Background: Despite its rewarding aspects; caring for a person with dementia can be a challenging experience associated with chronic stress and a heavy subjective burden. The quality of the relationship between a person living with dementia and their family caregiver is an important determinant of the wellbeing of both members of the dyad and one of the core factors contributing to the caregiver's subjective burden and ability to continue caregiving. To protect their well-being and that of the person living with dementia, caregivers need to acquire the skills necessary to cope with the challenges of the caregiving situation and to sustain their relationship. "Learning to feel better... and help better is a psychoeducational intervention that aims to empower the family caregivers of people living with dementia to improve their coping with the daily stress of caregiving. When evaluated in Switzerland, using a mixed methods design, the intervention showed positive results, reducing caregivers' subjective burden and psychological distress and improving their self-efficacy. However, despite considerable relevance to caregivers and their family members with dementia, changes in relationship quality occurring in the context of the intervention were not evaluated. To address this research gap, this thesis qualitatively explored the changes in relationship quality perceived by family dementia caregivers during and after their participation in the intervention.
Methods: Relationship quality was explored using a longitudinal, constructivist, grounded theory approach. Changes in relationship quality, related mechanisms and key intervention components were identified by exploring longitudinal qualitative data collected from 13 caregivers during individual interviews performed before, during and after the intervention (39 interviews in total). An additional analysis explored cross-sectional post-intervention interview data from 22 caregivers (22 additional interviews), to specify relationship quality's role within the intervention's broader change process.
Findings: Two models were developed as part of the present doctoral work, both contributing to the understanding of how the "Learning to feel better... and help better” intervention produces change in its participants. The first model, focusing on sustaining relationship quality in dementia, conceptualises the intervention's change process regarding relationship quality. It illustrates that caregivers require specific knowledge about dementia and effective coping strategies, as well as reflective skills, to develop and apply strategies supporting relationship quality. The second model-the calmness model:illustrates relationship quality's role within the intervention's overall change process. It conceptualises relationship quality as one of five intermediate changes associated with the intervention that interact and reinforce each other to facilitate the main change felt by caregivers: experiencing calmness. Both models highlight key intervention components that facilitate change among caregivers and the factors promoting or hampering caregivers' learning processes.
Conclusion: The two models provide valuable insights for nurses and other healthcare professionals about the relationship factors which can be influenced by interventions. They highlight key intervention components supporting caregivers trying to maintain or improve the quality of their relationships with their family members with dementia. The "Learning to feel better... and help better” intervention provides caregivers with the means to cope with many different issues related to dementia, including changes in their relationship with the person with dementia.