Storytelling in Home Care – Developing Diversity-Sensitive Stories for Family Caregivers of Turkish Individuals Living with Dementia

Storytelling in Home Care – Developing Diversity-Sensitive Stories for Family Caregivers of Turkish Individuals Living with Dementia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Storytelling in Home Care – Developing Diversity-Sensitive Stories for Family Caregivers of Turkish Individuals Living with Dementia Kübra ANNAC, Ela Rana ÖRS, Sümeyra ÖZTÜRK, Mualla BASYIGIT, Tugba AKSAKAL, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6640826/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Aug, 2025 Read the published version in BMC Nursing → Version 1 posted 3 You are reading this latest preprint version Abstract Background: Family caregivers play a crucial role in home care for individuals with dementia, particularly in migrant communities such as families of Turkish descent in Germany. However, caregivers often experience high levels of stress due to cultural expectations, family dynamics, and limited access to support services. Traditional self-help approaches frequently fail to address their diverse needs, necessitating innovative strategies to enhance self-management skills and emotional resilience. Storytelling, a method that facilitates knowledge transfer and emotional expression through narratives, has the potential to empower caregivers by fostering empathy, self-reflection, and problem-solving skills. This study aims to develop and evaluate storytelling interventions that are culturally and linguistically tailored to support Turkish family caregivers in managing caregiving challenges more effectively. Methods : A multi-stage methodological approach was used to develop diversity-sensitive storytelling interventions for Turkish family caregivers of individuals with dementia. The process included a comprehensive needs assessment through literature review and qualitative secondary data analysis of interviews. Based on these insights, different caregiver personas were identified, each representing different challenges and caregiving roles. Stories were then developed following principles of effective storytelling, incorporating key themes such as stress management, family conflict resolution, and cultural expectations. A quality assessment was conducted using a pretest with caregivers, applying the Community-Based Participatory Research (CBPR) approach to refine narratives based on clarity, accessibility, and relatability. Results: The study resulted in the creation of nine storytelling packs, each containing five stories tailored to specific caregiver personas. These narratives were developed in German and translated into Turkish and English to ensure linguistic and cultural accessibility. Pretests confirmed that the stories resonated with caregivers, addressing their unique caregiving realities while enhancing engagement and emotional support. Feedback led to refinements in language style and narrative structure, ensuring greater clarity and identification with the protagonists. Conclusion: Storytelling serves as an effective intervention to support Turkish family caregivers of individuals with dementia by fostering self-management skills and reducing emotional burden. The developed stories provide an inclusive, diversity sensitive approach to addressing caregivers' challenges, promoting self-reflection, and enhancing support networks. Future research should explore the long-term impact of storytelling interventions and their integration into caregiver support programs to improve well-being and caregiving outcomes. Storytelling Home Care Family Caregivers Dementia Diversity Migration Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Background A considerable number of individuals requiring care in Germany receive care at home from family members and close relatives [ 1 ]. Among individuals with a Turkish migration background, the proportion of those receiving care at home is nearly 100 % [ 2 ] Providing care for a relative can result in both physical and psychological stress for caregivers [ 3 ]. Approximately half of all family caregivers experience mental illness related to their caregiving responsibilities and the associated stress [ 4 ]. These burdens vary depending on factors such as age, gender, generational relationship, cultural background, and socio-economic conditions [ 5 ]. In order to guarantee the continuity of care at home, it is essential to reinforce the resources available to caregivers and alleviate the burden on them. One potential avenue for providing relief is by promoting the self-management skills of family caregivers, thereby supporting them in assuming responsibility for their own actions [ 6 , 7 ]. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies [ 8 ]. Nevertheless, specific demographic groups, including those with a history of migration, seldom engage in suitable support programmes, such as conventional self-help groups [ 9 ]. One reason for this is that significant differences between participants in such a self-help group in terms of age, biography, relationship to the person in need of care, religiosity, language skills, sexual orientation, level of education and care-related challenges can lead to a reduction in identification of the family caregivers with the other group members. This subsequently results in discontinuities in participation or dropping out of the group if the aforementioned factors are not adequately addressed [ 10 ]. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity [ 11 , 12 ]. To date, there is a paucity of studies that adopt an intersectional perspective and examine a broader range of differentiating characteristics beyond migration history, such as socio-economic status, sexual orientation or identity, and family role models [ 13 , 14 ]. Migrant caregivers often face specific barriers that cannot be fully captured by looking at individual diversity characteristics alone. An intersectional perspective is needed to examine the increased inequality or disadvantage that results from the interaction of multiple diversity characteristics. One technique that allows for such a perspective is storytelling. Storytelling is a concept based on the use of stories to convey knowledge, values and emotions. Greenhalgh describes storytelling as a method that makes complex issues understandable and accessible, using narratives (stories) to foster interpersonal connections and empathy [ 15 ]. Storytelling enables participants to share experiences and emotions through personal stories, which can help to promote wellbeing, particularly in a healthcare context. The utilisation of storytelling has the potential to enhance the development of self-management abilities, health literacy and self-efficacy expectations. The method entails the moderated presentation of narratives on a range of subjects, with the objective of fostering individuals' capacity to disseminate knowledge, experience and information autonomously [ 16 ]. Storytelling aligns with an intersectional approach by representing diverse caregiving experiences shaped by factors such as migration background, socio-economic status, gender, family structure, and language. By incorporating intersectionality, storytelling addresses the unique challenges of caregivers, ensuring their varied needs are recognized. This approach leads to more inclusive and effective support, enhancing the relevance and accessibility of caregiving resources [ 17 ]. The use of storytelling in the context of home care for Turkish individuals in Germany was first investigated in 2011 [ 18 ]. The narrative-generating methodology was particularly effective in facilitating the exchange of knowledge, experiences and information between family caregivers. The approach enabled valuable insights to be gained regarding the removal of access barriers, the utilisation of support services, the strengthening of the self-help potential of family caregivers and the necessity for the participation of the target group in the design of such services [ 18 ]. Through storytelling, caregivers' experiences that might otherwise remain unspoken can be expressed in a safe environment. The decision to use storytelling as a central concept is based on its ability to create an emotional and identifying connection between those involved. The utilisation of stories is particularly well-suited to addressing the emotional and practical challenges frequently experienced by caregivers, thereby facilitating their identification with the personas in the stories and enabling the acquisition of knowledge from them. Particularly for caregivers who often suffer from social isolation, storytelling provides an opportunity to reflect on their experiences and to feel understood. This approach helps to reduce the burden on caregivers by fostering a supportive community [ 16 , 17 ]. Despite the evident necessity for such approaches, there is an absence of suitable stories within the context of storytelling that address the care and living environment of caregivers of Turkish individuals living with dementia. Consequently, there is a demand for the development of stories that authentically reflect the multifarious disadvantages experienced by the target group, with a view to enhancing the quality of care. The objective of this study is to present the development of diversity-sensitive stories that can be applied according to the storytelling method for family caregivers of Turkish individuals living with dementia with the aim of strengthening their self-management skills in care. 2 Methods The design of the story development is based on a methodologically coordinated multi-stage process to conduct formative needs research and utilise the collected data to develop the stories [ 19 , 20 ]. The process combines a needs assessment based on a literature review and qualitative secondary data analysis, development according to elements of a 'good story', and a quality assessment (Fig. 1 ). The choice of these approaches was intended to facilitate the creation of stories that are practical, sensitive to diversity and geared towards the actual needs of family caregivers of individuals living with dementia. The specific methods and their relevance to the development of the stories are explained in detail below. 2.1 Needs Assessment Prior to the development of any given story, it is imperative to identify extant literature and undertake a comprehensive assessment of the needs of the target group. This process ensures that the stories are tailored to the specific experiences, challenges, and requirements of the intended audience. To this end, a literature review was carried out alongside a qualitative secondary data analysis of interviews with family caregivers of Turkish individuals living with dementia. The goal was to synthesize existing knowledge on the diverse needs of caregivers and to highlight gaps that the stories should address [ 21 , 22 ]. In addition to the literature review, a qualitative secondary data analysis was conducted using 31 interviews from three studies focused on family caregivers of Turkish individuals living with dementia [ 10 , 23 , 24 ]. The analysis employed Winker and Degele’s multi-level approach [ 14 ], which examines social structures, identity constructs, and interaction processes. This framework enabled a nuanced understanding of how cultural, social, and individual factors shape the caregiving experience. By integrating findings from the literature review and qualitative secondary data analysis, this needs assessment ensures that the developed stories authentically reflect the challenges, needs, and lived realities of caregivers, ultimately contributing to a more meaningful and impactful storytelling approach. 