Caregiver Communication Research Articles

Development and evaluation of a virtual patient-centered outcomes research training program for the cystic fibrosis community

BackgroundPatient-centered outcomes research (PCOR) emphasizes patient-generated research priorities and outcomes, and engages patients throughout every stage of the research process. In the cystic fibrosis (CF) community, patients frequently provide input into research studies, but rarely are integrated onto research teams. Therefore, we developed and evaluated a virtual pilot PCOR training program to build PCOR capacity in the CF community (patients, caregivers, researchers, nonprofit stakeholders and providers). We aimed to show changes among participants’ perceived PCOR knowledge (a.k.a PCOR knowledge), confidence in engaging stakeholders, and post-training session satisfaction.MethodsGuided by a prior CF community educational needs assessment, our researcher and patient-partner team co-developed a four-part virtual online training program. We structured the program towards two learner groups: patients/caregivers and researchers/providers. We evaluated participants’ PCOR knowledge, confidence in engaging stakeholders, and session satisfaction by administering 5-point Likert participant surveys. We tested for significant differences between median ratings pre- and post-training.ResultsA total of 28 patients/caregivers, and 31 researchers/providers participated. For both learner groups, we found the training resulted in significantly higher PCOR knowledge scores regarding “levels of engagement” (p = .008). For the patient/caregiver group, training significantly increased their PCOR knowledge about the barriers/enablers to doing PCOR (p = .017), effective PCOR team elements (p = .039), active participation (p = .012), and identifying solutions for successful PCOR teams (p = .021). For the researcher/healthcare provider group, training significantly increased participants’ ability to describe PCOR core principles (p = .016), identify patient-partners (p = .039), formulate research from patient-driven priorities (p = .039), and describe engagement in research grants (p = .006). No learner group had significant changes in their confidence score. Most participants were either “satisfied” or “very satisfied” with the training program.ConclusionsOverall, our virtual pilot PCOR training program was well received by patients, caregivers, researchers and providers in the CF community. Participants significantly improved their perceived knowledge with core PCOR learning items.Trial registration Retrospectively registered at clinicaltrials.gov (NCT04999865).

Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews.

PurposeTo critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews.MethodsMEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized.ResultsTwelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors’ physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services.ConclusionsDespite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups.Implications for Cancer SurvivorsRather than aiming for an optimal “one-size fits all” model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01128-1.

Collective caregivers: A novel examination of health literacy management approaches

ObjectiveHealth literacy and communication skills are necessary for family caregivers who often work in pairs, known as collective caregiving. Health literacy management is a relational process where communication between caregivers can be a barrier or pathway to improving or co-creating health literacy. The purpose of this study was to examine how collective caregivers manage health literacy. MethodsSemi-structured interviews were conducted separately for 42 caregiving pairs (n = 84). The interview guide was developed using a cancer caregiver health literacy framework. Caregiving pairs were placed into one of three collective caregiving communication patterns (absolute concordant, semi-concordant, absolute discordant). Interviews were audio-recorded, transcribed, and a thematic analysis was performed by independent coders. ResultsThe analysis revealed three different health literacy management approaches: a defined approach where caregiver roles were clearly designated (absolute concordant pairs); a contrasting approach where one caregiver was the health literacy expert (semi-concordant pairs); an independent approach characterized by individual information seeking, processing, and patient/provider engagement (absolute discordant pairs). ConclusionsHealth literacy support should address aspects of the family system such as caregiver-caregiver communication which influence variance in health literacy management.Practice implicationsOur study can inform provider communication and healthcare interventions aimed at supporting health literacy for caregivers.

