Recent research underlines a significant discrepancy between how healthcare professionals interpret culturally competent and sensitive care and the actual experiences of patients with a migration background as well as their informal caregivers.
Despite progresses in healthcare practices, patients and their carers often find their needs unanswered and mostly unmet . Embracing the principles of person-centred care, it becomes imperative to integrate the voices of patients and informal caregivers into healthcare evaluation processes and change management initiatives.
This piece of research seeks to bridge this knowledge gap by exploring how informal caregivers with a migration background perceive the cultural sensitivity of care delivered by healthcare professionals within the framework of delivering integrated care in the community.
The aim is to explore whether the received care aligns with the needs and preferences of informal caregivers. Informal caregivers, as those closest to the care recipients and instrumental in organizing and providing care, provide a deeper perspective to consider in evaluating the cultural competence of healthcare providers and services.

Data collection of this research piece is part of the larger Diverse Elderly Care research project, which focuses on culturally sensitive dementia care for first-generation labour migrants in Brussels. Participants were selected through purposive sampling and identified via a network of community contacts and key individuals. Interviews were conducted in Dutch, French, and or Turkish (with interpreters). The project comprised 17 individual interviews with informal caregivers with a migration background: 9 caregivers with Italian background and 8 with Turkish background. Collective vignettes were used to represent the stories of informal caregivers in the results .

This research aspires to explore and clarify the cultural competence and sensitivity of healthcare services through the perspectives of informal caregivers, contributing to a more comprehensive understanding of the diverse care needs within our communities.

Evaluations of integrated care often focus on systemic or clinical outputs. Theoretically informed research emphasising values, preferences and voice of older persons in relation to the experiential dimensions of PCIC for service users is less prominent.

This paper presents key findings and recommendations of a multiple qualitative case study exploring older persons’ and caregivers’ experiences of PCIC in NICPOP, an Irish integrated care programme. Conceptual underpinnings of person-centred care (PCC) and of McCormack and McCance’s interprofessional Person-Centred Practice Framework (PCPF) (McCormack and McCance, 2021) were used as a sensitising framework to interpret data generated in 23 interviews with 32 service users across 3 heterogeneous NICPOP sites. This study addressed the dearth of research on older people’s experiences of PCIC. While the terms ‘integrated care’ and ‘PCC’ abound in health care policy and practice documents, there remain contested definitions on integrated care (Baxter et al, 2018), PCC (Mitchell, 2022), and PCIC (Greenfield, 2014) and a lack of data concerning service users’ felt experiences of PCIC.

A key finding of this study was the central importance of the therapeutic relationship and
alliance between NICPOP staff and the client and caregiver and the significant value participants
placed on this. Participants cited relational processes of care as more important to them
than clinical or transactional processes in terms of constituting a good care experience
for them. Findings reveal the importance of care context and model of care delivery for this care relationship. An intensive and long-term case management model was found to foster and maintain this trusted relationship, ensuring that clients and caregivers had a single and consistent point of contact with NICPOP. This in turn enabled enhanced service provider understandings of complex and changing needs in the context of chronic illness and multimorbidity and required holistic care responses. Case manager relationships resulted in reassuring felt experiences of coordination of care for service users.

Home-based, as compared with clinical hub based, models of care enabled relationship building, providing for greater insight into the psychosocial contexts of older people and their families, revealing vulnerabilities, priorities and related care needs, and facilitating more personalised holistic care. Findings suggest that longer-term models of care or finite interventions with the capacity of a follow-up check-in built in following discharge to enable re-engagement where necessary contribute to felt experiences of management and relational continuity. Findings also elucidated the necessity of understanding the power dynamics at play within relationships between service providers and service users and caregivers. Power and power relations were evident in terms of PCIC that empowers, and health system fragmentation and related inaccessibility of services that are disempowering and disenfranchising for clients and their caregivers.

Finally, this paper presents recommendations for policy and practice regarding the further development of NICPOP. These include the continuation of longer-term home-based models of care, especially for more vulnerable and complex presentations and the establishment of dynamic and adaptive approaches to longer-term engagement and incorporation of the potential to re-engage with ICTOP in response to emerging needs, ensuring management continuity of care.

Background:
Medical Home (MH) is a Hospital-at-Home (HaH) service model by Yishun Health (YH) delivering multi-disciplinary care for patients requiring acute medical care in their homes.

