The Role of Caregiver Self-Efficacy in the Caregiving Stress Process Among Caregivers of Older Korean Americans with Dementia

Background & Purpose:Caregiver burden significantly influences well-being of caregivers, and their sense of efficacy may play an important role in this process.  According to the self-efficacy theory, stresses elicit emotional arousal which influences one’s sense of efficacy in coping with the stressor.  Self-efficacy (i.e. confidence in one’s ability) in managing caregiving may affect the psychological health of caregivers.  Despite increasing numbers of ethnic minority older adults, there is a dearth of research that examines caregiver self-efficacy effects on the care giving experience of ethnic minorities.  Addressing this gap, we examined how caregiver self-efficacy and acculturative background affect caregiving among caregivers of older Korean Americans (KAs) with dementia.  We examined the following: (1) whether caregiver self-efficacy mediates the relationship of caregiver burden and depressive symptoms; and (2) whether the relationships between caregiver burden, self-efficacy, and depressive symptoms are moderated by acculturative background.    

Methods: Using data from a cross-sectional survey of family caregivers of older KAs, we examined a sample of caregivers who were 18 years or older, and providing care for an elderly Korean relative (age 60 or older) with dementia (N = 123).  Linear regression based mediation and moderation models were used to estimate a simple mediation model and a moderated mediation model.  Confidence intervals were estimated using bootstrapping.  Controlling for the gender and relationship (spouse/non-spouse), we examined the mediating effect of caregiver self-efficacy on the effect of caregiver burden on depressive symptoms.  We then added an acculturative context variable (an index measure based on English proficiency, age at immigration, and the county of highest educational attainment) and examined its moderating effects on the relationships between burden, caregiver self-efficacy, and depressive symptoms.  

Results: The majority of caregivers were female (81%) with a mean age of 59.3 (SD = 12.2). About half of them were adult children and one-third spouses, providing care for their older family member for an average of 6 years. Fifty-nine percent of the caregivers displayed depressive symptomatology as measured by the CES-D (cut-off score 16). In a mediation model, there was a direct effect of burden on depression (b=.350; p=.003) as well as a significant indirect effect (b=.170; p=.005) through self-efficacy. Testing for moderation, we found that acculturative context had no moderating effect on the relationships between burden and self-efficacy or between burden and depression, but had a significant direct effect on the level of caregiver self-efficacy (greater acculturative context was associated with higher self-efficacy).  

Conclusions & Implications: Findings suggest that self-efficacy mediates the relationship of burden and depressive symptoms among KA dementia caregivers; caregivers’ sense of self-efficacy may protect against the adverse effect of caregiver burden on their depressive symptoms.  The direct effect of acculturative background on self-efficacy points to the important role of acculturative context in the development of KA caregivers’ confidence as caregivers.  Dementia caregiver interventions targeted at this ethnic minority group may benefit from including a component designed to increase caregivers’ self-efficacy. Such interventions should also take acculturative background context of caregivers in consideration in the program delivery.