Health and lived experiences of grandparent kinship carers: section 1. the health and wellbeing implications of grandparent kinship caring: a systematic review and thematic synthesis; and, section 2. an interpretative phenomenological account of the experiences of grandparent kinship carers

Abstract

BACKGROUND AND OBJECTIVES: Kinship carers are family members who care for related young people when their parents are unable to do so. Most kinship carers are grandparents and the role involves full-time responsibility for the children. The role brings with it rewards, but also many challenges and studies suggest kinship carers often feel unsupported by others, particularly statutory services. Understanding the impact of the role and the lived experiences of grandparent kinship carers is important to develop effective interventions and tailored support. The first section of this thesis is a systematic review and thematic synthesis of qualitative studies examining the health and wellbeing impacts of being a ‘full-time’ grandparent carer. This review set out to understand how full-time grandparent carers themselves experience the health and wellbeing impacts of the role. Secondary research questions were also considered. The second section of the thesis is an empirical study, presenting an Interpretative Phenomenological Analysis (IPA) of the experiences of lone and primary kinship carers. This project set out to explore the lived experiences of a sizeable subgroup of kinship carers not previously examined and add to sparse literature relating to kinship carers in Scotland.

METHODS: The systematic review searched online databases and reference lists to identify relevant articles according to predetermined eligibility criteria. Fourteen articles were identified and their findings were incorporated into a Thematic Synthesis (Thomas & Harden, 2008). The quality of each included study was also assessed. The empirical study involved semi-structured interviews with eight grandparent kinship carers. Interviews were audio recorded, transcribed and analysed using IPA.

RESULTS: The systematic review found that health and wellbeing impacts of grandparent caring commonly included psychological stress, depression, tiredness and fatigue and those with existing health problems experienced exacerbation of symptoms. A smaller number of grandparents experienced health benefits such as increased fitness and mobility. Parenting and interpersonal stress as well as financial pressures contributed to health problems and grandparents were found to have had difficulty accessing services for themselves and their grandchildren. Analytical themes highlighted the sacrifices grandparents made, and the various barriers that they face in accessing adequate support. From the analysis of the empirical study, three superordinate themes emerged: “It wasn’t included in the life plan”, “Not so much lonely..alone” and “They’re family, but it’s a job”. Eight sub-themes also emerged.

DISCUSSION AND IMPLICATIONS: The systematic review demonstrated the heterogeneity that exists in the circumstances of grandparent carers, despite some common challenges. The health implications of taking on a full-time grandparent carer role seem in part related to prior health and financial resources. This review found qualitative methodologies are appropriately utilised but that the application or reporting of reflexivity on the part of researchers is lacking. The empirical study highlighted how grandparent’s expectations for their stage of life influenced their adjustment to the role. Grandparents who adjusted to this most successfully made meaning from their sacrifices relating to social freedom and time to themselves. Grandparents who were isolated and overwhelmed by the demands of caring seemed to struggle to find meaning in their experiences and may represent a group of carers who would benefit most from avenues of peer support, such as groups. Mental health professionals working with grandparent kinship carers may find meaning making (Park, 2010) to be a valuable process to consider. Specialist kinship care teams appear to be experienced as respectful and compassionate by grandparent carers and may be more attuned to their lived experiences