Positive Aspects of Caregiving Among Alzheimer's Family Caregivers: The Roles of Ethnicity and Spirituality

Background: Caring for an Alzheimer's relative can engender physical, emotional, and psychosocial stress. More recently, an emerging body of research has began to examine the positive aspects of caregiving (PAC), which can be defined as the rewards or gains caregivers derive from the caregiving experience. Differences in caregiving appraisal and resources are posited to help account for different levels of PAC among ethnic groups. Spirituality, for example, may engender higher levels of PAC by embedding caregiving in transcendent narrative. The purpose of this study is twofold. First, to test Pearlin et al.'s stress process model in explaining PAC among Caucasian (n=220), African-American (n=211) and Latino (n=209) Alzheimer's family caregivers; and second, to identify the role of spirituality in predicting PAC for each of these groups.

Methods: A secondary data analysis was performed using baseline data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II project (Belle et al., 2006). Latent constructs included in the model included, objective stress, subjective stress, social support, spirituality, and PAC. Demographic variables included caregiver age, gender, education, and household income. Structural equation modeling (SEM) was performed using LISREL 8.80. First, we tested the measurement model fit for each ethnic group. Second, we tested the structural model for each ethnic group controlling for the effects of demographics. We used commonly recommended cut-off values for model fit indices, namely the comparative fit index (CFI ≥ .95), the standardized root mean square residual (SRMR≤ .08), and the Root Mean Square Error of Approximation (RMSEA < .06 -. 08 with confidence interval). Results: SEM results for the measurement model for each ethnic group suggested a good model fit. All factors loaded significantly on the latent constructs for Caucasian, African-American and Latino caregivers. This indicates that these latent variables are valid constructs for all three ethnic groups. Acceptable model fits were obtained for each group, suggesting that Pearlin et al.'s stress process model is a valid model for explaining the caregiving experience across these three groups regarding PAC. In terms of the role of spirituality for each group, differences differential relationships emerged. The results indicated a direct effect of spirituality on PAC for the Caucasian group (B=.27, p < .05), no effect for the African-American group (B=.20, p > .05) and both a direct (B=.26, p < .05) and a partial mediation effect (B= -.11, p < .05) of spirituality for the Latino group.

Conclusions and Implications: This study suggests: 1) the constructs in Pearlin et al.'s model are useful in explaining PAC for Caucasian, African American, and Latino caregivers and 2) spirituality plays a positive role in facilitating PAC among Caucasian and Latino caregivers, but not among African American caregivers. Although further research is needed with African American caregivers, the results suggest that spirituality is a strength that can be utilized to help frame the caregiving experience more positively. Social work practitioners might be trained in the process of conducting spiritual assessments. Such assessments can, for example, help identify barriers that inhibit caregivers from operationalizing their spiritual strengths.