Culturally Unique Yet Universally Applicable: The Psychological Adjustment Process of Vietnamese Family Caregivers to Their Caregiving Role for Their Relatives with Dementia

Background and Purpose: Vietnam is one of the fastest aging countries in the world. The percentage of people over the age of 60 are predicted to increase from 10.5% of the total population in 2014 to 30.8% in 2050. The burden of providing healthcare for people with chronic diseases, including dementia, is therefore projected to increase. In Vietnam, taking care of older relatives with dementia is carried out mostly by family members who reported multiple caregiving burdens with very limited social support. However, it remains unknown how they psychologically adjust to their caregiving role in dementia care. This study explores the psychological process through which Vietnamese family caregivers adjust to their role as primary caregivers for their relatives with dementia.

Methods: This study adopted a constructivist grounded theory approach to collect data with 20 self-identified primary caregivers of older adults with dementia from a geriatric hospital in Vietnam. Two-thirds of the participants were female, spousal caregivers, living in urban area, and retired. Their average age was 61 (SD = 12.7), and their highest educational obtainment varied from primary school to college. Thirty face-to-face, semi-structured interviews, including 10 follow-up interviews, were conducted in Vietnamese. All participants signed the informed consent before their first interviews and approved audio recording of the interviews, which were then transcribed verbatim for data analysis using MaxQDA12. Data analysis, which followed the three-phase coding procedure (initial-, focused-, and theoretical coding), was conducted iteratively with data collection.

Results: The data reveals a model that explains the psychological process through which Vietnamese family caregivers went through to adjust to their caregiving role. The core adjustment process emerged as an iterative cycle of four stages: (1) Experience of the symptoms and hands-on caregiving activities; (2) Acknowledgement of hardship and changes of the self in caregiving; (3) Experiment with strategies for providing care to the relative and strategies for self-care; and (4) Acceptance of the caregiving situation and role. This process highlights the importance of self-concept, self-identity, and self-acceptance of caregivers, and referred to their adaptation to the development of ‘the self’ in caregiving. The core process was in the transactional relationship with caregiver personal factors (demographic and relationship characteristics with care recipients; personal beliefs and commitments in caregiving; and personal history of caregiving and coping with past adversity) and structural factors (cultural values and norms; social support; and social pressure). The two-level factors interacted with each other to impact the psychological adjustment process of Vietnamese family caregivers.

Conclusions and Implications: Study results imply the need for further studies on the adaptation of Vietnamese family caregivers in dementia care, as well as advocacy for the development of strength-based interventions and social services for this group in their own sociocultural context. Results also call for the involvement of social workers in the hospital setting to provide tailored services and interventions for family caregivers to support them in their role transition and adjustment.