Conceptual Framework for Dementia Burden, Healthcare Worker Competence, Health System Capacity, and Family Caregiving Experiences
Résumé
Background Dementia presents a growing public health challenge in low-resource settings, where clinical burden intersects with limited health system capacity, inadequate healthcare worker competence, and complex family caregiving experiences. Aim This paper presents a conceptual framework developed to explain the multidimensional relationships between dementia clinical burden, healthcare worker knowledge and competence, health system capacity, and family caregiving experiences in rural South African contexts. Methods The framework was developed from mixed-methods research conducted in OR Tambo District, Eastern Cape, South Africa. The framework is underpinned by three theoretical foundations: the Biopsychosocial Model, Person-Centred Care Theory, and Social Ecological Theory. Results Five interrelated domains make up the framework: Clinical burden of dementia that includes multimorbidity, behavioural and psychological symptoms, communication problems, and cognitive impairment; Knowledge and competency of healthcare workers, including training, professional traits, clinical competence, and knowledge unique to dementia; Caregiver Experiences addressing socioeconomic factors, family dynamics, stigma, geographic barriers, cultural beliefs, and emotional burden; Health System and Service Capacity covering structural factors; and Dementia Care Outcomes covering patient outcomes, caregiver outcomes, and health system outcomes. Care quality, person-centred practices, communication effectiveness, carer coping techniques, social support, and professional attitudes are among the mediating factors identified by the framework. Conclusion This conceptual framework advances dementia care science by offering a testable model that recognises dementia not merely as a neurological disorder but as a social, psychological, economic, and health systems challenge. It emphasises integrated support programs that address clinical, educational, psychosocial, and structural determinants of dementia care outcomes and serve as a basis for multivariate analyses, longitudinal studies, and intervention design in rural healthcare settings.
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