2.2 Development according to Elements of a Good Story The findings of the needs assessment formed the foundation for designing stories that are both evidence-based and practical. Thus, the review ensured that the stories developed were not only aligned with the needs of the target audience but also scientifically grounded to maximize their impact. Therefore, the stories were initially developed in accordance with the fundamental principles of a 'good story' as outlined by Holzinger and Sturmer [ 25 ] (Table 1 ). Table 1 The fundamental elements of a 'good story' according to Holzinger and Sturmer [ 25 ] Elements Description Message What do you want to achieve with your story? Generate sympathy or disgust? Do you want to make your users laugh or cry? The message is essential for the choice of personas and the tonality of the language. Personas Every story lives through its personas. The personas must be connected to the theme. With experiences and feelings that are as intense as possible. Plot Stories have a beginning and an end. And a middle where the story can develop. What is the thread that can pull the user through the whole plot? Setting Where does your story take place? Good descriptions allow users to get an idea of the setting and understand the context of the story. Dramaturgy When researching a topic, look for dramatic moments. Are there turning points, biographical breaks or even conflicts? Conflict is the driving force behind stories. Narrator Narrators create perspective. Narrators determine the point of view and thus the perception of the story. First-person narrators can also be compelling. Language style Language creates atmosphere and must be adapted to the atmosphere to be created and to the target audience. The success of the stories is rooted in their strategic application of storytelling elements, each tailored to achieve a specific purpose and resonate deeply with the target audience. In the process of developing the stories, these elements of a 'good story' were given due consideration, with the stories being designed to embody the essential components of an effective story. Below is an explanation of how each element of a 'good story' contributes, with a focus on the application in the developed stories. Message The stories are written with a clear and focused message aimed at eliciting compassion and understanding from the readers. Each story is designed to shed light on the challenges faced by caregivers while promoting solutions such as seeking support and embracing self-help. By focusing on these aspects, the stories inspire empathy and action. Personas Personas form the emotional core of the stories, reflecting a wide range of diversity characteristics and life experiences. By presenting personas connected to the theme with intense emotions and relatable experiences, the stories enable readers to form an emotional connection and foster identification with the characters. The personas were chosen to reflect different types of caregivers identified in the needs assessment. The personas illustrate diverse dimensions of caregiving, highlighting variations in roles, family dynamics, beliefs, and traditions. They range from individuals caring alone to those supported by siblings or extended family. The stories depict different family constellations, spanning harmonious networks to more conflictual relationships. Religious or spiritual beliefs emerge as significant, serving either as a source of strength through practices like prayer or ritual, or as a point of tension when traditions evolve. Cultural expectations around caregiving, such as the notion that care should remain 'within the family,' are also explored, revealing both the burdens and benefits associated with these traditions. Plot The plots are structured with a beginning, middle, and end, ensuring coherence and engagement throughout the narrative. Core themes identified during research and the needs assessment guide the progression of the story, with conflicts and turning points thoughtfully integrated to create a meaningful and logical flow. Setting Realistic and vivid descriptions of the settings create an immersive atmosphere. Whether focusing on domestic environments, community centers, or everyday scenarios, the settings provide a tangible context for the stories, allowing readers or listeners to better understand and connect with the stories. Dramaturgy Dramatic moments, biographical breaks, and conflicts are authentically depicted to emotionally engage the audience. These moments serve as key drivers of the plot, creating turning points that capture attention and deepen understanding of the challenges and dynamics of caregiving. Narrator The first-person perspective is used to foster a deeper identification with the narrating persona, as it allows readers to directly experience their thoughts, emotions, and perceptions. This creates a personal connection and enables readers to witness events firsthand. Language Style The language is simple, appealing, and inclusive, creating an accessible story for a diverse audience with different educational backgrounds. The tone balances emotional depth without veering into clichés or excessive dramatization, ensuring that the stories remain authentic and respectful. By combining these elements thoughtfully, the stories not only engage readers or listeners but also achieve their goal of fostering empathy, understanding, and empowerment for caregivers. 2.3 Quality Assessment The objective of developing the stories was to ensure that they were sensitive to diversity and intersectionality, thereby facilitating identification with them by family caregivers and strengthening their self-management skills. The quality assessment of the developed stories was a key step in ensuring their effectiveness and relevance to the target audience [ 19 , 20 ]. This process focused on evaluating the stories against a set of well-defined criteria [ 25 ] designed to guarantee their clarity, accessibility, and suitability for the intended purpose. Additionally, the quality assessment of the stories was based on a pretest with family caregivers of Turkish individuals living with dementia according to the Community-based Participatory Research (CBPR) approach [ 26 ]. The criteria were derived from the elements of a 'good story' according to Holzinger and Sturmer [ 25 ], adapted and revised by an 'interpretation group' within the project team. These criteria are structure, language, length, relatability, problem orientation, open end, validity, and adaptability. The structure of the stories should follow a standardized three-phase approach. First, an Introductory Phase introduces the characters and the initial context. This is followed by the Problem Description Phase, where the cause and nature of the problem are outlined. Finally, the Closing Phase describes the consequences of the problem, such as feelings of fear or helplessness. The language of the stories should be simple and accessible, ensuring that participants can easily engage with the content. Given the diverse backgrounds of the individuals involved, who may not share the same level of education, it is crucial to use clear and straightforward wording. The length of the stories should be concise, summarizing essential details while maintaining brevity. A reading time of approximately five minutes is recommended to keep participants focused and ensure that all information is absorbed without overwhelming them. To enhance relatability , the realism of the stories is vital. The content should closely mirror the everyday experiences of family caregivers and individuals in need of care. True-to-life stories enable participants to connect with the material more effectively and actively engage in discussions. Problem orientation is another essential criterion. Each story should address a problem relevant to the participants' lives. This provides a foundation for subsequent discussions, where potential solutions can be explored collectively. Including an open ending in the stories facilitates greater engagement from participants. Those with prior experience of the depicted problems are encouraged to share their own stories, while those unfamiliar with such issues are prompted to think critically and explore the topics further. Validity is a cornerstone of quality storytelling. The stories should meet high qualitative standards, particularly communicative validity (as defined by Mayring [ 27 ]). This means that participants should interpret the stories as intended by the storytellers. To ensure this, pretests can be conducted where family caregivers listen to the stories and are asked to recount their understanding of the content. Lastly, adaptability is crucial. The topics of the stories should align with the specific needs of the participants, which are identified in advance. Tailoring the stories to these needs ensures they are relevant and meaningful to the target audience. To ensure the quality and relevance of the stories, pretests were conducted with three family caregivers of Turkish individuals living with dementia as part of a CBPR approach [ 17 , 28 , 29 ]. A purposive sampling approach with a maximum contrasting comparison, where individuals are deliberately selected for their relevant information concerning the research question, and who differ in key characteristics (e.g., age, role in care, relationship to patient), was used to gather a broad range of information [ 30 ] (Table 2 ). Using a think-aloud approach according to Charters [ 31 ], the draft version of the story was read aloud to the participants. Following the reading, the participants systematically reviewed the story using the defined quality criteria. The verbal statements of the participants were documented to ensure an accurate representation of their thought processes. The data were analyzed inductively using qualitative content analysis according to Mayring [ 27 ], allowing themes and patterns to emerge directly from the data. This approach enabled a comprehensive evaluation of whether the developed stories met the predetermined criteria. The pretests provided invaluable insights into how well the stories aligned with the needs and experiences of the participants, ensuring the material was both relatable and impactful [ 32 , 33 ]. Table 2 Sample Description of the participants of the Pretest Age Gender Role in Care Relationship to Patient Employment Family Situation Cultural & Traditional Expectations Use of Professional Support 49 Female Primary caregiver Daughter-in-law Part-time Own family with children Very strong Minimal 31 Female Supporting caregiver Granddaughter Full-time Own family without children Moderate Utilizes support services 20 Female Emergency caregiver Granddaughter In education No own family None Prefers full professional care The pretests provided valuable feedback, helping to assess whether the story met these standards and resonated with the experiences and expectations of the caregivers. Insights gained during this process guided further refinement of the story to ensure its practical application and life-world relevance. By applying these criteria, the assessment aimed to create stories that were not only informative but also engaging and adaptable to real-world contexts. The focus was on producing high-quality narratives that could effectively facilitate understanding, stimulate discussion, and address the challenges faced by the target group in a meaningful way. 3 Results The results of the three-stage development process of the stories, focusing on the key findings from the needs assessment and the development and quality assessment, will be presented below. The needs assessment based on a literature review and qualitative secondary data analysis revealed the complex and varied experiences of family caregivers of Turkish individuals living with dementia, emphasizing the importance of recognizing diversity in caregiving roles. Building on these findings, a series of diversity sensitive and intersectional stories were developed according to the principles of a 'good story' to address the specific needs of the caregivers. The stories were further evaluated against a set of well-defined criteria and pretests with the target group, ensuring that they were both relevant and engaging. 3.1 Needs Assessment In a literature review and qualitative secondary data analysis, the distinction between individual and structural challenges proved to be crucial for understanding caregivers' experiences. It has been determined that it is imperative to give due consideration to the role of the family caregiver. It is evident that the needs and requirements of family caregivers can vary significantly depending on the relationship they are caring for [ 34 ]. For instance, there may be substantial differences in the needs of a spouse, parent, sibling or even one's own children. The influence of gender, age, socio-economic status, educational level, and family circumstances is also pertinent in this context [ 35 ]. It is imperative to recognise and address these variations in a manner that is sensitive to diversity. Furthermore, from an intersectional perspective, it is crucial to acknowledge that family caregivers may also differ from each other in terms of identities, structures and representations [ 21 ]. The qualitative secondary data analysis showed that these diverse categories can exhibit significant disparities across multiple dimensions of diversity, thereby precluding their categorisation into a homogeneous group of 'family caregivers'. Rather, these roles reflect different stress situations and associated different coping strategies, which must be dealt with in very different ways. The needs assessment shows that different types of caregivers need to be considered. It identified different roles of caregivers, which differ from each other in various diversity characteristics. The comprehensive consideration of these factors is imperative to strengthen self-management skills, roles in care and types of caregivers, thereby providing a diversity-sensitive basis for story development. As a result of the needs assessment, a number of types of caregivers will be outlined as the basis for the stories. These will be described in