Most members of the older population in Thailand live in rural areas while their children live in cities. With the joint family system separated, elderly Thai persons often have to care for themselves, and opportunities for them to get involved in community care remain limited. In response, the aim of this study was to describe older persons’ and their family members’ experiences with shareholding networks for the care of older people in rural Thailand. Paired interviews with five older persons and five of their family members were conducted, and collected data were subjected to content analysis, which yielded results organized around two themes: older persons’ outsider status and disregard for older persons’ individuality. Whereas the theme of outsider status describes shortcomings in healthcare encounters, the theme of disregard for individuality describes the lack of engagement of authorities and caregivers in older persons’ care. In that sense, the concept of participation emerged as a framework for understanding interviewees’ experiences. Given findings from local authorities, older individuals and their family members should engage in dialogue in order to support healthcare based on shared understanding.
The expansion of older and aging populations represents a major global demographic trend [
Despite national policy addressing the aging Thai population [
Older persons who receive community-based healthcare are often considered to need more assistance than those allotted by other forms of community care, which risks the activation of associated power differentials [
Despite the need for both individual and general knowledge about aging persons, no studies have addressed the experiences of shareholding networks for older persons’ care in rural communities. However, capturing such knowledge could facilitate older persons’ improved participation and increase their involvement in communal healthcare―opportunities that to date remain rather limited. By letting older persons and their family members narrate stories about their experiences with community healthcare, it is possible to glean a deeper understanding of the care that they receive and, in turn, improve the quality of their daily lives. Accordingly, the aim of this study was to describe older persons’ and their family members’ experiences in shareholding networks for the care of older people in rural areas.
Drawing upon conventions of qualitative research, this study gathered and interpreted persons’ subjective experiences. The qualitative approach allowed the capture of nuances, details, and reflections undetectable by quantitative methods [
Following Malterud et al.’s [
The study was conducted in a rural subdistrict in central Thailand with a senior population of 927, or approximately 48 older people per km2, which had increased from 10% of the total population in 2010 to nearly 15% by 2015. The average income in the subdistrict where the study was conducted is approximately 8000 baht per month (210 EUR) and agricultural production is still high and the sector is important for employment. In the subdistrict, two primary government agencies provide healthcare services: local administrative organizations (LAOs), which provide basic healthcare services for older people in line with the government policy prescribed by health promotion hospitals (HPHs), which provide health promotion, prevention, treatment, and recovery services based on the criteria of the Ministry of Public Health.
The first author conducted paired interviews from May to October 2015. Initially interviewees were asked to speak openly about their own or their relative’s daily life. As their stories unfolded, more targeted questions:
・ What do you think is important for older people’s care in the community?
・ What are some experiences that you have had with your care as an older person?
・ What are some examples of health policy for older people’s care in the area?
・ How have community resources adequately helped to address needs identified by healthcare organizations in the community?
・ Would you describe healthcare system methods for exchanging information and facilitating interactions in the community?
The interviews occurred in the participant’s home. During interviews, the interviewer asked clarifying questions to support understanding or encourage interviewees to develop their responses. The first author conducted and audio taped all interviews, which lasted 60 - 80 min, and transcribed them verbatim. All interviews were performed in Thai. The first author also translated the transcripts from Thai to English. The second author checked the translation and confirmed that the meaning was kept throughout the process. The language in this article is assured quality by professional editing.
