Tripping into China: findings emerging on caring for older relatives

Oládayò Bífárìn tells us how his PhD “Perceptions and experiences of caregivers of older relatives in mainland China – A multigenerational study” (supervised by Prof Jan Oybode, Dr. Liz Breen and Dr Catherine Quinn)  is progressing and discusses the expected impact of his project. 

My doctoral study is exploring how the rapidly ageing population, urbanisation and the One-child policy (1979-2015) is impacting on caregivers of older relatives in China with a view to thinking about how this can be managed in future. A major central issue revolves around the expectations placed on adult-children to fulfil Xiao (filial piety), that is, to meet their parents’ needs and wishes; a context which was captured in this post. My aims are to understand the views and experiences of people with caring responsibilities for older relatives in China. I am exploring how prepared they are for their potential/current caring responsibilities, the meanings that they attach to Xiao (filial piety) and the extent to which they subscribe to the cultural values of Xiao.

In another blog post, I shared my experience of visiting Prof Liu Yu, our Chinese collaborator at China Medical University, Shenyang, with my primary supervisor Prof. Jan Oyebode. When these blogs were published, the plan was for me to return to China for data collection but unfortunately, due to the pandemic, I have had to conduct my interviews remotely. I have now completed interviews with children affected by One Child Policy, parents affected by One Child Policy and caregivers in employment. Here, I summarise some of the findings that are coming from my analysis of these interviews.

So far, I have published two peer-reviewed papers and have another one under review. I describe them below, before going on outline some other key findings.

  • Bifarin O., Oliver E., Oyebode J., & Liu Y. (2020). Supporting Family Caregivers to Care for Parents Living with Dementia: the experience shared from United Kingdom on specialized dementia care. Chinese Nursing Management, 20 (9): 1285-1291.

In response to the increasing need for community services to support caregivers of older relatives in China, this paper took a critical stance by suggesting how existing UK models for supporting care for older people could be adapted for the modern Chinese context. Drawing on the socio-cultural model of stress and coping, we recognised the centrality of Xiao in Chinese culture and the associated expectation that families look after their relatives. Therefore, we proposed that principles of ageing in place and relationship-centred care might be effective approaches to dementia care in China. We described the Admiral Nursing model that is used in the UK as an example.

  • Bífárìn, O., Quinn, C., Breen, L., Wu, C., Ke, M., Yu, L. and Oyebode, J., 2021. Stressors and coping mechanisms of family care-givers of older relatives living with long-term conditions in mainland China: a scoping review of the evidence. Ageing and Society, pp.1-38

This paper provides a scoping review of what is already known about stressors and coping with care for older relatives in China (it is available in print here), the key findings are:
“Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers’ unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China.” (p.1).

  • Bífárìn O., Quinn C., Breen L., Zhang, B. & Oyebode J. Intersections between the Chinese Culture Xiao (孝) and Caring for Older family relatives: The Perspectives of Millennials & Generation-Z.

My third paper, mentioned above, is under review, and its key findings are:

• Individuals from mainland Chinese younger generations each have their own interpretations of Xiao. This could be a stressor for future caregivers if their individual construction does not fit with the dominant societal expectations.
• Mainland Chinese younger generations may experience cognitive dissonance (i.e. they may experience a clash) between the wish/societal pressure to fulfil Xiao by caring for their parents and their need/societal pressure to succeed in work and other aspects of their lives. These pressures may lead to barriers to them accessing support to help them care for their parents within their cultural environment.

Most preceding research uses questionnaire measures to draw general conclusions about levels of caregivers’ “burden”, oversimplifying caregivers’ needs based on the collectivist culture and lack of empowerment for caregivers to self-actualise. However, given the speed of change in Chinese society and its distinctive sociocultural environment, I concluded that the subjective understanding of caregivers and care recipients’ experience would be a good predictor of the well-being of caregivers. I therefore needed to listen to individual caregivers’ in-depth accounts . Therefore, what is novel about my doctoral study is the multi-generational interpretative phenomenological approach that I have adopted.

Findings from my main study are emerging. I am finding that caregiving is very likely to cause family distress. Younger generations mirror parents’ devotion to providing care, despite being ‘only children’. As a result, they may be confronted in future with care demands which can be physically, emotionally, cognitively, and organisationally taxing.

Parents affected by the One-child policy are keen on receiving future care from their own children, despite being very considerate and aware of the need for their offspring to have well-being. With poor quality formal services, parents perceived long term care settings as an unviable option. Consequently, offspring would most likely be left with no other choice but to provide care, which they would be willing to do, albeit, recognising they would find it hard to manage on a long-term basis. Whilst responses are changing regarding the expectations associated with traditional filial piety, the culture of Xiao still takes pre-eminence. Within this collectivist society, there is a propensity for individuals to step up to their responsibilities. However, this cannot necessarily be construed as showing emotional fortitude. In situations where individuals are unable to match filial expectations with their performance, cognitive and emotional dissonance may arise, which could manifest as anxiety. Such discrepancies between ideal self and actual self have implications for the quality of care provided.

Formal services remain under-developed in China, contributing to low uptake. The implications are that future generation of caregivers are likely to provide care alone (literally and metaphorically) and will have to fend for themselves. Essentially, conversations therefore need to shift from care being the responsibility of offspring to articulating the nature of support needed by offspring, bearing in mind the competitive labour market in China and substantial economic pressure placed on the younger generation.

With my existing findings, I hope to raise awareness of both the public and professionals around distinct demands placed on individuals in the socio-cultural environment in China by reinforcing discourse around fidelity of feelings and the validity of emotions in the context of balancing individual needs with the demands associated with providing care. Building upon this, I hope my research will impact policy nationally and locally. I will be arguing for a value-based appropriation model , where service design is influenced by the values caregivers’ associate with caring for older relatives to improve caregivers’ and older relatives’ experiences, which aligns with goal number 3 of the United Nations’ Sustainability Development Goals (SDGs). I also expect my work to enhance discourse around the need for culturally competent care in developed countries, potentially influencing training and hiring processes.

Oládayò O. Bífárìn.

PhD Student