more detail below: Caregiver who is under multiple pressures, juggling the demands of work with caring for the family member living with dementia and bringing up children. Caregiver who feels lonely, overwhelmed and burdened by family conflicts and the fate of her family member's illness. Caregiver who is heavily burdened, suffering from differing views about dementia and how to deal with it within the family, unable to organise care as they would like. Caregiver who accepts their role and puts their own needs and well-being second out of love and in order to meet the expectations of others and maintain social peace. Caregiver who provides care due to favourable circumstances, traditional/cultural norms, family expectations and hierarchical structures. Caregiver who is a sole, active, controlling and decisive caregiver, using professional support because they believe that other family members are not competent to do so. Caregiver who makes care decisions at their own discretion, in line with their own life, also making use of professional support. Caregiver who actively disengages from the caring situation, playing a maximally supportive, rather observing role. Caregiver who is informed about dementia and care and therefore trusts only professionals and sees himself as a committed knowledge broker. Caregiving roles are shaped by factors such as cultural background, gender, socio-economic status, and family dynamics [ 35 ], requiring tailored stories to reflect these diverse realities authentically. Therefore, diversity-sensitive and intersectional stories for family caregivers are essential to address their varied and complex needs. The heterogeneity of the target group's care requirements gives rise to divergent interests among family caregivers. While some family carers prioritise emotional topics such as the division of care within the family and conflicts, others focus on practical concerns like finances and formalities or the intricacies of the German healthcare system [ 11 , 36 ]. To ensure a comprehensive understanding of the diversity of experiences and intersecting needs, it was imperative to explore a broad spectrum of topics, thereby ensuring no aspect was overlooked. Special attention was given to communication intensive, sensitive and often stigmatised issues. However, there is a paucity of research conducted on the subject of enhancing self-management skills among Turkish family caregivers in Germany. A seminal study by Tezcan-Güntekin and Razum [ 23 ] analysed the factors that inhibit or promote the strengthening of self-management skills, and identified intersectionalities in the activation and strengthening of self-management skills. As part of an individualised intervention for family caregivers of Turkish individuals living with dementia ('FörGes 5') [ 24 ], existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving. The findings revealed that the caregivers exhibited a wide range of self-management competencies, which were influenced by both existing supportive resources and diverse, intrafamily-specific psychosocial and life-world challenges in caregiving that had not been addressed. The development of self-management skills in family caregivers is determined by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic interplay gives rise to a range of levels of self-management ability among family caregivers [ 11 ]. 3.2 Development Based on the needs assessment, elements of a 'good story', and quality assessment, a total of nine story packs were developed to support family caregivers of individuals living with dementia. Each of the story packs contains a starter story and four further related stories. Nine starter stories have been created to correspond to different types of family caregivers and their needs. These starter stories serve as a starting point for the caregivers and deal with a specific persona tailored to their own diversity characteristics. The additional four stories address the key topics that were identified as part of the needs assessment. Consequently, each story pack contains five stories for a specific type of caregiver. With nine caregiving types, a total of 45 stories were developed. All stories were developed in German and then translated into Turkish by native speakers from the project team to further increase cultural and linguistic accessibility for the target group. For the purposes of this article, the stories were also translated into English. The stories include cross-cultural personas in similar life situations as the type of caregivers represented. The personas and content take into account identified diversity characteristics such as caring roles, family support, religious beliefs, cultural traditions and other relevant dimensions. All nine story packs developed can be viewed and downloaded in English, German and Turkish in the Additional file 1–3. 3.2.1 Starter Story The nine starter stories serve as a basis for the story and its listeners/readers and are specifically tailored to different types of caregivers as identified in the needs assessment. They depict typical life situations with possible everyday situations and challenges to feel connected to the persona of the story. The starter stories are chosen to match the characteristics of a wide range of listeners/readers of the story. This ensures that the target audience identifies with the persona of the story and also feels and thinks along with the further related stories. The starter stories deal with nine different personas, which differ from each other as follows, specific to a certain type of family caregiver as identified in the needs assessment. See Fig. 3 for an example starter story for Persona 1. 3.2.2 Further Related Stories The further related stories are coordinated with the various starter stories in the specific story pack and are used to illuminate and deepen specific topics within each persona. Each persona has their own resources and needs and shapes their care and living environment differently. Depending on their specific situation, certain issues need to be addressed, some need more focus and others do not. Due to the diversity-sensitive nature of the stories, key topics were identified for each persona based on the results of the needs assessment. The results were discussed in several meetings in the project team with experts and key topics were defined for each persona. Table 3 shows the key themes of the further related stories for each persona. They serve to deepen specific questions and aspects that may arise in everyday care and in the lives of the personas. They provide content and practical approaches for the subsequent discussion of specific care challenges. See Fig. 4 for an example further related story for Persona 1 with the key topic 'Stress and time management' and Fig. 5 for 'Family support and conflict resolution'. Table 3 Key topics of the further related stories for each persona in each story pack Persona Key topics of the further related stories 1 Stress and time management Family support and conflict resolution Professional support services Balancing different roles 2 Dealing with loneliness Overload in care Religious/spiritual support and inner strength Loss of identity 3 Different views in the family Dealing with family conflicts Overcoming the stigma of dementia Dealing with powerlessness 4 Loss of identity Acceptance of support Emotional burden of self-sacrifice Dealing with own needs 5 Caring out of family duty Social and cultural expectations Support and responsibility Self-fulfilment and independent living 6 Lack of trust in other family members Control and overload in care Need for perfection Professional support 7 Care and organisation Making decisions Professional support Finding emotional balance 8 Support in care Distinction from care Family support Role in care 9 Trust in experts Control and overload in care Social and cultural expectations Knowledge and support 3.3 Quality Assessment The pretests conducted as part of the CBPR approach with three family caregivers of Turkish individuals living with dementia provided valuable insights into the quality and relevance of the stories. The feedback gathered during these pretests helped assess whether the stories met the established standards and resonated with the caregivers' experiences and expectations. The caregivers expressed satisfaction with the overall themes of the stories and the personas, indicating that no major changes to the content were necessary. However, they suggested small modifications with regard to the criteria 'language style', in wording and phrasing to improve clarity and emotional resonance. Based on this feedback, the stories were refined and adjusted accordingly. The revisions focused on fine-tuning the language to ensure that the narratives were more engaging and easier to relate to, while maintaining their original content and intent. After these minor adjustments, the stories were finalized. The pretest process ultimately ensured that the stories were not only informative but also aligned with the caregivers' real-life experiences, making them more effective in addressing the challenges faced by the target group. 4. Discussion The development of diversity-sensitive and intersectional stories for family caregivers is of paramount importance, as these narratives have the potential to address the complex and multifaceted needs of caregivers in a meaningful way. The use of storytelling as a methodological basis enables the development of care-related and open-ended stories. This approach is particularly suited to addressing the emotional and practical challenges that caregivers often experience [ 18 ]. Storytelling builds empathy and connects people through shared experiences, so that caregivers can see themselves in the stories and learn from them [ 17 ]. Although the need for such approaches is clear, there is a lack of appropriate stories within the storytelling framework that specifically address the care and living conditions of caregivers of Turkish individuals living with dementia. As a result, there is a need to create stories that authentically portray the diverse challenges faced by this target group, with the aim of improving the quality of care. In response to this gap, we developed nine story packs that reflect the unique experiences and difficulties of the caregivers, with the goal of enhancing the care they provide. Because the stories are open-ended, they leave room for different perspectives and individual interpretations, which is particularly important when working with individuals from different backgrounds. The stories, which are based on real-life experiences, provide a form of identification and can therefore ease the emotional burden on caregivers. Findings from the development phase suggest that the use of storytelling as a technique to facilitate self-help and emotional recovery for family caregivers is promising. The stories developed contribute to the existing literature on approaches to support for caregivers with multiple diversity characteristics. Caregiving roles are deeply influenced by a range of factors, including cultural background, gender, age, socio-economic status, educational level, and family dynamics, all of which shape the caregiving experience and the associated challenges [ 34 , 35 , 37 ]. Recognizing these intersectional dimensions ensures that stories resonate authentically with the diverse realities of caregivers, fostering a sense of representation and empowerment and facilitating greater identification and a sense of belonging. The findings of this study are consistent with those of previous research and contribute to the existing body of knowledge, particularly in relation to the importance of inclusion, participation, and emotional support for family caregivers [ 38 ]. The consideration of diversity characteristics, such as migration history, gender, socio-economic status and cultural influences is in line with the current discourse on intersectional approaches in care and health research [ 14 , 39 ]. The intersectional perspective allows for a more in-depth examination of the complex challenges that arise from the confluence of multiple diversity characteristics, thereby taking into account the multifaceted realities of family caregivers. This approach has already been identified in the literature as a necessary step to reduce discrimination and inequalities in care [ 40 ]. While existing literature focuses primarily on narrative approaches and self-management [ 38 ], the created stories extend the discussion to include the need to consider other diversity characteristics such as religious affiliation, cultural traditions and social networks. This has been less emphasised in previous studies, highlighting the practical relevance and necessity of these additional dimensions. Furthermore, the study highlights the importance of linguistic and cultural accessibility in the context of narrative-based discourse on inclusive health approaches [ 7 , 41 , 42 ]. The strengths of the methodical multi-stage approach used for the development of the stories in the present study lie in the adaptive and inclusive design of the stories, which are oriented towards the individual and often complex needs of family caregivers. The needs assessment served as a critical foundation for this process, as it illuminated the intricate interplay between structural and individual challenges faced by caregivers [ 43 , 44 ]. The assessment uncovered variations in self-management abilities and caregiving experiences that are shaped by both supportive resources and unique psychosocial stressors. These variations in different factors resulted in nine different caring roles that could be identified. Further literature review showed that it is vital to take these roles into account when developing support services. This understanding underscores the importance of tailoring stories to reflect the specific needs, identities, and coping strategies of different caregiving roles [ 34 – 36 ]. Without the insights gained through the needs assessment, the development of such stories would risk oversimplifying the caregiving experience or neglecting the diversity of the target audience. Instead, the assessment provided a nuanced understanding of caregivers' lived realities, enabling the creation of stories that are not only inclusive but also capable of addressing key barriers to self-management [ 45 ]. The combination of narrative and intersectional approaches encourages deeper engagement with caring issues and facilitates caregivers’ personal development. In addition, the cultural and linguistic accessibility of the stories facilitates wider participation of the target audience. However, there are also potential weaknesses that can arise from the complexity of diversity characteristics. The need to consider a variety of different characteristics could hinder the development process and affect the speed of adaptation to new needs. Additionally, the implementation of such sensitive stories requires regular training and education of facilitators to prevent discrimination and ensure the support of all participants. Although these stories are thoughtfully designed to be adaptable, inclusive, and impactful, further evaluation studies are necessary to assess their effectiveness. Such studies are essential to understand how well the stories achieve their intended goals, such as raising awareness, promoting empathy, or driving behavioral change. Evaluation can provide valuable insights into the stories' impact across different settings, populations, and contexts, ensuring they are not only theoretically sound but also practically effective. This evidence-based approach will help refine the stories and maximize their potential benefits. It is essential that these stories are intersectional and sensitive to diversity, thoughtfully representing a wide range of individuals, experiences and roles. Rather than reinforcing stereotypes, the stories aim to challenge and dismantle them, fostering a more inclusive and nuanced understanding of diverse perspectives. The developed stories are highly versatile and can be used in various settings. They are adaptable to different population groups, patient demographics, illnesses, and life contexts, ensuring their long-term relevance. Storytelling has broad applications across many fields, making it a powerful tool for communication and education. 5. Conclusions The development of stories has significant implications for both practice and further research. In practice, the stories could be established as a supportive tool in self-help groups for family caregivers, with the aim of reducing their psychological distress and strengthening self-management. In addition, the stories produced could be used in the training of professional caregivers and in the provision of counselling and support services by social services. In terms of research, the narrative and intersectional methodology offers the potential for further studies focusing on the specific needs and challenges of caregivers with different diversity characteristics. Further development of narrative approaches could facilitate a more comprehensive examination of both the quantitative and qualitative aspects of caregivers' self-care and emotional wellbeing, thereby strengthening the evidence base for their effectiveness. Future research should explore how storytelling can be systematically embedded in care practices to promote equity and well-being. This study highlights the importance of integrating intersectionality and narrative-based approaches, such as storytelling, into health care to address the multiple roles and challenges faced by family caregivers. Storytelling fosters empathy, cultural understanding, and deeper engagement with caregivers' lived experiences, enabling more inclusive and personalised care. Particularly for vulnerable groups such as family caregivers, storytelling serves as a valuable tool to reduce stress and improve self-management skills, thereby strengthening their resilience and ability to provide care in a sustainable way. Declarations Ethics approval and consent to participate : The study was approved by the Ethics Committee of Witten/Herdecke University (Ref. No. S-50/2023). All personal data will be stored and later destroyed in accordance with the data protection concept and the ethical approval. Given the pseudonymous/anonymous nature of the survey, full disclosure, voluntary participation and the intention to publish anonymised data, no ethical concerns are associated with the study. Consent for publication : Not applicable Availability of data and materials: The story packs developed are available in English, German and Turkish in the Additional files 1-3. Competing interests : The authors declare that they have no competing interests. Funding : The study is funded by the Federal Joint Committee (G-BA) (funding reference 01VSF22048). Authors' contributions : KA developed the initial draft of the manuscript and is responsible for the development process of the stories. ERÖ and SÖ together with KA are responsible for the project implementation. MB, TA, CK and AR read and revised the manuscript. HTG is responsible for project planning and implementation. YYA and PB are responsible for project planning and design and corresponding work packages in the project. All authors read and approved the final manuscript. Acknowledgements : Not applicable References Statistisches Bundesamt, Pflegestatistik. 2017, Ländervergleich - Pflegebedürftige. 2018. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Pflege/Publikationen/Downloads-Pflege/laender-pflegebeduerftige-5224002179004.pdf?__blob=publicationFile Okken P-K, Spallek J, Razum O. Pflege türkischer Migranten. In: Bauer U, Büscher A, editors. 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Yilmaz-Aslan Y, Aksakal T, Yilmaz H, Annaç K, Bulic A, Razum O, Tezcan-Güntekin H. Selbstmanagement türkeistämmiger Menschen bei der Pflege von Angehörigen mit Demenz. Eine individualisierte Intervention. In: Hämel K, Röhnsch G, editors. Förderung von Gesundheit und Partizipation bei chronischer Krankheit und Pflegebedürftigkeit im Lebensverlauf. Weinheim: Beltz Juventa in der Verlagsgruppe Beltz; 2021. Holzinger T, Sturmer M. Die Online-Redaktion: Praxisbuch für den Internetjournalismus. Springer; 2010. Israel BA, Schulz AJ, Parker EA, Becker AB. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Educ Health (Abingdon). 2001;14:182–97. 10.1080/13576280110051055 . Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken. Weinheim: Julius Beltz GmbH & Co. KG; 2022. Patel MR, TerHaar L, Alattar Z, Rubyan M, Tariq M, Worthington K, et al. 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On the use of narratives in nursing research. J Adv Nurs. 2000;32:695–703. 10.1046/j.1365-2648.2000.01530.x . Crenshaw K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. Univ Chic Legal Forum. 1989;1. Fitzgerald E, Campinha-Bacote J. An Intersectionality Approach to the Process of Cultural Competemility – Part II. Online J Issues Nurs. 2019. 10.3912/OJIN.Vol24No02PPT202 . Naderbagi A, Loblay V, Zahed IUM, Ekambareshwar M, Poulsen A, Song YJC, et al. Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review. J Med Internet Res. 2024;26:e55130. 10.2196/55130 . Betancourt JR, Corbett J, Bondaryk MR. Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation. Chest. 2014;145:143–8. 10.1378/chest.13-0634 . Annac K, Basyigit M, Öztürk S, Örs ER, Aksakal T, Kuhn C, et al. Diversity-On: A Diversity-Sensitive Online Self-Help Program for Family Caregivers-A Protocol for a Mixed Methods Study. J Adv Nurs. 2024. 10.1111/jan.16443 . Brügger S, Jaquier A, Sottas B. Burdens and coping strategies of informal caregivers. The perspective of informal caregivers. Z Gerontol Geriatr. 2016;49:138–42. 10.1007/s00391-015-0940-x . Veld HIH, Verkaik J, van Meijel R, Verkade B, Werkman P-J, Hertogh W, Francke C. Self-management by family caregivers to manage changes in the behavior and mood of their relative with dementia: an online focus group study. BMC Geriatr. 2016;16:95. 10.1186/s12877-016-0268-4 . Additional Declarations No competing interests reported. Supplementary Files BMCAnnacStorypacksen2025.pdf Additional files: Additional file 1 BMC_Annac_Story-packs_en_2025.pdf All nine story packs developed in English BMCAnnacStorypacksde2025.pdf Additional file 2 BMC_Annac_Story-packs_de_2025.pdf All nine story packs developed in German BMCAnnacStorypackstr2025.pdf Additional file 3 BMC_Annac_Story-packs_tr_2025.pdf All nine story packs developed in Turkish Cite Share Download PDF Status: Published Journal Publication published 12 Aug, 2025 Read the published version in BMC Nursing → Version 1 posted Editor assigned by journal 20 May, 2025 Submission checks completed at journal 20 May, 2025 First submitted to journal 11 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6640826","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":459278438,"identity":"53a1585d-6a0e-406c-9b54-a36cc288a481","order_by":0,"name":"Kübra 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Among individuals with a Turkish migration background, the proportion of those receiving care at home is nearly 100 % [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Providing care for a relative can result in both physical and psychological stress for caregivers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Approximately half of all family caregivers experience mental illness related to their caregiving responsibilities and the associated stress [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These burdens vary depending on factors such as age, gender, generational relationship, cultural background, and socio-economic conditions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn order to guarantee the continuity of care at home, it is essential to reinforce the resources available to caregivers and alleviate the burden on them. One potential avenue for providing relief is by promoting the self-management skills of family caregivers, thereby supporting them in assuming responsibility for their own actions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNevertheless, specific demographic groups, including those with a history of migration, seldom engage in suitable support programmes, such as conventional self-help groups [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. One reason for this is that significant differences between participants in such a self-help group in terms of age, biography, relationship to the person in need of care, religiosity, language skills, sexual orientation, level of education and care-related challenges can lead to a reduction in identification of the family caregivers with the other group members. This subsequently results in discontinuities in participation or dropping out of the group if the aforementioned factors are not adequately addressed [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. To date, there is a paucity of studies that adopt an intersectional perspective and examine a broader range of differentiating characteristics beyond migration history, such as socio-economic status, sexual orientation or identity, and family role models [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Migrant caregivers often face specific barriers that cannot be fully captured by looking at individual diversity characteristics alone. An intersectional perspective is needed to examine the increased inequality or disadvantage that results from the interaction of multiple diversity characteristics.