Pediatrics shows the most extensive reference to PCC, followed by OBGYN, with a significant difference between all disciplines (p < 0.001). FCC remains exclusively embraced by pediatrics. Our results align with documented cognitive differences between men and women that recognize gender differences in empathizing (E) versus systemizing (S) with females demonstrating E > S, which supports PCC/PeCC/FCC approaches to healthcare.The concept of “patient-centered care” (PCC) emphasizes patients’ autonomy and is commonly promoted as a good healthcare practice that all of medicine should strive for. Here, we assessed how six medical specialties—pediatrics, OBGYN, orthopedics, radiology, dermatology, and neurosurgery—have engaged with PCC and its derivative concepts of “person-centered care” (PeCC) and “family-centered care” (FCC) as a function of the number of female physicians in each field. To achieve this, we conducted a scoping review of three databases—PubMed, CINAHL, and PsycInfo—to assess the extent that PCC, PeCC, FCC, and RCC were referenced by different specialties in the medical literature. Reference to PCC and PeCC in the literature correlates significantly with the number of female physicians in each field (all  Over the last several decades, patient-centered care (PCC) has become an increasingly popular approach in Western medicine . PCC empCrossing the Quality Chasm: A New Health System for the 21st Century [Accordingly, in the 1990s, the Picker Commonwealth Program was granted USD 9.7 million to bring PCC to the forefront of Massachusetts Hospital Health Services . In 2001 Century , which p Century . AccordiDespite the substantial academic enthusiasm for the PCC approach, it lacks a uniformly agreed-upon definition . Though To better understand the essence of PCC across medical specialties, one might explore what PCC is not. However, in trying to identify the opposite of PCC, we similarly find inconsistencies. Some authors have suggested that the opposite of PCC is volume-based care, which prioritizes revenue and efficiency for institutions and individual HCPs over patient satisfaction ,18,19. OPCC has additionally been distinguished from similar concepts, for example, person-centered care (PeCC). PeCC has been defined as prioritizing patient functionality in a medical decision over a patient’s emotional contentment and centers around long-term relationships rather than singular interactions in PCC ,24. ContIn this paper, we explore several topics related to the concept of PCC. One goal is to assess the evolution and stability of engagement with PCC and derivative concepts among different medical specialties. These derivative concepts include person-centered (PeCC) care and two less commonly referenced care terms: relationship-centered care (RCC) and family-centered care (FCC) . The conThe qualitative and quantitative evidence suggests that females have a greater capacity for empathy beyond cultural expectations of gender roles. For example, in affective empathy, females show higher emotional responsivity than men, and sex differences in empathy appear to be consistent and enduring throughout the lifespan . This stHere, we examine the medical literature in six specialties—pediatrics, obstetrics and gynecology (OBGYN), dermatology, radiology, and neurosurgery—that reference PCC and similar concepts as a proxy for the integration of PCC in their clinical practice. This serves as an indirect way to assess each specialty’s engagement with the approach of PCC as well as with derivative approaches of care centricity.These specialties were chosen due to their historical differences in gender ratios . For decData on gender composition of our selected medical specialties were taken from the Canadian Medical Association’s annual Canadian physician data from 2000 to 2019 . We usedThree databases—PubMed, CINAHL, and PsycInfo—were scoped to assess the extent that the literature in different specialties independently reference PCC, PeCC, FCC, and RCC. MeSH terms and keywords were used to search in PubMed, CINAHL, and PsycInfo. Papers published up to 1 January 2021 were included. PCC was also searched in Google Trends to assess any increase in popular, everyday use of the term.Medical specialty-specific terms were searched using the “OR” function and then combined with the “AND” function to search for papers indexed under the term “patient-centered care” (see All papers were imported into COVIDENCE (2022) and deduplicated via their automatic algorithm . In COVIWith these papers, we then examined the change in the number of publications referencing the term “PCC” within the literature for each specialty cross-referenced against the percent of female physicians in each specialty using a Pearson correlation test. These correlations were deemed significant with alpha set at 0.05.The same process, as outlined above, was completed for the terms “PeCC”, “FCC”, and “RCC.” To gain a sense of the public’s acceptance and understanding of the PCC approach, we also searched PCC and PeCC on Google Trends from 2000 to the present.As of June 2021, there were a total of 37,273 publications indexed in PubMed referencing the term “patient-centered care.” In the same period, there were 2785 references to “person-centered care,” 3434 references to “family-centered care”, and 269 references to “relationship-centered care”. PCC is the oldest of the terms, with the first reference in PubMed dated 1948. This was followed by FCC in 1953, PeCC in 1968, and RCC in 1995. Below, we explore how these terms have evolved in relation to each other since the IOM 2001 publication.The concept of PeCC has seen progressive uptake in the medical literature over the last two decades, with the trajectory of growth matching in shape that of PCC . Up untiAs seen in Journal of General Internal Medicine [The concept of RCC had a major academic debut in 2006 in a set of papers in the Medicine ,32,33. TAs shown in Even though “PCC” is the oldest and most frequently referenced term out of the four we examined, the annual citations of the term increased in a linear rather than exponential fashion from approximately 2007 to 2017. Since then, citations have plateaued at ~44 per year . In the Collectively, these data show substantial variations in the growth and evolution of reference to centricity-in-care language among specialties. Pediatrics and OBGYN have taken up the derivative concepts of PeCC and FCC, with signs of these terms replacing PCC. However, in the other disciplines we examined, these derivative concepts of care have shown little or no uptake, even though their names imply a broader and more inclusive reach than PCC .Many of the medical papers we examined used the term “patient centered care” only once with no discussion or citations to indicate how the approach is precisely understood or operationally applied. This suggests that the term has been widely accepted in the medical literature despite little evidence of engagement with principles of patient centricity in clinical practice.As evidence for the general popularity of the term “patient centered care” beyond the medical literature, a Google search on “patient centered care” yielded ~1.69 billion hits as of 15 January 2022. The same search on “PeCC” approximately equals the number (at ~1.7 billion).A Google Trend analysis shows PCC as the more common term in 2016–2017. In 2021, there was an average of 38 Google searches worldwide for PCC per week and 17 on PeCC. However, in 2016, they averaged 31 and 6 searches, respectively. This shows a higher slope for PeCC, indicating its use is growing more rapidly.When searching in just the United States, Google Trends reveals a consistently lower level of PeCC than PCC since 2004—the time at which Google Trends first became publicly accessible. In fact, from January 2004 to March 2007, there were no searches in the USA for PeCC.In testing our primary hypothesis that engagement with PCC is gender-correlated, we examined the relationship between the percentage of female physicians in our sample of six medical specialties and the extent to which the literature for those specialties reference PCC over the past 20 years.p < 0.00001. In neurosurgery, the correlation coefficient between the number of PCC publications and the percentage of female physicians was 0.44, with p = 0.051.In this time frame, the number of publications referencing PCC was strongly correlated with the percentage of female physicians in pediatrics, OBGYN, dermatology, radiology, and orthopedics with correlation coefficients of 0.86, 0.91, 0.87, 0.90, and 0.92, respectively see . All thehttps://www.ipfcc.org/ (accessed on 1 October 2022) are female, as are the rest of its 12-member team.Coincidentally, this gendered difference was present in the IOM’s Committee on Quality of Health Care in America, which produced the seminal 2001 treatise promoting PCC. Notably, all members of their study staff that produced the document were female. We have seen a similar pattern in other organizations that mention PCC and PeCC in their mission statements. For example, four out of five of the current board directors on the Institute of Patient- and Family-Centered Care PCC is a popular approach in both the