Perceived knowledge on type-2 diabetes of informal caregivers in rural communities of Thai Binh, Vietnam: Implications for health education

ObjectivesInformal caregivers' (ICGs') knowledge has substantial influence on the quality of caregiving. This study aims to identify caregivers’ perceived knowledge status and analyse associations between their characteristics and perceived knowledge on how to care for individuals with type-2 diabetes (T2D). Study designCross-sectional study. MethodsData were collected using a face-to-face survey with ICGs and perceived knowledge was evaluated on the 5-point Likert scale (ranging from 0 to 4). ResultsBetween April and July 2019, 1238 eligible ICGs were enrolled in the study. The mean age of participants was 48.3 years, about half (48.8%) were males and the majority (83.3%) were spouses or children of the person they cared for. ICGs mean knowledge score on overall activities was 2.48 (SD = 0.90); the highest score was seen for diet preparation (2.74 ± 0.85) and lowest for foot care (1.76 ± 1.45). Multivariate analyses showed that the following ICG characteristics were significantly more likely to result in a low level of T2D-related knowledge (mean score ≤2): age <40 years, educational level below high school, farming occupation, low economic status and caring for an individual with mild or moderate T2D. ConclusionsThe level of perceived knowledge on T2D among ICGs was particularly low for the care of T2D complications. Development of targeted and tailored educational interventions for ICGs is recommended.

Exploring The Challenges Faced by Informal Home Based Palliative (HBP) Caregivers in Ndola District, Zambia.

In order to explore informal Home-based palliative caregivers’ challenging experiences, this study gives an overview of the need of Home-based palliative caregivers in communities. Dialogs using In-depth interviews (IDI’s) with twenty-five (25) purposively and conveniently selected respondents aged 18 years and over were conducted. They were not professional caregivers but volunteers from within the community attached to health facilities in Ndola. Discussions on global, Africa and Zambian’ situations, and Ndola in particular were included. The findings, using thematic analysis, were lack of supporting resources, inadequate coordination, lack of training, undesirable working conditions and unreliable transport network. The study will facilitate formulation of guiding principles and policies for palliative care practices through recommendations based on results from this study to improve and sustain palliative care services.

Addressing caregiver-child conflict in public: Barriers and facilitators to bystander engagement

Child maltreatment is a serious public health issue. Bystander models have been applied in sexual violence and bullying prevention, with little application in public child maltreatment. Support Over Silence for KIDS (SOSFK) is a bystander program aimed at addressing public child maltreatment by supporting caregivers and their children. This study describes formative research conducted to inform the development of SOSFK. Data were collected from focus groups with community members (n = 29), hospital personnel (n = 60), and caregivers (n = 23) from aMidwestern city to examine barriers and facilitators to becoming an active bystander in cases of public child maltreatment. Data were analyzed through mixed content analysis. Participants highlighted contextual, situational, and intrapersonal factors that serve as both barriers and facilitators to bystander intervention in cases of public child mistreatment. The lack of and/or fragmented sense of community and perceived situational danger were identified as barriers to intervention. A shared sense of responsibility for caring for children in the community and having a personal relationship with the parent-child dyad were identified as facilitators to bystander intervention. Results from this study provide implications for the development of programs to support caregivers during stressful parenting moments and might reduce public instances of child maltreatment.

Les soins pharmaceutiques comme moyen de prévention contre les risques iatrogènes des médicaments : cas des anticoagulants oraux

Oral anticoagulant can have a significant risk of adverse events, particularly when it is initiated, modified or interrupted. Pharmaceutical care through medication reconciliation could improve the benefit-to-risk ratio of these drugs. A prospective and interventional single center study was conducted from March through August 2018 in medicine and surgical units. Patients with an oral anticoagulant prescribed and coming from outpatient sector were included. These patients received a medication reconciliation at admission and discharge. Frequency and type of discrepancies were studied. Their gravity rating was assessed using the Cornish et al. scale. This study included 162 patients. The medication reconciliation at the admission allowed the detection of 133 unintentional discrepancies which 16 of them represented a high risk for the patient included nine errors about oral anticoagulant prescribing. Concerning the reconciliation at discharge, 51 unintentional discrepancies had been detected: 12 of them represented a high risk for the patient included eight errors about oral anticoagulant prescription. The acceptance rate of the discrepancies was 86% and reflected discrepancies severity. This result reached 96.4% if we took into account discrepancies with a severe clinical impact. This study highlighted oral anticoagulant represented relevant prioritization criteria to the long-lasting implementation of pharmaceutical care. This secures the management of the patient since the admission until the hospital discharge. The last step of our approach would be to study the needs about data transmission to the community caregivers.

