Intersectionality

Intersectionality

It is important to discuss briefly the use of the above categories in approaching caregivers. First, although these categories are important, often recognized as social determinants of health, they are constructions and should be recognized as such. They are helpful at ‘simplifying’ seemingly disparate information under certain ‘headings’, however the caregiving experience is both rich and complex, so caution would be warranted when seeking to “simplify” categories of interventions or even categories of care recipients.  The fact that so much of the literature has shown incredible variability in outcomes reflects the challenge of the categories used in sample selection and analysis. How accurately these particular categories are in reflecting the essential components of the caregiver experience is certainly up for debate. A dimension to that debate, however, also has to include the extent to which these categories interact with one another, and their combined effect on the caregiving experience, not just at the individual level, but also at the group/community level and also at the broader policy levels.  Second, it is important to recognize that factors such as age, gender, relationships with care recipients and ethnicity/culture are interconnected and that the caregivers and care recipients are constantly navigating and negotiating their own identities as they respond to their broader sociocultural contexts as well as to evolving health conditions.

The literature for caregiver interventions demonstrates the breadth of ideas that have been put forward about what can be done to provide support for caregivers experiencing distress. In attempting to identify and distinguish interventions that are successful from those that are not, the research has uncovered a number of factors that both individually and in concert, influence the outcome of an intervention in a given population.  As such, the success of an intervention depends on more factors than just the content or type of intervention itself; who the intervention is directed to, when and for what length of time are all incredibly important questions for which the current evidence has only peripherally has addressed. The seductive nature of relying on the experimental studies to demonstrate “certainty” of an outcome’s effectiveness can be tempered by the results that these experimental studies have borne out – namely that there is a high degree of variability with respect to effect size.

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