A Reflective Journey and the Exciting Roads Ahead: Pioneering Fundamental Care and Care Networks through the Caring Life Course Theory

By Dr Maria Alejandra Pinero de Plaza

Reflecting on my part-time research journey over the past five years at Flinders University, I am deeply honoured to have led and contributed to multiple projects that have advanced our understanding of Fundamental Care and how care networks operate across the life course. The emerging?Caring Life Course Theory (CLCT)?is at the heart of my work because we are refining it to help us understand and measure care and its systems' relational and changing nature.

Through various studies, we've explored the interconnectedness of the CLCT constructs, such as self-care, care-from-others, and care networks, which are critical to shaping healthcare outcomes and meeting the needs of individuals, groups and organisations throughout life. Below, I reflect on only five of my studies and how they feed into the emergence of the CLCT.

PROLIFERATE and Its Applications

One key project I've led is the development of the PROLIFERATE Framework, a behavioural solution designed to co-create, measure, and optimise healthcare innovations. The framework has evolved into PROLIFERATE_AI, which uses artificial intelligence and behavioural science to overcome challenges related to implementing innovations in complex systems. PROLIFERATE_AI?ensures solutions are safe, effective, and sustainable, working closely with researchers, service providers, and end-users to deliver results that reduce risk and implementation failures and improve patient outcomes and workers' satisfaction.

Using PROLIFERATE_AI, I led the evaluation of RAPIDx_AI across 12 South Australian emergency departments. The framework captured individual behavioural patterns and care delivery experiences within socio-demographic and professional networks, providing insights into improving clinical management. This work aligns with the Care Biography construct in CLCT, demonstrating how care networks adapt and evolve based on personal assessments of new technologies like AI. It also highlights the interaction between self-care and care from others in broader healthcare systems, ensuring continuous support across care trajectories via consumer-centric metrics.

PROLIFERATE also facilitated the co-design of educational strategies through a transdisciplinary approach, tailoring interventions to specific care networks and socio-demographic groups. Our partnership with Health2Go strengthened interprofessional learning for student-led services, helping to integrate culturally relevant practices into their Allied Health learning workflows. From a CLCT perspective, these findings show how collaboration within care networks among healthcare professionals, educators, and students can enhance the ability to deliver Fundamental Care as a service while also integrating informal networks such as family and community support.

PROLIFERATE also supported the evaluation and dissemination of a frailty video targeting key socio-demographic groups to improve public understanding of frailty. This project revealed new insights into how accurate, accessible information strengthens self-care and care from others, aligning with the CLCT by tailoring health communication to the specific needs of different care networks.

These applications of PROLIFERATE and PROLIFERATE_AI showcase how these evaluation frameworks enhance our ability to capture and analyse Care Biography data and its connection to different CLCT constructs. With these studies, we understand that by investigating and evaluating care networks, self-care, and care-from-others, we can ensure that products, services, and processes are adaptable to individuals' changing fundamental care needs.

As we published in the Nature platform, these emerging methods based on the KT-Complexity Network Model help us tackle wicked problems by evaluating evidence-based interventions across personal, professional, educational, technological, and/or?research networks. These approaches allow us to understand, model, predict, and influence care services and their impact across different transitions, trajectories, and life stages.

The Fundamentals of Care Matrix

I led a study centred around the Fundamentals of Care (FoC) Matrix, designed to evaluate care delivery across three key dimensions: relationship, integration of care, and context. We published this method as a book chapter introducing Social Network Analysis (SNA) and Principal Components Analysis (PCA) to quantify the relationships between 38 elements of fundamental care based on patient's personal experiences.

The FoC Matrix revealed both positive and negative interactions between care elements, as reflected in patients' narratives within care settings. Focusing on how psychosocial, physical, and relational needs are integrated into care delivery provided a comprehensive understanding of how fundamental care can be measured, mapped and improved. We applied this method to analyse cases submitted to the Royal Commission into Aged Care Quality and Safety. We identified significant systemic patterns impacting care, such as staffing levels and resource availability.

This study also helped us understand and assess care through the Care Biography construct, which tracks the dynamic evolution of care needs over time. The FoC Matrix captures how self-care and care-from-others interact within broader care systems, echoing CLCT's emphasis on how care networks must adapt to changing life events, health conditions, and care experiences. This work is progressing in other languages and countries to demonstrate further that a person's care network—comprising family, healthcare professionals, technology and the healthcare system—must evolve to ensure continuous support throughout their care trajectories. Our research demonstrates that we can identify these patterns using the matrix and other fundamental care metrics and methods.

Health System Enablers for First Nations People

I led research that examined health system enablers for First Nations Peoples, identifying how informal care networks, deeply embedded within Indigenous communities, could be better integrated into formal healthcare systems. Our research found that while informal care networks are critical to health and well-being, formal healthcare systems often failed to incorporate them into their care strategies, resulting in gaps in care continuity.

So, in this context, the CLCT highlights the importance of care networks in supporting fundamental care. By touching on the cultural and relational dimensions of care, we introduced an evidence-based co-design matrix to integrate formal and informal systems that deliver more culturally responsive and holistic co-design approaches to continuity of care with and for First Nations Peoples living with chronic diseases.

Epidemiology of Frail, Homebound, and Bedridden People (FHBP)

In our study on the epidemiology of frail, homebound, and bedridden people (FHBP), I led the foundational work for our team to employ Multiple Correspondence Analysis to map out care needs and identify gaps in long-term support for these vulnerable populations. Our analysis revealed a strong relationship between perceived health status and the quality of care received from formal and informal care networks. We identified significant gaps in self-care and care from others, indicating that long-term care needs were not being met effectively.

The?care trajectory?and?care biography?constructs from CLCT are essential to understanding how the care needs of these groups evolve. These studies help us comprehend the healthcare marginalisation that FHBP experiences. Applying CLCT in this context highlighted the importance of building resilient care networks through technology to co-design new models of care for and with #FHBP.

The CLCT and Cardiac Rehabilitation: Operationalising Theory into Practice

I led a study operationalising the Caring Life Course Theory within 15 cardiac rehabilitation (CR) programs. This research addressed disparities in CR engagement, particularly in rural and low socio-economic regions, using thematic analysis and Jaccard coefficients to map relationships between key CLCT constructs such as self-care, care-from-others, and care networks. We found that patients with well-supported care networks achieved higher completion rates and better long-term outcomes in CR. However, we identified significant gaps in self-care practices, especially in underserved areas, highlighting the need for more personalised interventions.

This study significantly advances the CLCT by demonstrating its practical application in real-world healthcare settings, particularly for cardiac rehabilitation engagement. Incorporating?care biographies?into CR programs can enable a more comprehensive understanding of patients' evolving care needs and?behaviours. The study demonstrated the importance of adapting care strategies to life transitions and the complexities of individual care journeys, reinforcing CLCT's relevance in transforming complex care practices such as CR.

Looking Ahead: Embracing the Future of Care with CLCT

As I look ahead, I am optimistic about the future of care systems shaped by the Caring Life Course Theory. My research is focused on expanding the role of care networks, care biographies, and fundamental care metrics through innovative digital health approaches. By applying CLCT across various healthcare contexts, we can further personalise care strategies to meet the unique needs of individuals throughout their life course. I am excited because we are creating a new healthcare future that will increasingly be holistic, adaptive, and people-centred, ensuring that care systems evolve to support individuals across every stage of their care journey.