Relationship Between Anticipatory Grief and Communication Avoidance in Chinese Caregivers of Patients With Advanced Cancer

Anticipatory grief (AG) and its relationship with communication avoidance in Chinese caregivers of patients with advanced cancer have not been previously examined. An association between AG and communication avoidance could provide important insights to Chinese caregivers worthwhile to be investigated. The aims of this study were to evaluate AG and communication avoidance with patients among Chinese caregivers of patients with advanced cancer and to identify their relationship. A cross-sectional study was conducted with a convenience sample of caregivers of patients with advanced cancer practicing at an academic cancer hospital. The participants completed the Anticipatory Grief Scale (AGS) and the Caregivers' Communication With Patients About Illness and Death scale. Of the 256 participants, the mean age was 49.10 (SD, 12.87) years, and 63.28% of participants were female. The mean AGS score was 88.05 (SD, 18.42). The AGS subscales in descending order of scores were feeling of loss, sadness, decreased ability to function at usual tasks, anxiety, anger, guilt, and irritability. The mean Caregivers' Communication With Patients About Illness and Death score was 3.60 (SD, 1.13). In the multiple linear regression, AG severity was significantly, positively correlated with communication avoidance. Old age, low education level, religious belief, low income, and living with the patient, spouse, parents, and child implied severe AG. Chinese caregivers of patients with advanced cancer reported a high AG and poor communication with patients about illness and death. Less communication was related to more severe AG. Healthcare professionals should pay attention to AG severity and communication of caregivers of patients with advanced cancer to explore the suitable clinical intervention.

Helping Us Heal: telephone versus in-person marital communication and support counseling for spouse caregivers of wives with breast cancer.

Purpose(1) To test the short-term impact of Helping Us Heal (HUSH), a telephone-delivered counseling program for spouse caregivers of women with breast cancer. (2) To compare outcomes from HUSH with outcomes from a historical control group which received the same program in-person.MethodsTwo-group quasi-experimental design using both within- and between-group analyses with 78 study participants, 26 in the within-group and 52 in the between-group analyses. Spouse caregivers were eligible if the wife was diagnosed within 8 months with stage 0–III breast cancer and were English-speaking. After obtaining signed informed consent and baseline data, 5 fully scripted telephone intervention sessions were delivered at 2-week intervals by patient educators. Spouses and diagnosed wives were assessed on standardized measures of adjustment at baseline and immediately after the final intervention session.ResultsWithin-group analyses revealed that spouses and wives in HUSH significantly improved on depressed mood and anxiety; spouses improved on self-efficacy and their skills in supporting their wife. Additionally, wives’ appraisal of spousal support significantly improved. Between-group analyses revealed that outcomes from HUSH were comparable or larger in magnitude to outcomes achieved by the in-person delivered program.ConclusionsA manualized telephone-delivered intervention given directly to spouse caregivers can potentially improve adjustment in both spouses and diagnosed wives but study outcomes must be interpreted with caution. Given the small samples in the pilot studies and the absence of randomization, further testing is needed with a more rigorous experimental design with a larger study sample.

Training and health assistance for the elderly at the Griya Asih Home Care-Lawang, Malang

The arrangement of systems and facilities of the home care according to the needs of the elderly is still one of the obstacles at the Griya Asih home care Lawang-Malang, so that the management of the home care needs assistance activities. This activity aimed to increase the active participation of the target community (caregivers at elderly home care) in overcoming health problems that arise in elderly home care. The implementation methods were: (1) Training and mentoring on the rehabilitation of the elderly and (2) Training programs and health assistance for the elderly. Service activities have been carried out well according to the target, which is indicated by an increase in knowledge of 75%. In addition, the management of the elderly home care also provides positive support which is indicated by their involvement in the implementation of activities.

