An ethnographic study to understand the concept of rural Thai elderly resilience: rural elderly and community nurses’ perspectives

This ethnographic doctoral research study documents and clarifies the concept of resilience among Thailand (Thai) provincial elderly. The significance of this research is highlighted by the increasing global and Thai ageing population, with a concurrent decrease in the traditional family support of older persons in provincial areas. The Thai elderly who live in rural provinces are naturally affected by challenges in their lives, which is further compounded by chronic disease and geographic isolation. Resilience however, is poorly understood in the context of the rural Thai elderly existence, particularly so in relation to the contribution of the primary health care agencies and community nurses’ roles. This study describes the concept of older people’s resilience in the rural Thai community together with the perspectives obtained from their community nurses. The ethnography involved fieldwork, semi-structured interviews, and non-participant observation in four Tambon Health Promoting Hospitals (THPHs) and local villages. The study participants included 35 elderly rural Thai people who were willing to be interviewed and 7 community nurses, of which two were interviewed twice. In total, 44 semi-structured interviews and 340 hours of non-participant observation were conducted. A comprehensive qualitative thematic analysis using Nvivo10 was conducted to analyse the data collected. The key thematic findings from the older persons included ‘living well every day, ‘adversity and rural Thai older people’, and ‘elderly resilience. In terms of the community nurses’ perspectives, resilience consisted of three subthemes: ‘resilience-what is it?’, ‘overcoming adversity’, and ‘everyday nursing experience - resilience in rural Thai elders. The thematic findings of this study clarify, interpret, and deepen the understanding of the concept of resilience among rural Thai elderly and their community nurses. Understanding and providing care to support elderly resilience can lead to better health outcomes and health prevention strategies being developed in rural Thai aged care. Resilience planning could also contribute to the promotion of healthy interventions to improve primary health care that is supportive of rural Thai elderly in their communities. This study is also considered a valuable source of information for Thailand community nurses to use in the consideration of health promotion interventions to sustain and support healthy ageing for the rural Thai elderly population.