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Cultural Values and Caregiving The Updated Sociocultural Stress and Coping Model
Cultural Values and Caregiving The Updated Sociocultural Stress and Coping Model
Cultural values and caregiving: the updated sociocultural stress and coping model. Journal of Gerontology: Psychological Sciences, 65B(1), 5–13,
doi:10.1093/geronb/gbp096. Advance Access publication on November 24, 2009.
This review revises the sociocultural stress and coping model for culturally diverse family caregivers proposed in
1997 by Aranda and Knight. Available research on the influence of cultural values on the stress and coping process
among family caregivers supports a common core model that is consistent across ethnic groups and that links care
recipients’ behavior problems and functional impairments to caregivers’ burden appraisals and health outcomes.
Familism as a cultural value appears to be multidimensional in its effects, with obligation values often being more
influential than family solidarity. The effects of cultural values and other ethnic differences in stress and coping
appear to involve social support and coping styles rather than burden appraisals. Implications of the revised
model for research and practice are discussed.
A Revised Sociocultural Stress and Coping instances, both familism and filial piety operate through
Model coping style and social support when they are associated
This review provides a basis for a revision of the socio- with emotional or physical health outcomes at all. Cultural
cultural stress and coping model for caregivers (Figure 1) differences in the stress and coping model also result in
originally proposed by Aranda and Knight (1997). First, the differences between groups in terms of which resource
differences among diverse cultural groups are built around a variables appear in the model at all and in the factor struc-
shared common core model in which caregiving stressors ture of (at least) coping styles.
lead to the appraisal of caregiving as burdensome and thus We also emphasize that we are not arguing that the ap-
to poor health outcomes (Figure 2). Second, the familism to praisal of burden is unimportant per se in the revised socio-
individualism spectrum is multidimensional, with both ob- cultural stress and coping model. In fact, burden is a
ligation and family solidarity or support being possible sub- cornerstone of the common core of the model. Thus, the
components. Third, the time has come to leave behind the role of appraisals of caregiving as burdensome appears so
expectation that cultures will line up along simple single far to be consistent across many cultural groups and not part
dimensions like individualism to familism (as suggested in of the mechanisms of cultural distinctiveness.
the general context of cross-cultural psychology by Segall,
Lonner, & Berry, 1998, and Hermans & Kempen, 1998).
Filial piety and other measures of East Asian values show Background and Rationale: Development of the
promise in finding effects on stress and coping resources Sociocultural Stress and Coping Model
among caregivers of Korean heritage and should be ex- Numerous studies have shown that caring for an older
plored more broadly. This finding suggests that the role of family member with chronic health problems and functional
cultural values in the model appears to be more group spe- limitations is associated with negative mental and physical
cific. health outcomes (e.g., Schulz, O’Brien, Bookwala, &
Fourth, cultural values operate through influences on Fleissner, 1995; Vitaliano, Zhang, & Scanlan, 2003). Given
coping resources such as social support and coping styles that the number of older adults from minority cultures is
rather than through caregivers’ appraisals of burden. There predicted to increase at a significantly greater rate than that
was tremendous conceptual appeal to the hypothesis that of White Americans (U.S. Bureau of the Census, 2000), the
cultural values would operate through cognitive appraisals need to understand how caregivers from distinct cultural
of caregiving as less burdensome, and this conjecture has backgrounds are differentially affected by caregiving is be-
been a staple of discussions of group differences in caregiv- coming more pressing. Moreover, the prevalence of func-
ing burden for many years (e.g., see summaries by Dilworth- tional limitations among older adults from racial and ethnic
Anderson, Williams, & Gibson, 2002; Janevic & Connell, minority groups is greater compared with Whites (Sinclair &
2001). So far, this hypothesis has not stood up to measure- Gomez, 2006). Thus, the demands associated with long-
ment and testing. Instead, the evidence suggests that in most term care among minority caregivers are expected to grow,
© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America.
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5
6 KNIGHT AND SAYEGH
and the need for a theoretically based conceptual framework coping model added an emphasis on “ethnicity as culture”.
for understanding how these individuals are affected by The cultural focus guided the search for explanations for
these demands is more urgent. In addition, greater theoreti- ethnic group differences in caregiving health outcomes to
cal and methodological precision regarding the examination consider specific cultural values and their influences on the
of caregiving across different ethnic and cultural groups stress and coping process. We emphasize that the focus on
will help to inform the content of interventions and services cultural values is meant to be an additional element to con-
aimed at alleviating caregivers’ distress among individuals sider in comparisons of ethnic group differences in caregiv-
from diverse backgrounds. ing and is not meant to dismiss the real disadvantages from
Literature reviews on ethnicity and caregiving have em- which many minority groups suffer. Janevic and Connell
phasized the need to explicitly measure and assess the im- noted that caregivers may well share the disadvantages that
pact that cultural values have on caregiving experiences noncaregivers from their ethnic group experience, but the
instead of simply using group membership to examine cul- question of whether these general stressors add to or inter-
tural and ethnic differences in caregiving (Dilworth-Anderson act with caregiving status is a separate and important
et al., 2002; Janevic & Connell, 2001). The first attempts to empirical question.
understand ethnic differences in caregiving were rooted in Following contemporary trends in cross-cultural studies
the disadvantaged minority group model (Markides, Liang, & at that time, which were also commonly reflected in the dis-
Jackson, 1990), which argued that ethnicity reflects mainly cussion sections of papers on ethnic differences in caregiv-
disadvantaged minority status and is confounded by socio- ing, Aranda and Knight (1997) framed cultural values in
economic status. Thus, caregivers from non majority ethnic terms of an individualism/familism dimension. This dimen-
groups should suffer from the double stressors of being sion applies to the family the notion that Western majority
from a disadvantaged minority group and being caregivers. culture would emphasize individualism and perceive care-
Aranda and Knight (1997) noted that African Americans giving as a burden because it disrupts the caregiver’s life.