Co-creation and prototyping of an intervention focusing on health literacy in management of malaria at community-level in Ghana

IntroductionCollaborating with end-users to develop interventions tailored to fit unique circumstances is proposed as a way to improve relevance and effectiveness of an intervention. This study used a local needs driven approach to develop a health literacy intervention for caregivers in Ghana concerning management of malaria in children under 5 years.MethodFor the period, November 2017–February 2019, we carried out the study using a three-phase framework including: 1) Needs assessment based on data from questionnaires, focus groups, individual interviews and observations, 2) Co-creation of a board game and brochures for health education at Child Welfare Clinics to address needs in health literacy concerning malaria and 3) Development of a prototype of the game, brochures as well as determining feasibility. In addition to the research team, health administrators, community health workers, designers and caregivers contributed to the development of the intervention.FindingsThe needs assessment contributed to the development of interactive and useful materials including a board game and brochures, to help bridge the gaps in health literacy among caregivers. Co-creation of the materials and prototyping yielded a varying sense of ownership among stakeholders. End-users’ engagement and participation in developing the intervention resulted in a high interest and adherence to interventions. However, high attrition rates of health workers and caregivers’ inconsistent use of the Child Welfare Clinics challenged sustainability of this intervention.ConclusionCo-creation led to an interactive intervention. The interactive nature of the board game and brochures resulted in a better caregiver-health provider relationship and a sense of recognition of a more participatory approach to health delivery. We recommend co-creation as an approach to develop needs-driven interventions in a context like Ghana. Still, a stronger buy-in at the top-level of health management would improve sustainability and reach a larger audience.

Developmental Assets, Defiance, and Caregiver Communication among Black Adolescents with High Body Weights

Developmental Assets, Defiance, and Caregiver Communication among Black Adolescents with High Body Weights

Social Norms, Agency, and Marriage Aspirations in Malawi.

We evaluate whether community norms, caregiver beliefs, and adolescents' own beliefs and perceptions, focused on early marriage, predict adolescent marriage aspirations in a low-income context. The processes that contribute to adolescent marriage aspiration formation have received little attention in low-income contexts, particularly sub-Saharan Africa. Understanding how marriage aspirations are formed is important because they are associated with critical education and health outcomes. Using data that links Malawian adolescents (N=2,089) with their caregivers (N=1,452), we analyze gender stratified ordered logistic regression models to examine key relationships. We show that community norms for youngest acceptable marriage age predict when boys want to marry, but do not find conclusive evidence that they predict when girls want to marry. We also show that adolescents who believe it is acceptable to marry at an early age are more likely to want to marry early themselves. Both community norms and adolescents' own beliefs are central to the formation of their marriage aspirations. We recommend that programs incorporate adolescent beliefs and perceptions when designing child marriage interventions and measuring their impact. We also recommend theory-driven measurement of community norms to better evaluate their impact on both marriage aspirations and marriage age.

Community reintegration needs following paediatric brain injury: perspectives of caregivers and service providers

Purpose To explore the processes of community reintegration of children and families at least one year following a paediatric brain injury from the perspective of caregivers and outpatient/community service providers. Materials and methods A qualitative analysis of semi-structured interviews from outpatient or community service providers (N = 14; occupational, physical, and speech and language therapists, neuropsychologists, school counsellors, recreational providers) and caregivers of six children (N = 8) at least one year after their injury. Interviews were transcribed and thematically coded using deductive (employing Bronfenbrenner’s ecological systems theory) and inductive approaches. Results Themes from both providers and caregivers indicated additional supports needed at all levels of Bronfenbrenner’s ecological systems theory (i.e., individual, microsystem, mesosystem/exosystem, macrosystem, chronosystem). Participants felt that several characteristics would be needed in an ideal service system following paediatric brain injury including: community solutions (“it takes a village”), long-term approaches to care, and new financial approaches. Conclusions The results suggest that children and families have substantial community reintegration needs following paediatric brain injury. Multi-system interventions are needed to support long-term community reintegration, especially those that increase communication and support transitions. There is also a strong need for alternative funding to support these efforts. Implications for Rehabilitation Families with a child with a moderate to severe brain injury face challenges with community reintegration a year or more after their child’s injury. Effort should be put into helping families navigate the complex medical, insurance, and school systems with a navigator service and step-down care to ensure a continuum of care and to support community reintegration. Special support should be provided during transitions, such as transitions from hospital care to outpatient care, and across school transitions.

