INTERVIEWS VS. INSTRUMENTS: ASSESSING ADL ABILITY IN MEXICAN AMERICAN CAREGIVERS

2.50
Hdl Handle:
http://hdl.handle.net/10755/211678
Type:
Research Study
Title:
INTERVIEWS VS. INSTRUMENTS: ASSESSING ADL ABILITY IN MEXICAN AMERICAN CAREGIVERS
Abstract:
Purposes/Aims. Because informal care for parents is imperative for Mexican American (MA) families, caregivers are gravely concerned by their own declines in activities of daily living (ADLs). They know their functional abilities are the key to continuing this commitment. This presentation will (1) describe ADLs, acculturation, and cultural expectations in the informal caregiving trajectory of 31 MA caregivers and (2) evaluate the advantages of interviews vs. standardized instruments in obtaining accurate ADL data in such families. Rationale/Conceptual Basis/Background. We know little about caregiving in MA families, but they experience greater health deterioration, with higher levels of disability at earlier ages than Anglos.  ADL disability, age, and male gender are predictive of mortality in both MAs and Anglos. Our descriptive, multi-site, longitudinal, mixed methods study examines caregiving and ADL ability through life course perspective (LCP), a leading theoretical orientation for the longitudinal study of health. Methods.  Case- and variable-oriented methods offer insight into the initial data wave of 31 caregivers (similar in age, acculturation, education, socioeconomic status, income, and caregiving stage to the overall study sample of 110 MA caregiving families). We examined 180 semi-structured interviews (visits every 10 weeks for 15 months) for caregiver ADL problems associated with burden and strain (LCP constructs). Based on Katz ADL scores for Times 1-6, we dichotomized caregivers into “help needed” and “no help needed”, repeating the procedure for interview data. We then compared the two sets of dichotomized scores for congruency. Because somatization is traditionally viewed as higher in MAs (particularly if less acculturated) than Anglos, we compared scores on CES-D somatization items with General Acculturation Index scores and searched for evidence of somatization in interview data. Results. Fifteen of 31 caregivers indicated “no help needed” on the ADL instrument, yet all but one reported “help needed” during the interviews. Moderately acculturated caregivers considered institutionalization if they could not provide a critical level of informal care with 3 admitting family members temporarily. Rather than evidence of somatization in caregivers, we encountered minimization, defined as ignoring or diminishing the importance of illness or other life disruption due to caregiving. Caregivers brushed aside illness as a low-priority problem that interfered with their commitment to caregiving. Implications. The cause of the discrepancy between disability reports on ADL instruments and reports in interviews is unknown, but the use of personalismo during interviews by cultural brokers may have fostered a discussion in which ADL disabilities were not viewed by caregivers as conceding burden, which could threaten the bonds of la familia. Given the questionable accuracy of the widely used ADL instrument, other means of assessing disability in MA caregivers may be necessary, along with additional research into reasons for the discrepancy. Health care providers also must be alert for minimization which, although it may act as a coping strategy for caregiver burden and strain (LCP), may mask vital health issues and prevent timely intervention. This study was funded by NINR, National Institutes of Health (5R01NR0101541).
Keywords:
Mexican American; Caregivers
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
4831
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleINTERVIEWS VS. INSTRUMENTS: ASSESSING ADL ABILITY IN MEXICAN AMERICAN CAREGIVERSen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211678-
dc.description.abstractPurposes/Aims. Because informal care for parents is imperative for Mexican American (MA) families, caregivers are gravely concerned by their own declines in activities of daily living (ADLs). They know their functional abilities are the key to continuing this commitment. This presentation will (1) describe ADLs, acculturation, and cultural expectations in the informal caregiving trajectory of 31 MA caregivers and (2) evaluate the advantages of interviews vs. standardized instruments in obtaining accurate ADL data in such families. Rationale/Conceptual Basis/Background. We know little about caregiving in MA families, but they experience greater health deterioration, with higher levels of disability at earlier ages than Anglos.  ADL disability, age, and male gender are predictive of mortality in both MAs and Anglos. Our descriptive, multi-site, longitudinal, mixed methods study examines caregiving and ADL ability through life course perspective (LCP), a leading theoretical orientation for the longitudinal study of health. Methods.  Case- and variable-oriented methods offer insight into the initial data wave of 31 caregivers (similar in age, acculturation, education, socioeconomic status, income, and caregiving stage to the overall study sample of 110 MA caregiving families). We examined 180 semi-structured interviews (visits every 10 weeks for 15 months) for caregiver ADL problems associated with burden and strain (LCP constructs). Based on Katz ADL scores for Times 1-6, we dichotomized caregivers into “help needed” and “no help needed”, repeating the procedure for interview data. We then compared the two sets of dichotomized scores for congruency. Because somatization is traditionally viewed as higher in MAs (particularly if less acculturated) than Anglos, we compared scores on CES-D somatization items with General Acculturation Index scores and searched for evidence of somatization in interview data. Results. Fifteen of 31 caregivers indicated “no help needed” on the ADL instrument, yet all but one reported “help needed” during the interviews. Moderately acculturated caregivers considered institutionalization if they could not provide a critical level of informal care with 3 admitting family members temporarily. Rather than evidence of somatization in caregivers, we encountered minimization, defined as ignoring or diminishing the importance of illness or other life disruption due to caregiving. Caregivers brushed aside illness as a low-priority problem that interfered with their commitment to caregiving. Implications. The cause of the discrepancy between disability reports on ADL instruments and reports in interviews is unknown, but the use of personalismo during interviews by cultural brokers may have fostered a discussion in which ADL disabilities were not viewed by caregivers as conceding burden, which could threaten the bonds of la familia. Given the questionable accuracy of the widely used ADL instrument, other means of assessing disability in MA caregivers may be necessary, along with additional research into reasons for the discrepancy. Health care providers also must be alert for minimization which, although it may act as a coping strategy for caregiver burden and strain (LCP), may mask vital health issues and prevent timely intervention. This study was funded by NINR, National Institutes of Health (5R01NR0101541).en_GB
dc.subjectMexican Americanen_GB
dc.subjectCaregiversen_GB
dc.date.available2012-02-20T12:07:57Z-
dc.date.issued2012-02-20T12:07:57Z-
dc.date.accessioned2012-02-20T12:07:57Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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