Unravelling Swedish informal caregivers’ Generalised Resistance Deficits

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Informal caregivers (hence caregivers) provide the majority of care received by older adults not residing within formal care facilities. This emphasis on community care and demographic changes collaborates to make caregivers a fast‐growing population with specific needs 1, and a range of organisations have been founded to plead their cause (e.g. 3). Despite this population's heterogeneousness and each situation's uniqueness, a major intension is to provide scientific evidence informing policymakers regarding how they should create support and policies that enhance caregivers’ capability to continue their caregiving with acceptable levels of quality of life, well‐being and health (cf. 9).
Regulations regarding what is, and what is not, encompassed in ‘informal care’ differ from nation to nation. In Sweden, providing informal care should be a voluntary commitment complementing formal care 2. However, the reality is frequently the opposite. Therefore, the government has reinforced the legislation, and since 2009, Swedish municipalities are required to provide support for caregivers 11. This law does not stipulate how and what kind of support, merely that the municipalities have this obligation. An audit, published in 2014, revealed extensive differences between the municipalities regarding how they had proceeded to meet this new requirement. It also showed that they still failed to deliver the individualised, flexible support of good‐quality caregivers needed due to their diversifying circumstances 13. This seems alarming, since failing to meet this type of requirements may negatively affect not only individuals, but also welfare systems and economies 1. One underlying reason as to why the municipalities had failed may be lack of knowledge regarding the individual and communal (i.e. shared) resources caregivers use to resolve the challenges caregiving imposes upon them. Since resources are contextually dependent and each municipal has its own context, it seems as if such a knowledge gap makes it difficult to determine the type of support and policy a municipality should provide for ‘its’ caregivers. This section refers to Sweden and Swedish caregivers, but it seems likely that lacking knowledge regarding a target group's resources may have the same effect in other contexts.
Within caregiving research, far less congruent knowledge exists regarding positive aspects and resources than regarding negative aspects and risks, even if a paradigm shift has provided a more balanced picture (e.g. 14). To fill this knowledge gap, the resource‐oriented salutogenic theory focusing on how to maintain health, even when affected by stressors, may be utilised 17. This theory has been suggested as the appropriate theoretical framework when conducting health promotion according to the intensions of the Ottawa charter 19, and a handbook on salutogenesis guiding such actions has recently been published 25. In this study 26, the salutogenic framework was utilised to derive knowledge that could be used to promote caregivers’ health the ‘salutogenic way’ (cf. 20). A review of caregiving research literature showed that salutogenesis had mainly been utilised with quantitative designs to investigate the theoretical concept Sense of Coherence (SOC). Most results showed that a strong SOC increased a caregiver's capability to meet the challenges caregiving imposed. Consequently, a strengthening of caregivers’ SOC was frequently suggested as implications, but how such a strengthening could be accomplished was rarely described. The reason for this lack of guidance seems to be the focus on the SOC, instead of on the theoretical concepts Specific and Generalised Resistance Resources (SRRs/GRRs) or Specific and Generalised Resistance Deficits (SRDs/GRDs), which are essential for processes involved in the strengthening and weakening of the SOC 17.
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