Aging & Mental Health

ISSN: 1360-7863 (Print) 1364-6915 (Online) Journal homepage: http://www.tandfonline.com/loi/camh20

Measuring familism in dementia family caregivers:

the revised familism scale

Andrés Losada, María Márquez-González, Carlos Vara-García, Samara

Barrera-Caballero, Isabel Cabrera, Laura Gallego-Alberto, Ricardo Olmos &
Rosa Romero-Moreno

To cite this article: Andrés Losada, María Márquez-González, Carlos Vara-García, Samara
Barrera-Caballero, Isabel Cabrera, Laura Gallego-Alberto, Ricardo Olmos & Rosa Romero-Moreno
(2019): Measuring familism in dementia family caregivers: the revised familism scale, Aging &
Mental Health, DOI: 10.1080/13607863.2018.1562537

To link to this article: https://doi.org/10.1080/13607863.2018.1562537

Published online: 09 Jan 2019.

Submit your article to this journal

Article views: 9

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=camh20
AGING & MENTAL HEALTH
https://doi.org/10.1080/13607863.2018.1562537

Measuring familism in dementia family caregivers: the revised familism scale

Andre
s Losadaa , Mar
ıa M
arquez-Gonz
alezb , Carlos Vara-Garc
ıaa , Samara Barrera-Caballeroa,
Isabel Cabrerab , Laura Gallego-Albertob , Ricardo Olmosb and Rosa Romero-Morenoa
Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain; bFacultad de Psicolog
ıa, Universidad Aut
onoma de
a

Madrid, Madrid, Spain

ABSTRACT ARTICLE HISTORY

Objectives: Familism is a cultural value that has been shown to be important for understanding Received 18 February 2018
the dementia caregiving process. The aim of this study is to analyze the psychometric properties Accepted 13 December 2018
of the Revised Familism Scale (RFS).
KEYWORDS
Method: Face-to-face assessments were done with 199 dementia family caregivers. Exploratory
Caregivers; culture;
factor analysis, discriminant validity, and reliability analyses of the RFS were carried out. dementia; familism; scale
Results: The results suggest that the RFS has good psychometric properties and is composed of
three factors: “Familial interconnectedness”, “Familial obligations”, and “Extended family support”.
Conclusion: The RFS seems to be a reliable measure of familism, a multidimensional construct
measuring a relevant cultural value for dementia family caregivers.

Introduction
A variable that has been widely studied as reflecting an
important dimension of culture with significant influences
on the caregiving stress process is familism (Knight &
Sayegh, 2010). Familism has been defined as “a strong
identification and attachment of individuals with their
families (nuclear and extended), and strong feelings of
loyalty, reciprocity and solidarity among members of the
same family” (Sabogal, Mar
ın, Otero-Sabogal, Mar
ın, &
Perez-Stable, 1987, p. 398). Familism has usually been
associated with positive outcomes in non-caregiving popu-
lations. For example, it has been considered protective
against drug use in adolescents (Lac et al., 2011; Ramirez,
Crano, Quist, Burgoon, Alvaro, & Grandpre, 2004), linked
with better psychological health (Campos, Ullman, Aguilera,
& Dunkel Schetter, 2014), and associated with less depres-
sion and a better perception of school climate and relation-
ships with teachers (Cupito, Stein, & Gonz
alez, 2014).
With regard to caregiving, the positive effects of
familism that have been found in studies such as those
mentioned above has led some authors to state that fami-
lism “may be a source of lower distress in ethnic minority
caregivers” (Pinquart & So €rensen 2005, p. 93). As noted by
Gelman (2014), although highly familistic cultural groups
(e.g. Latinos) are viewed as composed of “family units that
are ready, willing, and able to provide care” (p. 57), it
seems that in the caregiving context, familism may not
have the expected positive consequences on caregivers’
distress. In fact, with reference to the sociocultural stress
and coping model (Knight & Sayegh, 2010), familism in
caregiving populations has been associated in several
studies and cultural groups with higher avoidant coping
and worse mental and physical health (Kim, Knight, &
Longmire, 2007; Parveen, Morrison, & Robinson, 2013;
Rozario & DeRienzis, 2008; Sayegh & Knight, 2011). For
Kim et al. (2007), these findings show that “familism may
represent obligation more than positive feelings about
family support” (p. 573). These findings highlight the
multidimensional nature of the familism construct and the
need to abandon the general assumption that family
cultural values per se have positive effects on caregiving
stress and the coping process (Sayegh & Knight, 2011).
Hence, the multidimensional nature of familism (e.g.,
Luna, de Ardon, Lim, Cromwell, Phillips, & Russell, 1996;
Mucchi-Faina et al., 2010) may contribute to explaining
why positive and negative effects have been associated
with familism. In a study carried out with dementia family
caregivers by Losada et al. (2010), the familism factor
“perceived support from the family” was found to have a
positive influence on the caregiving process, while the
factors “familial obligations” and “family as referents” were
found to have a negative influence, with these variables
having a positive association with dysfunctional thoughts
and depressive symptomatology. However, the familism
scale used by Losada et al. (2010) had some weaknesses.
For example, familial obligations were measured with a
two-item subscale (Losada et al., 2008), which was likely
insufficient to cover this complex construct and possibly
influenced the results by not providing a clear picture of
the importance of familial obligations in several caregiving
process dimensions.
Taking into consideration the above mentioned issues,
the objective of this study is to analyze the psychometric
properties of a Revised Familism Scale (RFS) that tries to
solve the shortcomings of the previous version of the scale
by combining areas or contents from previously existing
measures. It was expected that the resulting revised scale
would show stronger psychometric properties, such as
higher content validity.

