1,721,255 research outputs found
Understanding how dementia caregivers' interactions with their social environment affect their pre-death grief experiences : a causal loop diagram
No full textBackground: Pre-death grief is an inexorable phenomenon experienced by dementia caregivers. However, current research tends to overfocus on caregivers’ intrapsychic and caregiver-recipient relational grief processes. The role of the social environment and how caregivers interact with it in relation to their grief is overlooked.
Objectives: The thesis has two objectives. The first is to examine how the interactions between dementia caregivers and their social environment aggravate and attenuate caregivers’ pre-death grief. The second is to discover leverages in the interactions that could significantly affect caregivers’ pre-death grief.
Methods: The causal loop diagram (CLD), a systems thinking tool, was used to visualise and depict the systems of interactions between caregivers and their social environment. Based on conversations with 33 caregivers in Singapore, an enhanced purposive text analysis method was used to construct the CLD. The caregivers were recruited using purposeful, convenience, and snowball sampling methods. A maximum variation strategy was deployed to capture the broadest range of
experiences possible. Elements in the CLD were initially constructed using a thematic analysis approach embedded within the purposive text analysis method. The CLD was analysed to identify leverages, using Donella Meadows’ 12 places of intervention as a guiding framework. Eigenvector centrality values were calculated to rank the influence level of the elements on the CLD as leverage.
Findings: Thirty-two themes about caregivers’ grief were generated. After further analysis, 38 elements for the CLD were determined. The resulting CLD consisted of 128 directed connections and 37,854 feedback loops. The analysis of eight subsystems of interactions provided refreshing and sometimes paradoxical insights. Based on eigenvector centrality values, ten elements are identified as highly influential leverages.
Discussions: Based on the analysis, three key findings were developed. The findings are expressed as three recognitions about caregivers’ grief arising from their interactions with the social environment. The first is recognition of the complex interactional dynamics. The second is recognition of the deep influence of family (including the person with dementia and domestic helper) and fellow caregivers on caregivers’ grief. The third is recognition of caregivers’ agency amidst grieving.
Significances: By studying the interactions, this thesis expands and deepens the conceptual understanding of pre-death grief of caregivers. It also provides a novel proof-of-concept methodology for studying other thanatological topics. The thesis highlights a strong need to promote systemic practice approaches in working with caregivers to live with pre-death grief. The thesis also inspires the development of a new concept called compassion capital for future research.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
The role of rumination in coping with bereavement
No full textThe loss of a significant other is one of the most stressful events in life. Rumination is a common response to bereavement in which bereaved individuals engage in preoccupations, repetitive thoughts and emotions associated with the loss. Research on rumination has been predominately on studying bereavement in mood-related context and viewing rumination as a unitary construct. Taking a multifaceted view, this study aims to explore the inter-relationships among different types of rumination, the effect of different rumination types on bereavement outcomes, and the indirect effect of different rumination types on bereavement outcomes moderated by avoidance and confrontation coping responses, thereby gaining a deeper understanding of the role of rumination in coping with bereavement.
One hundred and thirty two Hong Kong Chinese adults completed an on-line questionnaire assessing rumination, coping responses and bereavement outcomes. Results indicate the four types of rumination, namely Brooding, Reflection, Intrusive rumination and Deliberate rumination are positively associated with each other. The correlation r ranges from 0.23 to 0.63, and all with statistical significance. Brooding and Intrusive rumination are positively associated with distress (r ranged from .38 to .63, p<.01) and negatively with life satisfaction (r= -35 and -.240 respectively, p<.01). Among the avoidance coping responses examined, Cognitive Avoidance is found to buffer the level of anxiety for the high brooders or those with more intrusive rumination. While avoidance coping strategies have been portrayed as maladaptive and literature tends to link the use of avoidance strategies to poor outcomes, present findings suggest that the use of Cognitive Avoidance can lower the influence of rumination on anxiety symptoms when one is disrupted by highly intrusive rumination (ß = -.24, R2= .39, p < .01), and brooding (ß = -.14, R2= .48, p < .05).
