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Family hardiness and associated factors among Chinese family caregivers of people with Alzheimer’s disease: an explanatory sequential mixed-methods study

Year: 2026

Type: article

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 R 2 = 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. Conclusion 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.

Source: Frontiers in Psychology

DOI: 10.3389/fpsyg.2026.1940356