\u003c/p\u003e \u003cp\u003eOne technique that allows for such a perspective is storytelling. Storytelling is a concept based on the use of stories to convey knowledge, values and emotions. Greenhalgh describes storytelling as a method that makes complex issues understandable and accessible, using narratives (stories) to foster interpersonal connections and empathy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Storytelling enables participants to share experiences and emotions through personal stories, which can help to promote wellbeing, particularly in a healthcare context. The utilisation of storytelling has the potential to enhance the development of self-management abilities, health literacy and self-efficacy expectations. The method entails the moderated presentation of narratives on a range of subjects, with the objective of fostering individuals' capacity to disseminate knowledge, experience and information autonomously [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStorytelling aligns with an intersectional approach by representing diverse caregiving experiences shaped by factors such as migration background, socio-economic status, gender, family structure, and language. By incorporating intersectionality, storytelling addresses the unique challenges of caregivers, ensuring their varied needs are recognized. This approach leads to more inclusive and effective support, enhancing the relevance and accessibility of caregiving resources [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of storytelling in the context of home care for Turkish individuals in Germany was first investigated in 2011 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The narrative-generating methodology was particularly effective in facilitating the exchange of knowledge, experiences and information between family caregivers. The approach enabled valuable insights to be gained regarding the removal of access barriers, the utilisation of support services, the strengthening of the self-help potential of family caregivers and the necessity for the participation of the target group in the design of such services [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Through storytelling, caregivers' experiences that might otherwise remain unspoken can be expressed in a safe environment. The decision to use storytelling as a central concept is based on its ability to create an emotional and identifying connection between those involved. The utilisation of stories is particularly well-suited to addressing the emotional and practical challenges frequently experienced by caregivers, thereby facilitating their identification with the personas in the stories and enabling the acquisition of knowledge from them. Particularly for caregivers who often suffer from social isolation, storytelling provides an opportunity to reflect on their experiences and to feel understood. This approach helps to reduce the burden on caregivers by fostering a supportive community [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Despite the evident necessity for such approaches, there is an absence of suitable stories within the context of storytelling that address the care and living environment of caregivers of Turkish individuals living with dementia. Consequently, there is a demand for the development of stories that authentically reflect the multifarious disadvantages experienced by the target group, with a view to enhancing the quality of care.\u003c/p\u003e \u003cp\u003eThe objective of this study is to present the development of diversity-sensitive stories that can be applied according to the storytelling method for family caregivers of Turkish individuals living with dementia with the aim of strengthening their self-management skills in care.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003eThe design of the story development is based on a methodologically coordinated multi-stage process to conduct formative needs research and utilise the collected data to develop the stories [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The process combines a needs assessment based on a literature review and qualitative secondary data analysis, development according to elements of a 'good story', and a quality assessment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The choice of these approaches was intended to facilitate the creation of stories that are practical, sensitive to diversity and geared towards the actual needs of family caregivers of individuals living with dementia. The specific methods and their relevance to the development of the stories are explained in detail below.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Needs Assessment\u003c/h2\u003e \u003cp\u003ePrior to the development of any given story, it is imperative to identify extant literature and undertake a comprehensive assessment of the needs of the target group. This process ensures that the stories are tailored to the specific experiences, challenges, and requirements of the intended audience. To this end, a literature review was carried out alongside a qualitative secondary data analysis of interviews with family caregivers of Turkish individuals living with dementia. The goal was to synthesize existing knowledge on the diverse needs of caregivers and to highlight gaps that the stories should address [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition to the literature review, a qualitative secondary data analysis was conducted using 31 interviews from three studies focused on family caregivers of Turkish individuals living with dementia [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The analysis employed Winker and Degele\u0026rsquo;s multi-level approach [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], which examines social structures, identity constructs, and interaction processes. This framework enabled a nuanced understanding of how cultural, social, and individual factors shape the caregiving experience.\u003c/p\u003e \u003cp\u003eBy integrating findings from the literature review and qualitative secondary data analysis, this needs assessment ensures that the developed stories authentically reflect the challenges, needs, and lived realities of caregivers, ultimately contributing to a more meaningful and impactful storytelling approach.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Development according to Elements of a Good Story\u003c/h2\u003e \u003cp\u003eThe findings of the needs assessment formed the foundation for designing stories that are both evidence-based and practical. Thus, the review ensured that the stories developed were not only aligned with the needs of the target audience but also scientifically grounded to maximize their impact. Therefore, the stories were initially developed in accordance with the fundamental principles of a 'good story' as outlined by Holzinger and Sturmer [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe fundamental elements of a 'good story' according to Holzinger and Sturmer [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMessage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat do you want to achieve with your story? Generate sympathy or disgust? Do you want to make your users laugh or cry? The message is essential for the choice of personas and the tonality of the language.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvery story lives through its personas. The personas must be connected to the theme. With experiences and feelings that are as intense as possible.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStories have a beginning and an end. And a middle where the story can develop. What is the thread that can pull the user through the whole plot?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhere does your story take place? Good descriptions allow users to get an idea of the setting and understand the context of the story.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDramaturgy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen researching a topic, look for dramatic moments. Are there turning points, biographical breaks or even conflicts? Conflict is the driving force behind stories.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNarrator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNarrators create perspective. Narrators determine the point of view and thus the perception of the story. First-person narrators can also be compelling.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage style\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLanguage creates atmosphere and must be adapted to the atmosphere to be created and to the target audience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe success of the stories is rooted in their strategic application of storytelling elements, each tailored to achieve a specific purpose and resonate deeply with the target audience. In the process of developing the stories, these elements of a 'good story' were given due consideration, with the stories being designed to embody the essential components of an effective story. Below is an explanation of how each element of a 'good story' contributes, with a focus on the application in the developed stories.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMessage\u003c/strong\u003e \u003cp\u003eThe stories are written with a clear and focused message aimed at eliciting compassion and understanding from the readers. Each story is designed to shed light on the challenges faced by caregivers while promoting solutions such as seeking support and embracing self-help. By focusing on these aspects, the stories inspire empathy and action.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePersonas\u003c/strong\u003e \u003cp\u003ePersonas form the emotional core of the stories, reflecting a wide range of diversity characteristics and life experiences. By presenting personas connected to the theme with intense emotions and relatable experiences, the stories enable readers to form an emotional connection and foster identification with the characters. The personas were chosen to reflect different types of caregivers identified in the needs assessment. The personas illustrate diverse dimensions of caregiving, highlighting variations in roles, family dynamics, beliefs, and traditions. They range from individuals caring alone to those supported by siblings or extended family. The stories depict different family constellations, spanning harmonious networks to more conflictual relationships. Religious or spiritual beliefs emerge as significant, serving either as a source of strength through practices like prayer or ritual, or as a point of tension when traditions evolve. Cultural expectations around caregiving, such as the notion that care should remain 'within the family,' are also explored, revealing both the burdens and benefits associated with these traditions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePlot\u003c/strong\u003e \u003cp\u003eThe plots are structured with a beginning, middle, and end, ensuring coherence and engagement throughout the narrative. Core themes identified during research and the needs assessment guide the progression of the story, with conflicts and turning points thoughtfully integrated to create a meaningful and logical flow.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSetting\u003c/strong\u003e \u003cp\u003eRealistic and vivid descriptions of the settings create an immersive atmosphere. Whether focusing on domestic environments, community centers, or everyday scenarios, the settings provide a tangible context for the stories, allowing readers or listeners to better understand and connect with the stories.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDramaturgy\u003c/strong\u003e \u003cp\u003eDramatic moments, biographical breaks, and conflicts are authentically depicted to emotionally engage the audience. These moments serve as key drivers of the plot, creating turning points that capture attention and deepen understanding of the challenges and dynamics of caregiving.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNarrator\u003c/strong\u003e \u003cp\u003eThe first-person perspective is used to foster a deeper identification with the narrating persona, as it allows readers to directly experience their thoughts, emotions, and perceptions. This creates a personal connection and enables readers to witness events firsthand.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLanguage Style\u003c/strong\u003e \u003cp\u003eThe language is simple, appealing, and inclusive, creating an accessible story for a diverse audience with different educational backgrounds. The tone balances emotional depth without veering into clich\u0026eacute;s or excessive dramatization, ensuring that the stories remain authentic and respectful.