Family Caregivers’ Preparedness to Support the Physical Activity of Patients at Risk for Hospital Readmission in Rural Communities: A Qualitative Study

doi:10.21203/rs.3.rs-1417221/v1

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Research Article

Family Caregivers’ Preparedness to Support the Physical Activity of Patients at Risk for Hospital Readmission in Rural Communities: A Qualitative Study

https://doi.org/10.21203/rs.3.rs-1417221/v1

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Background

Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients’ engagement in physical activity. Yet, there is very little research on family caregivers’ perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored family caregivers’ perspectives on their preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission.

Methods

In this qualitative descriptive study, semi-structured interviews were conducted by telephone with sixteen family caregivers. Interview transcripts were analyzed using conventional qualitative content analysis.

Results

Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26–67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 63%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers felt unprepared to support their relative’s physical activity, 2) family caregivers believed that rest was more important than physical activity to their relative’s recovery, 3) insufficient preparation for physical activity led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity.

Conclusions

Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-relative conflict surrounding physical activity, assess family caregivers’ ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative’s physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

physical activity

families

caregivers

preparedness

rural healthcare

hospital readmission

hospital-to-home transitional care

Physical activity refers to any bodily movement that expends energy and is not limited to exercise but also includes movements such as walking and doing housework [1]. Low physical activity in the post-discharge period is associated with poor health outcomes and 30-day hospital readmission [2–4]. Accordingly, promoting patients’ physical activity in the post-discharge period is important to maximize their recovery and prevent hospital readmissions.

Family caregivers (FCs) are often responsible for supporting their relative’s recovery after hospital discharge. While healthcare providers have identified FCs as potential facilitators of patients’ engagement in physical activity [5, 6], very few studies have examined FCs’ perspectives on their preparedness to support the physical activity of a relative. Furthermore, no studies have focused specifically on FCs of patients at risk for hospital readmission in rural communities. This is a crucial gap because nowhere are FCs more integral to patients’ physical activity following hospitalization than in rural communities. Rural communities have limited healthcare resources and face barriers to healthcare access because of distance, resulting in many patients relying heavily on their FCs [7].

Rural communities also typically have higher proportions of older people and people with multiple chronic conditions [7], which are risk factors for physical inactivity [8] and hospital readmission [2]. Understanding FCs’ perceived preparedness to support physical activity is crucial to knowing how to best position FCs to assist their relatives after discharge. Consequently, this study explored FCs’ perspectives on their preparedness to support the physical activity of a recently hospitalized rural-dwelling relative at risk for readmission.

Study Design

This qualitative descriptive study is part of a larger multi-method project in which FCs were interviewed on their preparedness to support multiple aspects of a relative’s post-discharge care [9, 10]. This paper focuses on FCs’ preparedness to support physical activity. Semi-structured telephone interviews were conducted to explore FCs’ perspectives of their preparedness to support the physical activity of a rural-dwelling relative at risk for hospital readmission. Interviews were conducted within 30 days of patients’ hospital discharge.

Sample and Setting

Our purposeful sample consisted of adults aged 18+ who were the unpaid, primary caregiver of an adult relative discharged home to a rural community following hospitalization for a medical illness or surgical procedure, able to stand or weight bear, and at risk for hospital readmission. FCs were recruited through hospital staff referrals as well as study flyers circulated throughout rural Southwestern and Northeastern Ontario. We targeted 8 to 12 FCs per region (for a total of 16 to 24 FCs) until informational saturation was reached. Two research team members (MF and JB) separately ascertained that saturation had been achieved with 16 FCs.

Data Collection

FCs were screened for eligibility, and information on their sociodemographic characteristics was obtained using the measures reported below. Qualitative interviews, guided by a semi-structured interview guide, were used to collect data on family caregivers’ perceived preparedness to support their relative’s physical activity.

Screening and Sociodemographic Measures

To determine if potential participants were caring for a relative at risk for hospital readmission, the LACE index was employed. The LACE uses four variables to assess risk for hospital readmission during the 30-day post-discharge period: length of stay in hospital (“L”), acuity of hospital admission (“A”), comorbidities (“C”), and ED visits in the six months prior to admission (“E”) [11]. LACE data were obtained through self-report or from medical records. LACE indices from 5 to 9 indicate moderate risk of hospital readmission whereas indices > 9 indicate high risk [11]. The LACE index was previously validated as a predictor of 30-day hospital readmission and demonstrated high discriminant ability [12].