CONTACT Andr
es Losada andres.losada@urjc.es

ß 2019 Informa UK Limited, trading as Taylor & Francis Group
2 A. LOSADA ET AL.
Method
Participants and procedure
The sample of this study is composed of 199 dementia
family caregivers who agreed to participate by signing
informed consent. Participants were recruited through
health and social care centers from Madrid (Spain). In an
initial telephone contact, all of them identified themselves
as the primary source of care for their relatives, reported
that they had been providing care for at least one hour
per day for the last three months and were 18 years of age
or older, and an appointment for a face-to-face interview
was arranged. All the interviews took place in the collabo-
rating centers. This study was approved by the Ethics
Committee of the Universidad Rey Juan Carlos.
Measures
Sociodemographic characteristics. Caregivers’ age (only
available for 136 participants), gender, time since becoming
a caregiver and daily hours devoted to caregiving, and
care-recipients’ illness were measured through single items.
Familism. Familism was measured through the revised
familism scale (RFS), which combines the 14 items (e.g.,
“One should make great sacrifices in order to guarantee a
good education for his/her children”) of the familism scale
(FS) developed by Sabogal et al. (1987) and items included
in the Attitudinal Familism Scale (AFS) of Steidel and
Contreras (2003). Specifically, the subscales Subjugation of
Self for Family (3 items; e.g., “A person should respect his
or her older brothers and sisters regardless of their differ-
ences in views") and familial Interconnectedness (5 items;
e.g. “Parents and grandparents should be treated with
great respect regardless of their differences in views”) were
included, in addition to 3 items from the Familial Support
subscale (e.g., “A person should help his or her elderly
parents in times of need, for example, help financially or
share a house”). Other items from the AFS scale were not
included due to similarities with items included in the FS
(e.g. “Aging parents should live with their relatives”). All
items were answered on a five-point Likert scale, with 0
indicating ‘very much in disagreement’ and 4 ‘very much in
agreement’. The psychometric properties of this scale,
including factor analysis and Cronbach’s alpha, are
described in the results section.
Data analysis
After a descriptive analysis of the sample, an exploratory
factor analysis (EFA) of the revised familism scale was
carried out first (KMO measure of sampling adequacy was
high: 0.850). Given the categorical nature of the items, a
polychoric correlation matrix was analyzed and a weighted
least square method for mean and variance imputation
was used in EFA (Brown, 2015). A geomin oblique rotation
method was used as the factors are assumed to be corre-
lated. Preliminary analysis of the data was carried out con-
sidering internal consistencies and item-scale correlations
(maintaining items with item-scale correlations higher than
.20). To estimate the number of factors, parallel analysis
was conducted, complementing the analysis with four
commonly used fit indices: RMSEA, TLI, CFI, and SRMR. The
final structure was analyzed after deleting items with factor
loadings lower than .40. Discriminant validity was tested
through a series of hierarchical regression analyses.
Considering familism total score as dependent variable,
one of the familism factors was entered in each of the
regressions in a first step. In a second step, a familism
factor different from that entered in the first step was
entered. A significant incremental change in percentage of
explained variance (R2) gives an estimate of the unique,
construct-specific component for each factor. All the
analyses were done using Mplus 7.0 (Muth
en & Muthen,
1998–2012) and IBM Statistics software.
Results
Sample characteristics
Most of the participants were female caregivers (155
female, 77.9%), with a mean age of 59.6 years (S.D. ¼ 13.10;
range ¼ 29–87). They reported being caregivers for
54.44 months (S.D. ¼ 46.50; range ¼ 3–312), devoting
11.55 hours (S.D. ¼ 8.07; range ¼ 1–24) per day to caregiv-
ing duties, and that they were caring for a relative with
Alzheimer’s disease (57.1%) or other cognitive disorders
