Unpacking how trust, communication and flow interact to sustain quality relationships between disabled people, family and support workers: a realist qualitative study.
John Bourke, Julianne Johns, Rachelle A Martin
PMID 39129515WHAT IT FOUND
Disabled people, families and support workers described three interlocking conditions for sustainable support: open communication about boundaries, trust built through consistent competent care, and a sense of flow where roles are clear.
Each group needed different resources to achieve these.
Key findings
01Clear communication about boundaries and expectations was foundational, but each group prioritised different aspects: disabled people focused on flexibility in care routines, families on respect for the domestic space, and support workers on clarity of job requirements.
02Trust was built through familiarity and competence, allowing disabled people to feel safe and flexible, families to take guilt-free respite, and support workers to feel valued and supported.
03A sense of flow, where tasks and relationships feel easeful, depended on all parties feeling known and valued, reducing the need for over-vigilance for disabled people and allowing families to maintain their own identities.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study recruited only non-Māori participants, despite Māori having higher rates of disability, so findings may not reflect indigenous perspectives. Recruitment via personal networks and local organisations excluded people with significant communication or cognitive disabilities and those from diverse socioeconomic or language backgrounds. The small sample size and specific geographical location limit generalisability. This is a qualitative study proposing an initial theory, not testing an intervention or measuring outcomes.
Declared interests
Funded by the Canterbury Medical Research Foundation emerging researcher grant awarded to one of the authors (JB).
The easy way to misread this
Do not treat these themes as evidence that specific interventions improve support worker relationships. The study describes participants' perceptions of what helps sustain relationships, not the effectiveness of any particular strategy.