Impact of Care-Recipient Resistance During Care Provision on Caregiver Emotional/Physical Well-Being: A Sequential Mixed Method Design with Between- and Within-Person Analyses and Semi-Structured Interviews

Abstract

To address some remaining questions in the extant family caregiving literature, the present study examined a specific care-recipient (CR) problematic behavior that could be the most critical to family caregiver (CG) emotional and physical well-being--CR-resistance or uncooperative behaviors vis-Ã -vis the CG. In order to provide detailed descriptions of CR-resistance and to determine the impact of CR-resistance on CG emotional and physical well-being, the present study applied a sequential quantitative-qualitative mixed method design approach with 8-day diary survey data on 63 family CGs and follow-up semi-structured interview data from 19 of those CGs.The quantitative data documented and revealed significant within- and between-person variance in CR-resistance. Hierarchical Linear Modeling (HLM) analyses results further revealed that neither the mean level nor the daily fluctuation of CR-resistance across 8 survey days by themselves appeared to have a significant impact on CG emotional or physical health. However, the combination of having relatively high mean level and daily fluctuation of CR-resistance brought had a significant impact on CG physical health; when CGs with relatively high mean level CR-resistance faced more than their usual amount of CR-resistance on a given day, they reported increases in physical health symptoms.The qualitative inductive thematic analyses revealed that based on the context in which CR-resistance occurred and the occurrence patterns, CR-resistance experiences could be divided into four types, and these four types of CR-resistance seem to pose different types and/or magnitude of impact on CG emotional well-being.Furthermore, informed by Social Cognitive Theory and Stress Theory, the present study also examined CG personal, interpersonal, and social resources as possible moderators of the link between CR-resistance and CG emotional/physical well-being. HLM analyses results revealed that CG sense of efficacy, community/professional service utilization, and family disagreement regarding care played significant moderating roles. The qualitative thematic analyses clearly suggested that specific CG cognitive resources--particularly those that were transferred and/or generalized from the CG's past professional or personal experiences--have a strong influence on CG resilience in the face of CR-resistance. The moderating results were interpreted light of theoretical frameworks and extant literature. Implications and future directions are discussed.