Experiences and Perceptions of Caregiving for Older African Migrants and their Care Networks in New South Wales, Australia

Globally, the population is ageing, and among the Culturally and Linguistically Diverse (CALD) population in Australia, there has been an exponential growth in the number of persons advancing into the older age status. While Australia is highly diverse, the government’s efforts to ensure access to equitable aged care services for its population are commendable. However, the specific needs of a segment of the CALD population, such as the African population, are often overlooked. Likewise, the experiences, perspectives, and needs of their care networks, including informal and formal carers and ethnic stakeholders, are underrepresented in the Australian literature. This multiphase PhD study aimed to explore the experiences of older African adults and their care networks, in relation to receiving and giving care, and their perception of the barriers and facilitators to using formal aged care services, including community care (home support, General Practitioner visits, religious support) or institutional care (Residential Aged Care and respite care) in the Australian context. Using a qualitative descriptive design informed by the constructivist research paradigm, I completed and published two scoping reviews in Phase 1 and conducted face-to-face, virtual, and telephone semistructured interviews in Phase 2 with 36 participants (12 older African adults, 12 informal carers, and 12 formal caregivers). In Phase 3, I conducted two focus groups with key stakeholders. Data was analysed thematically using the NVivo 12 Software, and thereafter, the independent results of Phases 2 and 3 were consolidated into a comprehensive framework of key findings and actionable steps, using thematic synthesis analysis. In Phase 1, three themes emerged in the first scoping review: positive experience, negative experience, and barriers to giving and receiving care by ethnic migrant older adults and their carers in Western countries. These findings provided the foundational exposure to the situation among migrants globally and informed the need for a second scoping review in Australia, specifically focused on the barriers to aged care services faced by CALD families in Australia. In the Australian review, findings show that while all 5A of access to care services (availability, accessibility, affordability, accommodation, and acceptability) were barriers for CALD older adults, accommodation and acceptability of services were the major areas of concern due to the gaps in cultural sensitivity of such services in Australia. It also captured the need for an expanded ‘access to care framework’ from Penchansky and Thomas’s five A to a possible six A framework. The proposed additional A means ‘Awareness’, which is often seen as a barrier in the Australian CALD caregiving literature. In Phase 2, the findings revealed that older adults believed in caregiving at home by their relatives and had negative perceptions of aged care services, especially residential aged care facility [RACF] relocation (aged care home). They also believed that the benefits of staying at home with their relatives outweighed the negative impacts, attributing their perception and use of services to their cultural orientation towards aged care. The older adults believed that care homes should be more sensitive to the culturally specific needs of Africans, and they ultimately advocated for the creation of Africanspecific care homes in Australia. For informal carers' beliefs and experiences, four themes emerged: (1) current beliefs and practice of care; (2) drivers of family-based care choice; (3) mixed effects of caring for older adults; and (4) facilitators of formal aged care consideration. The findings underscored African family carers’ commitment to family caregiving while highlighting the care burden and potentially susceptible family carers. These findings point to the critical need for culturally sensitive approaches and support for family carers of African backgrounds in Australia. The formal carers perceived a low rate of aged care service access and use by older African adults in Australia and had complex experiences providing care. The participants also shared tailored strategies to support formal carers of older African adults and to improve services. The stakeholders in the focus groups (Phase 3), through a co-creation process, confirmed the interview findings and co-designed culturally informed strategies to improve care for older African adults and their care networks in New South Wales (NSW), Australia. Amidst the low uptake and negative perception of formal aged care services by older African adults and their carers in Australia, there is potential for the use of these services if they are culturally appropriate and meet the needs of the African families in Australia. The novel study highlights the critical need and strategies for an Afrocentric, culturally sensitive approach to care for older African adults and their care networks in Australia. This timely study addresses a crucial gap in the literature concerning the caregiving of older African adults in Australia. Researchers, practitioners, and policymakers on ageing could leverage these findings to improve culturally sensitive practice by developing policies, programmes, and structures suited to African family-aged care needs in Australia. Aged care policy makers need to create culturally tailored policies specifically for African Australian families who are ethnic minorities within a multicultural Australia. Facilitating culturally focused awareness of existing and emerging services and programmes for African families in Australia is also recommended. Lastly, establishing strong partnerships between governmental and non-governmental agencies and the active involvement of African community stakeholders in aged care decision-making could potentially strengthen and improve the caregiving experiences of older African migrants and their care networks in Australia.