Ethnic Minority Caregivers Research Articles

HIGHER STRESS AMONG ETHNIC MINORITY ADULT-CHILD CAREGIVERS COMPARED TO SPOUSAL CAREGIVERS IN DEMENTIA CARE

Abstract Ethnic minority family caregivers of persons with dementia (PWD) suffer from negative health conditions resulting from continuous care responsibility for PWD. While adult-child caregivers have additional family care and job responsibilities, cultural and linguistic needs in ethnic minority families further compound caregiving challenges. Little research examines ethnic minority caregivers’ health statuses. This study aimed to understand the emotional health status and dementia care experiences of minority caregivers, between spouses and adult-children. The study collected cross-sectional survey data on perceived stress and utilizations of caregiving resources: Alzheimer’s agencies, state-funded in-home supportive service, adult-day service, support groups, and caregiving education. Recruitment focused on diverse communities with special emphasis on minority caregivers who speak Spanish, Vietnamese, or Korean in California. Seventy-six caregivers participated in surveys in their respective language; 42% Korean, 38% Vietnamese, 20% Spanish; 49% spouses/partners vs 51% adult-children/grandchildren; 78% females; 55% PWD with Medicaid; Mean English Proficiency (EP) of 3/5(1.3). Sixty-four percent of adult-child caregivers were employed (full-time or part-time) compared to 5% of spousal caregivers (P<.05). Adult-child caregivers showed higher stress compared to spousal caregivers (P<.05) despite no differences in PWD’s activities of daily living (ADL) scores and instrumental ADL scores. Although EP of adult-child caregivers was higher than spousal caregivers (P<.05), both caregivers underutilized care resources and showed little awareness of Alzheimer’s agencies. Findings demonstrated higher caregiving stress of adult-child caregivers compared to spousal caregivers of PWD among minority groups. Tailored interventions with appropriate language and cultural aspects should consider the caregiver’s relationship to the PWD.

Chronic health conditions in ethnic minority caregivers and the role of the acculturation

AbstractBackgroundLittle is known about how the social and cultural context affects cardiovascular risk factors in Latino and Asian Americans. This study utilizes the California Health Interview Survey (CHIS) to examine how caregiving status and acculturation are related to chronic health conditions in a culturally diverse sample.MethodThe 2009 CHIS is a state‐wide representative dataset assessing health and health care of Californians. We examined whether acculturation [i.e., generational status (1st, 2nd, or 3rd) and language of interview (English or Spanish/Asian language)] as well as caregiving status were related to prevalence of hypertension, diabetes mellitus, and obesity, controlling for age, gender, marital status, income, self‐rated health, and neighborhood safety (N = 14,241).ResultThe sample was 58.3% Latino, 34.5% Asian, and 7.1% Multiracial. Caregivers had higher BMI than non‐caregivers (β=0.82, 95% CI=(0.17, 1.47), p=0.01). However, caregiving status was not associated with odds of having diabetes (OR=0.80, 95% CI: (0.54, 1.20), p=0.8) or hypertension (OR=1.18, 95% CI= (0.86, 1.62), p=0.3). Additionally, those interviewed in an Asian or Spanish language were less likely to be told they had diabetes (OR=0.56, 95% CI=(0.45, 0.69), p<0.001) or high blood pressure (OR=0.53, 95% CI=(0.42, 0.67), p<0.001) compared to those interviewed in English. Among all participants, 3rd generation individuals had a 75% increased odds of having high blood pressure (OR=1.75, 95% CI= (1.32, 2.34), p<0.001) compared to 1st generation individuals.ConclusionResults indicate that while caregivers had higher BMI, caregiving status was not related to hypertension or diabetes. Additionally, more acculturated individuals (as indicated by generational status and language of interview) were more likely to report being diagnosed with diabetes and hypertension. These results are consistent with the Healthy Immigrant Effect, which posits that immigrants who are more acculturated tend to have worse health, as they adopt the host country’s diet and health behaviors. Surprisingly, caregiving status (and potentially associated stress), was not related to hypertension or diabetes. Implications are discussed.

