5.1. Appropriateness of Study Design, Representativenes and Reliability of Empirical Findings
Since LDCs are a neglected target-group in the public health sector in Austria [33
], an explorative-qualitative case-study based approach, exploring the suitability of the current offer of NCDFs for LDCs in one of the nine provinces of Austria was chosen addressing the “providers’” perspective. For time exposure reasons, the geographical dispersion [57
], of the NCDFs and due to the fact that there was no opportunity for third-party funding for this research, it was decided to conduct a written survey of all NCDF-group leaders in this province.
The results are based on a written survey of the NCDF-group leaders only show one side of the coin and call for research on the opinions of the LCDs relating to their support needs and ideas on the design of suitable NCDFs.
Nonetheless, related to the empirical findings a high representativeness is ensured due to a response rate of 61% out of all 77 Upper Austrian NCDFs. We can only speculate about the reasons for non-participation.
Given the fact that usually only one group leader is responsible for the NCDFs, in a way, the group leaders who have responded also reflect the situation in NDFs that, geographically speaking, have a regional dimension. It cannot be implied whether the results are true for the other eight Austrian provinces.
In addition, the limited information on LDCs indicates that the respondents know little about this target group and their health literacy and making use of health promotion offers. This, in turn, implies frankness in answering the questions and indicates reliability. Furthermore, the NCDF-group leaders cite the reasons for their knowledge deficit.
Since the NCDF-group leaders were not asked to unfold their assessment rules related to the life and strain situations of LDCs, it remains entirely open whether professional expertise and private experiences were mixed up.
However, it can be assumed that this is closely related to the fact that there still is a large knowledge gap on this target group in Austria [34
5.2. Interrelations between the Profile and Advertisment of the Current NCDF-Offer and the Lack of Reachability of LDCs
At this point, first of all it should be noted that in general caregiving persons are less likely to use health-promoting measures compared to non-carers [9
]. Referring to LDCs, one always has to keep in mind that time constrains are the focal obstacle that (could) hinder LDCs from making use of face-to-face and on-site health promotion offers. Besides that, the empirical results of the Upper Austrian case-study—in line with international findings [5
]—show that a lack of information about availability of NCDFs [56
] and the inappropriateness of the existing offer may explain the lack of reachability of LDCs.
Interestingly, the respondents did not interrelate reachability of LDCs with advertising efforts. This is quite comprehensible, as NCDFs are intensively advertised in urban and suburban, as well as in rural municipalities in a variety of ways, above all focusing the local level and directly addressing caregiving relatives—as was the case in 24 out of 47 cases—by telephone, Facebook or mail.
However, it must be recognized that the NCDF-group leaders neither have information on the procedure of the so-called “direct communication with LCDs”, nor are they able to assess the success of direct communication with the members of this specific target group.
5.3. On the Potential of NCDFs as a Health Promotion Measure and Requirements for a LDC-Suitable NCDF-Offer
Aside from the general problem of the measurability of the immediateness of effects of health-promotion measures [58
], basing on the survey results, first of all it can be assumed that an ideal support, relief or health promoting measure never will exist due to the impossibility considering the great diversity of the LDCs’ living and caregiving situations [10
]. At best, NCDFs will become a health promoting measure among others, above all web-based offers [36
For the heterogeneous collective of LDCs, it is difficult to estimate the need for professionally-led support groups such as the NCDFs, because the caregiving situations, including the amount of formal, or rather professional (health and care), and of informal (future) family support on-site, as well as the degree of personally experienced strains associated to strategies differ from case to case. Considering this, sound empirical data on the use of health promotion measures by LDCs are still missing [25
], but are urgently needed.
In addition, we still know little about the LDCs’ health literacy and self-awareness as a target group for health promotion, and in general. There is a knowledge gap on the meaning of professionally led on-site support groups for LDCs. Moreover, against the backdrop of time constraints, we do not know about whether LDCs give precedence to an informal chat with a friend with a cup of coffee over a professionally led conversation. It can be assumed that this decision also essentially depends on the content of the conversation (professional advice versus speaking something from one’s soul). Both in Austria and elsewhere, an in-depth discussion considering a wide-spread geographical scope on the issues of what is currently being discussed in NCDFs and—as far as LDCs are among the participants—what is burning in the soul of LDCs is needed.