Transcribed interviews were subjected to thematic content analysis in compliance with Downe-Wamboldt’s [
The study followed the ethical principles of the Helsinki Declaration [
The aim of the study was to describe older persons’ and their family members’ experiences with shareholding networks dedicated to the care of older people in rural areas. Themes and categories are presented in what follows and illustrated by quotations from the interviews. An overview of themes and categories is presented in
Interviewees highlighted experiences involving difficulty with participating in older people’s care, which they considered to threaten their dignity. Such situations involved conditions in which healthcare personnel showed no concern for interviewees’ opinions:
The LAO programs for providing health services to older people is a program planned by the government. Maybe they have gotten new ideas for the program from the community, but senior citizens have little chance to express their opinions [older persons’ experience of own care have no or little impact on program development of older persons’ care]. (P3)
Living in a rural area demands engagement from healthcare; however, professionals too often assume that older persons can manage, for example, to get to activities by themselves, even when activities are far from home and no busses or relatives are available to transport them. Interviewees also described healthcare workers’ lack of involvement in their personal health, which they considered a risk for and obstacle to positive healthcare encounters, including those intended to ensure ongoing care and future contact with healthcare workers. One interviewee even stated that
They [Healthcare workers] always say that they don’t have time to participate. (P2)
Interviewees also reported that they received insufficient attention from others in the community and could not give voice to their ideas concerning elderly policies in their community. They generally added that the problem related to widespread disinterest among team members in subdistrict organizations regarding older peoples’ social roles. They moreover emphasized that health service activities should grow out of older persons’ experiences, not those of the government, which was a tendency that frustrated interviewees and left them unsatisfied. As one interviewee suggested in response,
It would be great if there were a place or way for older persons and their families to express their opinions about policies. (P5)
Interviewees additionally stressed that they never had been invited to partici-
Themes | Categories |
---|---|
Older persons’ outsider status | Lack of engagement and interest Lack of resources |
Disregard for older persons’ individuality | Lack of responsibility Lack of communication |
pate in community elderly care policies, yet nevertheless claimed that it was important for LAOs and community committees to recognize the values of older people and their family members’ roles.
Interviewees highlighted older persons’ need for supportive resources from com- munity organizations in rural areas and stressed that older persons’ self-care activities often were based on their economic situations. As one relative said:
Mouths and bellies have to come first. If we were to join in activities, then we’d have to stop working. That would cost us 300 Bath [approximately 8 Euro] a day. (P2)
Along with their economic situations, other aspects of the necessity of self-care were identified, including lack of knowledge and education about basic elements of healthcare―for example, blood pressure control:
I’m old, and I’m afraid to tell them [healthcare workers]. The people working in LAOs and HPHs have knowledge. They have studied a lot more than me. (P5)
The lack of resources moreover seems to create additional distance between older persons and their relatives, on the one hand, and between them and their communities on the other hand. As interviewees pointed out, that circumstance could further frustrate relatives and put them in impossible situations:
Relatives have to work. It’s already dark when they get home. Sometimes it’s like they’re not interested in taking care of their elders. (P4)
According to interviewees, the causes of problems expressed generally relate to insufficient responsibility taken by staff in community care organizations. As they put it, LAOs and HPHs had failed to recognize their needs and, in turn, to manage the provision of healthcare services. As an antidote, they recommended that
Staff working in LAOs should create new healthcare services specifically for older persons in the area. (P1)
Interviewees moreover complained about the distance between them and the community organizations, as well as about the inappropriateness of routine work:
Staff do routine work only to meet their organization’s criteria. (P3)
Interviewees discussed the lack of opportunities to have their voices heard and thereby actively participate in the care policy and services of their communities. They added in particular that LAOs’ communication did not meet requirements or their needs as customers:
The government keeps to itself. It tells us to do what it wants... but it never asks what type of healthcare we need. Our older persons are different. For example, some bed-bound older persons have no interest in performing any activities, unlike our group members, who do everything to the fullest when we are told to. (P1)
It seems as though the lack of communication between officials and families had resulted in the stagnation of program content, which risked entrenching a sense of boredom and monotony:
The LAO programs for providing health services to older persons is a conventional program planned by the government. The programs are the same and without change for older persons in the area... The LAO takes care of senior citizens every year, but it’s the same old program every year. When one year is up... There are no changes in the program. (P1)
Interviewees stressed that the best way for the government to present information was to ask questions, such as about what older persons want or what problems they have. In short, they stressed the importance of referring to older persons’ needs when changing strategies or integrating LAO or HPH policies:
