Caregivers as transformative service mediators: navigating vulnerability and well-being

Purpose Emerging transformative service research (TSR) studies adopt a service system lens to conceptualise well-being across the micro, meso and macro levels of aggregation, typically within an organisation. No TSR has yet examined well-being across multiple interconnected organisations at the highest level of aggregation, the meta or service ecosystem level. This study aims to explore how value co-creation and, critically, co-destruction among different actors across interacting organisations enhances or destroys multiple levels of well-being. Design/methodology/approach This study uses semi-structured, in-depth interviews to collect data from five types of key actors (n = 35): players, team owners, tournament operations managers, casters and viewers, across 29 interconnected organisations in the oceanic esports industry. The interviews were coded using NVivo 12 and thematically analysed. Findings Resource integration on each level of aggregation within a service ecosystem (micro, meso, macro and meta) can co-create and co-destroy value, which leads to the enhancement and destruction of multiple levels of well-being (individual, collective, service system and service ecosystem). Value co-creation and co-destruction, as well as the resultant well-being outcomes, were interconnected across the different levels within the service ecosystem. Originality/value To the best of the authors’ knowledge, this research is the first to incorporate a multi-actor perspective on the well-being consequences of value co-creation and value co-destruction within a service ecosystem as opposed to service system. Thus, this research also contributes to the minimal research which examines the outcomes of value co-destruction, rather than value co-creation, at multiple levels of aggregation.

Systematic screening improves delirium detection among hospitalized older adults. This poster describes the development and pilot testing of an iOS-based app that incorporates the Ultra-Brief Confusion Assessment Method (UB-CAM), a two-step, delirium detection protocol that combines the UB-2 (2-item screener) and 3D-CAM. Previous work tested a RedCAP-based UB-CAM app in 527 patients with 399 physicians, nurses, and certified nursing assistants (CNAs) showing it can be successfully completed by all three disciplines in 97% of eligible patients in 80 seconds on average with over 85% accuracy relative to a gold standard. To improve accessibility to the clinical setting, our research team now collaborated with a computer scientist to develop and refine an iOS-based UB-CAM app for the iPhone and iPad through iterative “laboratory” testing. The app was piloted by non-clinician, research testers in hospitalized older adults (age x̄ =83, SD= 8.0) with dementia (Clinical Dementia Rating Scale x̄ =1.1, SD= .30); 64% were assessed to be delirium positive. The app demonstrated preliminary efficiency (90 seconds on average), high acceptability (100% satisfaction of users), and reliability (100% inter-rater). This project underscores the need for close collaboration between researchers, clinicians, and computer scientists with iterative testing of bedside-facing apps prior to testing with patients. Next steps include testing effectiveness in a pragmatic trial with clinician users (physicians, nurses, CNAs), integrating the UB-CAM app into the routine hospital care of all older patients. Having rapid, accurate bedside delirium detection has the potential to transform care.

Sleep health relates closely to physical health and well-being among older adults with chronic health conditions. However, little is known about the dyadic sleep patterns of these individuals and their spousal caregivers. Secondary analyses of the 2015 National Health and Aging Trends Study and National Study of Caregiving (N= 62 care dyads, mean age 78.59 years for care recipients and 75.77 years for caregivers) were completed to examine the sleep patterns, and related factors, of spousal dyads at both the individual and dyadic levels. Sleep measures included frequency in trouble falling back asleep and insomnia symptoms. Predictors included demographics, depressive symptoms, and positive affect for dyads and contextual factors such as dementia caregiving, care burden and support, neighborhood cohesion, and relationship quality. Multilevel dyadic and actor-partner interdependence models were used to complete analyses. Though intraclass correlation was poor (dementia care dyads ICC=0.123, non-dementia care dyads ICC=0.043), persons with dementia/spousal caregiver dyads (n=102) had more similar sleep and insomnia patterns than dyads with other chronic conditions. Poor sleep among dyads was correlated with higher care burden (β = -0.31, p <.0001), however, better relationship quality marginally enhanced the association (β = -0.23, p = .08). Individual depressive symptoms negatively affected dyadic sleep patterns. However, positive affect only had an actor effect and was related to better individual sleep. Other contextual factors did not affect sleep patterns. These findings suggest the importance of both caregiver and care recipient characteristics on sleep at dyadic levels, particularly those with dementia.

