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E-health and information- and communication technology (ICT) as support systems for older family caregivers in rural areas
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.ORCID iD: 0000-0003-1428-1950
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall objective of the thesis was to investigate how older family caregivers in rural areas experienced participation in an e-health based caregiver support system. Participants were 95 caregivers allocated to intervention group (n=63) and control group (n=32). The thesis had a mixed method design and is based on four original articles (I-IV). Data was collected through web-camera interviews (I-III), telephone interviews (II,IV) and questionnaires (II,IV) after 1.5 years of using e-health support. Quantitative data was analyzed using comparative statistics, multiple linear regression and logistic regression. Qualitative data was analyzed with content analysis. Article I showed that the caregivers, despite lacking experience from using computers, were able to adopt the new technology, with help from support nurses and family. Caregivers felt e-health helped them to regain social inclusion. Article II had a comparative design, comparing e-health support with conventional caregiver support. Caregivers using e-health were more satisfied with their support and found it to be available, flexible and helping them enhance caregiver competence. Control group caregivers were less satisfied with support and experienced unmet needs. Article III showed that e-health can reduce caregivers’ feelings of isolation. Two themes were created, Expanding the concept of place and Developing networks. Article IV revealed that caregivers used e-health frequently, experienced benefits from using it and had become more independent. Support nurses were disappointed about the decrease in contact with caregivers, and also acknowledged a need for developing the professional nursing role while working with e-health. Conclusions drawn from the findings were that participants experienced benefits from e-health support and it helped them become more independent. Swedish municipalities are obliged to provide caregiver support, the findings from the study are valid to conclude that e-health support are as good as, or even more effective, than conventional support for older family caregivers in rural areas.

Abstract [sv]

Det övergripande syftet vara att undersöka hur äldre anhörigvårdare på landsbygden upplevde att få anhörigstöd via en e-hälsa-tjänst. Avhandlingen hade en mixed method design och bestod av fyra originalarbeten (I-IV). Deltagare i studien var 95 personer, boendes i gles- och landsbygdsområden, som i det egna hemmet vårdade en make eller maka med kronisk sjukdom. Deltagarna var fördelade på interventionsgrupp (n=63) och kontrollgrupp (n=32). Datainsamling skedde efter 1.5 års användning av e-anhhörigstödet, genom web-kamera intervjuer (I-III), telefonintervjuer (II,IV) och frågeformulär (II,IV). Kvantitativa data analyserades genom komparativ statistik, multipel linjär regression och logistisk regression. Kvalitativa data analyserades med innehållsanalys. Artikel I visade att anhörigvårdarna, även om de inte hade någon vana av datorer sedan tidigare, kunde lära sig och bli användare av den teknik och utrustning som ingick i e-anhörigstödet, när de fick hjälp och stöd av anhörigstödjare eller andra. Anhörigvårdarna upplevde att e-anhörigstödet hjälpte dem att återfå social delaktighet. Artikel II hade en komparativ design och jämförde e-anhörigstöd med traditionellt anhörigstöd. De som använde e-anhörigstödet var nöjda med stödet i högre utsträckning än de som fick traditionellt stöd. E-anhörigstödet upplevdes som tillgänglig, flexibelt samt bidrog till att de utvecklade sin kompetens i vårdandet. Kontrollgruppen var mindre nöjd med sitt stöd samt upplevde att de hade behov som inte tillgodoseddes av stödet. Artikel III visade att e-anhörigstöd kan minska anhörigvårdares upplevelse av isolering, dels genom att de upplevde en känsla av att vara på andra platser fast de rent fysiskt befann sig i hemmet, dels genom att de utvecklade sociala nätverk. Artikel IV visade att anhörigvårdarna ofta använde e-anhörigstödet och att de upplevde nytta av att använda det. De blev också mer självständiga vilket ledde till färre kontakter med anhörigstödspersonalen. Personalen kände viss besvikelse över att kontakterna iv

med anhöriga minskade och uttryckte att den professionella omvårdnads-rollen behöver utvecklas när e-hälsa införs och tillämpas i vård- och omsorgsarbete. Slutsatser som drogs från fynden i avhandlingen var att anhörigvårdarna hade stor nytta av att använda e-anhörigstöd samt att det hjälpte dem att bli mer självständiga, vilket reducerade deras behov av kontakt med kommunernas anhörigstöd. Sveriges kommuner har en skyldighet enligt lag att tillhandahålla anhörigstöd, med stöd av fynden från den här studien kan man dra slutsatsen att e-anhörigstöd kan fungera lika bra som, ibland till och med effektivare än, traditionellt anhörigstöd.