This study not only advances the theoretical understanding of the concept of rumination by disputing the unitary conceptualization, it also clarifies the distinctive roles of the different rumination types in affecting bereavement outcomes, and their interplay with coping mechanisms on impacting bereavement outcomes. Methodologically, results suggest scales assessing rumination and bereavement outcomes should be reviewed and revised to capture aspects that reflect the experience in a more comprehensive and precise manner. On practice level, it is suggested that assessment should be conducted to identify the rumination types and distress and targeted strategies be delineated with respect to bereaved individuals’ specific coping patterns and the ways they ruminate. (393 words)published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
Flexibility and psychological well-being of adolescents: the case in 512 Sichuan earthquake
No full textTraumatic events such as natural disasters and violence are still happening around the world. While most of the studies on traumatic events focus more on the pathological end of the continuum, research related to their impact on more generic aspects, such as the psychological well-being of individuals, is comparatively less. Furthermore, flexibility has been posited to play a crucial role in the development of psychological well-being in adolescents but its significance has seldom been examined in the context of traumatic events. In addition, the construct and characteristics of flexibility have never been discussed before and no self-report measurement of emotional flexibility exists. Therefore, this thesis attempts to fill these gaps and extend our understanding of both the knowledge of flexibility and its role in the psychological well-being of Chinese adolescents.
The nature of study 1 represents the ground work of this research, with the purpose of developing and validating a qualified self-report measurement of emotional flexibility in order to lay the foundation for answering the main research question of this study. A panel meeting was used at the very beginning to generate an item pool consisting of an inventory of emotional flexibility subscales: Exploratory Factor Analysis and Confirmatory Factor Analysis were employed to test the subscale structures as well as for the total scale of emotional flexibility. A three-factor model for match, the subscale of emotional flexibility and the total model comprising one higher-order factor of emotional flexibility derived from the 5 first-order factors, with 10 and 30 items respectively, have all been confirmed.
The purpose of study 2 is to clarify the construct of flexibility by investigating the relationships connected to flexibility in cognitive, behavioral and emotional aspects, as well as the relation between flexibility in these three aspects and coping flexibility. The participants in study 2 were 941 adolescents recruited from three middle schools with different levels of earthquake exposure in Sichuan. The results show that cognitive flexibility mediates the relationship between emotional flexibility and behavioral flexibility. Moreover, coping flexibility was found to be related to flexibility in three aspects in different manners.
Study 3 has been designed to answer the main research question of this study: what role does flexibility play in the psychological well-being of adolescents with earthquake experiences. A cross-sectional survey was performed to test the effect of flexibility in cognitive, behavioral and emotional aspects on the relationship between earthquake exposure and psychological well-being. The data in this study was the same as for those in study two. The results show that emotional flexibility and cognitive flexibility had moderating effects between earthquake exposure and psychological well-being.
The thesis has developed a measurement tool, clarified the construct and summarized the characteristics of flexibility as well as explored the role of flexibility in the psychological well-being of adolescents. The implications and limitations as well as future directions are proposed as well.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
Grieving thrice, suffering dually, becoming one : an interpretative phenomenological analysis of the end-of-life caregiving experience for persons with comorbid dementia and cancer
No full textDying with comorbid dementia and cancer is a growing phenomenon with the ageing population worldwide. Family caregivers of persons with comorbid dementia and cancer (PwDnC) may face significant distress and unique challenges owing to the complexity of the intertwined conditions and immediacy of death. However, few studies pay attention to the end-of-life caregiving experience of this unique group of family caregivers.
This study aims to understand and examine of the caregiving experience for PwDnC in their end-of-life from the perspective of family caregivers to explore the challenges and opportunities as experienced.