The information trust formation process for informal caregivers of people with dementia: a qualitative study

PurposeThis paper provides new insights on trust formation during information-seeking processes of informal caregivers of people with dementia and identifies the sources of information deemed as trustworthy by caregivers.Design/methodology/approachThe study adopts a phenomenological qualitative approach in the form of in-depth, semi-structured interviews with a sample of 20 informal caregivers.FindingsCaregivers trust sources that are perceived as authoritative and particularly value the information and advice provided by other caregivers. Trust in information can be divided into subjective and objective, but both are important precursors to the actual use of the information. The information available to caregivers is sufficient in quantity but inadequate in terms of ease of use, clarity and usefulness. Often, some key information needs remain unsatisfied due to the lack of timeliness, relevance and personalisation of the information.Practical implicationsThis paper provides recommendations for information and healthcare providers on how to improve communication and information relevance for informal caregivers of people with dementia.Originality/valueThis paper contributes to a more comprehensive perspective on caregivers’ information trust formation processes, which takes into account both the characteristics of the information and caregivers’ individual factors.

Exploring the Perspectives of South African Parents and Primary Caregivers Living in Low-Income Communities on What Children Need to Thrive within the First 1000 Days of Life.

The first 1000 days is recognised as a critical period for the development of children. What children need to thrive in this particular phase of development may be different from any other phase. In South Africa, parents’ perception of children’s needs within the first 1000 days of life could be considered as emerging. Therefore, this study aims to explore the perspectives of South African parents and primary caregivers on what children need to thrive within the first 1000 days. An exploratory qualitative study design was used to explore the parents’ understanding of what children need to thrive in the first 1000 days. A purposive sampling approach was employed to select parents and primary caregivers in low-income communities. In all, thirty respondents participated in the study. The data were analysed using thematic analysis. During the analysis, four themes emerged. The themes included (1) the importance of parenting, care and support; (2) children’s need for holistic development; (3) parental roles; and (4) sharing responsibilities. Parents and primary caregivers living in low-income communities understand what children need to thrive within the first thousand days of life. The study could assist policymakers and service providers to design appropriate interventions for parents within these communities.

Write Like a Pro or an Amateur? Effect of Medical Language Formality

Past years have seen rising engagement among caregivers in online health communities. Although studies indicate that this caregiver-generated online health information benefits patients, how such information can be perceived easily and correctly remains unclear. This study aims to fill this gap by exploring mechanisms to improve the perceived helpfulness of online health information. We propose a multi-method framework, including a novel Medical-Enriched DEep Learning (MEDEL) feature extraction method, econometric analyses, and a randomized experiment. The results show that when the medical language of health information is informal, the senior care information is more helpful. Our findings provide a theoretical foundation to understand the influence of language formality on many other business communications. Our proposed multi-method approach can also be generalized to investigate research questions involving complex textual features. Forum sites could leverage our proposed approach to improve the helpfulness of online health information and user satisfaction.

Initial Development of a National Survey on Remote Learning in Early Childhood During COVID-19: Establishing Content Validity and Reporting Successes and Barriers.