To establish that potential participants were caring for a relative living in a rural community, we used the Rurality Index of Ontario – a census-based metric that uses population size and travel time to the nearest healthcare center. Scores were acquired by inputting the relative’s postal code into an online calculator; indices > 40 indicate rural residency, with higher indices indicating higher rurality [13]. Other eligibility criteria (e.g., age) were screened with self-report measures.

We used the corresponding item of the Basic Physical Capability Scale [14] to determine if potential participants’ relatives were able to stand or weight bear on discharge (indicated by a score of 1). Data were obtained by FC report. The scale demonstrated construct validity (all items fit the Rasch model testing) and internal consistency reliability (Cronbach’s alpha = 0.79) [14].

Additional FC eligibility criteria including age 18+, English speaking and reading, and primary unpaid caregiver were screened with self-report measures. FCs’ socio-demographic profile (highest level of education, employment status, and household income) were assessed using standard self-report questions.

Qualitative Interviews

Interviews were conducted using a semi-structured interview guide. Participants were invited to reflect on their recent hospital and post-discharge experience and to describe any parts of their relative’s care at home for which they felt unprepared, as well as any help they received at the hospital or at home to prepare them to support their relative’s physical activity. FCs were also asked to discuss if/how they could have been better prepared in supporting their relative’s physical activity. To prompt participants to clarify or expand on their responses, FCs were asked if there was anything specific about the physical activity recommendations (if any had been provided) they found difficult to implement and what would have made it easier for them to support their relative’s physical activity at home.

Data Analysis

Participants’ average standing on the screening and socio-demographic measures was summarized with descriptive statistics. Interview data were analyzed using conventional qualitative content analysis, which entailed creating preliminary codes and grouping them into hierarchically organized meta- and sub-categories [15]. Definitions for each code, category, and subcategory were developed, their interconnections recorded, and exemplars for each were identified. Salient categories were refined into overarching, interpretive themes. Where relevant, we accounted for negative cases and trends in participants’ narratives based on demographics (e.g., gender). Strategies for trustworthiness were employed continuously [16].

A total of 56 FCs expressed interest in the study but 6 declined the offer to participate after hearing more about what it entailed, and 22 were ineligible. Of the 23 eligible, consenting FCs, two became ineligible when their relative’s status changed, and 10 withdrew (most implicitly, by not responding to requests to schedule an interview). The final sample size was 16. All participants provided informed written consent.

Most FCs were women (n = 14; 87.5%) with an average age of 49 years (range 26–67). All self-identified as Caucasian. The majority were married or common law (n = 11; 68%). Most had a college diploma, apprenticeship or trades certificate (n = 10; 62.5%), were employed full-time (n = 10; 62.5%) and had an annual household income less than $70,000 before taxes (n = 9; 56.3%).

Most FCs were the primary caregiver of a parent (n = 9; 56.3%) and were living in the same home as their relative (n = 10; 62.5%) in a community with a median rurality index of 50 (range 41–89). Most FCs were the primary caregiver of a relative who had been hospitalized for a medical illness (n = 12; 63%) and was at high risk for hospital readmission, manifested by a mean LACE index of 10.9 (± 2.7).

Qualitative analysis revealed four themes: 1) FCs generally felt unprepared to support their relative’s physical activity, 2) FCs believed that rest was more important than physical activity to their relative’s recovery, 3) insufficient physical activity preparation led to FC-relative conflicts, 4) to defuse these conflicts, some FCs wanted healthcare providers to be responsible for promoting physical activity.

Theme 1: Family Caregivers Generally Felt Unprepared To Support Their Relative’s Physical Activity

FCs described receiving very limited preparation in hospital or at home on how to support physical activity; only FC5 reported having received sufficient preparation in the form of “very specific instructions about how much he [FC5’s father] should be doing, his leg flexes, and arm lifts.” Most expressed having received no information at all. For example, FC7 noted that she “never was spoken to at all about his [FC7’s father’s] condition by anybody”, and FC8 similarly recalled that “I've never talked to anybody. I've never had anybody talk to us [FC and his mother], it's, ‘Oh, you're good to go’ [to be discharged].”

