title: The Role of a Multicomponent Home-Health Intervention in Reducing Caregiver Stress in Singapore: A Qualitative Study.
abstract: The relationship between caregiving and negative health outcomes is well established in the literature. Previous studies have shown that community-based programs reduce caregiver stress. However, the mechanisms by which this happens have not been well investigated. This qualitative study examines caregivers' experiences as a part of the Aging-In-Place intervention, a home-health program in Singapore targeted at frequently hospitalized patients and their caregivers.
  
  
  
  We interviewed 32 caregivers to study the underlying processes by which caregiver stress was ameliorated. Transcripts from semistructured interviews were analyzed thematically within the theoretical framework of the stress process model.
  
  
  
  Primary stressors related to routine patient care were reduced through the intervention program that provided health monitoring to patients and facilitated linkages to community-based services. Increased access to advice and medical information provided by intervention staff reduced caregivers' uncertainty, a substantial secondary stressor. Caregivers who employed a foreign domestic worker (FDW) gained additional reductions in both primary and secondary stressors.
  
  
  
  The multidimensional home-health intervention reduced both primary and secondary stressors for caregivers. FDWs constituted a resource that caregivers could rely on and the training provided to FDWs by intervention staff further reduced caregiver stress. Implications for program planning and future research are discussed.
authors.affiliation: Centre for Ageing Research and Education.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Penkunas
authors.affiliation: Centre for Ageing Research and Education.|Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Department of Sociology, National University of Singapore, Singapore.
authors.forename: Angelique W M
authors.initials: AWM
authors.lastname: Chan
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Geriatric Education and Research Institute, Singapore.|Department of Geriatric Medicine, Alexandra Health System, Singapore.
authors.forename: Chek Hooi
authors.initials: CH
authors.lastname: Wong
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Singapore National Eye Centre, Singapore.|Medical Innovation and Care Transformation, KK Women's and Children's Hospital, SingHealth Duke-NUS Academic Medical Centre, Singapore.|Institute of Health Policy and Management, Erasmus University Rotterdam, Netherlands.
authors.forename: Dirk F
authors.initials: DF
authors.lastname: de Korne
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
authors.forename: See Mieng
authors.initials: SM
authors.lastname: Tan
authors.affiliation: Geriatric Education and Research Institute, Singapore.|Department of Geriatric Medicine, Alexandra Health System, Singapore.
authors.forename: Sweet Fun
authors.initials: SF
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000193:education / Q000523:psychology*; D003153:Community Health Services / Q000379:methods / Q000458:organization & administration; D005260:Female; D006701:Home Nursing / Q000193:education / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012846:Singapore; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control*
keywords: Caregiving/caregivers; Foreign domestic workers; Home-health; Qualitative; Singapore; Stress process model