失能老人非正式长期照护服务质量制约因素质性研究的Meta整合 [中文引用][英文引用]

目的 以社会生态系统理论为框架，从微观、中观、宏观三个层面系统评价失能老人非正式长期照护服务质量的制约因素，为制定非正式长期照护服务的高质量提升策略提供循证依据。方法 检索中国知网、万方数据库、维普数据库、SinoMed，PubMed，the Cochrane Library，Web of Science，EMbase，ProQuest 关于失能老人非正式长期照护服务质量制约因素的质性研究，检索时限为建库至 2024 年 5 月 2 日，采用汇集性 Meta 整合方法进行整合。结果 共纳入 19 篇研究，提炼出 95 个研究结果，归纳成 7 个新类别，综合得出 3 个整合结果，即微观系统 - 个体身心负荷过载（身心健康损耗、价值认同感低、照护知识与技能缺乏）；中观系统 - 家庭社交网络断裂（角色重构与社交丧失、家庭支持缺位）；宏观系统 - 政策服务供给缺位（信息与知识支持薄弱、医疗及政策资源可及性不足）。结论 失能老人非正式长期照护服务质量受个体、家庭及社会多重制约因素交互影响。社会各界应高度重视照护者的身心负荷，给予充分的情感支持，并从家庭与社会层面构建协同支持体系，切实提升照护服务质量。

Objective To systematically evaluate the barriers to the quality of long-term care services without contract for the disabled elderly at micro，meso and macro levels based on the theory of social ecological systems，and to provide evidence-based references for formulation of quality improvement strategies for the long-term care services without contract for the disabled elderly. Methods Qualitative studies on the barriers to the quality of non-contract long-term care services for disabled elderly were retrieved from CNKI，Wanfang Data，VIP Database，SinoMed，PubMed，the Cochrane Library，Web of Science，EMbase and ProQuest from the inception to 2nd May，2024. An aggregative meta-synthesis was employed for integration. Results A total of 19 studies were included. Ninety-five research findings were extracted and subsequently summarised into 7 new categories. The integrated results were synthesised at three levels: at the micro level，individually psychophysical overload（health depletion，low value recognition，and lack of care knowledge and skills；at the meso level，family social network disruption（role reconstruction and social loss，and absence of family support）；at the macro level，policy and service supply deficit（insufficient information and knowledge support，and poor accessibility to medical and policy resources）. Conclusion The quality of non-contact long-term care for the disabled elderly is influenced by interacting individual，family and social factors. All stakeholders should recognise caregivers' physical and mental burden，and provide adequate emotional support and establish collaborative support systems at both family and society levels to effectively enhance care quality.