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eBy combining these elements thoughtfully, the stories not only engage readers or listeners but also achieve their goal of fostering empathy, understanding, and empowerment for caregivers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Quality Assessment\u003c/h2\u003e \u003cp\u003eThe objective of developing the stories was to ensure that they were sensitive to diversity and intersectionality, thereby facilitating identification with them by family caregivers and strengthening their self-management skills. The quality assessment of the developed stories was a key step in ensuring their effectiveness and relevance to the target audience [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This process focused on evaluating the stories against a set of well-defined criteria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] designed to guarantee their clarity, accessibility, and suitability for the intended purpose. Additionally, the quality assessment of the stories was based on a pretest with family caregivers of Turkish individuals living with dementia according to the Community-based Participatory Research (CBPR) approach [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe criteria were derived from the elements of a 'good story' according to Holzinger and Sturmer [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], adapted and revised by an 'interpretation group' within the project team. These criteria are structure, language, length, relatability, problem orientation, open end, validity, and adaptability.\u003c/p\u003e \u003cp\u003eThe \u003cb\u003estructure\u003c/b\u003e of the stories should follow a standardized three-phase approach. First, an Introductory Phase introduces the characters and the initial context. This is followed by the Problem Description Phase, where the cause and nature of the problem are outlined. Finally, the Closing Phase describes the consequences of the problem, such as feelings of fear or helplessness.\u003c/p\u003e \u003cp\u003eThe \u003cb\u003elanguage\u003c/b\u003e of the stories should be simple and accessible, ensuring that participants can easily engage with the content. Given the diverse backgrounds of the individuals involved, who may not share the same level of education, it is crucial to use clear and straightforward wording.\u003c/p\u003e \u003cp\u003eThe \u003cb\u003elength\u003c/b\u003e of the stories should be concise, summarizing essential details while maintaining brevity. A reading time of approximately five minutes is recommended to keep participants focused and ensure that all information is absorbed without overwhelming them.\u003c/p\u003e \u003cp\u003eTo enhance \u003cb\u003erelatability\u003c/b\u003e, the realism of the stories is vital. The content should closely mirror the everyday experiences of family caregivers and individuals in need of care. True-to-life stories enable participants to connect with the material more effectively and actively engage in discussions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eProblem orientation\u003c/b\u003e is another essential criterion. Each story should address a problem relevant to the participants' lives. This provides a foundation for subsequent discussions, where potential solutions can be explored collectively.\u003c/p\u003e \u003cp\u003eIncluding an \u003cb\u003eopen ending\u003c/b\u003e in the stories facilitates greater engagement from participants. Those with prior experience of the depicted problems are encouraged to share their own stories, while those unfamiliar with such issues are prompted to think critically and explore the topics further.\u003c/p\u003e \u003cp\u003e \u003cb\u003eValidity\u003c/b\u003e is a cornerstone of quality storytelling. The stories should meet high qualitative standards, particularly communicative validity (as defined by Mayring [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]). This means that participants should interpret the stories as intended by the storytellers. To ensure this, pretests can be conducted where family caregivers listen to the stories and are asked to recount their understanding of the content.\u003c/p\u003e \u003cp\u003eLastly, \u003cb\u003eadaptability\u003c/b\u003e is crucial. The topics of the stories should align with the specific needs of the participants, which are identified in advance. Tailoring the stories to these needs ensures they are relevant and meaningful to the target audience.\u003c/p\u003e \u003cp\u003eTo ensure the quality and relevance of the stories, pretests were conducted with three family caregivers of Turkish individuals living with dementia as part of a CBPR approach [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A purposive sampling approach with a maximum contrasting comparison, where individuals are deliberately selected for their relevant information concerning the research question, and who differ in key characteristics (e.g., age, role in care, relationship to patient), was used to gather a broad range of information [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Using a think-aloud approach according to Charters [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], the draft version of the story was read aloud to the participants. Following the reading, the participants systematically reviewed the story using the defined quality criteria. The verbal statements of the participants were documented to ensure an accurate representation of their thought processes. The data were analyzed inductively using qualitative content analysis according to Mayring [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], allowing themes and patterns to emerge directly from the data. This approach enabled a comprehensive evaluation of whether the developed stories met the predetermined criteria. The pretests provided invaluable insights into how well the stories aligned with the needs and experiences of the participants, ensuring the material was both relatable and impactful [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample Description of the participants of the Pretest\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRole in Care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRelationship to Patient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFamily Situation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCultural \u0026amp; Traditional Expectations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUse of Professional Support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimary caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDaughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePart-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOwn family with children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVery strong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMinimal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupporting caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGranddaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOwn family without children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUtilizes support services\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmergency caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGranddaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo own family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePrefers full professional care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe pretests provided valuable feedback, helping to assess whether the story met these standards and resonated with the experiences and expectations of the caregivers. Insights gained during this process guided further refinement of the story to ensure its practical application and life-world relevance. By applying these criteria, the assessment aimed to create stories that were not only informative but also engaging and adaptable to real-world contexts. The focus was on producing high-quality narratives that could effectively facilitate understanding, stimulate discussion, and address the challenges faced by the target group in a meaningful way.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eThe results of the three-stage development process of the stories, focusing on the key findings from the needs assessment and the development and quality assessment, will be presented below. The needs assessment based on a literature review and qualitative secondary data analysis revealed the complex and varied experiences of family caregivers of Turkish individuals living with dementia, emphasizing the importance of recognizing diversity in caregiving roles. Building on these findings, a series of diversity sensitive and intersectional stories were developed according to the principles of a 'good story' to address the specific needs of the caregivers. The stories were further evaluated against a set of well-defined criteria and pretests with the target group, ensuring that they were both relevant and engaging.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Needs Assessment\u003c/h2\u003e \u003cp\u003eIn a literature review and qualitative secondary data analysis, the distinction between individual and structural challenges proved to be crucial for understanding caregivers' experiences. It has been determined that it is imperative to give due consideration to the role of the family caregiver. It is evident that the needs and requirements of family caregivers can vary significantly depending on the relationship they are caring for [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. For instance, there may be substantial differences in the needs of a spouse, parent, sibling or even one's own children. The influence of gender, age, socio-economic status, educational level, and family circumstances is also pertinent in this context [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. It is imperative to recognise and address these variations in a manner that is sensitive to diversity. Furthermore, from an intersectional perspective, it is crucial to acknowledge that family caregivers may also differ from each other in terms of identities, structures and representations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The qualitative secondary data analysis showed that these diverse categories can exhibit significant disparities across multiple dimensions of diversity, thereby precluding their categorisation into a homogeneous group of 'family caregivers'. Rather, these roles reflect different stress situations and associated different coping strategies, which must be dealt with in very different ways. The needs assessment shows that different types of caregivers need to be considered. It identified different roles of caregivers, which differ from each other in various diversity characteristics. The comprehensive consideration of these factors is imperative to strengthen self-management skills, roles in care and types of caregivers, thereby providing a diversity-sensitive basis for story development. As a result of the needs assessment, a number of types of caregivers will be outlined as the basis for the stories. These will be described in more detail below:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who is under multiple pressures, juggling the demands of work with caring for the family member living with dementia and bringing up children.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who feels lonely, overwhelmed and burdened by family conflicts and the fate of her family member's illness.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who is heavily burdened, suffering from differing views about dementia and how to deal with it within the family, unable to organise care as they would like.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who accepts their role and puts their own needs and well-being second out of love and in order to meet the expectations of others and maintain social peace.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who provides care due to favourable circumstances, traditional/cultural norms, family expectations and hierarchical structures.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Caregiver who is a sole, active, controlling and decisive caregiver, using professional support because they believe that other family members are not competent to do so.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who makes care decisions at their own discretion, in line with their own life, also making use of professional support.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who actively disengages from the caring situation, playing a maximally supportive, rather observing role.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCaregiver who is informed about dementia and care and therefore trusts only professionals and sees himself as a committed knowledge broker.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eCaregiving roles are shaped by factors such as cultural background, gender, socio-economic status, and family dynamics [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], requiring tailored stories to reflect these diverse realities authentically. Therefore, diversity-sensitive and intersectional stories for family caregivers are essential to address their varied and complex needs. The heterogeneity of the target group's care requirements gives rise to divergent interests among family caregivers. While some family carers prioritise emotional topics such as the division of care within the family and conflicts, others focus on practical concerns like finances and formalities or the intricacies of the German healthcare system [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. To ensure a comprehensive understanding of the diversity of experiences and intersecting needs, it was imperative to explore a broad spectrum of topics, thereby ensuring no aspect was overlooked. Special attention was given to communication intensive, sensitive and often stigmatised issues.