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To explore the perceptions of older female caregivers living in poverty in a high-income country regarding their health and self-care needs.
Descriptive qualitative study.
Seventeen semi-structured interviews were conducted with older female caregivers between October 2023 and March 2024. The reflexive thematic analysis method described by Braun & Clarke was followed, and ATLAS.ti 25 software was used for data analysis.
The analysis identified one main overarching theme, ‘Caring as an expected role that shapes identity and daily life’ and two interrelated themes: (1) ‘The need for a holistic approach to self-care’ and (2) ‘Caring on empty in the context of economic hardship and limited support’.
Self-care among older female caregivers living in poverty is constrained by caregiving expectations and socioeconomic disadvantage. Addressing their health needs requires nursing interventions that recognise caregiving as a central element of their lives and adopt holistic, context-sensitive approaches.
Nursing interventions should comprehensively assess older female caregivers' multidimensional health needs and enhance access to integrated support and services, addressing structural gender and socioeconomic inequities to strengthen health, dignity, and resilience.
Living in poverty exacerbates the challenges older female caregivers face in attending to their own health and self-care, increasing the risk of exhaustion, distress, and chronic illness. Recognising and addressing these needs through equitable, targeted interventions is essential to reduce health inequalities.
The study has been reported following the COREQ guidelines.
Limited patient and public involvement was incorporated, focusing on verification of their transcripts, ensuring accuracy and credibility in the interpretation of their accounts.
To explore how older women experiencing poverty in a high-income country perceive their family caregiver role from a gender perspective.
Descriptive qualitative study.
A convenience sample of seventeen older female caregivers experiencing poverty was interviewed in-depth between October 2023 and March 2024. Reflexive thematic analysis was conducted following the phases described by Braun & Clarke. ATLAS.ti software was used for data analysis.
Three main themes were developed from the data analysis: (1) The duality of family caregiving: between informal female support and structural neglect, (2) family care in later life as a continuation of a life devoted to others, (3) older female family caregiving as a gender issue.
Older female caregivers experiencing poverty have limited formal support and unequal access to resources. Older women experiencing poverty experience both gratitude and despair in their caregiving role, which inevitably deteriorates their health.
Nursing interventions for older female caregivers experiencing poverty should include an assessment of social determinants of health, focusing on gender and socio-economic barriers. Implementing system navigation interventions, such as community-based case management, resource referral programmes, and personalised care coordination, could connect older female family caregivers to essential resources and support networks, thus addressing their mental health needs and promoting equity, which would enhance their overall well-being and dignity.
Experiencing poverty increases the vulnerability of older female caregivers, exacerbating gender inequality. These women often face mental health issues as they face the pressure of meeting their own needs and those of their care recipients with a lack of formal support. This neglect can lead to serious health problems, which emphasises the need for equitable nursing interventions.
The study is reported following the COREQ guidelines.
No patients or public were involved in the study development and implementation.
Smoking is the leading cause of preventable deaths. The training of professionals on brief tobacco interventions (BTIs) increases the effectiveness of these interventions.
To assess the effectiveness of an online training program on BTI based on the 5As and 5Rs model in acquiring anti-tobacco brief advice competencies among nurses.
Quasi-experimental study with a pre-test and post-test design, with a control group and without random assignment. In the experimental group (EG), online training was provided in three sections: BTI theoretical content and methodology, clinical scenario videos, and feedback. Each scenario assessed the 5As and 5Rs as a validated instrument (BTI-Prof(C)). The control group (CG) only assessed the three videos of clinical scenarios. In both groups, competence was measured at the following points in time: T0 (before the training), T1 (at the end of the training), and T2 (after 90 days). The efficacy of the intervention was measured through a two-way ANOVA, and the variation rate was calculated from T0 to T1 and from T0 to T2.
236 nurses participated (157 EG; 79 CG). The mean age was 42.9 years, and 76.7% were women. There was a significant group*time interaction in the three cases, indicating that the online BTI training increases the competence of these professionals in clinical scenario 1 (F = 10.210; p ≤ 0.001; η 2 = 0.081), clinical scenario 2 (F = 6.235; p = 0.002; η 2 = 0.051), and clinical scenario 3 (F = 11.271; p ≤ 0.001; η 2 = 0.090).
