A quiet endurance: pragmatic family resilience in Chinese dementia care

Dementia research has overlooked the family as a collective unit of resilience. This study aimed to develop a substantive theory of family resilience for dementia care in China, a nation characterized by its high-context culture.

Employing a constructivist grounded theory approach, we conducted in-depth interviews with 36 participants from 21 families. Data were collected between March 2023 and April 2024. Data were analyzed concurrently using constant comparative methods, including initial, focused, and theoretical coding.

The analysis generated the theory of Pragmatic Family Resilience. This is a dynamic, organizational process comprising three core components: (1) a Motivational Core, a dual-engine of deeply internalized ethical obligations (filial piety) and enduring emotional bonds, which sustained the family's commitment through a process of "desacralized meaning-making"; (2) this core fueled an Adaptive Care Architecture, a flexible system governed by operational logics like resource conservation and managed through interactional patterns such as strategic ambiguity; (3) this architecture enabled a repertoire of Pragmatic Daily Strategies, exemplified by tenacious endurance (áo) and acknowledging limits over idealization.

This theory of Pragmatic Family Resilience catalyzes a paradigm shift from 'growth-oriented' models to a mechanism of sustainable endurance. By identifying adaptive pathways like strategic contraction (e.g., desacralized meaning-making) and flexible interaction (e.g., flexible boundaries and proactive contributions), it shifts the focus from managing individual 'caregiver burden' to facilitating the family's entire adaptive system. It provides crucial insights for developing family-centered services and policies that are culturally attuned to high-context societies.