Caregiving can be burdensome for both family caregivers and older care recipients (i.e., adults 75 years or older with care needs). This study aimed to determine dyadic associations between caregivers' and care recipients' perceived social support from others (e.g., family and friends) and psychological well-being as a dyad. Caregivers and care recipients (N = 215 dyads) in this cross-sectional study were recruited by pensioner trade unions in Italy. Both members of the dyad completed the World Health Organization-Five Well-Being Index (WHO-5). Social support was measured with the Carers of Older People in Europe Index for caregivers and the Oslo-3 Scale for care recipients. Dyadic data were analyzed with the actor-partner interdependence model. Caregivers' and care recipients' well-being was moderately correlated (r = 0.41, p < .01), with care recipients reporting significant lower well-being (MCR = 30.95 vs. MCG = 46.45). Social support perceived by the caregivers was positively associated with their own well-being (actor effect; β = 3.31, p < .001) and with the care recipients' well-being (partner effect; β = 0.58, p < .001). No significant care recipient actor and partner effects were detected. This study provided evidence on crossover effects between social support and well-being in caregiving dyads. Findings have implications for research and clinical practice in familial aged care. Family interventions targeted at the caregivers' broader social environment might enhance both dyad members' well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Excessive daytime sleepiness is common in Prader-Willi syndrome (PWS), with prevalence ranging from 52% to 100%. The goal of this study was to establish the content validity (ie, evidence that an instrument measures an intended concept of interest) of the parent/caregiver version of the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), a measure of daytime sleepiness, in PWS. Qualitative, dyadic semistructured video interviews were conducted with 18 caregivers and their children with PWS from April to June 2020. Concept elicitation and cognitive interview techniques were implemented. Thematic analyses allowed for examination of themes and data patterns. All caregivers (mean age 49 years) were mothers of individuals with PWS who experienced troublesome daytime sleepiness (mean age 14 years). The most prevalent observable signs/symptoms of daytime sleepiness were sleepy/sleepiness (n = 17; 94.4%), tired/tiredness (n = 16; 88.9%), exhaustion/exhausted (n = 5; 27.8%), anxious/stressed (n = 5; 27.8%), irritable/frustrated (n = 5; 27.8%), having tantrums/outbursts (n = 5; 27.8%), and lethargy (n = 4; 22.2%). Daytime sleepiness impacted various aspects of health including mental, emotional, physical, and social well-being. When caregivers were asked about the activities associated with daytime sleepiness, all salient concepts elicited mapped to the ESS-CHAD; saturation was met after the first 4 interviews. Only 2 concepts, after physical exertion and while inactive/bored, did not map. Caregiver statements indicated that these concepts, although related to daytime activities, were atypical of daily routines. The ESS-CHAD was well understood and relevant to caregivers. This study supports the content validity of the ESS-CHAD and its appropriateness for evaluating treatment efficacy of daytime sleepiness in PWS. Patel VP, Patroneva A, Glaze DG, Davis K, Merikle E, Revana A. Establishing the content validity of the Epworth Sleepiness Scale for Children and Adolescents in Prader-Willi syndrome. J Clin Sleep Med. 2022;18(2):485-496.