medical literature and the public . HoweverThe adoption of PCC and PeCC, without considering alternative approaches of care (such as RCC), may result in lost opportunities to improve healthcare. It has already been demonstrated that different stakeholders in healthcare—i.e., clinicians, hospital management, and the lay public—understand these terms differently . Our hisEven now, despite widespread support, PCC lacks a unified definition. Scholl et al. 2014)  found 414  found Our analysis of references to centricity-of-care terms derived from PCC, namely, PeCC and FCC, closely match what we saw with PCC. Once again, the two primarily female-represented medical specialties overwhelmingly account for the rise in citations to these approaches in the medical literature. The disciplines that first embraced PCC are also those that discuss and champion the derivative healthcare centricities of PeCC and FCC. In contrast, the uptake of the concept of RCC is so small that we do not have enough data to examine gender or disciplinary difference in the literature we reviewed referencing that term.One implication of the similar trajectories for both “PeCC” and “FCC” in relation to the parent term “PCC” is that the newer terms have not led to a significant expansion of uptake in the medical specialties that are less female-represented. The terms PeCC and FCC were promoted, in part, to further improve healthcare and increase the reach of the original concept of PCC . Our datAn underlying problem seems to be that the terms “FCC”, “RCC”, and “PeCC” are no more exact, precise, nor descriptive than “PCC” itself. Indeed, Hughes, Bamford, and May (2008) identified different types of centricities in clinical care, including PCC, FCC, PeCC, and RCC and concluded that these terms lack much difference . In otheA shift in the language from PCC to PeCC may be seen by many as enriching the scope and advancing the agenda of those honorably working to improve the healthcare system. As noted by Nolte, Merker, and Anell (2020), preference for the term “PeCC” shows up particularly in nursing, which has historically been highly represented by females compared to medicine . Howevermedical care” and “patient-centred nursing care” in Google Scholar, the former is 53% more common (N = 620 for nursing versus N = 951 for medicine). If one just looks at the last 10 years, the references for “patient” paired with “medical” climb to 80% more than references to “nursing”. This reiterates the point shown in There are other ways of documenting the disciplinary divide in reference to PCC vs. PeCC. For example, if one looks at references to the word strings “patient-centred medical care” versus “person-centred nursing care”, the word string with “nursing” embedded in it shows up 4X more often than with the word “medical” in the string . Furthermore, if we again restrict the analysis to the last decade, the ratio shifts by a mere 1.5%, indicating only a slight rise in pairing PeCC with “nursing” over pairing it with “medical”. Overall, this shows that medicine, in contrast to nursing, has had far less engagement with “person-centred” language, and that has not changed in the last ten years.If one then performs the same analysis as above for “person-centred Two other gender correlates may contribute to the general rise in references to both PCC and PeCC in the healthcare literature. As more nurses are publishing papers, we would expect more references to PeCC, as shown in Finally, the pediatrician Barbara Starfield, in her seminal 2011 paper “Is patient-centered care the same as person-focused care?” , makes aOur data suggest that, from its origins to the current day, the approach of PCC and its derivative concept of PeCC have been promoted and engaged with by women more than by men.This raises the question of why there is such a gender divide in patient-centric language in healthcare. The following comments are speculative but explore underlying factors that may account for gender differences in the patient-centric medical literature and practice. We acknowledge that our language here is simplistic and binary. It does not consider diversity in gender expression beyond a male/female dichotomy. However, the medical literature that is at the basis for this discussion is historically partitioned that way, so—without endorsing the binary—our discussion is framed in that language.The divide between females and males in engagement with PCC/PeCC may be explained by sex-specific differences in the nonverbal and verbal communication skills between men and women. This may contribute to why patient centricity appears to be more relevant in female dominated specialties.One of the most established differences between men and women relates to visual cognition and the ability to read facial expressions. As shown by Baron–Cohen and others ,40,41,42Understanding what another individual is saying is more fully comprehended if the speaker is facing the other person. What is commonly referred to as “eye contact” is an opportunity for the viewer to assess the valence in the facial expressions of the person before them. It thus follows that eye-contact is often presented as a key element in patient-centered care ,45. It aThis “reading of the mind in the eyes”  is a preIn a practical sense, it is difficult to expect all HCPs to master both the E and S ends of the cognitive spectrum, but it is reasonable to expect them to recognize their personal limitations and try to improve them. PCC/PeCC and its derivatives take time to master ,24, but As gender proportions shift and more women enter medicine, we anticipate more changes to the medical culture that may arise. Adapting to these changes to deliver the most patient/person-centered and analytically sound medical care should be the aspiration of all healthcare providers. Some medical specialties, by their very nature, may lean on individuals innately proficient in S or E approaches. So, despite any gender differences that may have been found in this research, the path to better medicine and healthcare is one that concurrently maximizes both S and E skillsets to meet the patients’ clinical needs.Although we have framed our discussion around gender differences in the literature, other factors may impact the appropriation and implementation of patient-centered models of care in specific specialties, such as the age and cultural background of physicians. Many physicians will not fit into the sex-specific stereotypes we have described. In addition, we used the medical literature to infer difference in PCC/PeCC clinical practices among a small sample of medical specialties. Using literature references to the terms PCC, PeCC, RCC, and FCC as a proxy to clinical practice styles is clearly the biggest limitation to this study. We also acknowledge that the definitions of care types may differ across papers or specialties, which may impact intergroup differences and trend data. It should also be noted that publication trends across specialties may account for some differences in the relative number of papers on PeCC, RCC, and FCC. Another limitation is the novel reporting of Google Trend data, the reliability of which is not independently verifiable. Moreover, using data for just six medical specialties to make inferences about gender difference across all of medicine yields, at best, hypotheses that need larger data sets to be considered firm conclusions. Furthermore, we analyzed only references published in the English language. Lastly, our data for the percentage of female physicians in each medical specialty were Canadian extrapolated beyond USA data as the former covered a shorter period of time.Patient-centered care is the principle that promotes shared decision-making between healthcare providers and patients, with patients’ sociocultural background and autonomy being central to the treatment plan. The implementation of PCC significantly improves patient-reported outcomes. Similar concepts such as PeCC, FCC, and RCC have been introduced in the past few years but have been adopted inconsistently among various medical specialties.As predicted, our data suggest that differences in engagement with PCC (and its derivative constructs of PeCC and FCC) strongly correlate with the percentage of female HCPs in each specialty. Although reference to these concepts in the medical literature has increased in the last 20 years, the relative uptake of the terms in different fields has not changed; the concepts continue to be predominantly associated with female-represented medical specialties.We found sex-specific cognitive differences between men and women are reflected in gender ratio differences in medical specialties. Women are faster and more accurate at recognizing facial expressions and other non-verbal emotional expressions than men. The ability to recognize emotions is important in affective empathy . Such a In the clinical setting, E and S behaviors reflect strengths and skills that have different values in different medical specialties. As such, the most comprehensive care would incorporate both cognitive styles regardless of a physician’s gender or whether they actively promote PCC/PeCC approach in their academic sphere. Shifts in medical student gender ratios, along with academic endorsements of PCC-related concepts, will likely continue to influence the evolution of healthcare.


