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To explore how community-dwelling older adults with multimorbidity experience, enact and navigate daily self-care using the Caring Life-Course Theory to identify opportunities for strengthening self-care and self-management support.
Qualitative descriptive study.
Semi-structured interviews were conducted with community-dwelling older adults aged ≥ 50 years living with two or more chronic conditions across three Australian states and territories. Data were analysed inductively and deductively using qualitative content analysis. Inductive coding was followed by theory-informed analysis to interpret self-care capability, capacity, care networks and system supports.
Eighteen participants (mean age = 70.9 years) described self-care as an adaptive, experience-based process influenced by lived experience, health transitions, informal care networks and system responsiveness. Participants generally demonstrated agency and resourcefulness in managing complex and changing care needs, often learning through trial and error. Psychosocial and relational needs were frequently under-recognised in healthcare encounters, requiring individuals and informal carers to compensate for fragmented, inconsistent support. Self-care capability and capacity were shaped by experiential learning, health and self-care literacy and access to informal and online resources, particularly where formal education was limited or unavailable.
Self-care for older adults with multimorbidity is shaped by dynamic interactions between personal capability, relational support and system-level factors across the life-course. The Caring Life-Course Theory provides a comprehensive approach for understanding these interdependencies and identifying opportunities for intervention.
Findings highlight the need to strengthen coordinated, person-centred and relationally grounded approaches to self-care and self-management in primary and community care, including improved access to evidence-informed resources and anticipatory support.
This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies.
Participants contributed through semi-structured interviews and provided feedback on study findings.
What problem did the study address? Community-dwelling older adults living with multimorbidity are expected to engage in self-care, yet little is known about how they experience, enact and sustain daily self-care, particularly when psychosocial and relational needs are inconsistently recognised within health and social care systems. What were the main findings? Self-care was characterised as an adaptive, experiential process shaped by life experience, informal support networks and system responsiveness. Participants frequently compensated for under-recognised psychosocial and relational needs through informal and online supports and resources. Where and on whom will the research have an impact? Findings can inform clinicians, service providers and policymakers in primary, community and aged care settings by identifying opportunities to strengthen coordinated, person-centred and relational self-care and self-management support for older people with multimorbidity.
To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user-friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice.
Multi-method study informed by participatory action principles.
Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October–December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis.
Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the ‘Context of Care’ dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology.
Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels—individual, team, unit/ward, organisational—identifying areas of strength and improvement to inform decision-making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi-dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery.
The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real-time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery.
Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision-making and planning tool to support improved fundamental care delivery across clinical settings.
This study is reported using the CROSS and SRQR guidelines.
No Patient or Public Contribution.
The Fundamentals of Care (FoC) Framework emphasises that care quality depends not only on clinical tasks but also on interpersonal relationships and the organisational context in which care is delivered. Although patient-reported outcome and experience measures (PROMs and PREMs) have gained relevance in capturing these aspects, tools based on the FoC Framework remain limited in non-English-speaking settings.
To psychometrically validate the Spanish version of the FoC Intelligence Modelling Tool (FoC-IMT) and explore predictive relationships among the FoC dimensions: Context, Relationship and Integration of Care.
A cross-sectional study was conducted with 1053 hospitalised patients in southern Spain. Exploratory and confirmatory factor analyses (EFA and CFA) were performed, alongside a mediation analysis using partial least squares structural equation modelling (PLS-SEM) to examine directional relationships among constructs.
EFA and CFA supported a two-factor model—Context and Integration of Care—with excellent internal consistency (Cronbach's α and McDonald's ω = 0.97). CFA showed a moderate correlation between these factors. However, PLS-SEM mediation analysis revealed a directional model in which Context influences Relationship (β = 0.39), which in turn predicts Integration of Care (β = 0.89). Although embedded within Integration under CFA, the Relationship showed independent predictive power in PLS-SEM, validating its conceptual importance. This aligns with the foundational assumption of the FoC Framework: that caregiving quality is shaped not only by tasks or procedures but by the broader environment and interpersonal relationships in which care occurs.
The Spanish FoC-IMT Tool is a valid, reliable instrument for assessing person-centred care. The predictive model highlights the pivotal role of therapeutic relationships in delivering integrated, high-quality care.
Hospitalised patients contributed directly by responding to the FoC-IMT survey, thereby shaping the psychometric validation and predictive model. Patients were not involved in the study design, conduct or manuscript preparation.
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