Exploration of meaning, motivation, and preparedness to care amongst the one‐child policy generation in China

In China there is a cultural expectation (Xiao, 孝‐filial piety) that offspring should provide care for their parents. However, the sustainability of this is threatened by the impact of the One‐Child Policy (OCP) (1979–2015), which has resulted in a diminution in numbers of children available to care, rapid urbanisation and increase in the number of women in employment. In this context, the objective was to explore the motivations, meaning, and preparedness for future caregiving of offspring affected by the OCP.


| BACKGROUND
China has a collectivist culture driven by interdependent selfconstrual, that is, where "one's sense of self is grounded in ones' social relationships, and the most meaningful aspects of oneself are those that emerge in relation to others". 1 As such, Xiao (孝-filial piety) requires offspring to provide care for parents, underpins socialisation 2 and embodies the social and ethical underpinnings for a stable society. Xiao embodies ideal expectations that offspring should fulfil to meet parents' needs in domains such as providing care, showing respect, greeting, ascertaining their happiness, being obedient and providing financial support. 3 The fulfilment of Xiao is a primary virtue in Confucianism and plays a crucial role within Chinese family identity. The gap between expectation and performance is referred to as filial discrepancy. 4 As the ageing population continues to increase in China with significant rises projected by 2050, 5 the numbers of older people living with adverse health conditions is increasing 6,7 and the changes in demography pose a risk to society. Due to socio-cultural and demographic transitions such as the four grandparents -two parentsone-child family structure resulting from the One-Child Policy (OCP) and rapid urbanisation, 8 a unique situation is unfolding. The OCP  has resulted in diminution of the family network and offspring often must move far away from parents to find work. Given the economic demands on the younger generation, older relatives seem unwilling to pressurise offspring to provide care, 9 so as not to "overburden" family. 10 However, despite the suggested evolution of attitudes regarding Xiao in modern China, 11 family caregivers (offspring) still consider it their duty and responsibility to prioritise parents' needs resulting in stressors. 12 Bearing in mind the context of interdependent self-construal, stressors can proliferate. Considering this, the demographic transitions coupled with expectations of filial piety have therefore resulted in a unique generation of future caregivers culturally motivated to deny personal needs to fulfil Xiao. 13 In response to these challenges, the Chinese government has been developing policies to promote ageing well (e.g., the National 13th Five Year Plan). However, a recent scoping review found that a lack of cohesion between government parastatals and top-down approaches impeded policy implementation and impact. 14 Therefore, many caregivers are not in receipt of sufficient support and are exposed to stressful situations. 12 This situation makes it vital that we give close attention to future caregivers. The pressures to fulfil Xiao in the current Chinese context 4 may have implications for caregivers' sense of identity and self-confidence. This would influence the caregiving process and have implications for sustaining family caregiving for current and prospective caregivers affected by OCP.
Therefore, the objective of this study was to explore motivations, meanings associated with caregiving, and preparedness for providing care for older relatives.

| DESIGN AND METHODS
We adopted a constructivist position with the view of listening to individuals' narratives of the phenomenon of interest, offering us the opportunity to make sense of their world. 15, 16 We considered qualitative methodology the most suitable approach for capturing participants' experiences 17 and carried out semi-structured in-depth interviews, offering participants flexibility to take the conversation in their direction of choice within the general scope of the research questions 16,18 (See Table 1 for interview guide).

| Ethics
We obtained Institutional Review Board approval from China Medical University, Shenyang, on 27/03/20. Further approval was granted at the University of Bradford on 06/04/20 (E800). Issues of risks and confidentiality were discussed with all participants, who were also reminded they could withdraw at any time. All provided written informed consent.

| Participants and procedure
L.Y. sent out information sheets via a professional network to solicit individuals keen to participate. We then sampled purposively, approaching those who were the only-child because of the OCP, age 20 and above, and identified as Han (the ethnic group mostly affected by the OCP). Eight participants took part (

| Data analysis
Verbatim transcripts were analysed manually, using six stages of reflexive thematic analysis. We employed inductive, descriptive, and interpretative orientations. Descriptive analysis focussed on participants' explicitly stated understandings, whereas interpretive analysis, drew on underlying or implicit meanings. 19 We integrated researchers' co-produced meanings into key concepts, that is, themes. 20 Central to this, our reflexive interpretative process was iterative and dynamic. 21 (See supplementary material and Table 1, for further detail).

| Reflexivity
We used the subjective experiences of the researchers as a resource, anchoring our social constructivist foundations. 21 Hence, the analysis involved an interpretative approach. 21 We reflected at every stage during team discussions, endeavouring to reach consensus regarding the themes that grounded participants' narratives. 22     impacting their ability to fulfil expectations, which could lead to neglect of their own personal needs. Themes and sub-themes are described in Figure 1, supported by direct quotes from interviews. 23

| Caregiving anticipation
Participants anticipated that caring as an only child in a context of concern about the quality of formal services, would leave them struggling to balance work and care, with most anticipating their selfsacrifice could lead to emotional consequences.

| DISCUSSION
The objective was to explore the motivations, associated meanings and how prepared the generation of offspring (young adults) affected by the OCP were for caregiving from their own perspectives. This study is the first we know to specifically adopt an interpretative orientation to examine these constructs within the context of filial expectations placed on family caregivers by their socio-cultural environment (Ideal self) plus the stressors and coping responses (Actual self). "Competing pressures-meanings, motivation and preparedness" meant each participant in this current study, indicated the significance of supporting their parents as society expects of "a good person" (filial expectations-Ideal self) and would most likely aim to enact this (filial performance-Ought self), but could lead to imbalances in responsibility prioritisation resulting in filial discrepancy (Actual self giving demands and filial discrepancy may manifest due to incongruences between beliefs (ideal) and performances (actual).
Older people, including older caregiving spouses, do not want to burden offspring, 10 consequently, younger generations are not put under caregiving pressure and are less resilient than society expects. 26 Also, current caregivers tend to minimise their needs which might explain why younger generations remain unprepared for the caregiving role. 12 As such, findings from this current study showed BIFARIN ET AL. In China about 45% of existing nursing home beds are unused. 34 Echoing findings from this current study, a recent study showed that nursing homes are considered unethical, making community services such as day-care centres more appealing. 30 Although nursing homes are a reasonable option, 35

| Strengths and limitations
The initial plan was for O.B. to travel to China to collect data but he could not because of the COVID-19 pandemic. Being directly involved in the recruitment process could have helped build trust, recruit more participants especially those from low socio-economic backgrounds, which might have led to collection of richer data.
Irrespective of this, L.Y., was able to liaise effectively with participants, data collected was rich and provided basis for knowledge created and conclusions made. 41 In addition, L.Y., critically reviewed the final manuscript to ensure that cultural nuances were not lost.
While Qualitative studies do not aim to provide generalisable findings as the sample size is small, it is important to acknowledge that participants were all well-educated. Given the intensity with which participants in this current study spoken about the socio-cultural implications for the caregiving process, it is important to stress that the relative reality of (future) caregivers is suggestive about wider applicability. As such, this study offers insights into the potential prevalence of the phenomenon of family caregiving within collectivist societies.