Planning activities and projects to care for the health of older persons in our community should be integrated with LAO and HPH work plans with a representative older person who participates by offering opinions during planning. (P4)
This study focused on older persons’ and their family members’ experiences with being part of shareholding networks for the care of older people in rural areas in Thailand. Since the study took place in one subdistrict in one province with a small sample, it is important to bear in mind that the results of the study cannot be generalized, but should be seen as another argument in an ongoing discourse [
Problems voiced by interviewees concerning cooperative networking for healthcare for older persons in the community were consistent with those re- ported by [
The findings furthermore indicate that interviewees experienced receiving insufficient attention from others in the community and a lack of opportunities to express their ideas about elderly care policies in their communities. It seems as though elderly care policies in the community addressed have been built by following a top-down approach, which has led to a lower level of participation instead of an objective to promote older persons’ and their families’ participation in community activities. In that sense, the benefits of using the community participatory process in providing healthcare to community populations include developing healthcare policies for older people toward ensuring a process that gives opportunities to the target group to participate in solving their own health problems [
Interviewees also described their lack of resources essential for self-care activities. Based on our findings, it seems that involvement from local and regional authorities in the matter is invaluable. Of course, authorities need to be involved throughout the process, from planning to evaluation [
Another important factor described by interviewees was their experiences with a shortage of financial support. Activities require funding to cover expenses, and economic support for projects is important in performing current work and making preparations for the future when building self-management programs for older people [
The findings also indicate that another problem encountered in older persons’ experiences with healthcare is their and their families’ sense of a disregard for their individuality. Older people and their family members sense a lack of responsibility among local authorities that has detrimentally influenced the quality and safety of healthcare services provided, particularly given the lack of consideration of them as unique individuals and stakeholders. To improve the care of older people, resources need to be developed not only by focusing on work with existing sources of care, but by also extending the rights of older people at least to include an assessment of needs and an equitable meeting of those needs with care services available [
Insufficient communication between local authorities and older people seems to be yet another problem. As our study indicates, older people and their families engage in inadequate, if any, communication with public employees working to provide healthcare for them and with others involved in the community. According to Lavoie et al. [
This study has revealed that the phenomenon of participation should be grounded in the idea of being master of one’s own life, which is essential to all humans and important for the self-esteem and dignity of older people and their family members in particular. By extension, older people’s and their family members’ involvement in community healthcare can be understood according to the concept of participation. Local participation may be regarded as natural in community development approaches, both as a necessary condition for change and in terms of the values of empowerment and partnership [
To protect older persons’ self-esteem and dignity, the level of participation has to be adjusted to the individual’s abilities at the particular time. From such a point of view, our findings can be understood in the light of Buber’s [
A major strength of this study was paired interviews with older persons and family members, which functioned as springboards for more open discussions and was effectively uncovered older persons’ experiences with healthcare. Furthermore, analyses were conducted jointly and reviewed independently by all authors, which added rigor to the study, and preliminary results were presented to interviewees to ensure rigor and ensure the credibility of data, as consistent with Lincoln and Gruba’s [
This paper has discussed the experiences of care for older people in rural areas in Thailand as perceived by them and their family members. The context can be conceived as a frame that represents how older persons and their family members experience healthcare services given by primary government agencies on a large scale. The results show that the chief reasons for shortcomings in healthcare encounters, according to the interviewees, caused experiences of feeling barred and, in turn, a sense of having outsider status in their own communities. Interviewees stated that problematic experiences involved a lack of engagement, interest, resources, responsibility, and communication barriers among local administrative organizations and subdistrict health promotion hospitals regarding older persons’ situations. Furthermore, authorities should afford opportunities to hear out older persons’ concerns when planning care offerings and services. It is therefore necessary to reflect on the concept of participation as a frame for understanding the experiences of interviewees in this study. On the basis of our findings, we suggest that local authorities and older individuals and family members engage in dialogue as part of a vital approach for healthcare based on shared understanding.
Every old person is unique and should be offered positive healthcare encounters with good nursing care based on his or her personal experiences. Old persons therefore need to be met with understanding, presence, and engagement in their relationships with healthcare workers.
The authors have no conflicts of interest to declare.
Voraroon, S., Meebunmak, Y., Enmarker, I. and Hellzén, O. (2017) Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members. Open Journal of Nursing, 7, 318-330. https://doi.org/10.4236/ojn.2017.72026