中国阿尔茨海默病家庭照护者的家庭坚韧性及相关因素：一项解释性序列混合方法研究

ORIGINAL RESEARCH article

Front. Psychol.

Sec. Health Psychology

• 1. Lishui University, Lishui, China

• 2. Lishui City People's Hospital, Lishui, China

Abstract

Aim: To examine family hardiness and associated factors among Chinese family caregivers of people with Alzheimer’s disease (AD), and to explore caregivers’ experiences of family adaptation in daily care. Methods: An explanatory sequential mixed-methods design was used. In the quantitative phase, 201 family caregivers recruited from a tertiary hospital in Zhejiang Province completed the Family Hardiness Index (FHI) and measures of potential associated factors. Multivariable linear regression examined associations with total and subscale FHI scores. Twelve caregivers subsequently took part in semi-structured interviews. Directed content analysis was used to interpret the quantitative findings in context and identify additional themes. The two phases were integrated through a following-a-thread approach and a convergence coding matrix. Results: The mean total FHI score was 56.85 ± 6.27. Commitment/responsibility had the highest mean subscale score (26.09 ± 3.71), and challenge the lowest (13.49 ± 2.04). In the final model for total FHI score (adjusted R² = 0.477), family resources (β = 0.390, p < 0.001), female patient sex (β = −0.286, p = 0.005), perceived caregiving burden (β = −0.262, p < 0.001), and family meaning-making (β = 0.190, p = 0.003) were independently associated with family hardiness. The qualitative analysis generated eight themes. Integration yielded two convergent findings, five complementary findings, and one exploratory theme found only in the interviews: companion-animal support. Conclusions: Family resources, perceived caregiving burden, family meaning-making, and patient sex were associated with total FHI scores. Interviews provided context on family obligation, changing roles, and urban-rural differences in access to support. Companion-animal support, mentioned by two participants, is reported as a hypothesis-generating observation. Prospective studies are needed to examine causal relationships and the effects of family-support interventions.

Keywords

Alzheimer's disease, Associated factors, family caregivers, Family hardiness, mixed methods

Received

17 July 2026

Accepted

28 September 2026

Copyright

© 2026 Lan, Xia, Chen, Zheng, Jin, Wang, Lu, Xu, Xu, Li and Yan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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