(42.9%).
Exploratory factor analysis of the familism scale
Even though the preliminary data analysis of the initial
pool of 25 familism items that were assessed provided a
good Cronbach’s alpha index (.85), the analysis of the
item-scale correlations showed that one item (“Children
should help out around the house without expecting an
allowance”) had a very low correlation (.02) and was thus
deleted. For the remaining 24 items, parallel analysis was
conducted with the results suggesting a three factor solu-
tion (the three empirical eigenvalues, 6.27, 2.62, and 1.63
were higher than the simulated eigenvalues). By deleting
items with factor loadings lower than .40 (“One should
help economically with the support of younger brothers
and sisters” (factor loading ¼ .36), “Aging parents should
live with their relatives” (factor loading ¼ .28), and “One of
the most important goals in life is to have children” (factor
loading ¼ .37)), 21 item were finally retained (see Table 1).
Parallel analysis confirmed a three factor solution and
goodness of fit indices also showed the model fit the data
well (v2(150) ¼ 274.093, p < 0.001; RMSEA ¼ 0.064 90% CI
[0.052–0.076]; CFI ¼ 0.966; TLI ¼ 0.952, and SRMR ¼ 0.054).
The final factor structure is shown in Table 1 and accounts
for a 53.22% of variance of the assessed construct.
The correlations between factors ranged from 0.047 to
0.228, thus showing discriminant validity of the theoretical
constructs. Further support for the discriminant validity of
the obtained factors is shown in Table 2: a significant
increase in percentage of explained variance was found for
each factor from step 1 to step 2, suggesting that each
factor has a construct-specific influence on the total score.
Factor 1 has been labeled “Familial interconnectedness”,
the same term used by Steidel and Contreras (2003), and
can be defined as the belief that family members are an
important source of help, and must keep respect as well as
emotional and physical closeness with other relatives. The
 AGING & MENTAL HEALTH 3

Table 1. Factor loadings, means, standard deviations and range of the RFS.
Factor
Item 1 2 3
3—I would help within my means if a relative told me that she/he is in financial difficulty .60
4—One should have the hope of living long enough to see his/her grandchildren grow up .65
7—When someone has problems s/he can count on the help of relatives .85
8—When one has problems, one can count on the help of relatives .73
9—One can count on help from his/her relatives to solve most problems .46
15—A person should help his or her elderly parents in times of need, for example, help financially or share a house .88
16—A person should live near his or her parents and spend time with them on a regular basis. .61
18—A person should respect his or her older brothers and sisters regardless of their differences in views. .54
19—A person should be a good person for the sake of his or her family .73
21—Parents and grandparents should be treated with great respect regardless of their differences in views .79
23—The family should control the behavior of children younger than 18. .64
24—A person should cherish time spent with his or her relatives .88
1—One should make great sacrifices in order to guarantee a good education for his/her children .40
10—Much of what a son or daughter does should be done to please the parents .60
12—One should be embarrassed about the bad things done by his/her brothers or sisters .52
13—Children should live in their parents’ house until they get married? .75
20—Children should obey their parents without question even if they believe they are wrong .60
6—A person should share his/her home with uncles, aunts or first cousins if they are in need .50
11—The family should consult close relatives (uncles, aunts) concerning its important decisions .72
17—A person should always support members of the extended family, for example, aunts, uncles, and in-laws, if they are in .70
need even if it is a big sacrifice
22—A person should often do activities with his or her immediate and extended families, for example, eat meals, play games, .42
go somewhere together, or work on things together
Mean 7.81 11.07 6.61
S.D. 6.50 4.72 3.98
Range 0-32 0-20 0-16

Table 2. Discriminant validity between factors.