Specifically, FCs emphasized that the preparation they and their relative received was inadequate in three ways. First, those FCs who did receive information from healthcare providers characterized it as vague and insufficiently detailed to guide FCs on how to support their relative’s physical activity. For example, some FCs explained that healthcare providers’ instructions included “get as much activity as you can”, “walk but don’t overdo it”, and “just take it easy.”

Second, FCs received insufficient guidance on what to expect in terms of their relative’s capacity for physical activity after discharge. In other words, FCs were unsure what their relative’s starting point for returning to their pre-hospitalization baseline would be. FF10, for instance, criticized that she did not even “know if he [her father] was going to be able to get in and out of bed by himself.”

Third, FCs received insufficient guidance on the progression of their relative’s recovery and how physical activity figured into it. They highlighted numerous ways in which they were uncertain about the trajectory it would take, and how they could support it. For example, FCs such as FC15 recounted not knowing what level of physical activity their relative should engage in at a given point in the recovery process:

I think what we [FC15 and his wife] were missing was a clear progression, path, what to expect, how many days in terms of mobility and getting around and when we need to start progressing it. Not having any clear, again plan of, you know, how much can she [FC15’s wife] move on the first day and how much can she move on the second and third day [after coming home from hospital]? [This] made it very difficult, and has still made it difficult, trying to figure out how much is too much and is this amount of pain just a normal part of recovery or has it now hit the point where we’re pushing too hard [physically] and going the opposite way from recovery by causing too much strain.

Consequently, FCs were unsure how to best support their relative’s physical activity after discharge; that is, they lacked information on the concrete steps and physical activities they needed to encourage their relative to engage in to facilitate recovery. FC7, for instance, recalled telling her father that “I don’t even really know what's best for you to get up the stairs at the front of the house. Should you be leading with your dominant foot? Or should you be leading with your injured foot?” FC7, similarly, recalled needing to know more about the “simple things, just day to day, you know, ‘how long he should be up walking for?” Typically, FCs were only confronted with the full ramifications of their lack of preparation when their relative returned home from hospital and realized that they did not know how to support their relatives’ physical activity. FCs acknowledged the importance of their relative’s return to physical activity, but conceded that, as FCs, they were unprepared for how to help their relative achieve that goal.

Theme 2: Most family caregivers believed that rest was more important than physical activity to their relative’s recovery

In the absence of direction explicitly outlining how to support their relative’s physical activity, FCs relied on their “common sense”, which was informed by the belief that rest promotes healing, and too much physical activity threatens recovery. In practice, that meant emphasizing rest over physical activity. FC11, for instance, explained that when she “didn't get anything [physical activity plan or instructions] from them [healthcare providers]”, she automatically assumed “he’s [FC11’s father] supposed to get lots of rest…just came from common sense, make sure he's getting enough rest.” She went on to describe how she saw her father’s eagerness to resume physical activity as something to be limited:

You need to ensure that your body has that time to heal. I know a lot of people go home after surgery and want to lay in bed. It was kind of the opposite for my dad. [He] wanted to get up and get moving and get back to his daily activities. And that's the goal, but, I think you can’t go at 100 percent all the time while you’re healing.

FCs’ entrenched views on the importance of rest were evidenced by their criticism of healthcare providers who, FCs believed, pushed their relative too hard after a period of prolonged inactivity during hospitalization. For some FCs, the belief that rest had to be promoted was so strong that they disputed healthcare providers’ instructions that heavily emphasized physical activity. FC7 noted with frustration that “they told him, ‘You can't walk enough.’ Well, I would argue that [it was too much] when he was out walking for five hours, up and down hills and trying to help with projects around the house. And then the next day, he felt like crap all day.”

FC2 also recounted resisting healthcare providers’ guidance to let her mother do as much for herself as possible. As FC2 put it: “She [FC2’s mother] can do it, but the thing is, if she’s coming home and she’s supposed to recover, she shouldn’t be doing those things. She will say that she can do all those things, you know, clean, cook, laundry, but the thing is she shouldn’t be [doing them]. And, I see that [she can do it herself], but then I do it for her, you know, just, to help out so that she can recover, you know, get some rest.”

