Exploring the Perceived Role and Impact of Family Participation in Hospital Care: A Qualitative Study in a Resource-Limited Hospital in Bangladesh
Summary
The global shortage of healthcare workers, particularly in low- and middle-income countries (LMICs), presents a critical challenge to hospital care delivery. In Bangladesh, where public tertiary hospitals face severe workforce constraints, family members often assume vital caregiving roles during inpatient stays. This qualitative study investigates how different hospital stakeholders (i.e., patients, family caregivers, and healthcare workers) perceive the effects of family participation (FP) in patient care within a resource-limited tertiary hospital in Bangladesh. The research aims to understand these perceptions, their variations by stakeholder role, and how informal caregiving influences patient outcomes, caregiver experiences, and hospital workflows.
Guided by an integrated theoretical framework combining the Socio-ecological Model (SEM) and Practice Theory, the study explores caregiving as a multilayered, socially embedded practice. Data were collected through in-depth interviews with patients, family caregivers, nurses, doctors, and hospital administrators. The findings reveal that FP is simultaneously perceived as indispensable and disruptive. Patients emphasize the emotional reassurance and comfort derived from family presence, reinforcing the psychosocial benefits identified in previous research. Conversely, caregivers and healthcare staff highlight operational challenges, including caregiver stress, role ambiguity, and infection risks, which complicate hospital workflows.
The SEM-Practice framework elucidates how caregiving is shaped by intersecting levels of influence, from individual motivations and gendered cultural norms to organizational resource shortages and absent formal policies. Family caregivers often fill systemic gaps, yet their contributions remain informal and unrecognized, creating tensions within hospital routines. Positive interactions between caregivers and staff foster cooperation, while miscommunication exacerbates conflicts and mistrust.
These findings underscore the dual reality of FP as both a critical coping mechanism for resource scarcity and an unsanctioned workaround with ethical and operational implications. This study contributes a nuanced understanding of informal caregiving in LMIC hospital settings and offers evidence to inform the design of context-sensitive, culturally appropriate, and ethically sound models for formalizing family participation in inpatient care. Addressing these complexities is essential for improving patient care and supporting sustainable health systems in resource-limited environments.