Step Beta t DR2 Beta t DR2 Beta t DR2
1 F1 .83 20.62 .69 F2 .71 13.84 .50 F3 .76 16.06 .57
2a F1 .68 31.55 .23 F2 .50 23.39 .42 F3 .48 16.01 .30
F2 .50 23.39 F1 .68 31.55 F1 .61 20.56
2b F1 .61 20.56 .18 F2 .48 12.47 .27 F3 .56 14.68 .19
F3 .48 16.01 F3 .56 14.68 F2 .48 12.47
Two hierarchical regressions have been done for each of the familism factors. The first step is the same for the two regressions, and amakes reference to
the second step of the first hierarchical analysis (e.g. discriminant validity between factors 1 and 2) and bmakes reference to the second step of the
second hierarchical analysis (e.g., discriminant validity between factors 1 and 3); F1 ¼ Familial interconnectedness; F2 ¼ Familial obligations; F3 ¼ Extended
family support; DR2: Increase in the percentage of explained variance;p<.01.

first factor accounts for 28.77% of the variance. Factor 2
has been labeled “Familial obligations”, the same term
used by Sabogal et al. (1987). This factor may be defined
as caregivers’ perceptions of the familial obligations and
what is expected by the relatives, who are considered as
behavioral and attitudinal referents (Sabogal et al., 1987).
This second factor accounts for 13.60% of the variance. The
third factor has been labeled “Extended family support”,
and may be defined as caregivers’ perceptions of the
extended family as a source of support. This factor
accounts for 11.15% of the variance.
Reliability
The internal consistency (Cronbach’s alpha) for the 21 final
items of the revised familism scale (RFS) is .85. The internal
consistency for the factors is .82, .74, and .74 for “Familial
interconnectedness”, “Familial obligations”, and “Extended
family support”, respectively. The average inter-item
correlation for the factors is .31, .36, and .42, for “Familial
interconnectedness”, “Familial obligations”, and “Extended
family support”, respectively.
Discussion
The present study was aimed at analyzing the psychomet-
ric properties of a revised familism scale (RFS) in dementia
family caregivers. The obtained results suggest that the RFS
has good psychometric properties, including accounting for
significant variance in the construct, good inter-item correl-
ation ranges, and acceptable-to-good internal consistency
indices for all the subscales. The findings from the explora-
tory factor analysis suggest that the scale is composed of
three factors (“Familial interconnectedness”, “Familial
obligations”, and “Extended family support”), which are
quite independent of each other, according to the results
of the discriminant analysis. Given that the items compos-
ing the revised scale are part of already existing measures
(Sabogal et al., 1987; Steidel & Contreras, 2003), it is not
surprising that the factors obtained are similar to those
yielded by previous studies analyzing scales for measuring
familism. The decision to develop a revised scale was based
on previous studies on the measurement of the familism
construct (Losada et al., 2008). These recommended the
addition of new items to the scale in order to cover
additional relevant dimensions or to complete the familial
obligations factor, which was composed of only two items.
In the present study, the factor “Familial obligations” is
composed of 5 items, including, among others, items
that in the study by Losada et al. (2008) were part of the
obligations and family as referents dimensions. These two
dimensions were correlated (.57; p < .001) in Losada et al.
(2008), and both contributed to a path that linked familism
to caregivers’ dysfunctional thoughts and depressive
4 A. LOSADA ET AL.
symptomatology in Losada et al. (2010). Considering these
previous findings together with those reported in the
present study, we believe that the revision of the scale
has improved this measure, mainly by increasing its con-
tent validity, supporting the discriminant validity of the
theoretical constructs covered by the scale, and increasing
its reliability. In fact, the internal consistency of the
“Familial obligations” factor, which had a Cronbach’s alpha
of .59 in the 2008 study, now yields a Cronbach’s alpha
of .74.
The findings of this study should be considered with
caution due to several limitations. The sample size does
not allow testing for a confirmatory analysis of the
obtained factor structure, so future studies are needed in
order to confirm the resulting dimensional structure. In
addition, even though one of the objectives of the pre-
sent study was to develop a revised familism measure
that tapped additional areas or contents to those previ-
ously analyzed in dementia family caregivers (Losada
et al., 2008; Steidel & Contreras, 2003), additional dimen-
sions of familism may not be covered by the proposed
scale. The fact that the sample is composed of caregivers
who volunteered to participate in the study may not
allow for the generalizability of the findings to the whole
caregiving population. Generalization of the findings may
also be limited due to other characteristics of the sample,
such as care-recipients’ illness. For example, more intense
behavioral and psychological symptoms of dementia
have been observed in frontotemporal dementia when
compared with other illnesses such as Alzheimer disease
(de Vugt, Riedijk, Aalten, Tibben, van Swieten, & Verhey,
2006). These differences associated with care-recipients’
variables may have an influence on caregiver reporting of
variables such as those measured in this study. Future
studies with a larger sample controlling for cognitive and
behavioral characteristics of the illnesses could contribute
to further advancing our knowledge about the interplay
between care-recipients’ and caregivers’ variables, includ-
ing cultural values. Finally, even though the assessment
through face-to-face interviews has several advantages
compared to other methods (e.g. self-administered or
postal assessments), including increasing response rates
or maintaining motivation, potential biases such as
social desirability bias or interviewer bias may exist
(Bowling, 2005).
In spite of the above mentioned limitations, we believe
that this study contributes to the empirical research
focused on the analysis of cultural variables on the
dementia caregiving process by providing support for the
multidimensional nature of the familism construct and
offering a scale with stronger psychometric properties
than those reported in previous studies (e.g. Losada
et al., 2008).
Acknowledgements
This work was supported by the Spanish Ministry of Economy and
Competitiveness under Grant PSI2015-65152-C2-1-R. We thank all
the caregivers for their participation in the study and also the fol-
lowing centers for collaborating with us in the project: Fundacio
n