N = 763 participants, we analyzed the impact of perceived and suggested risk on the degree of bias in selecting risk-related information on a fictitious Google search results page. Applying a 2 × 2 design with the experimental factor “risk feedback” and the quasi-experimental factor “perceived risk,” we formulated six hypotheses. First, we expected a main effect of perceived risk on selective exposure to information suggesting no risk, and second, we hypothesized a main effect of perceived risk on mean quality rating of information suggesting a risk. Third, we proposed a main effect of risk feedback on selective exposure to information which suggests no risk, and fourth, we proposed a main effect of risk feedback on mean quality rating of information suggesting a risk. Fifth, we expected an interaction effect between perceived and suggested risk, and sixth, we proposed an interaction effect between perceived and suggested risk in different forms for each of the four conditions on quality ratings. Only the third hypothesis was confirmed: Receiving information which suggested a health risk increased the tendency to select information denying the risk. Additional exploratory analyses revealed moderator effects of health information literacy and participant age on the aforementioned relationships. In sum, our results underline the crucial role of defense motives in the context of a suggested health threat.Selective exposure to online health information can be ascribed to two related defense motives: the motivation to confirm one’s subjective perceptions and the motivation to protect relevant parts of the self-image, such as physical integrity. Our aim was to identify how these motives come into effect in the context of a health threat . In a preregistered online study with  Health information plays a major role in everyday life. It influences, for example, how you shape your nutrition, how and how often you brush your teeth, or the amount of sleep you try to get each night. It also helps you to recognize potential alarm symptoms, and it may shape your opinions on political agendas . Nowadays, vast amounts of health information are freely accessible through all kinds of information sources, most notably through the internet . HoweverA number of explicit and implicit intentions shape health information seeking due to the self-responsibility of an independent information search and the peculiarities of the health domain, which, for example, can threaten psychological well-being as well as physical integrity. So-called defense motives are triggered in response to threatening information and lead to favoring and specifically searching for information corresponding to one’s self-image . SometimHealth information can be threatening in various ways. For example, it may implicate that a health condition is present, or it may suggest a necessity of changing beloved everyday routines to maintain one’s health. Different defense motives may be triggered by different kinds of threats. In this context, While the defense motives described above are specific for the health context, more general motives for selective exposure may play a role in health information seeking behavior, too. For example, one may selectively search for, and select information to confirm one’s opinion or expectation about a specific topic , or one One crucial similarity can be identified in all of these different motives: They strive to protect parts of the self, be it the self-image, attitudes, and opinions , or the physical integrity , as a consequence of a potential  threat and as a precondition for biased information seeking and/or appraisal . Threat,perceived risk (low or high) crossed with risk feedback (suggested risk or no suggested risk).However, taking “risk” into account as a precursor for selective exposure requires a differentiated look at the concept of risk. While perceived risk represents a potential precondition to perceiving a threat, suggested risk  must also be considered. A suggested risk implies that a certain individual characteristic like the body mass index (BMI), for example, is suggested to be associated with an increased risk of suffering from a health impairment . Depending on your individual BMI, this message might thus involve a threat (if your BMI is high) or not (if your BMI is low). Moreover, you may or may not have perceived a high risk for cardiovascular diseases in the first place. Hence, with suggested as well as perceived risk taken into account, several scenarios that may or may not trigger defense motives (and selective exposure) are conceivable. In fact, combining perceived and suggested risk (or risk feedback) leads to four possible combinations in individuals who are confronted with health information: via risk feedback—depending on the individual’s perceived risk. Based on our aforementioned theoretical considerations, we distinguish between the following two types of defense motives: First, the general motive to defend one’s opinion and attitudes by approaching confirming information and avoiding disconfirming information  may be additionally boosted when this information is not in line with one’s opinion about one’s health status (which would trigger the opinion-defending motive). In contrast to this example where opinion-defending and health-defending motives are consistent, they may, however, also be dissonant. For example, imagine a person who believes that his diet is rather unhealthy. If this person receives information on the health-damaging effects of this diet, the person’s opinion is supported by the external information—even though the information itself is threatening to the person’s physical integrity. This congruence between the external information and the person’s opinion, in turn, may possibly buffer the effects of the health-defending motive that would usually lead to selective exposure to information denying the diet’s health risks. However, although generally acknowledged as two central precursors of a biased search for information, both types of defense motives have—to our knowledge— never been considered in one study simultaneously, let alone in the context of health information seeking. This is puzzling given the potential for a complex interplay between both motives, and corresponding experimental research may help us better understand the psychological dynamics that underlie selective exposure to health information.To put it bluntly, we consider the opinion-defending motive to be about being right, whereas the health-defending motive may be more about feeling healthy. Of course, everyone wants to be healthy no risk feedback and low risk perception = NL; see yes, perceived risk: high; YH), the reported risk corresponds to one’s own perception, which is why the opinion-defending motive has no relevance. However, for the protection of one’s own physical integrity, as a reaction to the risk feedback, the health-defending motive may be relevant. While the health-defending motive maintains relevance in the last group (YL), the opinion-defending motive also becomes relevant. This group receives risk feedback, although individuals in this group perceive a rather low risk for themselves. Therefore, a conflict between risk self-assessment and risk feedback arises, which is the precondition for the opinion-defending motive. An overview of the four resulting groups can be found in For this reason, we applied a 2 × 2 design with one experimental factor “risk feedback” (suggested risk vs. no suggested risk) and one quasi-experimental factor “perceived risk” (high vs. low). With this, we tested the notion that feedback of a higher health risk . The suggested risk may trigger both defensive motives. First, it may be a threat to physical integrity. Second, it poses a threat to participants’ self-image as it may contradict, depending on the experimental condition, their opinion about the individual risk . This leads to the following hypotheses:The dependent variables (DVs) are (1) the amount of selective exposure to information which suggests no risk in an information selection task on a fictitious Google results page, and (2) the quality ratings of every piece of information at participants’ disposal. Based on this, six hypotheses were formulated, one for each main effect of the two factors on each of the two dependent measures for selective exposure, and respectively, one for the interaction between the two factors. To induce the perception of a health threat in an experimental study, a scenario that is realistic, relevant, and understandable is essential. We opted to suggest an increased risk for developing heart disease caused by a specific degree of achievement motivation, which we had measured beforehand. This ensures a certain level of comprehensibility: The background is understandable and credible while, at the same time, purely fictitious (without the participants being aware of it). Moreover, from an ethical standpoint, an experimental manipulation based on the suggestion of a risk is not as problematic as a more direct induction of a health threat , selective exposure to information suggesting no risk will be stronger compared to the lower perceived risk conditions (YL and NL).Hypothesis 1Hypothesis 2: We expect a main effect of the perceived heart disease risk on mean quality rating of information that suggests a risk: In the higher perceived risk conditions (YH and NH), the average quality rating of information suggesting a risk is lower compared to the lower perceived risk conditions (YL and NL).defend one’s opinion. Therefore, we argue that the health-defending motive should trump the opinion-defending motive when risk feedback is kept constant across conditions . Hence, overall, we expect a higher amount of selective exposure in the groups which perceive themselves at a higher heart disease risk (NH and YH) compared to the groups perceiving a lower risk (NL and YL).The psychological mechanism we expect to be behind these first two hypotheses is the health-defending motive. We expect that individuals who perceive themselves at a higher health risk generally strive for soothing or reassuring information, as a health threat is associated with a preferential processing of positive information (Hypothesis 3: We expect a main effect of the risk feedback on selective exposure to information that suggests no risk: In the conditions with risk feedback (YH and YL), selective exposure to information suggesting no risk will be stronger compared to the conditions with “no risk” feedback (NH and NL).Hypothesis 4: We expect a main effect of the risk feedback on mean quality rating of information that suggests a risk: In the conditions with risk feedback (YH and YL), the average quality rating of information suggesting a risk is lower compared to conditions with “no risk” feedback (NH and NL).Again, the main diver behind these hypothesized effects is the health-defending motive. Even if it is in line with one’s opinion (YH group), risk feedback implies a threat to one’s physical integrity, which is why it should lead to stronger selective exposure compared to “no risk” feedback. In addition, external risk feedback constitutes a strong driver of selective exposure if this feedback is not in line with one’s opinion (YL group) because of the opinion-defending motive. This is because such a constellation gives an incentive to defend one’s opinion against an “attack” from the outside. Overall, we therefore expect a higher amount of selective exposure in the groups which receive “high risk” feedback (YH and YL) compared to the groups which receive “no risk” feedback (NH and NL).2: We expect an interaction effect between the perceived and the suggested risk of heart disease in different forms for each of the four conditions on selective exposure: Given that individuals with a low self-perceived risk who receive risk feedback should be most motivated to reject threatening information , we expect that the direction of the main effect of self-perceived risk specified in Hypothesis 1 will reverse in individuals who are given risk feedback.Hypothesis 5Hypothesis 6: We expect an interaction effect between the perceived and the suggested risk of heart disease in different forms for each of the four conditions on quality ratings. Given that individuals with a low self-perceived risk who receive risk feedback should be most motivated to reject threatening information, we expect that the direction of the main effect of self-perceived risk specified in Hypothesis 2 will reverse in individuals who are given risk feedback.via threatening information. We therefore expect the main effects specified in Hypotheses 1 and 2  to reverse when individuals are given risk feedback.These two interaction hypotheses are based on our expectations regarding the combined effects of the opinion-defending and the health-defending motive. In the case of risk feedback, more selective exposure should arise with decreasing self-perceived risk since a discrepancy between risk feedback and self-perceived risk likely prompts an opinion-defending motive e.g., , possiblN = 787 is required to detect a small effect (f = 0.10) in a 2 × 2 ANOVA (numerator df = 1) when testing for main effects and interactions. We therefore aimed for a sample size of 800 participants , n = 36 participants did not respond to the DV, and n = 4 participants stated that they chose the eight snippets “at random” when asked to justify their responses on the DV (see below) in a free-text field at the end of the study3. These n = 84 participants were removed from the analysis, which resulted in a final sample of N = 763 . The distribution of educational attainment levels was representative of Germany’s population. Age distribution was slightly skewed to the left, meaning that older participants were slightly more frequent than younger participants, thus also approximating the age distribution in the German general population. Considering the restricted age range of our sample (30–65 years) as specified in our inclusion criteria (see preregistration), this variable was not normally distributed. The sample was recruited through a panel, administered by a professional agency, and data collection was performed solely online.To determine the sample size, we conducted a power analysis in GPower 3.1 . With poEthical approval for the study was granted by the ethics committee of the German Psychological Society (DGPs). After completing an informed consent form and a check on whether the inclusion criteria were met, participants were told that current research is investigating how to explain the relationship between achievement motivation and heart disease. This was followed by an explanation that the study ties in and investigates how achievement motivation is distributed among the population and how people assess their personal risk of heart disease.My risk of developing heart disease in the next 5 years…”) with six response levels (1 = “…is much lower compared to other people my age” to 6 = “…is much higher compared to other people my age”). Participants reported a mean perceived risk of M = 3.09 (SD = 1.11), and a visual inspection revealed a normal distribution of the corresponding variable. Before the statistical analyses, the variable was median-split (median = 3), resulting in n = 430 participants in the low perceived risk group and n = 273 participants in the high perceived risk group. Finally, dispositional achievement motivation was assessed by the subscale “achievement motivation” of a German instrument measuring occupation-related personality variables, the “Bochumer Inventar zur berufsbezogenen Persönlichkeitsbeschreibung”  were measured. Health information literacy (HIL) was assessed by a slightly adapted version of the Health Information Literacy Knowledge Test (HILK) , and selng” BIP; .I find the information disturbing” and “I need more information on the subject”) with five response options each (1 = “Strongly disagree” to 5 = “Strongly agree”). A mean score (variable perception of threat) was calculated before the statistical analyses; scale reliability was high with a Cronbach’s Alpha of α = 0.90.After completing these questionnaires and tests, a 50-s loading screen was presented along with the explanation that the inputs are processed, analyzed, and compared with a norm sample. This was to ensure a higher fidelity of the upcoming threat intervention. The participants were then randomly assigned to one of two conditions of the experimental factor “risk feedback,” which should induce a threat or no threat. Every participant’s real score and result of the BIP were displayed as well as the notion if it was higher or lower than average. This statement was combined with a text indicating a higher risk or indicating no risk for developing heart disease , which also included a reference to a fictitious research report that makes this assumption. Besides the PANAS, three self-constructed items were presented as an additional manipulation check, which assessed subjective feelings of threat and the corresponding information need . Using the data gathered from this task, our DV were computed. First, we calculated a selective exposure score by subtracting the number of selected results suggesting a risk from the number of selected results suggesting no risk. Since participants had to choose eight results, this results in a score ranging from –8  to +8 . A score of 0 suggests a balanced selection of snippets, as it indicates that four snippets of each kind had been selected. Regarding the quality ratings of the different search results, the average quality rating of snippets suggesting a risk constituted the first quality rating DV , and the average quality rating of snippets suggesting no risk constituted the second quality rating DV .Finally, participants completed a selection task to assess the DV selective exposure. The task is a variation of the task used by After completion of the task, participants were asked to rate the perceived authenticity of the snippets and were presented with the final page of the survey containing a comprehensive debriefing. An overview of the study procedures can be found in no threat”) and 5 (“high threat”). The two groups, “no risk feedback” and “risk feedback,” differed significantly in their perception of threat . The average score for the “no risk feedback” group was M = 1.55, with 58% of the participants having a score of 1. In the “risk feedback” group, the average score was M = 2.40, with 28% of the participants having a score of 1. Concerning the PANAS scores, only the “risk feedback” group showed a significant reduction of positive affect between the two measurement points . Therefore, it seems that the induction of risk for the corresponding condition was successful. To additionally investigate whether the effects of the threat induction varied over participants depending on their perceived risk, we conducted a two-factorial ANOVA with the independent variables risk feedback and perceived risk  and the DV perception of threat. While the main effect of risk feedback remained significant and of large effect size , we also found a small but significant main effect of perceived risk  and a small but significant interaction between both factors . This interaction, according to a visual inspection of the corresponding plots, suggested that individuals with high perceived risk were more susceptible to the risk feedback (in terms of an increased perception of threat) compared to individuals with low perceived risk. Finally, all prerequisites  for further analyses were tested and were fulfilled.To examine the impact of perceived risk (high vs. low) and risk-feedback (yes vs. no) on respondents’ selective exposure, univariate analyses of variance were conducted with these two factors.risk feedback and perceived risk . In this analysis, a main effect for risk feedback was found, with F = 52.92, p < 0.001, η2 = 0.065. Examination of estimated marginal means indicated that participants with feedback of a higher risk selected more snippets that communicate no risk than participants with no risk feedback , thus supporting hypothesis 3. Neither the hypothesized main effect of perceived risk , nor the postulated interaction between perceived risk and risk feedback became significant . Hypotheses 1 and 5 thus were not confirmed.A descriptive overview of selective exposure scores across experimental conditions, including error bars with 95% confidence intervals, can be found in F = 2.068, p = 0.15, η2 = 0.003), no significant main effect for perceived risk , and no significant interaction between both factors . With regard to the average quality rating of snippets suggesting no risk , results again revealed no significant main effect for risk feedback , no significant main effect for perceived risk , and no significant interaction between both factors . Thus, hypotheses 2, 4, and 6 were not confirmed.Effects on the two quality rating DVs were tested in two separate two-factorial ANOVAs with the independent variables risk feedback and perceived risk . With regard to the average quality rating of snippets suggesting a risk , results revealed no significant main effect for risk feedback  influence the DVs of selective exposure and quality assessment. In this regard, two influential and often mentioned constructs come into mind: HIL  and emotthe set of abilities needed to recognize health information need; identify likely information sources and use them to retrieve relevant information; assess the quality of the information; and analyze, understand, and use the information to make good health decisions”  with increasing emotion regulation ability. In contrast, participants in the no risk feedback condition seemed not to be affected by different levels of emotion regulation ability, as they did not differ in their selective exposure results.Emotion regulation is the ability to leave or alter an emotional state . In a stp > 0.066). However, with regard to the selective exposure DV, we found a significant interaction between age and perceived risk , as well as a significant three-way interaction between age, perceived risk, and risk feedback . In addition, the pattern of results regarding risk feedback was very similar to our confirmatory analyses (see above). To investigate this further, we conducted the exact same analyses as we did when testing our confirmatory hypotheses (see above), but this time separately for younger and older participants. These analyses revealed a marginally significant main effect of perceived risk on selective exposure in older adults , but not in younger adults . This effect was in the expected direction , thus providing partial and tentative support for hypothesis H1. In addition, the two-way interaction between perceived risk and risk feedback was significant in younger adults , but not in older adults . However, the specific pattern of the interaction in younger adults was contrary to our expectations because, at least on a descriptive level, the main effect of perceived risk was negative in the no risk feedback condition  and positive in the risk feedback condition . Hypothesis 5 is not supported.Older individuals often have more health problems and often feel more threatened by disease compared to younger persons e.g., . In addiThe present paper aimed to gain further insight into the effects of two defense motives—a self-confirming and a self-defending motive—on respondents’ selective exposure to health information. Overall, our findings indicate that a suggested health risk influences selective exposure to health information, while a self-perceived risk seems to have no significant effect in this context. As predicted in our preregistration, we found that risk feedback leads to stronger bias toward the preference of information which denies the risk: Receiving feedback which suggests a potential health risk shifted task performance from a rather balanced selection of snippets to a biased selection of snippets that deny a particular risk. Furthermore, it seems that in the context of one’s own health, the motivation to defend one’s self-image from a threat  is superior to the motivation to confirm one’s opinion . This is because, in the condition of no risk feedback, respondents showed no significant bias in either direction—even in the case of a high perceived risk. While it should be noted that we found some tentative and exploratory evidence for a corresponding bias in older participants, it generally seems that participants neither confirmed their own risk perception when they saw themselves as being at higher risk, nor did they deny a risk and therefore confirm the “no risk” feedback. Together with the significant effects of the risk feedback, this can be interpreted as an indication that in such an essential and potentially existentially relevant context as the health context, coping with a health threat has a higher implicit value than the need to confirm one’s opinion.This is in line with other findings from the field of coping research that, in general, suggest that there is a stronger bias when individuals are in a negative emotional state, which may be more strongly triggered by an unexpected and immediate risk feedback compared to self-perceptions that have probably been present for a long time . Moreovevia the self-directed (biased) choice of information channels, a process which is described in the theory of counter-regulation . However, a disadvantage of this procedure would be that the lower number of selected snippets leads to a lower variance in the DV because possible resulting values are restricted. Our initial idea was that the relatively high number of eight selected snippets would result in more detailed differences in the extent of selective exposure, depending on the independent variables and moderators. Another solution to this problem was recently implemented by via consulting reassuring information about their health. One could argue that this is a positive implication in the sense that it may help them to develop a more positive view of their body and make them feel better. However, the findings also implicate that a suggested health threat leads to a bias in information selection. This might be because, as we have discussed, a suggested risk increases negative affective states like anxiety, which trigger defense motives to feel better and/or reassured. This is also in line with previous research that states that the likelihood of a unilateral selection of positive information is higher when a negative affective state is present, which is also referred to as “counter-regulation”  status.doi: 10.23668/PSYCHARCHIVES.2770.The original contributions presented in the study are publicly available. This data can be found here: The studies involving human participants were reviewed and approved by Ethics Committee of the German Psychological Society (DGPs). The patients/participants provided their written informed consent to participate in this study.OW, AC, and TR conceived and planned the study. OW and AC conducted the data collection, analyzed the data, and prepared a first draft of the manuscript. TR reviewed and revised the manuscript and prepared it for publication. All authors contributed to the article and approved the submitted version.


