Positive life stories of Stroke-Survivor's spousal caregiving in Hong Kong: Lessons for policy and practice.

BACKGROUND: Advances in medical-care for immediately post-stroke mean that many stroke-survivors now live a normal lifespan, although they may suffer residual disability. They are often cared for at home by their spouse, who may be ill-prepared for this task, and may also have health concerns. As demands on formal services increase with population aging in Hong Kong, equipping spousal-caregivers with positive effective caring strategies is increasingly important. OBJECTIVE: To understand what constitutes positive spousal-caregiving for stroke-survivors in Hong Kong within the cultural lens of 'Zhong (Loyalty)' METHOD: Naturalistic qualitative research was employed to hear stories about positive caregiving from Hong Kong couples living with stroke sequelae. Three in-depth face-to-face semi-structured interviews were undertaken with eleven dyads (stroke-survivor alone, spousal-caregiver alone, then the couple together). Data validation was by member-checking, further questions, and feedback at a second interview, and corroboration by field-notes. FINDINGS: A strength-based interactive model of positive spousal-caregiving was described, whose core tenet was Zhong (Loyalty). This fostered, and in turn was nurtured by, three paired key behaviours (1. Learning new skills linked with satisfaction when efforts paid off; 2. Utilizing formal and informal resources linked with supporting others; 3. Cherishing and bringing out the best linked with managing life- and self-care). Couples' capacity to develop these behaviours reflected their inner strengths. CONCLUSIONS: Couples who practiced positive caring and were resilient in the face of adversity were likely to optimise dyadic health and deal constructively with unexpected challenges. To address a looming shortfall between client need, and formal health and social services in Hong Kong, evidence-based policies are required to support effective, positive community-based spousal-caregiving.

Narrative therapy an evaluated intervention to improve stroke survivors' social and emotional adaptation.

OBJECTIVE: To describe a theoretical and practical framework of using a train metaphor in narrative therapy for stroke rehabilitation in group practice. BACKGROUND: There is a paucity of literature on the application of narrative therapy in meeting the psycho-social-spiritual needs of stroke survivors in rehabilitation. In the current article, the use of narrative therapy being evaluated in a formal randomized study in stroke survivors is described in detail. The metaphor may be of practical interest to those working with populations confronted with unpredictable life challenges. METHOD: Narrative practice using the metaphor of 'Train of life' is an alternative practice to psychopathology, which provides a means for the participants to deconstruct from the illness experience, re-author their lives, and reconstruct their identity with hopes and dreams. This therapeutic conversations, primarily using questions, can be divided into six steps: (1) engaging participants to a Concord station; (2) unfolding the experience with Stroke: where each of the participants are coming from; (3) dialoging directly with Stroke; (4) co-constructing the train carriage; (5) planning for a future life journey with Stroke; and (6) celebrating the unlocking of a new journey. Along with the train of life metaphor, therapeutic documents and outsider witness conversations are used to strengthen the preferred identity, as opposed to the problem-saturated identity of the participants. DISCUSSION: This metaphor poses an alternative methodology in stroke rehabilitation by reconnecting the survivors' inner resources, skills, and competencies. Eventually, it could re-author the survivors' identity developed from previous life challenges and reconstruct their purpose in life.

The relationship between psychological resources, social resources, and depression: results from older spousal caregivers in Hong Kong.

OBJECTIVES: The rapidly ageing population in Hong Kong has led to a major concern in providing care for the elderly. Due to the current social changes in Hong Kong, such as smaller family size, longer life spans, and increasing employment demands, spouses increasingly serve as the primary caregivers for older adults. To explore the mental health of older spousal caregivers, this study investigated the relationships between psychological resources, social resources, and depression. METHOD: One hundred fifty-eight spousal caregivers aged 55 and above were recruited from 13 caregiver resource centres in Hong Kong. Data were collected using structured questionnaires. RESULTS: Hierarchical regression analysis revealed that the number of duties and psychological resources including purpose in life, caregiver burden, and personal wellbeing explained 56% of the variance in depression. Logistic regression analysis further indicated that purpose in life predicted the likelihood of depression reported by caregivers. Social resources did not significantly predict depression. CONCLUSION: Results suggest that mental health enhancement programs should be developed for Chinese spousal caregivers with a focus on purpose in life, burden, and personal wellbeing.