Family Care for Persons with Alzheimer's Disease in Taiwan and the US---Development and Testing of a Cross-National Family Care Inventory

The increased globalization and mobility among countries provides more opportunities for health care providers to care for families of different ethnicity, culture and national origin. Thus, it is necessary for health care providers to understand family care cross-nationally. Different from many cross culture/nation comparison that focus on testing concepts developed in one culture/nation in another culture/nation. The intention of this study is to develop a cross-nation family care inventory and to test the model containing key family care concepts that have been developed previously by this research group both in Taiwan and the United States. Some of these concepts/instruments were uniquely found in each cultural, such as caregiving rewards and enrichment in the United States, and finding a balance point among competing needs in Taiwan. Others, such as role strain, predictability, and mutuality, are similar in both countries. In the proposed study, similarities and differences in family care processes in Taiwan and the US will be further elucidated and compared. Because of the extensive experience the research group has had with family caregivers for patients with Alzheimer’s disease (AD), families of patients with Alzheimer’s disease have been selected as the target population for this study. In addition, due to the fact that family caregiving to elders with dementia is a long-term trajectory, the longitudinal changes will be built and examined in the model. This is a 5-year research project. In the first three years, we have accomplished the following objectives under the support of National Science Council: 1) Cross-cultural equivalence of family care concepts and measures was established via expert knowledge, literature review and qualitative data from 7 family caregivers in each nation. Language equivalence was established use symmetric translation, translation/back translation, and a formal equivalence check by a research team consisting of researchers from both cultures. 2) The initial reliability and validity of the two versions of the new measures (English and Chinese) in Taiwanese and US samples (N=30 each) were examined and compared. The biological indicators (e.g. total antioxidant capacity and IL 6) were used to determine the concurrent validity for this population. 3) A total of 173 subjects in Taiwan and 179 in the United States were collected for two countries and tested for reliability and validity. A preliminary conceptual framework has been explored. In future 2 years, we will examine the responsiveness to changes of these measures. Also, we will specify and test a conceptual framework containing family care variables in both countries in considerations of longitudinal changes. In a general model, we evaluate whether the direct effects of the family care situation variables on the consequences of family care are mediated by family care process variables. In a long-term perspective, consequences of family care would feedback to the family care situation and further influence the family care process variables. All subjects in each culture will be followed every 6 months for 2 1/2 years to examine and compare the longitudinal changes of the phenomena. We will collect data in Taiwan and the US concurrently so that for the model testing, we will have two parallel data sets ready for cross-culture analyses. The findings will be able to provide an equal stand for cross-nation (culture) comparison and be expanded to also expand to different population and to include different countries such as Japan and Thailand in future. Our hope is that the study will serve as the basis for international collaboration in the development of interventions to strengthen and support family care.

Project ID:PC9706-0966
External Project ID:NSC96-2628-B182-031-MY2