Health geography provides a relational approach to understanding elders’ wellbeing experience in relation to place. That the migrating grandparents move between their home and their adult children’s home to support their children’s life in the migrating city provides a particular pattern to supplement the place-based wellbeing literature. How they negotiate their wellbeing remains to be observed in the daily home-making practices related to their two homes. This study conducted in-depth interviews with 35 migrating grandparents and nine of their adult children and conducted extensive field notes in Shanghai from 2020 to 2022. Through thematic analysis, it finds that the migrating grandparents met a series of differences, challenges and tensions in the material, social and emotional home-making practices brought by the separation and rotation between their own and their children’s homes. It weakens their physical, social and mental wellbeing. However, they take some initiatives to overcome and relieve these tensions. Therefore, accompanied by sacrifices and negotiations, they also obtain sustained material, social and spiritual–emotional values to negotiate a suboptimal experience of wellbeing. This study contributes to the intersection of elderly wellbeing and home-making studies by revealing the complex and ongoing inter-relationships between migrating grandparents and home in the rotating lifestyle. The wellbeing of the elderly has received multi-disciplinary research attention, including economy, psychology, sociology and geography . Among tThe relational approach that emerged in health geography in the last 20 years challenges the conventional view of place . Such a Elders’ periodic mobility among multiple places further complicates how elders negotiate their wellbeing with multiple homes. Previous studies have shed light on the amenity-led seasonal retirees’ wellbeing experience in moving between their original and second homes ,16,17. ISuch a moving lifestyle shows two particularities to advance the migrating elders’ home-based wellbeing research. First, it differs from the pure labor migrants who move for work nor the amenity-led consuming migrants. These grandparents are not only consumers of the migrating city but also labor forces free of charge to their children’s families . Second,Therefore, it remains to dig up the home-making practices of these migrating grandparents to see how they adapt to the shared home life, overcome the separation of the two homes and achieve physical, social and mental wellbeing. Currently, it is relatively neglected in the literature. Hence, this paper aims to explore the dynamic wellbeing experience of these migrating grandparents by focusing on the elder-home interrelations in their home-making practices. To this end, we take Chinese migrating grandparents moving to Shanghai, the biggest city in China, as a typical case. The paper is structured as such. We combed through the literature on both the well-being of elders and the practice of home-making. Through the relational approach, we identified the research gap on how the migrating grandparents negotiate their wellbeing in their home-making practices. This is followed by a review of the Chinese socio-cultural context of migrating grandparents. After the method section, we reported our findings about the migrating grandparents’ wellbeing experience in their balancing with the relations to their separated homes in three aspects: material, social, and emotional. The discussion and conclusion section further highlights the theoretical and practical contributions. Wellbeing is an important concern for aging seniors and has attracted multi-disciplinary research interests. A consensus is that both the hedonic (a utilitarian view emphasizing satisfaction of preferences) and the eudaimonic  approaches complement each other in conceptualizing wellbeing ,26. SchwPrevious studies have highlighted the crucial role of the home in influencing elders’ wellbeing experience ,28,33,34For those elders who step into a moving lifestyle, home seems to be more unstable and separated for them. Thus, a more challenging and complicated picture to piece together these temporary and multi-site homes is formed. The elderly may have to adapt to the new home’s resources and materials through their corporeal body and bear the loss of the familiar social ties in their original home . They maHome-making has increasingly attracted academic interest in the past 20 years, mainly in international mobilities ,42,43. ASpecifically for the elderly, previous home-making studies have paid some attention to the family task-oriented migrating grandparents, who move from their hometown to the big metropolis domestically or transnationally to support their kids’ families . They beAlong with the relational turn, it gradually emphasizes a de-territorialization of home in home-making studies . Home isSuch a relational perspective becomes more prominent to consider the grandparents migrating domestically. Previous studies mainly focus on the transnational migrating grandparents who deal with long-haul distance, low moving frequency and significant cultural differences . To the Moreover, previous literature about migrating grandparents is mainly grounded in European and American societies. More empirical studies in different contexts are warranted. This study makes up for these gaps by investigating the domestic migrating grandparents rooted in China. Hence the Chinese context is reviewed as follows. Based on the Confucian tradition, Chinese people put great emphasis on family and home . The culWith rapid Chinese urbanization, especially in the past 40 years, many young talents flowed from rural and suburban areas to big cities for education and employment. Some of them settle down and organize their families there. However, as they are new citizens, these young couples have to struggle hard to afford the high housing price, especially in the first and second-tier cities in China, and also to obtain “Hukou”, a permanent certificate of citizenship. To deal with such great living pressure, most of them become dual-earner families. Since the governmental power has withdrawn from the public childcare field, these newly-born families have to spend a lot on employing housework and caring workforce from the market . To elimThen, through the relational approach, how do the migrating grandparents negotiate their relations with the two separated homes through home-making practices? How do they proceed with their wellbeing in this process? These are questions that this paper aims to answer .We took Shanghai as the case immigrant city for this study. It is a prominent city with the largest population and economic volume in China, attracting many migrating workers and talents each year. The latest census conducted in Shanghai 2021 shows that the migrant population in Shanghai is 10.48 million. Its proportion increased from 25.4% in 2010 to 42.1% in 2021 . TherefoThe qualitative approach is chosen as this study aims to explore the migrating grandparents’ wellbeing experiences by looking into their home-making practices. A semi-structured in-depth interview is mainly conducted, which has been widely used in previous place-based wellbeing and home-making studies ,17,20,64In between the two stages of interview, the first author frequently conducted informal face-to-face talks with her parents, who are also migrating grandparents, and the other unfamiliar migrating grandparents in the community. Informal talk is commonly used in qualitative studies to understand the phenomenon and supplement the formal data collection . These iAll three authors have systematically learned the qualitative study method. The first author has over ten years of experience in qualitative study, and she supervised the whole process. The interview questions surrounded the material, social and emotional aspects of home-making practices and their connections with the grandparents’ physical, social and mental experiences of wellbeing. Typical questions are: How do you arrange the daily home issues in the immigrant city? How do you perceive and feel about the moving lifestyle? How do you perceive the two homes you rotate and their influence on your physical and mental health, capabilities, self-efficacy, and spiritual belongings? The interview time ranges from 15 to 40 min. It ranges along with the interviewees’ different willingness to disclose their inner thoughts. After each round of data collection, we transcribed all the interview recordings into texts and read the transcripts and field notes to fully understand the home-making stories and personal feelings. Thematic analysis was adopted manually through thematic charts as it is suitable to extract the themes about the negotiation of wellbeing in home-making practices and is frequently used in the literature on elders’ place-based aging and wellbeing ,68. BaseWe coded the data iteratively and inductively . To ensuOnce moving to Shanghai, the grandparents dedicated their efforts to the material practices in their offspring’s home. Most interviewees reported their adaptation to various differences from those in their own homes, during which they experienced physical and mental sacrifices, adjustments and gains. The sacrifice is typically reflected in their concession in the usage of home space and the labor dedication of their corporeal bodies. For three generations living together, allocating the home space is a big challenge. Our research finds that most migrating grandparents self-consciously leave more home space for their children and grandchildren. Just as A05 describes,“I should leave some space for the children. It’s not easy for them (after working) a whole day. Let them three watch TV and do something of their own in the living room…I just browsed the mobile phone in my bedroom. Now the mobile phone is very convenient.”