An interpretative phenomenological study was undertaken. Twenty-one bereaved family caregivers of PwDnC were recruited from a palliative care unit in Hong Kong through purposive sampling after receiving ethical approval. Eighteen semi-structured interviews were conducted with the family caregiver alone or with a pair of primary and secondary caregivers. The interviews were then transcribed and analysed following the philosophical principles of interpretative phenomenological analysis.
Two models are proposed by interpreting the findings in relation to existing knowledge and theoretical understanding. The 3-2-1 Model of Family Caregiving for PwDnC encapsulates the essential meaning of the phenomenon as a whole, and it is understood as “grieving thrice, suffering dually and becoming one”. The model is characterised by how family caregivers understood the meaning of togetherness after grieving losses from dementia through cancer to death and suffering dually with their loved ones.
The 5U Model of Ambiguous Suffering denotes the challenges and opportunities experienced by family caregivers. Ambiguous suffering is identified as the overarching concept that connects the five superordinate themes: unprepared anticipated loss, uncontrollable worries, unhelpful support, unrequited vicarious suffering and unremembered perpetual togetherness. Ambiguous suffering is not present before the diagnosis of cancer but emerges in the context of comorbid dementia and cancer when the family caregivers interpreting and appraising their internal and external resources.
These important findings fill the knowledge gap in the caregiving literature related to the end-of-life caregiving experience for PwDnC by developing new theoretical understandings of the meaning and process of caregiving. The findings also lay the foundation for the future development of appropriate policies and interventions to support family caregivers through a holistic approach.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
Physical activity and posttraumatic growth in patients receiving maintenance hemodialysis : a longitudinal study
No full textEnd-stage renal disease (ESRD) is the final stage of chronic kidney disease, indicating a severe loss of kidney function. Hemodialysis is the major treatment modality for ESRD in mainland China, and the prevalence of patients with hemodialysis-treated ESRD is expected to increase in the following decades. The research on ESRD and dialysis has primarily focused on the deleterious effects of disease and its treatment, such as elevated depressive symptoms and anxiety symptoms. However, understanding of psychological adjustment in dialysis population can benefit from a more balanced approach by integrating positive psychological experiences. The current research examined posttraumatic growth (PTG) and its association with physical activity in patients on maintenance hemodialysis.
This thesis presents a comprehensive systematic review of quantitative and qualitative studies on relationship between physical activity and PTG. To better synthesize the findings, a meta-analysis of quantitative studies was conducted to examine the average effect size for association between leisure-time physical activity and PTG, and a meta-ethnographic synthesis of qualitative studies was conducted to examine the processes linking physical activity and PTG. The meta-analysis revealed a positive, yet small, correlation between leisure-time physical activity and PTG. These effect sizes did not differ by measurements of PTG and participants’ age and sex but were smaller in studies with a binary variable of physical activity and a longer period since the stressful event. The meta-ethnographic synthesis identified potential mechanisms linking physical activity and PTG, including perception of self, social experiences, health effects, and philosophical re-evaluation. However, the systematic review highlights methodological limitations of previous studies, including predominantly using a cross-sectional design, employing less reliable measurements of physical activity, and examining solely the leisure-time or total physical activity.
This study used a prospective design to examine the predictive effect of context-specific physical activity on PTG and test the mediating effect of emotional distress and social support on this relationship in patients receiving maintenance hemodialysis. A consecutive sample of 150 patients from two hemodialysis units participated in this study, and 117 of them completed the assessment at the 12-month follow-up. The patients reported small to moderate levels of PTG in general, and patients were more likely to report higher levels of PTG if they were married, and perceived more social support and less emotional distress. Higher levels of physical activity in multiple contexts could predict greater PTG. Within the contexts of physical activity, transport-related, household, and leisure-time physical activity were positively associated with subsequent PTG. Social support mediated the relationship between household physical activity and PTG at baseline and follow-up, and depressive symptoms mediated the relationship of total physical activity with PTG at baseline.