commonly reporting lower levels of burden than Whites Aranda and Knight thus assumed that familism would lead
contradicted this conceptual model. The disadvantaged mi- to lower perceptions of caregiving as burdensome. Concep-
nority group model also overlooked the potentially positive tually, familism would lead to lower burden appraisals and
effects of cultural values on the stress and coping process. also to different patterns of using social support and coping
Aranda and Knight proposed the sociocultural stress and styles and thereby provide an explanation for differing
coping model in order to provide a framework for under- physical and mental health outcomes for ethnic caregivers.
standing caregiver stress and coping processes across di- In the years since the proposal of the sociocultural stress
verse cultural groups, using Hispanic American caregivers and coping model, the literature on ethnic differences in
as an exemplar. The authors based this model on the stress caregiving has grown and the focus on measuring cultural
and coping theoretical model proposed by Lazarus and values and testing their influence has increased, as recom-
Folkman (1984), which holds that variables such as apprais- mended by Dilworth-Anderson and colleagues (2002) and
als, social support, and coping style mediate the conse- Janevic and Connell (2001). We begin our review of this
quences of stressors on people. The sociocultural stress and literature by making the case for a common core model for
caregiver distress that appears to be consistent across the
ethnic groups studied to date. In the following sections, we
show that the nature of familism is more complex than
thought a decade ago and its influence is not as positive as
Figure 2. The common core stress and coping model for caregivers. expected. Then, we discuss the potential role of other
CULTURAL VALUES AND CAREGIVING 7
cultural values in the caregiving stress and coping process generation). Levels of familism among Japanese Americans
and note that ethnic group differences in the stress and cop- were lower, which reflects greater acculturation within the
ing model often are expressed in what resource variables United States. African Americans, who have been in the
(e.g., social support, coping style) are included in the model. United States for centuries, were most similar to Whites
Finally, we discuss various recommendations for future with regard to familism, but they still reported statistically
research regarding cross-cultural differences in caregiving significantly higher levels on this measure. Thus, familism
and discuss the potential practical implications of this line represented a good measure of an individual’s ranking on
of research. the individualism to collectivism dimension and confirmed
the commonly perceived differences on this dimension
complex multidimensional construct for these different eth- support from others can reduce the negative effects of care-
nic groups (Spanish, African American, and White). These giving on physical health outcomes (e.g., Barusch & Spaid,
subcomponents can have competing effects within the so- 1989; Pinquart & Sörensen, 2007).
ciocultural stress and coping model. Measuring subcompo- Connell and Gibson’s (1997) review of the literature sup-
nents of familism has been far more productive in terms of ported the ethnic and cultural differences in views of family
gaining insight into cultural variations in caregivers’ burden support, with African American caregivers endorsing more
appraisals and health outcomes. Future studies that examine strongly held attitudes of family support than Whites. How-
the effects of familism on the caregiving process should ex- ever, findings from several studies regarding the directions
plicitly contrast the obligation values of familism with the of the effects of specific cultural values on social support
have reported that avoidant coping styles among dementia components of the model are added to the common core
caregivers are related to various negative emotional and model (Figure 1). For example, in Chun and colleagues’
psychological outcomes (e.g., Papastavrou, Kalokerinou, (2007) comparison of Korean caregivers with Korean Amer-
Papacostas, Tsangari, & Sourtzi, 2007; Powers, Gallagher- icans and Whites, instrumental social support was added for
Thompson, & Kraemer, 2002). Korean caregivers, emotional support for Korean Americans,
J. Kim and colleagues (2007) found that higher levels of and neither for Whites. Reaching conclusions about the ele-
familism, as measured by the Bardis (1959) scale, resulted ments of specific group models is premature, given that the
in increased levels of avoidant coping styles rather than ac- reported differences often reflect differences in choices of
tive coping styles among their sample of African American variables included in the study by the research team.
across groups. As noted above, different cultural groups American caregivers, given that spousal caregivers tend to
may have dissimilar coping styles, differing meanings for be more burdened, or the perception of burden being offset
social support, and varying ways of expressing emotional by a greater tendency to experience uplifts and satisfaction
distress. with caregiving (Pinquart & Sörensen, 2005); however, both
of these possibilities could benefit from further exploration
of why these factors would reduce burden. Clearly, more
How Culture Affects Stress and Coping Processes
work remains to be done to understand the influence of cul-
We also need a better understanding of the ways in which
tural values and other differences among ethnic groups in
culture can affect the stress and coping process. If culture
coping with caregiving.
does not influence the appraisal of caregiving as burden-
measurement of physical health outcomes among caregiv- could assist caregivers in highlighting the beneficial effects
ers. Knight, Flynn Longmire, Dave, Kim, and David (2007) of cultural values and decreasing the impact of their detri-
found that although African American caregivers did not mental effects on health outcomes. Culturally specific inter-
report worse physical health outcomes on self-report ventions may do well to focus on understanding and working
measures, they showed elevated baseline diastolic blood to change specific meanings of social support and coping
pressure readings compared with other groups in the study styles that are found to be specific to the cultural group tar-
(African American and White noncaregivers and White geted by the intervention, as these variables may be more
caregivers). Similarly, J. Kim and Knight (2008) reported amenable to modification than cultural values.
that in their sample of Korean American caregivers and
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