Abstract：
OBJECTIVE: To identify culturally related stressors that influence self-care in Chinese older adults with multiple chronic conditions.
BACKGROUND: Effective self-care can improve health outcomes for chronic conditions, but implementing self-care is challenging. Individuals with multiple chronic conditions face even more self-care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self-care in multiple chronic conditions, the role of culture in generating stressors has been neglected.
METHODS: This paper reports on the qualitative component of a larger mixed-methods study. Two free-response items in a survey were used to identify culturally related stressors that influence self-care. This report adhered to the SRQR guideline checklist.
METHODS: Data were collected between January and April 2022. One hundred and thirty-eight free text responses asking participants to identify stressors that influenced their self-care effectiveness were analysed sequentially using deductive content analysis and thematic analysis.
RESULTS: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems.
CONCLUSIONS: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day-to-day self-care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self-care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions.
UNASSIGNED: Stressors that might influence self-care ability are important for nurses to assess in people with multiple chronic conditions. The design of self-care interventions should take a culturally tailored intergenerational family-centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes.
CONCLUSIONS: What problem did the study address? Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self-care in Chinese older adults with MCCs is lacking. What were the main findings? Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Where and on whom will the research have an impact? The research will have an impact on guiding nurses\' assessment of culturally relevant stressors\' impact on self-care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self-care.
UNASSIGNED: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist.
UNASSIGNED: During the member-checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences.
BACKGROUND: Effective self-care can improve health outcomes for chronic conditions, but implementing self-care is challenging. Individuals with multiple chronic conditions face even more self-care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self-care in multiple chronic conditions, the role of culture in generating stressors has been neglected.
METHODS: This paper reports on the qualitative component of a larger mixed-methods study. Two free-response items in a survey were used to identify culturally related stressors that influence self-care. This report adhered to the SRQR guideline checklist.
METHODS: Data were collected between January and April 2022. One hundred and thirty-eight free text responses asking participants to identify stressors that influenced their self-care effectiveness were analysed sequentially using deductive content analysis and thematic analysis.
RESULTS: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems.
