Graduation Date

Spring 5-6-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Dr. Diane Brage Hudson

Second Advisor

Dr. Sheri Rowland

Third Advisor

Dr. Stephen Bonasera

Fourth Advisor

Dr. Christine Eisenhauer

MeSH Headings

Spouse Caregiver, Caregiver, Rural Nursing, Rural Health, Dementias, Promotion, Health, Qualitative Research


Rural spousal caregivers caring for a person living with moderate to severe dementia at home are at risk of serious health consequences because they are unable to attend to their own personal health needs. Insufficient evidence exits that informs how contextual components of the rural spousal caregiving situation prevent caregivers from practicing personal health promotion and wellness while caregiving during the later stages of dementia. The aims of this qualitative, descriptive, multiple case study were to: 1) describe transition points in the rural spousal caregiver’s role across the dementia disease trajectory, 2) describe the rural spousal caregiver’s experience with personal health promotion and physical activity across the dynamic context of care provision to a spouse in the moderate to severe stages of dementia, and 3) describe the rural spousal caregiver’s perceptions of feasible and desirable strategies and resource needs for promoting their own physical activity across the dementia caregiving trajectory. Four cases of spousal caregivers were enrolled from rural areas of Nebraska. Multiple sources of data informed analysis including environmental descriptive memos, serial in-person semi-structured interviews, life history timelines, archival and photo data, field and reflexive notes, rural community resources, and local community resource mapping. Thematic analysis was conducted within-case and across-case. Rigor was achieved with confirmability, dependability, credibility, and transferability. Themes related to caregivers’ emotional experience undergoing role transition periods, enduring unpredictable days, and struggling with balancing personal health promotion emerged. Rural spousal caregivers did everything for their livelihood themselves with little support. As the spouse’s dementia worsened, rural contextual nuances including the stress of maintaining upkeep of the farm, the immense physical labor of work on the farm, and scarcity of rural caregiving resources contributed to caregivers postponing their own health needs and health promotion activities. Knowledge gained from this research provides the groundwork for an intervention that includes unique rural specific supports and resources during the later stages of dementia so caregivers can focus on personal health promotion.


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