The current research has provided empirical support for the link between physical activity and PTG in different daily contexts in patients receiving maintenance hemodialysis. Further study is suggested to test the alternative directional link of PTG to physical activity, use objective assessment of physical activity, and investigate additional potential factors that mediate the physical activity–PTG relationship in different daily contexts.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
My wonderful life: developing a game based intervention for patients with advanced cancer
No full textpublished_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
Rumination following bereavement in Chinese bereaved people : a process-oriented perspective
No full textRumination, a widely experienced cognitive process after the death of a close person, is expected to be linked to bereavement outcomes. However, the role of bereavement-specific rumination in bereavement adjustment remains unclear, probably due to the diversified conceptualization of rumination. Guided by a comprehensive literature review, this work proposes rumination as a process-oriented multicomponent construct. No valid measure exists for this integrative conceptualization. Moreover, findings from Western cultures may be inapplicable to the Chinese people, who embody a family-centered cultural value system. Therefore, this thesis aims to conceptualize a bereavement rumination process, develop an evidence-based and psychometrically rigorous measurement tool for the process, and investigate its role in bereavement adjustment among Chinese bereaved people.
The multilevel research objectives include describing, measuring, and exploring bereavement rumination and predicting its effect on bereavement outcomes. Thus, a multilevel inquiry involving qualitative and quantitative methods was adopted, namely, the exploratory sequential mixed method. In the first and qualitative phase, 16 bereaved people were interviewed about their bereavement-specific rumination experiences, thereby establishing the conceptualization and laying the foundation for developing a new measure. In the second and quantitative phase, 711 bereaved people completed a cross-sectional online survey, providing data for the measurement evaluation and model testing.
The qualitative phase entailed the thematic analysis of the interview transcriptions. Forty-five codes were grouped as different themes including the circumstances of occurrence, content, metacognition, and reaction. An item pool was also generated from the verbatim account to create the process-oriented multi-component measure of bereavement rumination.
The newly designed measure, Bereavement Rumination Process Scale (BRPS), and a few validated scales comprised the online survey in the quantitative phase. Split-half datasets were used to sequentially perform the exploratory factor analysis and confirmatory factor analysis. The finalized BRPS contains an 8-question section of circumstance, a seven-factor 39-item section of content, a three-factor 10-item section of metacognition, and a three-factor 8-item section of reaction. Circumstances include timing, location, companion, busy status, transit status, special days, life events, and reminders. Content includes yearning, recalling conflicts, regretting, self-comforting, seeking positivity, questioning feelings and reactions, and considering others. Metacognitions involve perceiving rumination as disturbance, connection, and assistance. Reaction comprises "let nature take its course," engagement, and disengagement. The BRPS demonstrated satisfactory internal consistency; test-retest reliability; and convergent, discriminant, and concurrent validity.
The test of the inter-component structure of bereavement rumination process using the full dataset verified the distinct mediating roles of metacognitions between content and reaction. Prevalence, risk and protective bereavement rumination patterns, content, metacognitions, and reactions were identified. Additionally, metacognition and reaction mediated the paths from content to bereavement outcomes.
This thesis advances knowledge by providing a process-oriented multicomponent conceptualization of the rumination process. It also poses new perspectives for theory development in bereavement-specific rumination by verifying the mediation model of the components in the process. The newly developed and validated measure is useful for future research and practice. Finally, this research adds the Chinese perspective to the study of bereavement and rumination.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
Understanding ambivalence of settlement: a qualitative study on time arrangement, gender relationship andidentity of rural-urban migrant families in Nanjing
No full textpublished_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph
Perceived parental support in the resilience of childhood cancer survivors in Singapore: an exploratorystudy
No full textpublished_or_final_versionSocial Work and Social AdministrationMasterMaster of Philosoph
An exploratory study on the change of family rituals among divorced parent families in Beijing
No full textpublished_or_final_versionSocial Work and Social AdministrationMasterMaster of Philosoph
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