Place, publisher, year, edition, pages
Sundsvall: Mittuniversitetet , 2014. , 60 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 203
Keyword [en]
caregiver support, e-health, family caregivers, ICT, isolation, rural health, web-camera interviews
Keyword [sv]
anhörigstöd, e-hälsa, informations- och kommunikationsteknologi, IKT, isolering, glesbygd, web-kamera intervjuer
National Category
Nursing Nursing
Identifiers
URN: urn:nbn:se:miun:diva-23281ISBN: 978-91-87557-87-3 (print)OAI: oai:DiVA.org:miun-23281DiVA: diva2:758156
Public defence
2014-10-17, M102, Sundsvall, 14:00 (Swedish)
Opponent
Supervisors
Available from: 2014-10-24 Created: 2014-10-24 Last updated: 2014-11-06Bibliographically approved
List of papers
1. Older family carers in rural areas - experiences from using caregiver support services based on Information and Communication Technology (ICT)
Open this publication in new window or tab >>Older family carers in rural areas - experiences from using caregiver support services based on Information and Communication Technology (ICT)
2013 (English)In: European Journal of Ageing, ISSN 1613-9372, Vol. 10, no 3, 1-9 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this intervention study was to illuminate the meaning of ICT-basedcaregiver support as experienced by older family carers living in vast ruralareas, caring for a spouse at home. In order to access the support serviceparticipants were provided with a computer and high speed Internet in theirhomes. Semi structured webcam-interviews were carried out with 31 familycarers. A strategy for webcam interviewing was developed in order to ensurequality and create a comfortable interview situation for the family carers.Interviews were analyzed using content analyses, resulting in the themes: Adoptingnew technology with help from others and Regaining social inclusion.The results indicate that ICT-based support can be valuable for older familycarers in rural areas as it contributes to improve quality in daily life in anumber of ways. In order to fully experience the benefits, family carers needto be frequent users of the provided support. Adequate training andencouragement from others were essential in motivating family carers to use thesupport service. Access to Internet and webcamera contributed to reducingloneliness and isolation, strengthening relationships with relatives living faraway and enabled access to services no longer available in the area. Use of theICT-service had a positive influence on the relationship between the oldercarer and adult grandchildren. It also contributed to carer competence andpromote feelings of regaining independence and a societal role.

Keyword
carer support, family carer, information and communication technology, rural, webcam interviews
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-15498 (URN)10.1007/s10433-013-0260-1 (DOI)000322722100004 ()2-s2.0-84881030471 (Scopus ID)
Available from: 2011-12-20 Created: 2011-12-20 Last updated: 2014-10-24Bibliographically approved
2. The benefits of e-health support for older family caregivers in rural areas
Open this publication in new window or tab >>The benefits of e-health support for older family caregivers in rural areas
2014 (English)In: Journal of Telemedicine and Telecare, ISSN 1357-633X, Vol. 20, no 2, 63-69 p.Article in journal (Refereed) Published
Abstract [en]

We conducted a pragmatic, mixed methods study comparing rural family caregivers receiving e-health caregiver support (n = 35) with a control group (n = 21) receiving conventional, non-e-health, caregiver support. After 18 months, the benefits of support were evaluated using the Care Effectiveness Scale (40-items exploring the domains of preparedness, enrichment and predictability). In all domains the e-health group scored significantly higher than the control group. The adjusted difference for overall benefits was 3.0 (P = 0.02) on the scale 0-10. In addition, semi structured interviews were conducted with a sub-sample of the caregivers. For the e-health group flexibility, availability and being able to individualise the support were essential factors. All caregivers in the control group found conventional support to be beneficial, but also stressed unmet needs related to the conventional support being standardised and non-flexible. The study suggests that providers of caregiver support should offer e-health support as an alternative to conventional caregiver support, as it can be more beneficial to family caregivers.

National Category
Nursing Information Systems, Social aspects
Identifiers
urn:nbn:se:miun:diva-21990 (URN)10.1177/1357633X13519901 (DOI)000332530600002 ()2-s2.0-84898838648 (Scopus ID)
Available from: 2014-06-04 Created: 2014-05-28 Last updated: 2015-01-14Bibliographically approved

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