The Costs of Caregiving: Exploring the Perceived Burden of Dementia among Bangladeshi Caregivers in Britain

There are currently 700,000 carers caregiving for 850,000 people with dementia in Britain, with Bangladeshi caregivers three times more likely to provide family care compared with their White British counterparts. However, few studies have been conducted to explore how caregiving for a loved one with dementia affects caregivers in Britain. The purpose of this study was to highlight the impacts of dementia on Bangladeshi caregivers. The roles of the caregivers were physically, psychologically, and socioeconomically demanding, particularly when their relative’s condition gradually worsened. This study will also help improve the advice, care, and support available for other ethnic minority caregivers.

Barriers to access and ways to improve dementia services for a minority ethnic group in England.

There is a general lack of awareness and understanding of dementia within ethnic minority groups in the United Kingdom. There is also a dearth of research involving ethnic minority caregivers about reducing barriers to accessing services and optimizing engagements with religiously tailored interventions. This paper reports findings from a qualitative study that examined the barriers to health care service use in the Bangladeshi community living in the United Kingdom. The research draws on findings from a doctoral level research study on understanding dementia among the Bangladeshi community in England. The data for the doctoral research were gathered in two ways: (a) focus group discussions and (b) semi-structured interviews. All data were audio-recorded and analysed using thematic analysis. NVivo software was used to aid transcribing, coding, and interpretation of emergent themes. The data showed that there were some barriers experienced by participants due to their religious and cultural beliefs and practices with other barriers related to the complexity of the UK health care system. Gender-based caregiving also appeared to interfere with religious ideologies while religiously appropriate health care services were deemed of great importance for successfully accessing those services. The findings provide an understanding of the experiences of the Bangladeshi community when seeking to access mainstream UK health care services and may help to provide useful directions for future research.

Race and parenting in the context of youth incarceration

ABSTRACT This article examines the experiences of ethnic minority caregivers related to young men in prison. Focussing on how parenting was shaped through ethnic identity, we show that caregivers (especially mothers) developed a strong protectionist stance towards their children – a response partly conditioned by the pressures of crime and policing in their neighbourhoods. Reflections on parenting also encompassed specific forms of cultural shame, which were interpreted as responses to actual and perceived judgements about parenting competence. The role of faith as a means of coping with the ordeals of criminal justice contact was also identified. These findings are examined through the literature on race and parenting in explaining the consequences of crime and imprisonment in shaping family lives.

The role of cultural factors in engagement and change in Multisystemic Therapy (MST)

Evidence has shown that Multisystemic Therapy (MST) has been particularly effective in the treatment of youth with antisocial behaviour from ethnically diverse backgrounds. Although the process of change within MST has been explored, there is a dearth of research in looking at this for families from ethnic minority backgrounds. This qualitative study aimed to explore ethnic minority caregiver experiences of MST and understand how this might impact on engagement, the presenting problems and the process of change. Semi‐structured interviews were conducted with seven ethnic minority caregivers who had completed treatment. A constructivist version of grounded theory was used to analyse the data. Specific cultural theoretical codes that emerged were around the consideration of cultural difference in terms of the engagement process, the conceptualisation of difficulties and the therapist acting as cultural broker in the process of change. This research integrates culturally specific ideas into the existing MST Analytical Process.Practitioner points Being culturally understood, cultural sensitivity and respecting difference can help engagement with ethnic minority caregivers The role of culture may be important to consider in the conceptualisation of difficulties For change to occur therapists may need to act as cultural brokers

Cultural Construction of Dementia Progression, Behavioral Aberrations, and Situational Ethnicity: An Orthogonal Approach.

Neurodegenerative diseases, such as Alzheimer's disease and related dementias, induce caregivers already struggling to cope with the behavioral aberrations of dementia to constantly update their cultural construction of the disease because the outward symptoms used to interpret it are in constant flux. For ethnic minority caregivers, particularly, coping is a process of tracking a moving set of symptoms, making cultural sense of them across time, and negotiating a medical environment that can be hostile to them because of their "nonstandard" cultural health beliefs. In the midst of a constantly changing disease, achieving optimal communications with the medical establishment causes the ethnic minority caregivers to change their behaviors to better fit the expectations of the clinic, then retreat to their own cultural comfort zone only to continue oscillating between cultures for the duration of their caregiving responsibilities. Ethnic minority dementia caregiving is conceptualized here from an orthogonal perspective in which the moving elements of the ethnic minority dementia experience intersect in numerous ways and produce many coping strategy permutations corresponding to the evolving disease and its cultural constructs.

Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam

BackgroundIn Vietnam, primary government health services are now accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. However, little is known about EMGs' own perspectives on illness treatment and use of health services. This study investigates treatment seeking strategies for child diarrhoea among ethnic minority caregivers in Northern Vietnam in order to suggest improvements to health services for EMGs and other vulnerable groups.MethodsThe study obtained qualitative data from eight months of field work among four EMGs in lowland and highland villages in the Northern Lao Cai province. Triangulation of methods included in-depth interviews with 43 caregivers of pre-school children (six years and below) who had a case of diarrhoea during the past month, three focus group discussions (FGDs) with men, and two weeks of observations at two Communal Health Stations (CHGs). Data was content-analyzed by ordering data into empirically and theoretically inspired themes and sub-categories assisted by the software NVivo8.ResultsThis study identified several obstacles for EMG caregivers seeking health services, including: gender roles, long travelling distances for highland villagers, concerns about the indirect costs of treatment and a reluctance to use government health facilities due to feelings of being treated disrespectfully by health staff. However, ethnic minority caregivers all recognized the danger signs of child diarrhoea and actively sought simultaneous treatment in different health care systems and home-based care. Treatments were selected by matching the perceived cause and severity of the disease with the 'compatibility' of different treatments to the child.ConclusionsIn order to improve EMGs' use of government health services it is necessary to improve the communication skills of health staff and to acknowledge both EMGs' explanatory disease models and the significant socio-economic constraints they experience. Broader health promotion programs should address the significant gender roles preventing highland mothers from seeking health services and include family elders and fathers in future health promotion programs. Encouraging existing child health care practices, including continued breastfeeding during illness and the use of home-made rehydration solutions, also present important opportunities for future child health promotion.

Ethnic Differences in Stressors, Resources, and Psychological Outcomes of Family Caregiving: A Meta-Analysis

We investigated ethnic differences in caregiver background variables, objective stressors, filial obligations beliefs, psychological and social resources, coping processes, and psychological and physical health. We used a meta-analysis to integrate the results of 116 empirical studies. Ethnic minority caregivers had a lower socioeconomic status, were younger, were less likely to be a spouse, and more likely to receive informal support. They provided more care than White caregivers and had stronger filial obligations beliefs than White caregivers. Asian-American caregivers, but not African-American and Hispanic caregivers, used less formal support than non-Hispanic White caregivers. Whereas African-American caregivers had lower levels of caregiver burden and depression than White caregivers, we found that Hispanic and Asian-American caregivers were more depressed than their White non-Hispanic peers. However, all groups of ethnic minority caregivers reported worse physical health than Whites. Observed ethnic differences in burden and depression were influenced by study characteristics, such as the type of illness of the care recipient and the representativeness of the sample. The results suggest that more specific theories are needed to explain differential effects of ethnic minority groups of caregivers. Intervention needs vary, in part, between ethnic groups of caregivers.

A social cognitive examination of responses to family conflicts by Arfican-American and Chinese-American carrgivers

Conflict between caregivers and their family members has been examined in relation to caregiver burden. However, specific theoretical models have not been applied to analyses of caregiver family conflicts. Nor has there been much research on the family conflicts of ethnic minority caregivers. Using Selman's1 interpersonal conflict strategies and their related levels of social perspective coordination as our framework, we content analyzed conflict reports of African-American and Chinese-American caregivers. Overall, there were more similarities in the strategies and social perspective coordination levels of the two groups than differences. In narratives where conflict was present (78 percent), about half of caregivers in both groups reported higherlevel conflict strategies, and half reported lower-level strategies. More advanced social perspective coordination seemed associated with greater satisfaction with family sharing of responsibilities in both groups. If these data patterns bear up under further testing, training in conflict resolution and social perspective coordination skills may prove an effective means of fostering better social relationships and sharing arrangements between caregivers and family members, and be a worthwhile complement to existing stress reduction interventions for caregivers.

The influence of ethnicity and culture on the caregiver stress and coping process: a sociocultural review and analysis.

The authors review the literature on ethnic minority caregivers and suggest that ethnicity and culture play a significant role in the stress and coping process for Latino caregivers. Caregivers of older Latinos face special challenges in the caregiving for individuals at higher risk for specific chronic diseases, who are disabled at earlier ages, and who have more functional disabilities. Ethnicity and culture can also influence the appraisal of stress events, the perception and use of family support, and coping behaviors. Socioeconomic class and minority group status are discussed as additional sources of variation in the caregiver stress and coping model.