Pfeifer, Enrico; (2025) The relationship between unpaid caregiving transitions and health behaviours across the lifecourse. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

In the UK, demographic and epidemiological shifts have led to an increase in unpaid caregiving. However, the impact of caregiving on caregiver’s ability to maintain positive health behaviours remains unclear. This thesis focuses on caregiving transitions and their impact on health behaviours. Four types of transitions were examined: entering caregiving, exiting caregiving, changes in caregiving intensity, and multiple caregiving transitions. Using data from the nationally representative UK Household Longitudinal Study, this thesis employs an interdisciplinary framework that integrates caregiving role theory and health behaviour theories from a lifecourse perspective. Statistical models, including propensity score matching, piecewise growth curve models, and latent class analysis (LCA), are used to model the trajectories of smoking, physical activity, diet and alcohol consumption during caregiving transitions. The results indicate that caregiving transitions are associated with both positive and negative changes in health behaviours, which are influenced by caregiving intensity and the caregiver's lifecourse stage. Transitioning into caregiving was associated with an increased probability of smoking and a decrease in physical inactivity. Exiting caregiving was linked to an increase in physical activity but was not associated with other health behaviour changes. LCA revealed five distinct classes of caregiving intensity. An increase in caregiving intensity was not associated with changes in health behaviours, while stable high-intensity caregiving was linked to increased physical inactivity, lower fruit and vegetable consumption, higher odds of smoking, and lower odds of problematic drinking. Regarding multiple transitions, a count variable of the number of transitions and LCA showed conflicting results, but generally, recurrent caregiving was associated with more positive health behaviour changes compared to non-caregiving. These findings highlight the complex relationship between caregiving and health behaviours that is influenced by caregiving intensity and lifecourse stage of the caregiver, suggesting the need for targeted interventions to support caregivers in maintaining healthy behaviours.

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