(A05)A05 represents those whose adult children get home from work on time and do not need to look after their grandchildren in the evening. However, many other migrating grandparents have to care for the kids all day long. A11 reports his schedule one day: “After breakfast, we send our grandson to school. Then we have housework to do. We wash clothes and clean the house. It takes almost the whole morning. Then we read the news on the phone. Sometimes we go out for a walk. After lunch in the afternoon, we have a rest for an hour. Around 2 o’clock, we go out for a walk. Then we get our grandson back. I accompanied my grandson to study. Sometimes I asked him to write and read. After supper, I took him out to play in the small park. He played with other children. At 7 o’clock, we would come back to watch TV. At 9 o’clock, I would wash my face and go to sleep. That’s the end of my day.”(A11)A11 reflects the hard physical strength paid by these migrating grandparents. In this sense, except for the living room and their bedroom, the other rooms seem purely the production space as the elders have to do cleaning, washing, cooking or baby-caring work the whole day. To match the work intensity of their adult children, they have to squeeze time to rest. A05 also use the word “fight” and “busy” to describe one day.Therefore, it dramatically challenges the physical wellbeing of the migrating grandparents. Most of them do not report having a big illness but some common chronic diseases  that can be controlled through daily medication. Their physical health is quite important to the migrating family. Thus, their children also keep a close eye on it.“I usually pay more attention to my mother’s health. After all, she’s old. I tell her if feeling uncomfortable, speak out and don’t hold on… body comes first.”(B08)“If the elders get sick, the family will be in disorder.”(B06)Hence, their adult children’s care gives these grandparents some psychological comfort. All the interviewees expressed that they would insist on supporting their children as long as their body permits. They always buy medicines wholesale and apply for medical reimbursement when returning to their home city to save money for their children.Moreover, the grandparents also gain a better economic state as most of their daily expenditure is included in the living expenses paid by their adult children. “We basically bear all (the daily expenses). It’s already so hard for them (their parents) to come to help us. Their round-trip fare, we also pay.”(B05)With the financial support of their children, the migrating grandparents arrange the everyday recipes for the family. However, as they come from different parts of China, many of them are not adapted to the ingredients and tastes in Shanghai. Some from the remote areas even could not adapt to the climate and environment of Shanghai and experienced bodily discomfort.“I’m not used to the food in Shanghai. The food back home tastes salty and spicy, but the food in Shanghai tastes very sweet.”(A29)“At the beginning, when I came to Shanghai, I was a little uncomfortable. Three years later, things are getting better. In the beginning, I had diarrhea and didn’t feel well.”(A06)They also have to deal with the conflicting preferences of other family members. Since their adult children are also recent immigrants to Shanghai, their daughters-in-law or sons-in-law may come from different places and have different tastes. To cope with this dilemma, the seniors mainly take two strategies. The first is to take their customary way to cook local ingredients. Although the ingredients taste different from those at home due to the climate difference, they still cook them in their familiar way, making more familiar flavors.“The wax gourd here tastes different from ours. There is a smell in it. The lotus root is not glutinous either. But we still get used to using them in soups, duck soup and rib soup, which is a typical way of cooking in our hometown.”(From the first author’s field notes)The tastes of all family members are grinding-in in this way, in which the grandparents gradually customize the taste of “home” in this new city and gain a sense of control and self-efficacy. However, such cooking sometimes makes the table monotonous. Hence, a second strategy is to borrow tastes in other ways, such as buying take-out, purchasing their favorite ingredients through mobile apps, and occasionally going to restaurants. Many of the researched grandparents mentioned that they were pretty surprised by the convenience of e-commerce services in Shanghai. These experiences also enhance the seniors’ insight and curiosity to taste modern city life, which benefits their mental wellbeing:“We also have express delivery (in our hometown), but it’s not as fast as here……There are packages to pick up almost every day……You can buy anything you want through your phone… I’ve also bought earth eggs a few times……If they (the kids) don’t like the dish of the day, they can also ask for “Wai Mai (take-out food)” and in half an hour, they will arrive. Very convenient.”(A16)“In Shanghai, I have opened my eyes and learned a lot of fashionable things. Recently, I gradually learned to sort my garbage. I will probably keep this habit when I return to Xuancheng (my home city) in the future.”(A29)The migrating grandparents’ social wellbeing experience is dynamic and fluctuating, entangling with the social contacts around their two homes. Initially, their social connections were restricted by the physical distance but gradually reconstructed and renewed in real and virtual communities. However, long-term nostalgia for familiar social circles persists in their minds.Because of the tight schedule, most interviewed migrating grandparents reported their limited social contact with local communities.“There are singing and dancing (teams) in the community, but I have no time. Sometimes they (practice) at 8 a.m. or 4 p.m., but I can’t leave. Because there are little kids here, you have to take care of them, right? My wife has to cook. There is no one to pick up my little granddaughter outside, or she must stay at home alone, right? The old ladies are singing and dancing in the community, but I can’t join. No way. If it’s just our old couple here, then it’s possible.”(A09)Hence the migrating grandparents’ social contact within the neighborhoods is quite restricted by the housework. However, simultaneously it is some other housework that pushes them to enter the social circle of the neighborhood community. As many female migrating grandparents have to stroll babies or look after kids in the nearby neighborhood and park, they find a common tribe and start new social contact within it.“In Shanghai, there are also friends like us looking after grandchildren. We chat together. When we take our babies out to play, we are mostly the same age. Then we get to know each other.”(A06)“…We have gathered a group of the same people here. For example, many grandmothers and maternal grandmothers in our neighborhood also come to care for their grandsons or granddaughters. They play in this neighborhood. We are similar. Later, we became familiar with each other. We chat like close friends, talk and play. At leisure, we bring kids to play together, play together there, just like new old friends. Then you will feel a little more delighted, a little happier, and life is not so monotonous, not completely staying home. We feel happy to play with some new friends.”(A08)As A08 described, the tribe taking care of kids enlarges the grandparents’ social contacts and improves their social wellbeing. To some extent, it relieves the loneliness and boredom and attaches freshness and intimacy to their migrating home. Nevertheless, this kind of social contact is shallow and happens more among grandmothers. More often, the internet, smartphone and social media help them open the social world and build connections with their old friends and relatives in their hometown. Just like (C05) said, “In WeChat, we have a group called ‘a loving family’. We send pictures of our daily lives and voices, to chat and talk in it.”The technologies empower the migrating elders with new platforms for social interaction, especially for those who come from slightly backward rural areas and cannot type words. However, maintaining the social bonds with hometown people may also bring a sense of loss to them:“We keep the connection on WeChat...Generally, there are many brothers and sisters of our age. All are retired. Then I’m afraid they ask me, ‘When will you come back? ’Once they ask me, my heart seems to be very uncomfortable. I will tell them that don’t ask me when I will come back. I will tell you when I want to come back. I say that when you ask me, my heart will crack.”