A brief, asynchronous, and online intervention using standardized video-based cases is effective in improving nurses' BTI competence. This type of training can be a useful option for the National Health System as part of a global and continuous strategy for nurses to perform BTI.
An asynchronous online training program provides nurses with standardized, evidence-based tools to implement brief tobacco interventions in routine care, offering a scalable and practical solution to strengthen preventive strategies in health systems.
Sweden, as many other high-income countries, has adopted guidelines to offer induction of labour at 41+0 gestational weeks to decrease the risk for perinatal death. As more than 20% of the pregnant population reach this gestational age, and along with other contributing factors, induction rates have increased up to 30% in many countries. Both women and care providers have raised the question if outpatient induction could be a convenient, safe and economic alternative, reducing the burden on inpatient care in maternity hospitals. Before introducing outpatient induction into clinical routine, studies need to assure safety for the child and woman as well as efficacy of the method.
A register-based randomised controlled multicentre non-inferiority trial to study if outpatient induction in low-risk inductions is (1) as safe for the child (perinatal composite of mortality and morbidity) and (2) as effective (proportion of vaginal deliveries) as inpatient induction at the hospital. Secondary outcomes are further health outcomes, experiences of pregnant women, partners and care providers, health economics and future pregnancy outcome. Participating women with a singleton pregnancy and unripe cervix between 37+0 and 41+6 gestational weeks planned for low-risk induction will undergo induction of labour with either a balloon catheter or oral misoprostol according to clinical practice at the study site and the woman’s informed choice. Randomisation will allocate women to either outpatient (home or patient hotel) or inpatient induction (standard care). Women undergoing outpatient induction can remain at home for up to 2 days, with an assessment after 24 hours including cardiotocography. Once active labour ensues, all women will receive standard care in the hospital.
The assessment of non-inferiority will involve a two-sided 95% CI and 80% power, requiring randomisation of 8891 women to ensure a probability of at least 0.80 that the upper limit of a two-sided 95.7% CI for a difference in the primary safety outcome is below the non-inferiority margin of 1.5%. 31 of the 45 delivery units in Sweden are currently recruiting. Data will be collected from the electronic case report form and Swedish healthcare registers. Questionnaire and qualitative interview-based studies will be performed to explore experiences of pregnant women, partners and care providers. Additionally, a health economic evaluation will be performed.
The Swedish Ethical Review Authority approved the study (3 June 2020; 2020-02675 with amendments 2021-03045, 2022-00865-02, 2023-01252-02, 2024-00560-02, 2024-2024-04597-02). The Swedish Medical Products Agency approved the study for the medication arm (25 August 2020, EudraCT number: 2020-000233-41; 5.1-2020-60240 with amendments 5.1-2022-73500, 5.1-2023-630). Due to changed regulation, in 2023, the study medication arm was transferred and approved by the European Medicines Agency (23 October 2023, EU CT Number: 2023-507164-39-00; CTIS 5.1.2-2023-099775 with amendments 5.1.2-2024-081916, 5.1.2-2025-036291). The Swedish Medical Products Agency approved the study for the medical device arm (6 April 2021, CIV-ID: CIV-20-09-034712; 5.1-2021-14812 with amendments 5.1-2022-14252, 5.1-2023-596, 5.1-2024-8886, 5.1-2024-55554). The medical device arm was transferred to Regulation (EU) 2017/745 (23 December 2024, 5.1-2025-24242 and amendment 5.1-2025-6050). The study will involve more than 80% of all delivery units in Sweden, which will allow for a smooth implementation of any new routine after the study’s conclusion. Results will be published in relevant scientific journals, presented at national and international conferences, and communicated to participants and relevant institutions through the Outpatient Induction study homepage (www.optionstudien.se), the webinars of the Swedish Network for National Clinical Studies in Obstetrics and Gynecology (
EudraCT No: 2020-000233-41, after transfer to the European Medicines Agency EU CT Number: 2023-507164-39-00; CIV-ID 20-09-034712.
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