Development of strategies to alleviate caregivers' burden of visually impaired patients at Mankweng Tertiary Hospital, South Africa

Thesis (Ph.D. (Health Sciences)) -- University of Limpopo, 2024

Background: Sociodemography and socioeconomic status are directly linked with whether one can adequately provide care to those needing such care. Unfortunately, caregivers, including those in the lower social class, provide caregiving services to their loved ones, thus leading to various challenges that may be considered burdensome and the development of depressive symptoms. Depressive symptomatology amongst family caregivers can occur due to taking up primary responsibility to support the patients while maintaining their daily responsibilities. However, it is unfortunate that there is a lack of knowledge on family members caring for a patient with visual impairment, considering the constraints of eye care services such as specialised optometric and ophthalmological services in the current study site. Therefore, a holistic approach for those providing care is needed. Purpose: This study sought to determine the relationship between sociodemographic information, socioeconomic status, caregiver burden and depressive symptomatology of caregiver’s for the visually impaired as they provide prolonged care in a developing country and develop intervention strategies to alleviate the caregiver's burden at the Mankweng Tertiary Hospital. Methods: The current study followed a mixed-method sequential explanatory research design. Therefore, purposive sampling was subsequently adopted, with 253 caregivers enumerated as participants following the criterion-I-strategy. The current study used the Modified Kuppuswamy Socioeconomic Scale, Zarit Burden Interview questionnaire and Centre for Epidemiological Studies-Depressive scale questionnaire consisting of 22 and 20 Likert questions to determine the socioeconomic status, caregivers' burden, and depressive symptoms, respectively. The caregiver's burden and depressive symptomatology were categorised into little to mild, mild to moderate, moderate to severe, and severe. The data were analysed using descriptive statistics and generalised linear logistic regression analysis; p <0.05 was considered statistically significant. After quantifying the problem, high and low extreme cases were selected for an in-depth semi-structured interview to give meaning to the established phenomenon under investigation. Thematic analysis was used to interpret data following a deductive approach. Data integration for quantitative and qualitative data were presented and triangulated in side-by-side tables. The Delphi method validated the developed strategies for the problem under investigation. Results: The participants were informal, unpaid family caregivers for the visually impaired patients consulting at the Mankweng Tertiary Academic Hospital. The mean age of participants was 45.11±14.128. The female proportion was 70% and 30% males. Approximately 34% of study participants suffered little to mild, followed by 50.6%, 13.4% and 1.6% of participants who suffered mild to moderate, moderate to severe, and severe caregiver burden, respectively. This study found that 66.4%, 17.8%, and 4.7% of caregivers were in the upper lower, upper middle and upper socioeconomic class, respectively (p=0.001). Of the above caregivers, 53%, 57.8%, and 66.7% had mild to moderate, moderate to severe, and moderate to severe caregiver burden, respectively (p<0.001). Caregivers in the upper lower social class were at a higher risk of experiencing caregiver burden. Regarding depressive symptomatology, approximately 29.2% and 28% experienced moderate to severe and mild to moderate depressive symptoms. At the same time, 21.3% was shared among little to mild and severe depressive symptoms. Of these caregivers, 22.4% of males and 20.9% of females experienced severe depressive symptoms, p<0.0019. 58.3% and 48.9% were in upper and upper middle social class, p<0.001. Integrated results confirmed each strand and the close link between both data sets; it also revealed a disintegration of family relationships, responsibility neglect, lack of family support, overthinking about the future, lack of economic participation, and limited leisure and social time—a financial burden emanating from transportation costs to the treating facility. Conclusion: The study found that males are equally caregivers as females and are susceptible to caregivers' depressive symptoms. Also, those in the higher social class were experiencing more symptoms than those in the lower social class. Therefore, caregivers caring for visually impaired relatives should be screened for depressive symptoms and referred to a mental health practitioner. Therefore, caregiving role responsibility needs to be defined within a family unit by elucidating the nuances that blur the role responsibility, group belonging for discussion and emotional support and the social modelling by providing respite services. Further, re-orientate and decentralise eyecare services to primary health care centres and provide leisure activities for caregivers by providing short-term respite services. Contribution: This study provided the relationship between sociodemographic information, socioeconomic status, and magnitude of caregiver burden and depressive symptoms amongst the informal caregivers for the visually impaired in the rural Limpopo Province as they care for the people with visual impairment attending the Mankweng Hospital and developed intervention strategies to promote prolonged caregiving.