the lack of emotional support provided to them, but these were unspoken between the caregiver and the family members. Insufficient and unhelpful support giving was exacerbated with the perception of family members' limited understanding of the demands of caregiving.

CONCLUSION

The findings offer four practical suggestions to address unmet support needs. First, public education is needed to enhance general knowledge about the symptoms and progression of dementia. Second, help is needed to address miscommunication about support within the family. Third, the development of guidebooks is needed to help family caregivers communicate with family members about their various support needs. Fourth, the relationship between cultural expectation and caregiving must be understood within the context of modernity and urbanism.

Does the Presence of Anxiety and Depression Symptoms Mediate the Association Between Family Functions and Self-Efficacy in Pregnant Women in the Third Trimester?: A Community-Based Cross-Sectional Survey

Objectives: Pregnant women in the third trimester can be more vulnerable to adverse mental health outcomes, but there is limited research on the association between family function and self-efficacy and potential mediation by symptoms of anxiety and depression. Methods: The cross-sectional study enrolled 813 pregnant women in the third trimester from 14 communities of Hengyang city, Hunan province of China. All of the participants completed a battery of self-report measures of family function (Family Adaptation Partnership Growth and Resolve Index, APGAR-family), self-efficacy (General Self-Efficacy Scale, GSES), anxiety (measured by Generalized Anxiety Disorder scale with seven items, GAD-7), and depression symptoms (Patient Health Questionnaire with nine items, PHQ-9). The correlation analysis was performed using Spearman's correlation coefficient. Baron and Kenny's method and multiple mediation models with bootstrapping were used to determine whether the symptoms of anxiety and depression mediated the association between family functions and self-efficacy. Results: There were 22.6% pregnant women in the low level of self-efficacy, with 60.9% in the moderate level and 16.5% of respondents in the high level. Self-efficacy had significant correlations with both anxiety symptoms (r = -0.19, p < 0.05), depression symptoms (r = -0.22, p < 0.05), and family function (r = 0.31, p < 0.05). Anxiety symptoms were significantly associated with self-efficacy (β = -0.016, p < 0.05). Depression symptoms were significantly associated with self-efficacy (β = -0.024, p < 0.05). Anxiety and depression symptoms partly mediated the association between family function and self-efficacy, accounting for 11.4 and 16.4% of total effect, respectively. It was indicated that pregnant women with a high degree of family function are less likely to have emotional symptoms and predicted to have higher levels of self-efficacy. Conclusions: Anxiety and depression show mediating effects in the association between family function and self-efficacy. Improved family function can have a positive impact on pregnant women in the third trimester.

Examining Live-In Foreign Domestic Helpers as a Coping Resource for Family Caregivers of People With Dementia in Singapore

In Singapore, the responsibility of caring for persons with dementia falls on family members who cope with a long-term caregiver burden, depending on available support resources. Hiring foreign domestic workers to alleviate caregiver burden becomes a prevalent coping strategy that caregivers adopt. This strategy allows caregivers to provide home care as part of fulfilling family obligations while managing the caregiver burden. This study aimed to investigate primary caregivers' relationship with hired support and its impact on coping with caregiver burden. Twenty in-depth interviews were conducted with primary caregivers who hired live-in domestic helpers to take care of their family members with dementia. The findings revealed that caregivers perceived the normative obligations to provide home care to family members with dementia. They sought support from domestic helpers to cope with physical and mental burnout, disruption of normal routines, and avoidance of financial strain. A mutual-support relationship was built between caregivers and domestic helpers through trust and interdependence. The presence of domestic helpers as a coping resource reveals the positive outcomes of problem-, emotional-, and diversion-focused coping. This study illustrates that coping strategies are employed in different ways depending on the needs of caregivers, access to infrastructure, cultural expectations, and available resources.