Family Caregiving as a Moral and Spiritual Commitment in Zambia’s Mental Health Care Setting
Abstract:
Family
caregivers of individuals with chronic psychosis often navigate cultural,
social, and emotional challenges while providing care. This study explored the
moral and spiritual dimensions of caregiving, focusing on how family, cultural
values, and spiritual beliefs shape caregivers’ commitment and coping approaches.
Using an interpretive phenomenological design, in-depth interviews were
conducted with 30 caregivers, and data were analysed using interpretive
phenomenological analysis by Smith et.al (2009) criteria. The results had four
superordinate themes; Providing care as a religious duty;
Moral duty rooted in kinship and culture; Psychological and emotional strain;
Coping through resourcefulness and faith. Findings showed that caregiving is viewed
as a moral duty grounded in family and cultural expectations. Caregivers formed
their roles as acts of love, loyalty, and responsibility, reinforced by spiritual
beliefs that endure perseverance despite stigma, discrimination, and societal
opposition. The study highlights that moral commitment serves as both
motivation and ethical compass, guiding caregivers through demanding
circumstances. However, the findings also showed risks of emotional exhaustion
and self-neglect, pointing to the need for institutional and social support.
Recognizing caregiving as a moral and culturally informed commitment provides
insights for health professionals and policymakers to develop culturally
sensitive interventions that support family caregivers’ well-being while
strengthening their moral stance.
References:
[1].
WHO, Comprehensive mental
health action plan 2013–2020., 2013, World Health Organization: Geneva.
[2].
Mwape, L., Mweemba, P., and Kasonde, J. M., 2010,
Strengthening the health system for mental health in Zambia, Lusaka. Zambia
Forum for Health Research, 2010.
[3].
Malhotra, R., & Lim‐Soh, J., 2024, Family
caregiving: time-varying contexts of social support, finances, burden, and
benefits. Innovation in Aging, 8(Supplement_1), 198. https://doi.org/10.1093/geroni/igae098.0639.
[4].
Marius, S., 2024, Caring for Family Caregivers of the
Mentally Ill: A Social Work Perspective. Journal of Social Science and
Humanities, 6(7), 105–109. https://doi.org/10.53469/jssh.2024.06(07).23.
[5].
Bekui, B. A. A., Ohene, L.
A., Ampomah, M. O., and Aziato, L., 2022, Physical and socioeconomic burden of
caregiving on family caregivers of children with cancer at a tertiary hospital
in Ghana. Nursing Open, 9(1), e1359. https://doi.org/10.1002/nop2.1359.
[6].
Irshad, S., Batool, I., and Nazim, H., 2022,
Relationship between caregiver burden and psychological well-being among the
caregivers of cancer patients: Mediating role of resilience. Bulletin of
Business and Economics, 13(2), 763–766. https://doi.org/10.61506/01.00391
[7].
Jatoi, H. N., and Majeed, S., 2022, Psychological
distress, coping styles and emotional well-being among caregivers of patients
with schizophrenia. Journal of Pakistan Psychiatric Society. https://doi.org/10.63050/jpps.19.02.143
[8].
Ofovwe, C. E., and Osasona, S. O., 2022, Burden of
caregiving among caregivers of patients with severe mental illnesses in Benin
City, Nigeria. African Health Sciences, 22, 657 - 667.
[9]. Setyawati, M. B., Parsons, A.
P. J., Laing, B., Lynch, A., Habiburahman, I. L., and Izza, F. N., 2024, The
family caregiving; A Rogerian concept analysis of Muslim perspective &
Islamic sources. In Heliyon (Vol. 10, Issue 3). Elsevier Ltd. https://doi.org/10.1016/j.heliyon.2024.e25415
[10]. Angelin, R. R., Saravanan, S., James, F. C., and
Samuel, R., 2025, Experience of religiosity in caregiving for persons with
serious mental illness: a qualitative study using interpretative
phenomenological analysis from India. BMJ open, 15(3),
e090838. https://doi.org/10.1136/bmjopen-2024-090838
[11]. Sichimba, F., Janlöv, A., and Khalaf, A.,
2022, Family caregivers’ perspectives of cultural beliefs and practices towards
mental illness in Zambia: an interview-based qualitative study. Scientific
Reports, 12, 1-11. https://doi.org/10.1038/s41598-022-25985-7
[12]. Casaleiro, T., Caldeira, S.,
Cardoso, D., and Apóstolo, J., 2022, Spiritual aspects of the family
caregivers' experiences when caring for a community-dwelling adult with severe
mental illness: a systematic review of qualitative evidence. Journal of
Psychiatric and Mental Health Nursing, 29(7), 1014-1029. https://doi.org/10.1111/jpm.12816.