This article describes the development and administration of a survey to identify early childhood educators’ successes and barriers when delivering remote instruction (e.g., online whole or small group instruction) during the COVID-19 pandemic to children 2–5 years old. The survey was developed using procedures outlined by the commonly accepted stages of an instrument development process. Content validity was established using four approaches: (a) identification of the purpose of the survey, (b) creation of a blueprint of items, (c) cognitive interviews, and (d) expert panel review. A total of 1,053 early childhood educators began the survey, with 808 (77%) of the responses included because educators met the inclusion criteria of working in the United States and responding to at least one question related to remote instruction. The survey contained 37 closed-ended and six open-ended items covering eight domains: (a) demographic information; (b) preparation, guidelines, and materials for remote learning; (c) caregiver communication and engagement; (d) assessment; (e) instruction; (f) educators’ levels of confidence before and after remote learning; (g) access to services (i.e., wraparound and/or special education); and (h) planning for the return to face-to-face instruction. Both quantitative (descriptive, t-test, regression, ANOVA, and Chi-square tests) and consensual qualitative research analyses were applied to summarize the survey results. Findings from this survey indicated that even with limited or no guidance from administrators, educators successfully adapted to remote instruction and their levels of confidence increased over time. Ongoing improvements need to be made to sustain regular communication with all families, to offer access to technology (i.e., devices and internet), to administer assessments or universal screeners, and to provide cohesive guidelines and expectations. Results from this study begin to shed light on early childhood educators’ adaptation to remote instruction as a result of COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10643-021-01216-y.

Using Cultural Domain Analysis to Understand Community Perceptions of Infant and Young Child Foods in Sri Lanka

Objectives1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children MethodsDesign: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data followed an inductive approach whereby themes were identified, coded, and extracted for interpretation using Dedoose. Findings across methods were triangulated to enhance credibility. Results1. Among all sectors of Sri Lanka, caregivers identified rice as the most important food for young children diets, highlighting the importance of this staple regardless of sector or ethnicity. Only 2 animal source foods (eggs and fish) were included within the top 15 most salient foods. 2. Local food classification systems highlight a ‘hot’ and ‘cold’ paradigm, reflecting the underlying Ayurvedic medical belief system, influencing dietary choices. 3. Overall, 48 food proscriptions were identified, including ‘egg’ and ‘fish, specifically during child illness. Some locally-available fruits and vegetables were also proscribed, depending on their ‘cold’ nature, level of digestibility, and relation to illness causation. Prescribed foods (n = 47) were also found, most of which were herbal remedies (22 food or spice mixtures) to address child illness. ConclusionsUnderstanding local food definitions, food classification systems, and food rules may aid in shaping policies aiming to include culturally-appropriate strategies to improve feeding practices in Sri Lanka. Funding SourcesUNICEF.

Examining Ghana’s Cash Transfer Programme Outcomes in the Ejisu-Juaben Municipality from Conversation and Membership Categorisation Analyses Perspectives

Since the start of cash transfer programmes in developing countries in the late 1990s and its spread, studies have demonstrated a variety of outcomes comprising education, health, and nutrition for the poorest households. These studies focused on macro analysis of programmes’ outcomes but paid little attention to an indepth micro study of the everyday intersubjective accounts and actions of local community focal persons and caregivers, which construct programme outcomes. The objective of this study is to highlight the everyday concrete outcomes of a cash transfer programme in Ejisu-Juaben Municipality in Ghana. This study draws on Foucault’s notion of subjectivation and discourse to construct a conversation and membership categorisation analyses framework to explore community focal persons’ and female caregivers’ conversations from focus group discussions. The Livelihood Empowerment against Poverty cash transfer programme in Ghana is the empirical case. This article demonstrates that caregivers and poor households arehappier, practice joint decision-making, and have cohesive social relations in poor households. Thus, localised programme outcomes improved participation in the decision-making, happiness, and social cohesion of beneficiary poor households. Evaluation mechanisms for programme outcomes could consider the everyday intersubjective accounts, practices of focal persons, caregivers/beneficiaries in poor households at the micro-level.&#x0D; Keywords: Social Protection, Ethnography, Discourse, Subjectivation, Governmentality