CONCLUSIONS: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day-to-day self-care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self-care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions.
UNASSIGNED: Stressors that might influence self-care ability are important for nurses to assess in people with multiple chronic conditions. The design of self-care interventions should take a culturally tailored intergenerational family-centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes.
CONCLUSIONS: What problem did the study address? Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self-care in Chinese older adults with MCCs is lacking. What were the main findings? Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Where and on whom will the research have an impact? The research will have an impact on guiding nurses\' assessment of culturally relevant stressors\' impact on self-care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self-care.
UNASSIGNED: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist.
UNASSIGNED: During the member-checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences.
摘要：
目的：确定影响患有多种慢性疾病的中国老年人自我护理的文化相关压力源。
背景：有效的自我护理可以改善慢性病的健康状况，但是实施自我护理是具有挑战性的。患有多种慢性病的人比患有单一慢性病的人面临更多的自我护理复杂性，产生额外的压力源。尽管已经发现压力因素在多种慢性疾病中对自我护理产生负面影响，文化在产生压力源中的作用被忽略。
方法：本文报道了更大的混合方法研究的定性成分。在一项调查中，使用了两个自由反应项目来确定影响自我护理的与文化相关的压力源。本报告遵循SRQR指南清单。
方法：数据收集于2022年1月至4月之间。使用演绎内容分析和主题分析依次分析了118个自由文本回答，要求参与者识别影响其自我护理有效性的压力源。
结果：演绎内容分析的结果在很大程度上证实了西方文献中已发表的关于压力源使自我护理复杂化的工作，包括症状负担，财政紧张，社会脱节，照顾责任和重大生活事件。反思主题分析的发现通过确定三个文化相关的压力源扩展了当前的文献：代际义务和承诺，对接受护理的矛盾和对潜在问题的担忧。
结论：患有多种慢性疾病的中国老年人发现了多种压力源，这些压力源影响了他们的日常自我护理。这项研究为患有多种慢性疾病的老年人的文化相关压力源提供了有价值的见解。研究结果加深了我们对文化影响对患有多种慢性病的老年人自我护理成功的认识，表明了覆盖不同文化和地区人群的潜力。
■可能影响自我护理能力的压力对于护士评估患有多种慢性疾病的人很重要。自我护理干预的设计应采取文化上量身定制的代际以家庭为中心的方法，以帮助减轻压力源的影响并最终改善患者的预后。
结论：该研究解决了什么问题？在患有MCC的老年人中记录的应激源都来自西方人群的研究。中国现在是世界上老年人口最多的国家。缺乏了解文化相关压力源对中国患有MCC的老年人自我护理的影响。主要发现是什么？演绎内容分析的结果在很大程度上证实了西方文献中发表的关于压力源的工作，这些工作使自我护理复杂化，包括症状负担，财政紧张，社会脱节，照顾责任和重大生活事件。反思主题分析的发现通过确定中国患有MCC的老年人的三种文化相关压力源，扩展了当前文献：代际义务和承诺，对接受护理的矛盾和对潜在问题的担忧。这项研究将在哪里以及对谁产生影响？这项研究将对指导护士评估与文化相关的压力源对患有MCC的老年人的自我护理的影响产生影响。此外,研究结果可以为研究和政策制定提供信息，以减轻基于文化的压力源对自我护理的影响。
■本研究遵循定性研究报告标准（SRQR）指南清单。
■在成员检查过程中，10名参与者对结果的准确性进行了验证，他们也发现了这些发现和他们自己的经历之间的共鸣。
背景：有效的自我护理可以改善慢性病的健康状况，但是实施自我护理是具有挑战性的。患有多种慢性病的人比患有单一慢性病的人面临更多的自我护理复杂性，产生额外的压力源。尽管已经发现压力因素在多种慢性疾病中对自我护理产生负面影响，文化在产生压力源中的作用被忽略。
方法：本文报道了更大的混合方法研究的定性成分。在一项调查中，使用了两个自由反应项目来确定影响自我护理的与文化相关的压力源。本报告遵循SRQR指南清单。
方法：数据收集于2022年1月至4月之间。使用演绎内容分析和主题分析依次分析了118个自由文本回答，要求参与者识别影响其自我护理有效性的压力源。
结果：演绎内容分析的结果在很大程度上证实了西方文献中已发表的关于压力源使自我护理复杂化的工作，包括症状负担，财政紧张，社会脱节，照顾责任和重大生活事件。反思主题分析的发现通过确定三个文化相关的压力源扩展了当前的文献：代际义务和承诺，对接受护理的矛盾和对潜在问题的担忧。
结论：患有多种慢性疾病的中国老年人发现了多种压力源，这些压力源影响了他们的日常自我护理。这项研究为患有多种慢性疾病的老年人的文化相关压力源提供了有价值的见解。研究结果加深了我们对文化影响对患有多种慢性病的老年人自我护理成功的认识，表明了覆盖不同文化和地区人群的潜力。
■可能影响自我护理能力的压力对于护士评估患有多种慢性疾病的人很重要。自我护理干预的设计应采取文化上量身定制的代际以家庭为中心的方法，以帮助减轻压力源的影响并最终改善患者的预后。
结论：该研究解决了什么问题？在患有MCC的老年人中记录的应激源都来自西方人群的研究。中国现在是世界上老年人口最多的国家。缺乏了解文化相关压力源对中国患有MCC的老年人自我护理的影响。主要发现是什么？演绎内容分析的结果在很大程度上证实了西方文献中发表的关于压力源的工作，这些工作使自我护理复杂化，包括症状负担，财政紧张，社会脱节，照顾责任和重大生活事件。反思主题分析的发现通过确定中国患有MCC的老年人的三种文化相关压力源，扩展了当前文献：代际义务和承诺，对接受护理的矛盾和对潜在问题的担忧。这项研究将在哪里以及对谁产生影响？这项研究将对指导护士评估与文化相关的压力源对患有MCC的老年人的自我护理的影响产生影响。此外,研究结果可以为研究和政策制定提供信息，以减轻基于文化的压力源对自我护理的影响。
■本研究遵循定性研究报告标准（SRQR）指南清单。
■在成员检查过程中，10名参与者对结果的准确性进行了验证，他们也发现了这些发现和他们自己的经历之间的共鸣。
