Third-party disability among family caregivers of older adults with post-stroke disability in mainland China: a qualitative study based on the ICF framework

In China, families are the primary caregivers for older adults with post-stroke disability; caregiving challenges intensify with increasing disability severity, and these caregivers are prone to third-party disability, a condition where caregivers experience health and functional impairments due to caring for disabled family members. Guided by the International Classification of Functioning, Disability and Health (ICF) framework, this qualitative study aims to clarify the specific manifestations and influencing factors of third-party disability in this group, laying a foundation for developing localized assessment tools and targeted interventions. A descriptive phenomenological approach was adopted in this study. Between January and May 2024, a purposive sampling method was used to recruit 27 family caregivers of older adults with post-stroke disability from Shanghai East Hospital, Tongji University, and Shanghai Sunshine Rehabilitation Center. Semi-structured face-to-face interviews were conducted with these participants. To ensure methodological rigor and trustworthiness, triangulation, team coding by two independent researchers, and member checking were applied throughout data collection and analysis. The interview data were then analyzed using Colaizzi’s seven-step method for thematic analysis. Guided by the ICF framework, this study identified five core themes of third-party disability among family caregivers: impairments of physical and mental functions, increased caregiving responsibilities, restrictions in social participation and activities, heightened economic pressure, and lack of support systems. Many family caregivers reported persistent sleep disturbances due to round-the-clock care duties and reduced social engagement because of time constraints related to caregiving. Third-party disability has become a widespread issue among family caregivers. Society should pay close attention to the practical needs of this group. By enhancing policy support, streamlining the supply of professional services, and establishing social support networks, we can effectively tackle the practical difficulties faced by family caregivers, relieve their third-party disability situations, and thus contribute to the realization of the healthy aging goal.