Beyond the Burden: Exploring Gratitude Among Informal Caregivers of People Living with Chronic Health Conditions

This portfolio thesis consists of three parts. Part one is a systematic literature review, part two is an empirical paper, and part three forms the supporting appendices. Together, they offer an exploration of the meaning of gratitude and the ways in which it is experienced by individuals living as informal caregivers to a person diagnosed with a long-term physical health condition (LTHC).Part One: Systematic Literature ReviewPart one presents a qualitative systematic literature review which explored the lived experiences of gratitude among informal caregivers of individuals living with a LTHC. Following a systematic search, eleven empirical research papers met the inclusion criteria and were included in this review. Data were synthesised using thematic synthesis to develop a nuanced understanding of how gratitude was experienced in participants’ accounts and defined within the qualitative literature. The methodological quality of studies was assessed via the CochrAne qualitative Methodological LimitatiOns Tool (CAMELOT). Three higher-order themes with five subthemes captured both the inter- and intrapersonal experience of gratitude among informal caregivers, these included: 1) Gratitude in the Moment, centring present-focused gratitude and an appreciation for daily life; 2) Gratitude for Growth, reflecting thankfulness for both personal and care-recipient transformation; and 3) Gratitude in Interpersonal Connections. The findings are explored in relation to the broader literature, and the implications for clinical interventions and future research on gratitude are discussed.Part Two: Empirical PaperPart two is an empirical study that used a qualitative approach to explore the meaning and experience of gratitude, specifically for spousal caregivers of people living with dementia in the community setting. Nine participants took part in semi-structured interviews, and qualitative data were analysed using Interpretative Phenomenological Analysis. Three group experiential themes with eight underlying subthemes were identified. These captured how: 1) gratitude was relational in nature, emerging through meaningful social connection, recognition of caregivers’ individual identities, and the preservation of couplehood and partner dignity; 2) gratitude stemmed from both the availability of external resources and internal reflective efforts; and 3) gratitude was experienced as a dialectical process, often coexisting with experiences of loss and intertwined with other emotions like sadness, frustration, and guilt. Findings highlight the potential value of gratitude-centred interventions tailored to caregivers' lived experiences, offering a foundation for future positive psychology approaches to support caregiver wellbeing.Part Three: AppendicesPart three comprises the appendices, wherein the supporting documentation for the systematic literature review and empirical paper is listed. This section also includes a reflective statement (Appendix A) and an epistemological statement (Appendix B) which provide personal insights into the research process and outline the philosophical foundations and assumptions within this research.