Theme 3: Insufficient Physical Activity Preparation Led To Family Caregiver-relative Conflicts

For those FCs who attempted to support physical activity, unclear guidelines created space for their relative to challenge their attempts. These FCs explained how, when they encouraged their relative to be more physically active, they experienced pushback. Notably, gender appeared to figure prominently in these dynamics; all the FCs who flagged their relative’s resistance to physical activity as problematic were women (i.e., wives/partners or daughters) caring for a male relative.

Analysis identified that FCs perceived pushback from their relatives as taking two main forms. First, some FCs reported that their relative actively questioned their credibility when it came to promoting physical activity and strategies to support it. As FC13 explained, her father “thinks we [family] don’t know what we’re talking about.” Other FCs recounted how their interpretation of healthcare providers’ instructions was viewed as suspect by their relative, who was skeptical that their FC had fully understood the instructions.

Second, other FCs described their relative’s outright refusal to engage in physical activity. FC13 noted that it’s “always a challenge - to get him [her father] to move.” FC7 similarly explained:

When we try to get him out walking, he just is very stubborn and won’t go. Or he refuses to do it. We’ve tried since he’s been home to get him out walking, and he just refuses to go.

FC4 concurred that the greatest “difficulty I had was to get him [FC4’s father] to do it [walk]”, because he made clear that “I don't have to listen to you.” FC4 suggested that this friction was the result of the established power dynamics of their relationship being upset by her father’s illness. As FC4 explained, “it’s kind of like a child with their parent, you know? Just the whole resistance part.” She maintained that, because her father felt disempowered, he was using interactions surrounding physical activity as an opportunity to assert himself. She elaborated that “it’s a control thing, because he doesn't have a lot of control over some things in his life, but he can control whether or not I help him, control him. If he'll think I'm trying to control him he doesn't want that, he wants his own control, autonomy.” Other FCs were less empathetic, and when faced with resistance from their relative they responded by relentlessly policing their relative’s physical activity. These FCs insisted that promoting physical activity required taking on an authoritative, taskmaster role to ensure her father engaged in sufficient activity.

Theme 4: To defuse these conflicts, some FCs wanted healthcare providers to be responsible for promoting physical activity

With such conflict in mind, some FCs indicated that, ideally, it would be healthcare providers’ responsibility to support their relative’s physical activity because a healthcare provider’s credibility and authority were more likely to be accepted. FC6 noted that:

I want her [FC6’s mother] to do more but there's nothing more I can do for her here by myself. She sees physiotherapy with me as just a game. When she does it with the physiotherapist, she understands it's serious and she needs to do it.

Accordingly, some FCs believed a healthcare provider would help their relative be more physically active. When asked about strategies to help their relative participate in physical activity, FC4 explained that “outside motivation…is something that works better with him [FC4’s husband]. For his PSW [personal support worker], he will do things for her [that he won’t do for me].” As FC10 conveyed “it’s always different when somebody else says it, right? Like the ones closest to you are the ones you least listen to.” FC13 similarly noted that:

I think having somebody else involved in telling him to get up and move a little bit more, I think that would be very helpful…they could kind of reiterate that it’ll only get better if you keep moving…getting it from somebody else other than his kids. I think he’d listen to somebody else.

Our study adds to the sparse literature on FCs’ perspectives on their preparedness to support physical activity in the post-discharge period and stakes out important new ground by exploring this issue specifically in the rural context. Given the outsized role FCs play in rural healthcare, promoting physical activity amongst patients at high risk for readmission – who often require significant support in the post-discharge period – thus involved carefully elucidating the FCs views.

In general, we identified that FCs of predominantly medical patients at high risk for hospital readmission do not feel prepared. Our study’s timely addition to this literature is essential because, even though current guidelines stress the importance of promoting physical activity during and following hospitalization, evidence indicates that many patients continue to have limited physical activity during hospitalization and consequently leave hospital with newly acquired declines in their physical functioning [17]. As a result, preparing FCs in how to support physical activity after hospital discharge is crucial to patients’ ability to return to their baseline pre-hospital levels of physical activity which, in turn, can influence recovery and sustainable hospital-to-home transitions.