\u003c/p\u003e \u003cp\u003eHowever, there is a paucity of research conducted on the subject of enhancing self-management skills among Turkish family caregivers in Germany. A seminal study by Tezcan-G\u0026uuml;ntekin and Razum [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] analysed the factors that inhibit or promote the strengthening of self-management skills, and identified intersectionalities in the activation and strengthening of self-management skills. As part of an individualised intervention for family caregivers of Turkish individuals living with dementia ('F\u0026ouml;rGes 5') [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving. The findings revealed that the caregivers exhibited a wide range of self-management competencies, which were influenced by both existing supportive resources and diverse, intrafamily-specific psychosocial and life-world challenges in caregiving that had not been addressed. The development of self-management skills in family caregivers is determined by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic interplay gives rise to a range of levels of self-management ability among family caregivers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Development\u003c/h2\u003e \u003cp\u003eBased on the needs assessment, elements of a 'good story', and quality assessment, a total of nine story packs were developed to support family caregivers of individuals living with dementia. Each of the story packs contains a starter story and four further related stories. Nine starter stories have been created to correspond to different types of family caregivers and their needs. These starter stories serve as a starting point for the caregivers and deal with a specific persona tailored to their own diversity characteristics. The additional four stories address the key topics that were identified as part of the needs assessment. Consequently, each story pack contains five stories for a specific type of caregiver. With nine caregiving types, a total of 45 stories were developed.\u003c/p\u003e \u003cp\u003eAll stories were developed in German and then translated into Turkish by native speakers from the project team to further increase cultural and linguistic accessibility for the target group. For the purposes of this article, the stories were also translated into English. The stories include cross-cultural personas in similar life situations as the type of caregivers represented. The personas and content take into account identified diversity characteristics such as caring roles, family support, religious beliefs, cultural traditions and other relevant dimensions. All nine story packs developed can be viewed and downloaded in English, German and Turkish in the Additional file 1\u0026ndash;3.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Starter Story\u003c/h2\u003e \u003cp\u003e The nine starter stories serve as a basis for the story and its listeners/readers and are specifically tailored to different types of caregivers as identified in the needs assessment. They depict typical life situations with possible everyday situations and challenges to feel connected to the persona of the story. The starter stories are chosen to match the characteristics of a wide range of listeners/readers of the story. This ensures that the target audience identifies with the persona of the story and also feels and thinks along with the further related stories. The starter stories deal with nine different personas, which differ from each other as follows, specific to a certain type of family caregiver as identified in the needs assessment. See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e for an example starter story for Persona 1.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Further Related Stories\u003c/h2\u003e \u003cp\u003eThe further related stories are coordinated with the various starter stories in the specific story pack and are used to illuminate and deepen specific topics within each persona. Each persona has their own resources and needs and shapes their care and living environment differently. Depending on their specific situation, certain issues need to be addressed, some need more focus and others do not. Due to the diversity-sensitive nature of the stories, key topics were identified for each persona based on the results of the needs assessment. The results were discussed in several meetings in the project team with experts and key topics were defined for each persona. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the key themes of the further related stories for each persona. They serve to deepen specific questions and aspects that may arise in everyday care and in the lives of the personas. They provide content and practical approaches for the subsequent discussion of specific care challenges. See Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e for an example further related story for Persona 1 with the key topic 'Stress and time management' and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e for 'Family support and conflict resolution'.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey topics of the further related stories for each persona in each story pack\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersona\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eKey topics of the further related stories\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress and time management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFamily support and conflict resolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProfessional support services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBalancing different roles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDealing with loneliness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverload in care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReligious/spiritual support and inner strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLoss of identity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDifferent views in the family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDealing with family conflicts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOvercoming the stigma of dementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDealing with powerlessness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLoss of identity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcceptance of support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmotional burden of self-sacrifice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDealing with own needs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaring out of family duty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSocial and cultural expectations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupport and responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelf-fulfilment and independent living\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of trust in other family members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl and overload in care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeed for perfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProfessional support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare and organisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaking decisions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProfessional support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFinding emotional balance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport in care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDistinction from care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFamily support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRole in care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrust in experts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl and overload in care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSocial and cultural expectations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKnowledge and support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Quality Assessment\u003c/h2\u003e \u003cp\u003eThe pretests conducted as part of the CBPR approach with three family caregivers of Turkish individuals living with dementia provided valuable insights into the quality and relevance of the stories. The feedback gathered during these pretests helped assess whether the stories met the established standards and resonated with the caregivers' experiences and expectations. The caregivers expressed satisfaction with the overall themes of the stories and the personas, indicating that no major changes to the content were necessary. However, they suggested small modifications with regard to the criteria 'language style', in wording and phrasing to improve clarity and emotional resonance.\u003c/p\u003e \u003cp\u003eBased on this feedback, the stories were refined and adjusted accordingly. The revisions focused on fine-tuning the language to ensure that the narratives were more engaging and easier to relate to, while maintaining their original content and intent. After these minor adjustments, the stories were finalized. The pretest process ultimately ensured that the stories were not only informative but also aligned with the caregivers' real-life experiences, making them more effective in addressing the challenges faced by the target group.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe development of diversity-sensitive and intersectional stories for family caregivers is of paramount importance, as these narratives have the potential to address the complex and multifaceted needs of caregivers in a meaningful way. The use of storytelling as a methodological basis enables the development of care-related and open-ended stories. This approach is particularly suited to addressing the emotional and practical challenges that caregivers often experience [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Storytelling builds empathy and connects people through shared experiences, so that caregivers can see themselves in the stories and learn from them [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although the need for such approaches is clear, there is a lack of appropriate stories within the storytelling framework that specifically address the care and living conditions of caregivers of Turkish individuals living with dementia. As a result, there is a need to create stories that authentically portray the diverse challenges faced by this target group, with the aim of improving the quality of care. In response to this gap, we developed nine story packs that reflect the unique experiences and difficulties of the caregivers, with the goal of enhancing the care they provide. Because the stories are open-ended, they leave room for different perspectives and individual interpretations, which is particularly important when working with individuals from different backgrounds. The stories, which are based on real-life experiences, provide a form of identification and can therefore ease the emotional burden on caregivers. Findings from the development phase suggest that the use of storytelling as a technique to facilitate self-help and emotional recovery for family caregivers is promising.