[13]. Kabelenga, I., 2023,
Perceptions of community leaders about normative understandings of good family
care of older people in rural and urban Zambia. International Journal of
Care and Caring, 7(4), 708-726. https://doi.org/10.1332/239788221x16770625208518
[14]. Kabembo, I. M., 2024, Forgone
healthcare for medically vulnerable groups during the pandemic era: Experiences
of family caregivers of young adults with substance use disorders in Zambia. Frontiers
in Public Health, 12, 1250608. https://doi.org/10.3389/fpubh.2024.1250608
[15]. Mulima, O., 2025, Religion and
mental health in Zambia. Working paper, Academia.edu, pp. 1–11. Available at: https://www.academia.edu/126727293/Religion_and_Mental_Health_In_Zambia
[16]. Nqabeni,
K., and Davids, R., 2024, We need support: The experiences of family members
caring for a relative diagnosed with schizophrenia. Social Work/Maatskaplike
Werk, 60(2), 313-338. https://doi.org/10.15270/60-2-1299
[17]. Phillips,
R., Durkin, M., Engward, H., Cable, G., and Iancu, M., 2021, The impact of
caring for family members with mental illnesses on the caregiver: a scoping
review. Health Promotion International, 38, 1–23. https://doi.org/10.1093/heapro/daac049
[18]. Khalaf,
A., Nakazwe, K., Halawi, L., and Sichimba, F., 2025, Professional competence
and spiritual care provision among Zambian maternal healthcare providers:
Through the lens of Watson's Theory of Human Caring. Journal of Holistic
Nursing, 8980101251321970. https://doi.org/10.1177/08980101251321970
[19]. Kropf,
M., 2024, Spirituality and family caregivers: Ethical considerations on the
role as a spiritual guide. Journal for the Study of Spirituality, 14,
156–168. https://doi.org/10.1080/20440243.2024.2392093
[20]. Bunkley,
E., Asante, C., Burack, S., Kaufman, L., Miti, S., and Hunleth, J., 2023, A
heart for the care: Affect, kin, and care work in a Zambian hospital. Medical
Anthropology Quarterly. https://doi.org/10.1111/maq.12837
[21]. Kombo, D. K., Tromp, D. L. A., 2016, Proposal
and thesis writing: An introduction. Nairobi: Pauline Publications Africa.
[22]. Creswell, J. W., 2009,
Research design: Qualitative, quantitative, and mixed methods approaches. 3rd
ed. Thousand Oaks, CA: Sage Publications.
[23]. Wertz, F. J., Charmaz, K.,
McMullen, L. M., Josselson, R., Anderson, R., and McSpadden, E., 2011, Five
ways of doing qualitative analysis: Phenomenological psychology, grounded
theory, discourse analysis, narrative research, and intuitive inquiry. New
York: Guilford Press.
[24]. Pietkiewicz, I., and Smith, J.
A., 2012, A practical guide to using interpretative phenomenological analysis
in qualitative research psychology. Psychological Journal, 18(2),
361–369.
[25]. Smith, J. A., and Osborn, M.,
2008, Interpretative phenomenological analysis. In: J. A. Smith (ed.), Qualitative
psychology: A practical guide to research methods, 2nd ed. (London: Sage
Publications), pp. 53–80.
[26]. Muvwimi, T. S., Ngoma, C. M.,
and Salgado, A. B., 2025, Cultivating self-motivation, lifestyle modification
and emotional resilience in elderly patients with multimorbidity: A path to
successful self-management. Texila Advanced Journal of Multidisciplinary
Health Research, 5(1), Article 018. doi:10.21522/TAJMHR.2016.05.01.Art018.
[27]. Smith, J. A., Flowers, P., and Larkin, M.,
2009, Interpretative phenomenological analysis: Theory, method and research (London:
Sage Publications Ltd).
[28]. Bhattacherjee, A., 2012,
Social Science Research: Principles, Methods, and Practices (University of
South Florida). Available from: http://scholarcommons.usf.edu/oa_textbooks/3/
[29]. . Neuman, B., and Fawcett, J.,
2011, The Neuman systems model (5th ed.). Upper Saddle River, (NJ): Pearson.
[30]. Silaule, O., Adams, F., and Nkosi,
N. G., 2024, Health effects of caregiving and coping with severe mental
disorders: A caregivers' experience. S Afr J Psychiatry. 2024;30: a2144.
https://doi.org/10.4102/sajpsychiatry.v30i0.2144
[31]. Nkomo, T., and Kekana, M. P.,
2025, The realities of caring for a person with a mental disorder in rural and
remote Capricorn District of South Africa: A qualitative study. Community
Ment Health J;61:531–543. https://doi.org/10.1007/s10597-024-01360-w
[32]. Phillips, A., Durkin, M., Engward, H., Cable,
G., and Iancu, M., 2023, The impact of caring for family members with mental
illnesses on the caregiver: a scoping review. Health Promot Int;38(3):daac049.
https://doi.org/10.1093/heapro/daac049
[33]. Bharti, V., Joseph, J., Malik,
Y. K., and Devi, R., 2025, Assessment of mental, spiritual well-being, and
religious coping among caregivers of people with mental disorders: A
cross-sectional study. Journal of Mental Health and Human Behaviour,
30(1), 56–60. https://doi.org/10.4103/jmhhb.jmhhb_25_25
[34]. Kropf, M., and Schmidhuber, M.,
2024, Family caregivers and the ethical relevance of moral identity. Nurs
Inq;31(4):e12670. doi:10.1111/nin.12670
[35]. Sarradon-Eck, A., Mathiot, A.,
Holmes, S. M., Gilbert, E., Capodano, G., and Proux, A., 2023, The moral
dimensions of family caregiving for patients with advanced cancer: A
qualitative study. European Journal of Cancer Care. https://doi.org/10.1155/2023/6635542
[36]. Verity, F., Turiho, A.,
Mutamba, B. B., and Cappo, D., 2021, Family care for persons with severe mental
illness: Experiences and perspectives of caregivers in Uganda. International
Journal of Mental Health Systems, 15(1), 48. https://doi.org/10.1186/s13033-021-00470-2
[37]. . Bahrami, R., and Sadeghi, S.,
2025, Spiritual well-being and resilience among family caregivers of people
with mental disorders. Mental Health, Religion & Culture, 1–13. https://doi.org/10.1080/13674676.2025.2489083
[38]. Angelin, R. R., Saravanan, S., James, F. C. J., and Samuel, R., 2025, Experience of religiosity in caregiving for persons with serious mental illness: A qualitative study using interpretative phenomenological analysis from India. BMJ Open, 15, e090838. https://doi.org/10.1136/bmjopen-2024-090838
