A Mixed Methods Study: Examining the Relationship between Therapeutic Self-care and Adverse Events for Home Care Clients in Ontario, Canada

The purpose of this mixed methods study was to examine the concept of therapeutic self-care in the context of home care, as well as its influence on the safety of home care clients and their informal caregivers. The quantitative approach used a retrospective cohort design and utilized secondary databases available for Ontario home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care and adverse events. The qualitative approach utilized one-on-one interviews with the clients and their informal caregivers recruited from one home care agency in Ontario. Qualitative description was used to analyze data that generated themes about clients and their caregivers' perspectives of home care safety in relation to therapeutic self-care and informal caregiving. The quantitative results indicated that low therapeutic self-care ability was associated with an increase in the odds of clients experiencing: (1) unplanned hospital visits; (2) decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication. Analyses of the qualitative interview data revealed four over-arching themes: (1) Struggling through multiple aspects of safety challenges; (2) Managing therapeutic self-care by developing knowledge, competency and self-confidence; (3) Coping with informal caregiving through problem-solving, stress management and caregiver relief; (4) Seeking education, support and collaboration from home care.This mixed methods study advanced understanding of therapeutic self-care in the context of home care. The results provide a better understanding of the relationship between therapeutic self-care ability and the prevalence of adverse events experienced by home care clients. The qualitative findings provide insight into the safety problems related to therapeutic self-care and informal caregiving. This knowledge is vital to policy formulation related to the role of home care services in improving client's therapeutic self-care ability to reduce safety related risks and burden for home care recipients.Ph.D