\u003c/p\u003e \u003cp\u003eThe stories developed contribute to the existing literature on approaches to support for caregivers with multiple diversity characteristics. Caregiving roles are deeply influenced by a range of factors, including cultural background, gender, age, socio-economic status, educational level, and family dynamics, all of which shape the caregiving experience and the associated challenges [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Recognizing these intersectional dimensions ensures that stories resonate authentically with the diverse realities of caregivers, fostering a sense of representation and empowerment and facilitating greater identification and a sense of belonging. The findings of this study are consistent with those of previous research and contribute to the existing body of knowledge, particularly in relation to the importance of inclusion, participation, and emotional support for family caregivers [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The consideration of diversity characteristics, such as migration history, gender, socio-economic status and cultural influences is in line with the current discourse on intersectional approaches in care and health research [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The intersectional perspective allows for a more in-depth examination of the complex challenges that arise from the confluence of multiple diversity characteristics, thereby taking into account the multifaceted realities of family caregivers. This approach has already been identified in the literature as a necessary step to reduce discrimination and inequalities in care [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. While existing literature focuses primarily on narrative approaches and self-management [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], the created stories extend the discussion to include the need to consider other diversity characteristics such as religious affiliation, cultural traditions and social networks. This has been less emphasised in previous studies, highlighting the practical relevance and necessity of these additional dimensions. Furthermore, the study highlights the importance of linguistic and cultural accessibility in the context of narrative-based discourse on inclusive health approaches [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe strengths of the methodical multi-stage approach used for the development of the stories in the present study lie in the adaptive and inclusive design of the stories, which are oriented towards the individual and often complex needs of family caregivers. The needs assessment served as a critical foundation for this process, as it illuminated the intricate interplay between structural and individual challenges faced by caregivers [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. The assessment uncovered variations in self-management abilities and caregiving experiences that are shaped by both supportive resources and unique psychosocial stressors. These variations in different factors resulted in nine different caring roles that could be identified. Further literature review showed that it is vital to take these roles into account when developing support services. This understanding underscores the importance of tailoring stories to reflect the specific needs, identities, and coping strategies of different caregiving roles [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Without the insights gained through the needs assessment, the development of such stories would risk oversimplifying the caregiving experience or neglecting the diversity of the target audience. Instead, the assessment provided a nuanced understanding of caregivers' lived realities, enabling the creation of stories that are not only inclusive but also capable of addressing key barriers to self-management [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The combination of narrative and intersectional approaches encourages deeper engagement with caring issues and facilitates caregivers\u0026rsquo; personal development. In addition, the cultural and linguistic accessibility of the stories facilitates wider participation of the target audience.\u003c/p\u003e \u003cp\u003eHowever, there are also potential weaknesses that can arise from the complexity of diversity characteristics. The need to consider a variety of different characteristics could hinder the development process and affect the speed of adaptation to new needs. Additionally, the implementation of such sensitive stories requires regular training and education of facilitators to prevent discrimination and ensure the support of all participants. Although these stories are thoughtfully designed to be adaptable, inclusive, and impactful, further evaluation studies are necessary to assess their effectiveness. Such studies are essential to understand how well the stories achieve their intended goals, such as raising awareness, promoting empathy, or driving behavioral change. Evaluation can provide valuable insights into the stories' impact across different settings, populations, and contexts, ensuring they are not only theoretically sound but also practically effective. This evidence-based approach will help refine the stories and maximize their potential benefits.\u003c/p\u003e \u003cp\u003eIt is essential that these stories are intersectional and sensitive to diversity, thoughtfully representing a wide range of individuals, experiences and roles. Rather than reinforcing stereotypes, the stories aim to challenge and dismantle them, fostering a more inclusive and nuanced understanding of diverse perspectives. The developed stories are highly versatile and can be used in various settings. They are adaptable to different population groups, patient demographics, illnesses, and life contexts, ensuring their long-term relevance. Storytelling has broad applications across many fields, making it a powerful tool for communication and education.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe development of stories has significant implications for both practice and further research. In practice, the stories could be established as a supportive tool in self-help groups for family caregivers, with the aim of reducing their psychological distress and strengthening self-management. In addition, the stories produced could be used in the training of professional caregivers and in the provision of counselling and support services by social services.\u003c/p\u003e \u003cp\u003eIn terms of research, the narrative and intersectional methodology offers the potential for further studies focusing on the specific needs and challenges of caregivers with different diversity characteristics. Further development of narrative approaches could facilitate a more comprehensive examination of both the quantitative and qualitative aspects of caregivers' self-care and emotional wellbeing, thereby strengthening the evidence base for their effectiveness. Future research should explore how storytelling can be systematically embedded in care practices to promote equity and well-being.\u003c/p\u003e \u003cp\u003eThis study highlights the importance of integrating intersectionality and narrative-based approaches, such as storytelling, into health care to address the multiple roles and challenges faced by family caregivers. Storytelling fosters empathy, cultural understanding, and deeper engagement with caregivers' lived experiences, enabling more inclusive and personalised care. Particularly for vulnerable groups such as family caregivers, storytelling serves as a valuable tool to reduce stress and improve self-management skills, thereby strengthening their resilience and ability to provide care in a sustainable way.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e: The study was approved by the Ethics Committee of Witten/Herdecke University (Ref. No. S-50/2023). All personal data will be stored and later destroyed in accordance with the data protection concept and the ethical approval. Given the pseudonymous/anonymous nature of the survey, full disclosure, voluntary participation and the intention to publish anonymised data, no ethical concerns are associated with the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e The story packs developed are available in English, German and Turkish in the Additional files 1-3.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e: The study is funded by the Federal Joint Committee (G-BA) (funding reference 01VSF22048).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e: \u0026nbsp;KA developed the initial draft of the manuscript and is responsible for the development process of the stories. ERÖ and SÖ together with KA are responsible for the project implementation. MB, TA, CK and AR read and revised the manuscript. HTG is responsible for project planning and implementation. YYA and PB are responsible for project planning and design and corresponding work packages in the project. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e: Not applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStatistisches Bundesamt, Pflegestatistik. 2017, L\u0026auml;ndervergleich - Pflegebed\u0026uuml;rftige. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Pflege/Publikationen/Downloads-Pflege/laender-pflegebeduerftige-5224002179004.pdf?__blob=publicationFile\u003c/span\u003e\u003cspan address=\"https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Pflege/Publikationen/Downloads-Pflege/laender-pflegebeduerftige-5224002179004.pdf?__blob=publicationFile\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkken P-K, Spallek J, Razum O. 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BMC Geriatr. 2016;16:95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-016-0268-4\u003c/span\u003e\u003cspan address=\"10.1186/s12877-016-0268-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Storytelling, Home Care, Family Caregivers, Dementia, Diversity, Migration","lastPublishedDoi":"10.21203/rs.3.rs-6640826/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6640826/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Family caregivers play a crucial role in home care for individuals with dementia, particularly in migrant communities such as families of Turkish descent in Germany. However, caregivers often experience high levels of stress due to cultural expectations, family dynamics, and limited access to support services. Traditional self-help approaches frequently fail to address their diverse needs, necessitating innovative strategies to enhance self-management skills and emotional resilience. Storytelling, a method that facilitates knowledge transfer and emotional expression through narratives, has the potential to empower caregivers by fostering empathy, self-reflection, and problem-solving skills. This study aims to develop and evaluate storytelling interventions that are culturally and linguistically tailored to support Turkish family caregivers in managing caregiving challenges more effectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A multi-stage methodological approach was used to develop diversity-sensitive storytelling interventions for Turkish family caregivers of individuals with dementia. The process included a comprehensive needs assessment through literature review and qualitative secondary data analysis of interviews. Based on these insights, different caregiver personas were identified, each representing different challenges and caregiving roles. Stories were then developed following principles of effective storytelling, incorporating key themes such as stress management, family conflict resolution, and cultural expectations. A quality assessment was conducted using a pretest with caregivers, applying the Community-Based Participatory Research (CBPR) approach to refine narratives based on clarity, accessibility, and relatability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study resulted in the creation of nine storytelling packs, each containing five stories tailored to specific caregiver personas. These narratives were developed in German and translated into Turkish and English to ensure linguistic and cultural accessibility. Pretests confirmed that the stories resonated with caregivers, addressing their unique caregiving realities while enhancing engagement and emotional support. Feedback led to refinements in language style and narrative structure, ensuring greater clarity and identification with the protagonists.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eStorytelling serves as an effective intervention to support Turkish family caregivers of individuals with dementia by fostering self-management skills and reducing emotional burden. The developed stories provide an inclusive, diversity sensitive approach to addressing caregivers' challenges, promoting self-reflection, and enhancing support networks. Future research should explore the long-term impact of storytelling interventions and their integration into caregiver support programs to improve well-being and caregiving outcomes.\u003c/p\u003e","manuscriptTitle":"Storytelling in Home Care – Developing Diversity-Sensitive Stories for Family Caregivers of Turkish Individuals Living with Dementia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-21 07:19:14","doi":"10.21203/rs.3.rs-6640826/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2025-05-21T01:56:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-21T01:53:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-05-11T16:51:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2b5e3972-e3cf-4414-99f0-55637d7336e7","owner":[],"postedDate":"May 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-18T16:10:27+00:00","versionOfRecord":{"articleIdentity":"rs-6640826","link":"https://doi.org/10.1186/s12912-025-03712-7","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-08-12 15:58:01","publishedOnDateReadable":"August 12th, 2025"},"versionCreatedAt":"2025-05-21 07:19:14","video":"","vorDoi":"10.1186/s12912-025-03712-7","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03712-7","workflowStages":[]},"version":"v1","identity":"rs-6640826","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6640826","identity":"rs-6640826","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}