That FCs received insufficient guidance on their relative’s capacity for physical activity and how to support it parallels Najjar et al.’s findings which identified that few FCs receive information on how to support their relative’s physical activity; FCs in that study indicated that their lack of knowledge was the greatest barrier in assisting their relative to mobilize [18]. Our finding that FCs needed more information on the trajectory of their relative’s recovery, and how physical activity figures into it, parallels other studies concluding that FCs need more information on their relative’s health trajectory [19], what to expect at home [20], and how to support physical activity after discharge [21]. In Mitchell et al.’s study, for instance, FCs identified the importance of having detailed post-discharge instructions to enhance their preparedness [22]. Crucially, FCs in that study maintained that, when they were prepared, they felt more competent, confident, and better able to adhere to post-discharge instructions [22].

Regarding our finding that FCs’ beliefs shape how they support physical activity, we were only able to locate a few relevant studies. Our finding that, in the absence of direction explicitly outlining how to support their relative’s physical activity, FCs relied on “common sense”, informed by the belief that too much physical activity threatens recovery, parallels Lim et al.’s study which reported that FCs tend to emphasize the importance of rest to their relative’s recovery [23]. Likewise, Najjar et al. found that FCs were hesitant to have their relatives mobilize in hospital because of the potential health dangers [18].

Overall, our study underscores how resistant many FCs were to supporting their relative’s physical activity because doing so led to interpersonal conflict. Our finding that a lack of clear guidelines created space for patients to challenge their FC’s attempts at promoting physical activity echoes Mitchell et al.’s finding indicating that when FCs and patients are poorly prepared for discharge, they experience confusion which can give rise to conflict [22]. Such friction may be rooted in FC-patient dynamics and may exacerbate conflictual relationships which are often characterized by disagreements surrounding each other’s capabilities, level of involvement in care, and healthcare decision-making [24]. In a systematic review of studies examining how FCs and patients support each other during patients’ chronic and terminal health conditions, McCauley et al. found that shifts in power dynamics were associated with role reversal, particularly in instances where the FC was historically in a subordinate position [25]. It may be that FCs in our study were wary of such conflicts when they indicated that they did not want to take on the responsibility for their relative’s physical activity.

Implications for practice and policy

The findings have several implications for practice. Healthcare providers can prepare FCs of patients at risk for hospital readmission by giving them information on their relative’s capacity for physical activity, how it promotes recovery, and how to support it. Healthcare providers should be conscious that FCs’ beliefs may lead to them suppressing their relative’s physical activity and should educate FCs on the hazards of inactivity in the post-discharge period. Ensuring that FCs recognize the importance of physical activity and promote it is essential because prior studies have identified that adults are more physically active when they are supported by family members [26]. Healthcare providers may consider modelling strategies that FCs can use to promote patient activity starting in hospital. Clear, rather than vague, physical activity guidelines are needed because the latter are open to interpretation and have the potential to serve as a source of friction. Healthcare providers should be attuned to the potential for FC-patient conflict when relying on FCs to support patients’ physical activity. Ideally, physical activity instructions should be given to FCs and patients together to provide the opportunity to seek clarification and achieve consensus about the activity plan moving forward.

On a policy level, decision-makers should note that our call for better FC preparation should not be construed as an endorsement of having FCs take on roles that are beyond their abilities. Overestimating FCs’ capacity to take on the seemingly straightforward task of supporting a relative’s physical activity could lead to an important element of post-discharge care being neglected or ignored altogether.

Implications for research

In terms of implications for future research, more studies are needed on FCs’ perspectives of rest and physical activity in the post-discharge period, particularly in FCs of patients at risk for hospital readmission in rural settings. Future research is needed to explore how pervasive the belief is amongst FCs that rest should supersede physical activity during recovery, as well as whether and how such beliefs function as barriers to patients’ physical activity. More research is also needed on interpersonal conflict rooted in the promotion of physical activity and how to address it. For example, studies should examine the precise nature of the conflict in the post-discharge period and the factors (e.g., lack of clear guidelines) influencing conflict and physical activity adherence. Lastly, while our study identified that FCs reported receiving vague instructions from healthcare providers on how to support physical activity, future studies with healthcare providers are needed to explore the nature of their instructions surrounding physical activity. It is possible that healthcare providers attempted to put instructions in lay terms that are accessible to FCs but in doing so may have inadvertently rendered them imprecise and open to interpretation.

