Measuring the impact of informal caring

A factor-analysis of caregiving impact appraisals amongst a community-derived sample of informal carers of elderly people revealed two negative (care work strain and relationship dissatisfaction) and two positive (care work satisfaction and care lifestyle satisfaction) scales. Validity was assessed by means of concurrent correlations with levels of assistance with daily living tasks provided by carers and levels of behaviour problems exhibited by elderly dependents. Criterion validity was considered in relation to two important carer outcomes; willingness to care and a standardized measure of strain. Each of the four scales was significantly associated with concurrently assessed willingness to care. Care work strain and relationship dissatisfaction were associated with concurrently measured strain symptomology. Evidence of 6-month predictive validity was obtained for the care work strain scale.     

What's Stressful About Caring?1

Karasek's (1979) demand-discretion theory of job strain and satisfaction was tested in a cross-sectional survey of informal carers of elderly people (n= 108) identified from a preliminary screening survey. The theory was largely supported by the findings. Multivariate analysis of variance showed that carer well-being and satisfaction with caring work were predicted by high levels of demand arising from the needs of elderly dependents and the interaction of high demands with discretion over meeting demands. The results allow some clarification of previously inconsistent findings from caregiver well-being research and have implications for the design of services to relieve carers of the burden of care.     

Conceptualizing ‘social capital’ for health promotion in small local communities: a micro‐qualitative study

This paper reports on a micro‐qualitative case study of peoples' experiences of local community life in a south‐east English town. This material is used as the basis for a critical discussion of the suitability of Putnam's notion of social capital as a conceptual tool for the design and evaluation of ‘community strengthening’ policies and interventions. The study was motivated by a concern that too much debate about social capital has been conducted by academics and policy‐makers in a top‐down manner, with inadequate attention to the realities of life in the local communities that they refer to. Three‐hour semi‐structured interviews were conducted with 37 residents in two less affluent wards in our town of interest. Informants—half men and half women, and spread across the 15–75 age group—were encouraged to talk about their personal experiences of local community life. Interview findings are presented within the ‘norm’ categories of trust, neighbourliness and reciprocal help and support, and the ‘network’ categories of participation in informal networks, voluntary groupings and community activist groupings. Our case study points to a number of ways in which Putnam's concept needs to be refined if it is to inform ‘community strengthening’ policies and interventions in England. Far more notice needs to be taken of the role played by informal networks of friends and neighbours in the construction of local community life. Attention also needs to be given to the complex and shifting geographical spread of peoples' significant social networks. Putnam's conceptualization of cohesive local communities and his unitary notions of trust and local identity may also be unduly essentialist. In our particular communities of interest, they failed to capture the fluidity of local community norms and networks in a rapidly changing society. They also failed to do justice to the extent to which social distinctions—such as age, gender, ethnicity and housing tenure—shape and constrain the way in which people create, sustain and access social capital. Copyright © 2001 John Wiley & Sons, Ltd.     

Belief Revision And Epistemology

Postulational approaches attempt to understand the dynamics of belief revision by appealing to no more than the set of beliefs held by an agent and the logical relations between them. It is argued there that such an approach cannot work. A proper account of belief revision must also appeal to the arguments supporting beliefs, and recognize that those arguments can be defeasible. If we begin with a mature epistemological theory that accommodates this, it can be seen that the belief revision operators on which the postulational theories are based are ill-defined. It is further argued that there is no way to repair the definitions so as to retain the spirit of those theory. Belief revision is better studied from within an independently motivated epistemological theory.     

Mechanisms and the Evidence Hierarchy

Evidence-based medicine (EBM) makes use of explicit procedures for grading evidence for causal claims. Normally, these procedures categorise evidence of correlation produced by statistical trials as better evidence for a causal claim than evidence of mechanisms produced by other methods. We argue, in contrast, that evidence of mechanisms needs to be viewed as complementary to, rather than inferior to, evidence of correlation. In this paper we first set out the case for treating evidence of mechanisms alongside evidence of correlation in explicit protocols for evaluating evidence. Next we provide case studies which exemplify the ways in which evidence of mechanisms complements evidence of correlation in practice. Finally, we put forward some general considerations as to how the two sorts of evidence can be more closely integrated by EBM.     

Loss,Grief, and the Search for Significance: Toward a Model of Meaning Reconstruction in Bereavement

Constructivist theories recently have begun to inform understandings of grief, emphasizing the role of meaning making in adaptation to bereavement. In this article we review empirical studies using qualitative, quantitative, and mixed methods, investigating how three activities of meaning reconstruction are involved in the grieving process: sense making, benefit finding, and identity change. In particular, we consider how critical processes have been operationally defined and how study methods and designs have constrained what can be concluded from this burgeoning field of research. We conclude by positing an integrated model of meaning reconstruction pathways as a heuristic guide to further research and briefly note the implications of this model for clinical practice.