n Mar
ıa Wolff, Centro Reina Sof
ıa de Cruz Roja, and
Cien, Fundacio
Centro de Psicolog
ıa Aplicada de la Universidad Auto
noma
de Madrid.
ORCID
Andr
es Losada http://orcid.org/0000-0002-3134-7133
Mar
ıa Ma
rquez-Gonza
lez http://orcid.org/0000-0001-6572-8949
Carlos Vara-Garc
ıa http://orcid.org/0000-0002-5379-5770
Isabel Cabrera http://orcid.org/0000-0001-8362-764X
Laura Gallego-Alberto http://orcid.org/0000-0002-0094-834X
Rosa Romero-Moreno http://orcid.org/0000-0001-5454-3586
References
Bowling, A. (2005). Mode of questionnaire administration can have
serious effects on data quality. Journal of Public Health, 27(3),
281–291. doi:10.1037/a0034094
Brown, T. A. (2015). Confirmatory factor analysis for applied research.
New York: Guilford.
Campos, B., Ullman, J. B., Aguilera, A., & Dunkel Schetter, C. (2014).
Familism and psychological health: the intervening role of closeness
and social support. Cultural Diversity & Ethnic Minority Psychology,
20, 191–201. doi:10.1037/a0034094
Cupito, A. M., Stein, G. L., & Gonz
alez, L. M. (2014). Familial cultural
values, depressive symptoms, school belonging and grades in
Latino adolescents: Does gender matter? Journal of Child and
Family Studies, 24(6), 1638–1649. doi:10.1007/s10826-014-9967-7
de Vugt, M. E., Riedijk, S. R., Aalten, P., Tibben, A., van Swieten, J. C., &
Verhey, F. R. J. (2006). Impact of behavioural problems on
spousal caregivers: A comparison between Alzheimer’s disease and
frontotemporal dementia. Dementia and Geriatric Cognitive Disorders,
22(1), 35–41. doi:10.1159/000093102
Gelman, C. R. (2014). Familismo and its impact on the family caregiving
of Latinos with Alzheimer’s disease: A complex narrative. Research
on Aging, 36(1), 40–71. doi:10.1177/0164027512469213
Kim, J. H., Knight, B. G., & Longmire, C. V. (2007). The role of familism
in stress and coping processes among African American and White
dementia caregivers: Effects on mental and physical health. Health
Psychology, 26(5), 564–576. doi:10.1037/0278-6133.26.5.564
Knight, B. G., & Sayegh, P. (2010). Cultural values and caregiving: the
updated sociocultural stress and coping model. Journals of Gerontology
B: Psychological Sciences, 65, 5–13. doi:10.1093/geronb/gbp096
Lac, A., Unger, J. B., Bas
an ~ez, T., Ritt-Olson, A., Soto, D. W., &
Baezconde-Garbanati, L. (2011). Marijuana use among Latino adoles-
cents: Gender differences in protective familial factors. Substance
Use & Misuse, 46, 644–655. doi:10.3109/10826084.2010.528121
Losada, A., Knight, B. G., M
arquez-Gonz
alez, M., Montorio, I., Etxeberr
ıa,