PurposeThe purpose of this transformative service research (TSR) is to apply, innovate on and extend the understanding of service-dominant logic (SDL) perspectives, sustainable service ecosystem design ideas, transformative value and meeting sustainable development goals (SDGs). This study explores these through volunteers’ lived experiences and their perceived health and well-being outcomes in the context of botanic gardens as health-care service settings.Design/methodology/approachA total of 3 UK botanic gardens and 84 volunteers between 22 and 87 years of age participated in this qualitative study. Volunteering stories were collected through emails, telephone exchanges, online and in-person interviews, free-flowing discussion and field observations. These were coded and analysed by using computer-assisted qualitative data analysis software, NVivo 14 Plus and Leximancer. Thematic analysis facilitated the mapping of well-being outcomes highlighting transformative value against existing health and well-being indices.FindingsInsights extend knowledge into SDL, TSR and transformative value experienced by volunteers across three UK botanic garden service ecosystems. Environmental, organisational and personal factors, and physical, mental and social health outcomes are presented to emphasise transformative value experienced, especially in retiree volunteers. Theoretical contribution is in the form of empirical evidence to support and extend insights about transformative value and more so, significant epistemological change and meeting SDGs in botanic gardens. Results add to contemporary TSR on health-care-related well-being outcomes and ideas regarding sustainable service ecosystem design.Research limitations/implicationsIt is recommended that service research be extended across other botanic gardens, as well as other novel underexplored contexts for comparative studies of transformative value. Continued development and consideration of service designs as ongoing efforts to redefine and reimagine services marketing innovation for botanic gardens are recommended. Botanic gardens are complex service ecosystems worthy of rigorous service research to capture and measure the impact and outcome of ongoing work of the sector in advancing SDGs and having a transformative effect on individual and societal health and well-being.Practical implicationsThis study highlights opportunities for greater area-based, coordinated, collaborative, multi-stakeholder services marketing partnerships for strategic sustainable service ecosystem design for the botanic gardens and health-care sectors. These sectors can make better use of service research and marketing to further innovate and co-develop health and well-being strategies, campaigns and opportunities to develop services to transform and influence positive health and well-being outcomes for people. Results reveal greater opportunities for collaborative partnership and services marketing’s role and practice for the ongoing vitality and viability of botanic gardens. Joint efforts would enable innovation on sustainable service ecosystem design, advancing SDGs and improving life on planet Earth.Social implicationsTransformative value linked to newfound life experiences and meaning to life after retiring with a range of factors, and health and well-being outcomes were prominent. Social connections to the wider community were present, revealing links to a range of people who may not have traditionally had contact with botanic garden heritage and their strategic efforts. Therefore, it is services marketing opportunities for botanic gardens that hold one key to greater transformative value, sustainability and greater influence and impact on individual and societal health and well-being.Originality/valueTo the best of the author’s knowledge, this is the first TSR on botanic gardens as health-care service settings, resulting in a conceptual framework on transformative value and well-being outcomes in meeting SDGs. It extends insights on SDL, sustainable service ecosystem design and roles of marketing for the common good. Botanic gardens are unique research institutes, highly acclaimed for research, conservation, education and displays of special botanical collections, as well as providing health care, among other impactful SDG opportunities. This can be made more explicit through ecosystemic thinking, service research and integrated services marketing of botanic garden’ roles and contributions worldwide.

Purpose Following the continued development of transformative service research and the prevalence of the service-dominant logic in services marketing literature, increased scholarly interest centers on the co-creation of service actors’ well-being. In light of this significant evolution in service research, this study aims to provide a systematic review and synthesis of the growing, fragmented body of literature on well-being co-creation in services. Design/methodology/approach The hybrid systematic review approach combines bibliometric and framework-based literature reviews to analyze a sample of 160 article obtained from the Web of Science database. To examine the conceptual structure of the research domain, VOSviewer is used for conducting a bibliometric coupling analysis and a keyword co-occurrence analysis. Next, a content analysis is used to explore how the extant literature addresses the key concepts of service actors’ participation in co-creation, their resource integration and well-being outcomes across the micro-, meso- and macro levels of service ecosystems. Findings Service actors’ participation and resource integration are key theoretical concepts for understanding well-being co-creation. Yet, a comprehensive overview of well-being co-creation across the different levels of service ecosystems is lacking due to the presence of various application contexts, levels of aggregation, theoretical backgrounds and methodological perspectives. A conceptual framework of well-being co-creation in service ecosystems is developed, highlighting the participation of multilevel service actors and suggesting priorities for further research. Originality/value To the best of the author’s knowledge, this paper represents a first effort to systematically review and organize growing literature on well-being co-creation in service ecosystems.

