Variation in Health Status Reports: Triangulating Mixed Methods Data to Assess the Health and Wellbeing of Primary Caregivers to Older Rural South Africans

Caregivers' health status is important, given its importance for their own wellbeing and capacity to provide quality care. While single item self-rated health questions in surveys are an efficient measure, responses limit understanding of what people mean when they rate their health in a particular way, and do not address reporting heterogeneity. We draw on data collected in a mixed-method study on the informal caregiving of older people in rural northeast South Africa, which including a standard cross-sectional quantitative survey, an ethnographic survey, and longitudinal ethnographic observations. Results indicate that who becomes the caregiver, and the form of care provided, are influenced primarily by conventional expectations of gender, age, and kinship, and of caregiving alternatives. Caregivers invoke the social circumstances in which they provide care when describing and rating their own health and ability to care, and in determining what conditions they include or dismiss as indicators of health or illness. Social context influences respondents' evaluation of own health and capacity to care, future ability and needs, including as reported in response to different methods. We advocate carefully constructing health condition response categories to include functional impairments and to be informed by context.