~acoba, C. (2008). Confirmatory factor analysis of the
I., & Pen
familism scale in a sample of dementia caregivers. Aging & Mental
Health, 12, 504–508. doi:10.1080/13607860802224227
Losada, A., Marquez-Gonzalez, M., Knight, B. G., Yanguas, J., Sayegh, P.,
& Romero-Moreno, R. (2010). Psychosocial factors and caregivers’
distress: Effects of familism and dysfunctional thoughts. Aging &
Mental Health, 14, 193–202. doi:10.1080/13607860903167838
Luna, I., de Ardon, E. T., Lim, Y. M., Cromwell, S. L., Phillips, L. R., &
Russell, C. K. (1996). The relevance of familism in cross-cultural studies
of family caregiving. Western Journal of Nursing Research, 18(3),
267–283. doi:10.1177/019394599601800304
Mucchi-Faina, A., Pacilli, M. G., & Verma, J. (2010). The two faces of
familism: A cross-cultural research in India and Italy. Psychological
Studies, 55(4), 365–373. doi:10.1007/s12646-010-0042-1
Muth
en, L. K. & Muth
en, B. O. (1998–2012). Mplus user’s guide (7th ed.).
Los Angeles, CA: Author.
Parveen, S., Morrison, V., & Robinson, C. A. (2013). Ethnicity, familism and
willingness to care: Important influences on caregiver mood? Aging &
Mental Health, 17, 115–124. doi:10.1080/13607863.2012.717251
Pinquart, M., & So €rensen, S. (2005). Ethnic differences in stressors,
resources, and psychological outcomes of family caregiving: A meta-
analysis. The Gerontologist, 45(1), 90–106. doi:10.1093/geront/45.1.90
Ramirez, J. R., Crano, W. D., Quist, R., Burgoon, M., Alvaro, E. M., & Grandpre,
J. (2004). Acculturation, familism, parental monitoring, and knowledge
as predictors of marijuana and inhalant use in adolescents. Psychology
of Addictive Behaviors, 18(1), 3–11. doi:10.1037/0893-164X.18.1.3

Rozario, P. A., & DeRienzis, D. (2008). Familism beliefs and psychological
distress among African American women caregivers. The
Gerontologist, 48(6), 772–780. doi:10.1093/geront/48.6.772
Sabogal, F., Mar
ın, G., Otero-Sabogal, R., Mar
ın, B. V., & Perez-Stable, E. J.
(1987). Hispanic familism and acculturation: What changes and
what doesn’t? Hispanic Journal of Behavioral Sciences, 9(4), 397–412.
doi:10.1177/07399863870094003
AGING & MENTAL HEALTH 5
Sayegh, P., & Knight, B. G. (2011). The effects of familism and cultural
justification on the mental and physical health of family caregivers.
Journals of Gerontology B Psychological Sciences, 66, 3–14.
doi:10.1093/geronb/gbq061
Steidel, A. G. L., & Contreras, J. M. (2003). A new familism scale for
use with Latino populations. Hispanic Journal of Behavioral
Sciences, 25(3), 312–330. doi:10.1177/0739986303256912