To examine the association between care recipients' agitated behaviors, family caregivers' burnout, and abuse in community dwelling older Chinese with dementia in Hong Kong. This was a 6-month prospective study. One hundred forty-nine caregivers provided information on their demographic characteristics, care recipients' everyday functioning and agitated behaviors, and caregivers' burnout symptoms. Caregivers were re-interviewed 6 months later and provided information on changes in both care recipients' everyday functioning and agitated behaviors, and verbally and physically abusive behaviors directed at care recipients in the past month. The single most significant variable in predicting abuse at 6-month follow-up was abuse at baseline. In addition, verbal abuse was predicted by more co-residing days, a high level of agitated behavior, and a strong sense of caregiver depersonalization. Care recipients were more likely to be physically abused if they were male, had no chronic conditions other than dementia, and demonstrated a high level of agitated behaviors. Entering caregiver burnout into the model did not modify the association between care recipients' agitated behavior and abuse for either verbal or physical abuse. This study is the first to establish an association between care recipients' agitated behaviors, burnout, and abuse by family caregivers using prospective data. The present results confirmed that care recipients' agitated behaviors and caregivers' symptoms of burnout are associated with family caregivers' abusive behaviors. Caregiver burnout did not mediate the association between agitated behaviors and abuse. Proper management of care recipients' agitated behaviors and adequate support provided to family caregivers may help prevent the development of new cases of elder mistreatment.

Objectives: The primary aim of this study was to explore the impact of falling for frail community-dwelling older persons with and without cognitive impairments who have experienced a recent fall and their primary family caregivers. The secondary aim was to define components for a future fall prevention programme. Methods: Grounded theory interview study, with 10 patients (three cognitively unimpaired, four with mild cognitive impairment and three with dementia) and 10 caregivers. Results: All patients described a fear of falling and social withdrawal. Caregivers reported a fear of their care recipient (CR) falling. Most patients were unable to name a cause for the falls. Patients rejected the ideas that falling is preventable and that the fear of falling can be reduced. Some caregivers rated the consequences of their CRs’ cognitive problems as more burdensome than their falls and believed that a prevention programme would not be useful because of the CRs’ cognitive impairment, physical problems, age and personalities. Conclusion: Falling has major physical and emotional consequences for patients and caregivers. A fall prevention programme should focus on reducing the consequences of falling and on promoting self-efficacy and activity. The causes of falls should be discussed. The programme should include dyads of patients and caregivers because caregivers are highly involved and also suffer from anxiety. Before beginning such a programme, providers should transform negative expectations about the programme into positive ones. Finally, caregivers must learn how to deal with the consequences of their CRs’ falling as well as their cognitive impairment.

Background: Recently, health tourism has become one of the fastest growing industries in the world. Egypt occupies a distinguished location on the chart of therapeutic tourism. However, this discipline suffers from a sort of skepticism in general interest of public health. Aim of the study: Explore healers’ and care recipients’ perspectives about recuperationtourism. Subjects and Methods; Design: A qualitative approach was adopted to address the research question, which allowed for in-depth exploration of the unique perspectives of 10 healers and 10 care recipients using recuperative therapeutic techniques as Sulphurous water springs, Salt caves, or Sand burial. Setting: The study took place in three famous recuperative districts affiliated to New Valley Governorate; they are Dakhla, Kharga and Farafra. Tool of data collection: An individual semi-structured inductive interview was used; it included two parts for each category of participants. Part I: Face sheet; and Part II: The main study questions (experience). Data analysis began with verbatim transcription, then data was sorted into codes and then into higher order themes. Results: Healers’ passion, belief inthe therapeutic power of natural resources, plus their expertise were remarkable perspectives. Meanwhile, care recipients suffering from persistent health issue, and their confidence in the healing ability of these recuperative techniques were two main driving forces to use it. Conclusion: Egyptian healers' expertise and care recipients’ confidence intherapeutic techniques healing ability, as well as the Egyptian government's interest in raising awareness about it, has increased the demand for recuperation tourism as a promising issue. Also, it is noteworthy that both healers’ and care recipients’ perspectives crisscrossed in the importance of science for the evolution of recuperation tourism. Recommendations: Recuperative therapeutic techniques are better to be taught in universities to be on scientificbase. Moreover, from researchers’ point of view, license of competence must be given to healers to guarantee high level of safety of care recipients.

The science of caregiver health.

This study examined how the psychological well-being of Japanese caregivers changed over time; it also examined the variation across kin relationships with care recipients. Three interviews over the course of 30 months were conducted with a representative sample of community-dwelling caregivers of frail elderly persons living in a Tokyo suburb. Latent growth modeling demonstrated that mean levels of both depression and emotional exhaustion worsened over time. Change in emotional exhaustion over time showed significant individual variability, whereas change in depression showed little individual variability. Although wife caregivers tended to experience the worst trajectory of emotional exhaustion, daughters-in-law also showed a similar negative trend. The difference in individuals' well-being trajectories by kinship may be explained partly by differences in care recipients' disabilities.

