title: Understanding the Role of the Informal Caregiver in Infection Prevention and Control in Hospitals in Vietnam
title: A Focused Ethnographic Study.
titleType: Subtitle
Creators: name: Hogan, Unarose
Publisher: name: Lancaster University
Year: 2024

description: Background: In low- and middle-income countries, informal caregivers
 assume an expanded role in patient care, driven by cultural factors and
 human resource constraints. A comprehensive systematic review was
 undertaken to consolidate existing evidence concerning the distinct
 engagement of informal caregivers in patient care across low- and
 middle-income countries. This review highlighted a critical gap in
 understanding their pivotal yet inadequately explored contribution to
 infection prevention and control within hospital environments in these
 settings. Hospital-acquired infections pose a significant global
 healthcare challenge, disproportionately affecting low- and middle-income
 countries due to systemic challenges, including inadequate infrastructure
 and human resources. Given the significance of hospital-acquired
 infections, exploring the role of the informal caregiver in infection
 control is warranted. 
 
 Methods: This study employed focused ethnography involving informal
 caregivers and healthcare workers at a secondary-level acute public
 hospital in Hanoi, Vietnam. Data collection took place in adult inpatient
 departments over four intermittent weeks from August to December 2018.
 Purposive sampling using snowballing selected information-rich
 participants. Data collection methods included observation,
 semi-structured interviews with informal caregivers and healthcare
 workers, and a reflection diary to acknowledge researcher biases and
 ensure quality. Data analysis used Roper and Shapira's (2000)
 framework for thematic analysis, which was adapted for focused
 ethnography. Initially, the data was coded into broad categories, which
 were then refined into descriptive labels. Patterns were identified within
 these labels, forming themes relevant to the research question. A flexible
 approach allowed for theme identification through frequency, aligned with
 the research question. The World Health Organization's core
 components of the infection control model were then applied for further
 coding, refining the initial codes. Themes were iteratively reviewed to
 ensure alignment with participant experiences and research questions.
 Complex relationships between themes were identified and refined
 throughout the iterative process.
 
 Results: Over four intermittent weeks, spanning four hospital departments
 (general medicine, neurosurgery, orthopaedics and the emergency room), 32
 hours of participant observation and 25 participant interviews were
 conducted with informal caregivers and healthcare workers. Three themes
 were identified in the research. Firstly, the embedded role of informal
 caregivers in the healthcare ecosystem was highlighted, identifying a
 cadre of commercial caregivers and an increasing professionalisation of
 the informal caregiving role. The research further identified informal
 caregivers' acknowledgement of national health policy, cultural
 expectations, and reliance on their role but found their integration into
 the healthcare workforce remains incomplete. Secondly, informal caregivers
 as proxy healthcare workers in infection prevention and control
 highlighted their involvement in patient care tasks, many of which pose
 infection control risks. The research also revealed the formation of a
 community among informal caregivers, and their interaction with the
 hospital environment akin to a domestic space was noted. Lastly,
 navigating the duality of informal caregivers' role in infection
 prevention and control as both a challenge and an opportunity underscored
 disparities in infection prevention and control between healthcare workers
 and informal carers, revealing varying knowledge levels and blame-shifting
 tendencies among staff. Patients and carers are often uninformed of
 infection diagnoses, highlighting the need for improved education and
 consistency. Moreover, constraints such as hospital infrastructure hinder
 infection control measures, necessitating action to support informal
 carers and enhance healthcare settings.
 
 Conclusion: The research underscores the crucial yet often overlooked role
 of informal caregivers in healthcare systems, particularly evident in
 low-income countries, emphasising the need to consider cultural-specific
 factors. It highlights the intricate interplay between culture and patient
 safety within the context of informal caregivers in hospitals, revealing
 various dimensions that influence caregivers' interactions and impact
 patient safety. Moreover, it identifies a lack of awareness among informal
 caregivers regarding their role in infection control, indicating the
 necessity for targeted education and training programmes tailored to them.
 The study also uncovers significant infrastructural, educational, and
 cultural barriers hindering the practical implementation of infection
 control measures by informal caregivers. It provides policy, practice, and
 research recommendations across infection control, emphasising the need
 for infection control training among informal caregivers, recognition of
 their role, resource allocation and understanding of their interactions in
 the hospital environment. Furthermore, it contributes to the existing body
 of knowledge by deepening our understanding of the role of informal
 caregivers in infection prevention and control. The findings carry
 implications for policy and practice, supporting tailored interventions to
 empower informal caregivers in their infection control roles. Addressing
 the identified challenges and promoting collaboration between healthcare
 workers and informal caregivers can enhance patient safety and mitigate
 the risk of healthcare-associated infections in low- and middle-income
 countries. Lastly, while valuable insights have been provided, it is
 essential to acknowledge the research's limitations and the need for
 further research to build upon these findings and further advance our
 understanding of this important area.