An Exploratory Multi-Case Study of the Health and Wellbeing Needs, Relationships and Experiences of Health and Social Care Service Users and the People who Support them at Home

Abstract

Introduction: International policies and legislation set a precedence of person-centred sustainable integrated Health and Social Care (HSC) that meets the health and wellbeing needs of service users through improved experiences. However, current research focuses on service models, with fewer studies investigating experiences and needs.Methods: This qualitative multi-case [n = 7] study was co-designed with key stakeholders and aimed to explore experiences and needs of people who access and provide HSC at home. Data were collected in a regional area of Scotland (UK) via single [n = 10] or dyad [n = 4] semi-structured interviews with service users [n = 6], informal carers [n = 5] and HSC staff [n = 7] and synthesised using Interpretive Thematic Analysis.Findings: Interpersonal connections and supportive relationships were instrumental in helping all participant groups feel able to cope with their changing HSC needs and roles. They promoted reassurance, information sharing and reduced anxiety; when they were lacking, it negatively impacted upon experiences of HSC.Discussion: Promoting inter-personal connections that encourage supportive relationships between people who access and provide HSC and their communities, could promote person-centred Relationship-based care and improve HSC experiences.Conclusions: This study identifies indicators for improved HSC, advocating co-produced community-driven services to meet the self-defined needs of those who access and provide care.

Use of Home and Community-Based Services and Loneliness in Older People with Functional Limitations

“…As we know, functionally limited older adults are at great risk of feeling lonely due to a decline in social participation, loss of autonomy, and potentially decreasing social relationships [65]. Possible mechanisms underlying the relationship between HCBS use and loneliness include how HCBS may help expand the social network of older adults with disabilities and increase their opportunities for social participation [30][31]35]. In terms of the subjective experience of individuals, HCBS help older adults with disabilities perceive subjective increased availability of support [33] and make meaningful social connections with professionals, while receiving the emotional support of close family and friends [66-67].…”

“…with the following responses: 1) day care centers, nursing homes, senior meals; 2) regular medical checkups; 3) home visits; 4) family beds (a form of care in which a patient is regularly visited at home by a professional for treatment, and the progress of the service is documented in a medical record); 5) community nursing; 6) health management; 7) entertainment; 8) other services; or 9) none of the above. In our study, the value of this variable was coded as "treatment group" if the respondent selected one or more of the above choices and home care services, otherwise the value of this variable was coded as "control group" if the respondent selected "9) none of the above;" this method has been applied in other existing studies [31,35].…”

“…First, limited by qualitative inductive design, previous studies have focused on describing perspectives of older adults with disabilities on experienced loneliness during home-based rehabilitation [36], but we know little about the loneliness of functionally limited older adults in China. Also, previous studies have reported that those who received HCBS were more likely to have objective social contacts [30][31]35], without examining the association of HCBS use with speci c loneliness. This is important because it is possible to feel lonely even when one is surrounded by people.…”

“…HCBS helped all participants access social relationships [33] and promoted reassurance [34], indicating HCBS might be a potential way to reduce the risk of loneliness. Although studies have reported that those who received HCBS were more likely to have objective social contacts [30][31]35] and subjective perceived availability of support [33], knowledge gaps still exist in the association of HCBS and loneliness. First, limited by qualitative inductive design, previous studies have focused on describing perspectives of older adults with disabilities on experienced loneliness during home-based rehabilitation [36], but we know little about the loneliness of functionally limited older adults in China.…”