PurposeThe world continues to grapple with grand challenges – climate change, pandemic, poverty, social injustice and diminishing resources – requiring mitigation if we are to focus on well-being and move towards a more sustainable future. Cultivating sustainable ecosystems offers a possible solution. The purpose of this paper is to understand how sustainable organizations at the meso level can nurture sustainable service ecosystems that provide the potential for greater well-being outcomes for individuals, business, society and the planet.Design/methodology/approachCase study data is gathered from 11 sustainable fashion organizations operating at the meso level within a complex ecosystem. The analysis includes interviews with founders and/or key managers and secondary information from company websites and publicly available reports.FindingsThe findings identify key value co-creation sustainable practices at the meso level that facilitate the function of the service ecosystem to create well-being outcomes. Value co-creation practices include – embedding a sustainable ethos; implementing sustainable strategies that embrace innovation, transparency and stakeholder collaboration; and incorporating sustainable communication practices that engage.Originality/valueEncapsulating sustainability within macromarketing and service ecosystems enables the development of a sustainable service ecosystems framework that has the potential to offer enhanced well-being. Implications for marketing practice in terms of important factors that facilitate service-sustainable ecosystems to enhance well-being are considered.

Poor sleep is common among older adults with chronic health conditions and their spousal caregivers. However, dyadic sleep patterns among spouses are underexplored within the literature. This study examines dyadic sleep characteristics and associated contextual factors among spousal care dyads. Participants included 462 older adult spousal care dyads from the 2015 National Health and Aging Trends Study and National Study of Caregiving (mean ages of care recipients/caregivers = 79 and 76 years, respectively; 22% of dyads were living with dementia). Self-reported sleep included frequency of (a) trouble falling back asleep among dyads, (b) care-related sleep disturbances among caregivers, and (c) trouble initiating sleep among care recipients. Predictors included between-dyad characteristics such as whether respondents had dementia, care burden and support, relationship quality, neighborhood cohesion, and within-dyad characteristics such as demographics, depression, and positive affect. We conducted multilevel dyadic analysis and actor-partner interdependence modeling. Sleep was correlated more among dyads living with dementia than those with other chronic conditions. Care dyads had poorer sleep if caregivers reported higher care burden; however, better relationship quality marginally ameliorated the association. Depressive symptoms had a partner effect on poorer sleep among care dyads, whereas positive emotions and older age only had an actor effect on better sleep for care recipients and spousal caregivers. Neighborhood cohesion, care support, and other demographic characteristics were not associated with dyadic sleep outcomes. Addressing both care recipient- and caregiver-related factors may improve sleep health for both members of the care dyad living with chronic conditions.

The well-being of care recipients (CR) and informal caregivers (CG) is intricately interconnected. However, research on sleep concordance among caregiving dyads is scarce. Leveraging longitudinal dyadic data and a cross-lagged panel design, this study aims to investigate whether: 1) sleep patterns are concordant among caregiving dyads over time; and 2) the extent of sleep concordance differs by caregiving contexts (i.e., dementia caregiving versus non-dementia caregiving) or by living arrangements (i.e., living together versus living apart). Longitudinal data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) were included (N = 2,204 care dyads). Cross-lagged panel models and multiple group analysis were used. Sleep problems of CR and CG in 2015 were significantly associated with their own sleep problems in 2017. The partner effects were statistically insignificant (P&amp;gt;0.05). However, CR sleep problems in 2015 were associated with more CG sleep problems in 2015 (β=0.141, 95% CI=0.015, 0.268), which were further linked to more CG sleep problems in 2017 (β=0.504, 95% CI=0.431, 0.577). Furthermore, these relationship patterns remained significant among dementia care or co-residing dyads, but not among non-dementia or living apart care dyads. CR sleep problems could affect CG sleep synchronously, potentially leading to long-term deterioration of CG sleep. This can be attributed to the cumulative physical exhaustion and psychological strain associated with caregiving. Our findings highlight the importance of early intervention in mitigating CR sleep problems and targeted assistance to CG of persons with dementia and those co-residing with their CR.