(A14)A14’s words reflect these migrating grandparents’ complex feelings towards their mobile life. On the one hand, they insist on staying with their children and supporting their life. On the other hand, relatives and friends in their hometown are long-term acquaintances and represent the belongings and roots of their life. They have to devote themselves to their children’s home, but at the same time, they are pretty missing and reluctant to give up their roots.The migrating grandparents devote much energy and emotions to their grandchildren and gradually obtain emotional attachment and spiritual fulfillment in the migrating home. However, emotionally, they are always eager to bridge the distance between the two homes. Most interviewed grandmothers identify themselves as babysitters making every effort to take care of the grandchildren:“…After arriving here, I stay at home. Say a bad word, I’m a nanny. I’m here to serve them, such as babysitting and doing housework…I want to relieve their burden, not employ a nanny.”(A08)“Anyway, it’s necessary to do things conscientiously and contribute to our children. (We have) no other requirements. We have shallow requirements for ourselves. We just contribute to others. It’s all true. It is what our generation is. Bearing hardship without complaint, we are just nannies.”(A10)Some grandfathers who can drive also make jokes about themselves being the exclusive family driver in their children’s new home. Although tough and tiring, witnessing the grandchildren’s growth gives them great spiritual satisfaction and enriches their retiring life, improving their mental wellbeing. Just as C05 and B08 commented:“……The elderly in China always regards children as the center of our lives. After reaching old age, children are usually not around, and life will feel lost. So, although tired, bringing up the grandchildren feels very fulfilling and meaningful.”(C05)“They are extremely good with the grandchildren, even closer than their daughters. These days they come back to their hometown and make phone calls (with the grandchildren) every day.”(B08)Hence the intergenerational kinship becomes a vital bond for the grandparents to build a tremendous emotional attachment to the new home, enhancing their internal sense of gain and happiness.However, at the same time, there is continuously a kind of emotional entanglement between enjoying a family reunion in Shanghai and missing the familiarity and belongings of hometown among the elders. Such tangled emotions change along with their moving between these two places. A21′s words provide a clear description:“At first, I was not very satisfied (with life in Shanghai), but now I slowly get used to it, (though) there will always be something unsatisfied. after staying here long, I want to go back. But if I go back and stay at home, I will miss them and want to come back again. Later, my son said to me, ‘You just have a rest in your hometown, and have a reunion when coming to Shanghai.”(A21)Just as A21 describes, although to many migrating grandparents, their material, social and spiritual wellbeing can be satisfied and improved to some extent in the new home, they still feel they are lacking some belongings and familiarity with their hometown. However, they miss the reunion with their children again after returning to their hometown. Some migrating grandparents use the “on duty by turns” strategy to balance such emotional entanglement. For example, A21 and A22 are relatives by marriage. They take turns visiting Shanghai and caring for the same young couple. They initiatively increase the rotating frequency between Shanghai and their hometown and become highly mobile migrating “birds”. In the subconsciousness, they hope to balance their attachments to the two homes and piece together a complete home. Such high mobility eased their emotional tension in the two homes and enriched their holistic wellbeing. Just as C03 said, “We just pretend to be travelling each time we switch the place… to feel the different lives in both the big and small cities is also a wonderful thing”.However, this high-frequent mobile lifestyle is not common among migrating grandparents. After all, it requires close cooperation among the family members, good economic situations, and a strong body.How to improve the wellbeing of the elderly is a worldwide issue. By absorbing the multi-disciplinary thoughts of wellbeing, health geographers call for a relational and processual approach to understanding elders’ wellbeing experiences in dynamic human–place relationships. From the relational perspective, the home is de-territorialized without being fixed to a specific location. Rather than bounded by physical distance, it is separated by social–relational distance crossing multi-scales. Hence, it provides a new perspective to dig into the elder–home relations and their wellbeing experience in a moving lifestyle. This study concentrates on a unique group of migrating grandparents who rotate domestically between their own homes and their adult children’s homes to support the children’s living. It provides a particular case to explore home-based wellbeing in a rotating lifestyle.Through analyzing the interviews and the first author’s field notes, we find that the migrating grandparents’ wellbeing experiences are dynamically negotiated in their material, social and emotional home-making practices. Through their corporeal and social body, the elders experience the differences between the two homes in various material aspects such as housework, use of home space, household expenses and diets. It significantly interrupts their life pace and challenges the physical strength and adaptability of their body. They take initiatives such as squeezing time to rest, making space for their offspring, cooking in the familiar style or ordering some delicious food to overcome the physical and mental tiredness and discomfort. They also receive more economic and medical support from their offspring, which can be seen as additional safeguards for their physical and mental wellbeing. In the social aspect, the grandparents have to endure the physical separation from their familiar social circle in their homeland, although some can build external social connections with the neighbors in the migrating home. Communicative technologies such as WeChat rebuild their links with the hometown people, thus relieving their loneliness and improving their social wellbeing. However, long-term homesickness persists in their imagination of the original home. In the emotional aspect, supporting their adult children’s careers and accompanying grandchildren’s growth greatly adds value to the retirement stage of these grandparents, improving their mental wellbeing. However, in Chinese culture, the co-existence of “Jia” and “Hu” in the same space and time consist of a completed home . “Jia” mThis study makes theoretical contributions to the intersection of elderly wellbeing and home-making studies by incorporating the relational approach. In the study of elderly wellbeing, previous studies have revealed the elders’ home-based wellbeing experiences from material, social–cultural, emotional and mental dimensions ,29,71,72In the home-making literature, previous studies connecting migrating elders and home-making practices have presented their roles, responsibilities, and relationships with the host destination ,50,51,52Moreover, previous studies show that western grandparents primarily provide their adult children with short-term support only at some important life moments, but Asian grandparents can stay longer and persist in this two-home rotating lifestyle ,53. ThisThis study has some practical implications. As the separation between the lineal kinship and the homeland forms the central tension for improving the migrating grandparents’ wellbeing experience, some supportive work could be carried out in the migrating cities. Specific measures include building communicative groups such as WeChat chatting groups for fellow-hometown migrating elders, constructing more amenity spaces such as gardens and parks around communities for the migrating grandparents to conduct grandchildren care, socialization and recreation, and providing consultation and guidance to the migrating family members. These external supports are also necessary to relieve the tension and help the grandparents achieve suboptimal wellbeing. This study has some limitations. Because of the refusal of informed consent, the sample size of the formal interview is limited. The triangulation could be partly limited by interviewing only nine adult children of the 35 interviewed grandparents. We make up for this defect by collecting field notes through informal talks with the migrating grandparents. Future studies could combine other qualitative methods such as observations and auto-ethnography to collect more detailed data about the migrating grandparents’ wellbeing experience along with the change in time, places and socio-demographic characteristics. For example, this study indicates that gender, age, previous working experiences and the migrating time are important factors influencing the grandparents’ home-making practices, through which different place-based wellbeing experiences would be produced.