This study aims to conceptualize family caregivers as transformative service mediators (TSMs) who navigate vulnerabilities while shaping well-being outcomes within caregiving dyads. It examines how they mediate service interactions and influence their care recipients’ and their own well-being across micro, meso and macro levels of community-based care ecosystems.
Using a qualitative case study approach, the authors analyzed semi-structured interviews with 29 caregivers supporting older adults with chronic conditions. Abductive analysis guided by the dialogue, access, risk, transparency, execution (DART-E) framework uncovered how caregivers’ mediation practices shape various well-being trajectories.
Empirical analysis identifies four distinct caregiver–care recipient dyad outcomes: symmetrical value co-creation, asymmetrical empowerment (caregiver gains agency while recipient well-being stalls), passive cooperation and symmetrical value co-destruction. They suggest that caregiver enablement is necessary but not sufficient for positive well-being outcomes; caregiver empowerment and family-centered support aligned with caregiver needs determine well-being trajectories.
This study advances transformative service research by first conceptualizing family caregivers as dual-positioned TSMs who simultaneously manage secondary vulnerability and function as intermediaries/apomediaries, thereby extending the agency view from individuals to interdependent actors shaping value outcomes in service ecosystems. Second, it articulates a process theory of caregiver empowerment through the vulnerability–enablement–empowerment trajectory, which clarifies how enablement differs from empowerment. Third, the four outcomes reveal the conditions under which caregiver empowerment translates to value co-creation/co-destruction, positioning caregivers as the central architects of well-being and informing more inclusive, family-centered service logics.