The study was conducted in one province of Canada, which may limit the transferability of the findings to other rural jurisdictions. Our entire sample identified as Caucasian and thus may not speak to the full diversity of perspectives on preparedness for supporting the physical activity of a relative discharged from hospital.

Despite assertions that FCs are a potential source of support for patient physical activity, our study revealed that FCs are largely unprepared to support the physical activity of a relative recently discharged from hospital. Our findings suggest that more work needs to be done to ensure FCs can assume that role and perform it effectively. This is particularly important given that many patients are discharged with newly acquired functional declines [17] and many rural communities have limited formal healthcare services to support them. FCs need information on their relative’s capacity for physical activity, how it promotes recovery, and clear guidelines on how to support it. Healthcare providers should be conscious of the potential for family caregiver-patient conflict surrounding physical activity, assess family caregivers’ ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly.

Ethics approval and consent to participate: Ethics approval was obtained from the Office of Research Ethics at York University, Certificate#: e2018-014, and from the Research Ethics Office at Health Sciences North, Project# 18-053. Written informed consent was obtained from all participants. All methods were carried out in accordance with the relevant guidelines and regulations of the World Health Organization’s Declaration of Helsinki.

Consent for publication: N/A

Availability of data and materials: According to the guidelines of our hospital site’s Research Ethics Board, we are not permitted to post the study data for public consumption. Given that our sample was recruited from small towns and participants’ narratives may be recognizable to others even in de-identified data, we are also unable to share the data by request.

Competing interests: The authors declare that they have no competing interests.

Funding: This work is supported by the Ontario Ministry of Health & Long-Term Care, Health System Research Fund, grant #484. The Ontario Ministry of Health & Long-Term Care had no role in the writing of this manuscript.

Authors’ contributions: All authors made substantial contributions to the conception or design of the manuscript, or the analysis or interpretation of the data and participated in drafting the manuscript and revising it critically for important intellectual content. All authors read and approved the final version. MF conceived the study. MF, JB and SS designed it. MF and JB analyzed the data and led the overall writing of the manuscript. SS critically revised the manuscript for important intellectual content. AN assisted with reviewing the literature and drafting the implications for practice section.

Acknowledgements: The authors are grateful to the family caregivers who shared their perspectives with us.

Authors' information:

MF is an Associate Professor in the School of Nursing and holds appointments at the School of Health Policy and Management, the School of Kinesiology and Health Sciences at York University. She is an Adjunct Scientist at the KITE Toronto Rehabilitation Institute of University Health Network in Toronto, Canada. Her research focuses on older persons’ functional abilities during illness and responds to profound social and economic changes (e.g., population aging, the movement of care into communities) affecting healthcare services in Canada and beyond.

JB holds a PhD in Sociology from York University and is a Project Manager in the School of Nursing at York University and the Faculty of Nursing at the University of Alberta. His research focuses on improving gerontological care and health outcomes for older persons in Canada.

SS was a full professor at the School of Nursing, Ryerson University, at the time of writing this paper. Her research focuses on the design and evaluation of health and patient-centered interventions.

AN is a Geriatric Nurse Practitioner at Humber River Hospital. She is currently pursuing a PhD in Nursing at York University. Her research interests focus on the use of digital health in supporting family caregivers during the hospital-to-home transition of an older relative.

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No competing interests reported.

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Editorial decision: Major revision
04 Apr, 2022
Reviews received at journal
16 Mar, 2022
Reviewers agreed at journal
16 Mar, 2022
Reviewers agreed at journal
14 Mar, 2022
Reviewers invited by journal
14 Mar, 2022
Editor assigned by journal
14 Mar, 2022
Editor invited by journal
14 Mar, 2022
Submission checks completed at journal
14 Mar, 2022
First submitted to journal
03 Mar, 2022

You are reading this latest preprint version

Family Caregivers’ Preparedness to Support the Physical Activity of Patients at Risk for Hospital Readmission in Rural Communities: A Qualitative Study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Background

Methods

Results

Theme 1: Family Caregivers Generally Felt Unprepared To Support Their Relative’s Physical Activity

Theme 3: Insufficient Physical Activity Preparation Led To Family Caregiver-relative Conflicts

Discussion

Limitations

Conclusions

Declarations

Authors' information:

References

Competing Interests

Status:

Version 1