Comparison of African American and Caucasian caregiver self-efficacy

Author(s): Easom, L., Cotter, E., and Ramos, A.

Published In: . J of Gerontological Nursing, 44 (3): 16-20

Study Aim/Purpose:
This study examined the self-efficacy impacts of an intervention targeted to caregivers of individuals with Alzheimer’s diseases, with a specific focus on differences in effects on African American versus Caucasian caregivers.

Summary of Methods:
This study evaluated the Resources for Enhancing Alzheimer’s Caregiver Health (REACH II) intervention, using a pre/post quasi experimental design with a sample of 123 caregivers (54 percent African Americans and 40 percent Caucasian) who lived with or were responsible for daily meal preparation for an individual with Alzheimer’s disease or related dementia. To be eligible, caregivers of individuals with Alzheimer’s or dementia also had to verbally express that their care recipient had memory problems, provide at least 4 hours of care per day, and rate themselves as having stress at a level of 5 or greater on a scale of 1 to 10. Study participants completed nine in-home sessions and three caregiving coach telephone conversations of 12 REACH II sessions over six months and completed a survey at the first and last home visit. Statistical analysis measured the effects of the intervention on caregivers’ self-efficacy, measured using the 15-item checklist known as the Revised Scale for Caregiving Self-Efficacy. Subscales for self-efficacy included (1) obtaining respite, (2) response to disruptive behaviors, and (3) controlling their upsetting thoughts about caregiving.

Summary of Results:
Statistical analyses of racial differences found that both African-American and Caucasian caregivers showed significant and comparable magnitudes of improvement in overall selfefficacy and in all the subscales, which contradicted the authors initial hypothesis. Another interesting finding was that African American caregivers both started and finished with higher levels of self-efficacy than Caucasian caregivers and this was consistent for all subscales measured.

Study Limitations (as cited by authors):
The authors noted that the study sample size and limited geographic area may limit the generalizability of findings. Additionally, they acknowledged that because the caregiver race groups were not matched for severity of the care recipient’s dementia severity this may have caused bias.

Authors’ Discussion/Conclusions:
Recognizing that African American individuals have not in the past been adequately included in health care research samples, the authors recommend follow-up research to examine whether their results represent an anomaly unique to the current sample or more generalizable racial differences that can help guide culturally responsive programming for caregivers. They recommend that future studies include more racially diverse populations and be designed to determine which individual or combined components of caregiver support programming like REACH II are effective in encouraging caregivers to seek respite.