Assuming that LDCs are or rather would be interested in face-to-face professionally led group-discussions on-site—regardless of whether the cared-for parent(s) is or are living at home or in a nursing home—based on the findings for the local caregiving relatives, only a small number of actual demanders can be expected. At this point, it is recalled that (1) the small number of participants of mainly female caregiving relatives (spouses) belonging to the first generation of caregiving relatives as well as the interrelation between the decline of use of health promotion measures and increasing age [4
], (2) the small number of participants belonging to the second generation of caregiving relatives (daughters, daughters-in-law) as well as the observed declining trend of utilization and (3) the downwards trending NCDF-attendance [33
Findings from the written survey referring to the differences between the strains and requirements of local caregiving relatives and LDCs and from literature can serve as a starting point for conceptualizing LDC-suitable NCDFs (see Table 7
Although both target groups suffer from time constraints, physical distress dominates in local caregivers, whereas today’s LDCs are more likely to be psychologically overstrained [26
]. It is to be expected that the psychological burdens of those LDCs, whose parent(s) in need of care are living in rural areas, will increase in the near future, because due to the continuing trend towards the beanpole family, the support potential within the family will decrease [35
]. This, in turn, will raise particularly the loneliness among the very old [59
]. Furthermore, in rural areas, the provision of daily goods and services, including mobile social and health care is thinning out and the accessibility of age-specific infrastructure facilities becomes more and more challenging [60
]. These developments affect especially those LDCs who are on the one hand are single children, and whose spouses or partners experience the same caregiving situation on the other hand.
Since LDCs perceive geographical distances differently—on the one hand, they are experienced liberating and relieving, on the other hand, they can enhance the psychological pressure on LDCs—the perceived emotional pressure on LDCs also depends on their cared-for-older parents’ understanding for the demanding caregiving-situation and caregiving limitations [26
]. Against this backdrop, the question arises of whether NCDFs for LDCs (in the future will) take over the function of “a safe haven” (according to justification and serving as time-outs from caregiving), focusing on exchanging personal caregiving experiences with others. Here, further healthcare research needs to focus more on health promotion measures from the perspective of the different target groups [10
]. Due to the fact that non-carers are more likely to use health promotion measures than caregivers [9
], and the assumption that work-life-balance becomes more important in society as well as it is predicted that health promotion will gain a higher social value in the future [63
], referring to the potential of NCDFs as a health promotion measure, it is important to consider the following three questions:
Where should NCDFs be located in order to save time?
To what extent and at which locations could a handful of LDCs be brought together?
What are the requirements for tailor-made NCDFs in terms of organization and scope?
Based on the NCDF-group leaders’ assessments, the following conceptual relations can be derived (see Table 7
), which need to be evaluated in the course of future quantitative-oriented studies exploring both the provider’s (NCDF-group leaders) and the “consumer’s” (LDCs’) perspective (see Table 7
The profile of the NCDF-participants is as follows: women and men in midlife, of different marital status.
LDCs living in cities or towns with older parent(s) in need of care living in rural municipalities are not likely to make us of NCDFs located in their parents’ rural residential municipality. This may be due to the “fact” that LDCs only come for caregiving reasons and exclusively dedicate each minute to their parent(s). NCDFs are to be designed as a location-based offer in the residence municipalities or (urban) working places of LDCs.
Urban NCDFs might have a larger catchment area of LDCs and a larger number of (potentially interested) LDCs in comparison to NCDFs in rural municipalities.
At the moment, we can only speculate about the scope of tailor-made NCDFs for LDCs. Basing on evidence on the burdens and strains of LDCs, dealing with guilt and responsibility may be focal issues.
LDCs approach to NCDFS with different concerns in comparison to local caregivers. That is why it should be considered to offer target-group-specific and LDC-specialized NCDF-offers regardless of the spatial setting.