Yishun Health (YH) is a regional hospital system caring for 300,000 people in the north of Singapore that has embarked on a multi-year, whole regional health system transformation to improve outcomes. Care and services delivery transformation to enable greater person-centeredness and value-driven integration of care is based on the Unified Care Model (UCM) and its two subsidiary Episodic and Lifelong Care Models. A Population Health Survey conducted by YH in 2022 had also revealed that close to half of the caregivers living in the northern population served by YH reported caregiving-related needs that may require our help. MH is a critical component to enable YH’s ongoing remodeling of Episodic Care to meet residents’ needs during episodes of acute medical crisis and has been hypothesized to improve patient experience as well as reduce care giver burden.

Methods:
A mixed-method quasi-experimental study designed to recruit 125 eligible patients under MH, and 125 eligible patients who underwent usual hospital care under control group (CG) is currently ongoing. A preliminary analysis of the caregiver stress measured at admission, discharge and 90-days post-discharge from MH or the hospital was conducted for 125 MH patients and 125 controls. Caregiver was defined as the main spokesperson in charge of patient’s care, excluding domestic helper. Caregiver stress was measured using the Zarit Caregiver Burden Interview Short Form (ZBI-12).

Results:
Caregivers in both groups had similar age, gender, ethnicity, marital status and education level. A larger proportion of MH caregivers are working full time (MH 68.2% vs CG 50%; p0.033) while a larger proportion of CG caregivers has domestic helpers who live in with patients (MH 6.8% vs CG 44%; p<0.05). MH and control group caregivers had similar ZBI-12 scores on admission (MH: 12.35 vs CG: 12.56; p0.893) and discharge (MH: 10.57 vs CG: 12.06; p0.379). MH caregivers had a significantly lower ZBI-12 score compared to CG caregivers at 90-days post-discharge, (MH: 7.17 vs CG: 10.94; p0.019), indicating lower caregiver stress.

Conclusions:
MH service model is a value driven HaH alternative to Inpatient Care and supports YH’s ongoing remodeling of care process towards the Episodic Care Model. Caregivers of patients served by MH experienced significantly lower caregiver stress even at 90 days post discharge, despite a lower proportion having domestic helpers. More studies should be done to further evaluate the factors associated with caregiver stress and how a HaH service like MH can support and benefit more caregivers. Systemic scaling up of MH may help address and improve the extent of caregiving-related needs reported by YH’s northern population.

The Building Better Caregivers (BBC) is a 6-week self - management programme aimed at enhancing caregiving skills and reducing caregivers’ stress (Lorig et al., 2012, 2019). No study to date investigated the suitability of BBC in Ireland for the population of caregivers of people with cancer.
This project was developed in collaboration of a research team from Munster Technological University in Ireland and representatives of Recovery Haven Kerry Cancer Support House, which delivers caring and therapeutic services to those who have experienced cancer, their families and carers. The overall aim of this project was to implement and evaluate the BBC intervention in the population of caregivers of people with cancer in Ireland. Two data collections waves were completed. Both waves were conducted fully online (an introductory session was followed by 6 weekly 2.5-hour intervention sessions). A total of 15 participants took part.
The project employed sequential mixed methods design. Data were collected using multiple qualitative and quantitative methods, including individual interviews, reflective diaries, focus groups, observations, and six quantitative surveys. There were three data collection points for each wave: prior to, during and after the BBC programme. Qualitative data were analysed using thematic analysis, and quantitative data were analysed statistically.
The qualitative data analysis relieved three main themes: 1) BBC in the context of cancer in an Irish setting, 2) The power of the group, and 3) Self-management skills. Participants provided a range of experiences related to the intervention and suggested potential modifications for the future BBC programmes. Overall, the BBC intervention was perceived as helpful and applicable to the caregivers of people living with cancer in Ireland. Some suggestions for change included the inclusion of follow-up sessions and scheduling modifications (for example, shorter sessions delivered over 8 rather than 6 weeks). The BBC intervention provided an opportunity for participants to meet other caregivers, which was perceived as very beneficial. Participants reported gaining better self-management skills on completion of the intervention.
The quantitative data revealed a statistically significant effect for depression (PHQ-8), caregiving self-efficacy (CSES) and exercise behaviour (cycling). There was a downward trend in means in shortness of breath, stress, sleeping problems, and fatigue, meaning the intervention had a positive effect on these measures. Similarly, there was an upwards trend to all exercise behaviour means, which indicates the BBC intervention was effective in increasing participants engagement in exercise. There was a slight increase in stress measured by the Caregiver Strain Index and in the scale pain in some participants. The individual qualitative data provided insight and reasoning to this (one participant had an acute medical issue leading to pain at the time of the BBC intervention).
Overall, the BBC intervention had a positive effect on the majority of outcomes measured. Data collected provided promising insights into the usefulness of BBC in the context of cancer in Ireland. BBC seems to have a promising potential to caregivers of people living with cancer in Ireland. There is potential for BBC intervention to be applicable to other settings, such as palliative care.