Negative and depressive outcomes of caregivers in the United States has dominated academic domains in the social, behavioral, and gerontological literature. This dissertation enhances the literature on caregiver well-being by focusing particularly on the more positive outcomes and on the differences between White and African American caregivers in the United States. The ABC-X model of family stress was used as a framework, along with family systems theory, to determine whether within the context of race, levels of caregiving stress and strain, levels of formal and informal coping resources, and manageability/mastery could be integrated to predict well-being for caregivers. Predictor variables such as, intensity of care demands (stress), formal and informal coping support use, and manageability/mastery of unmet needs were used to determine if there were differences between Whites and African Americans.
To examine the research question, a secondary analysis was performed using data from the National Alliance for Caregiving and the American Association of Retired Persons (NAC & AARP, 2003). The final dataset which focused on White and African American caregivers consisted of 828 individuals and key questions from the original survey that addressed the hypothesis and research question. Variables of interest were constructed, using items measuring the constructs: intensity of care demands (stress), formal coping resources use, informal coping resource use, manageability/mastery, and well-being. Race was also included in the model as a control variable. The analysis was conducted using structural equation modeling (SEM) with AMOS 7.0 software.
Analysis of variance (ANOVA) revealed no mean difference on scores between White and African American caregivers on well-being or on informal coping resource use. However, significant mean differences existed for intensity of care demands (stress), formal coping resource use, and manageability/mastery. Results from this analysis showed that African American caregivers had higher mean scores on intensity of care demands (stress), used more formal coping resources, and experienced lowered manageability/mastery as indicated by more unmet needs in the care situation. Separate path analyses were performed to test for the influences of predictor variables in the model on the outcome variable as well as a comparison model of the critical ratio differences between White and African Americans. The variables predicting well-being were intensity of care demands (stress), formal coping resource use, informal coping resources use, and manageability/mastery. The findings revealed that intensity of care demands (stress) was significantly related to well-being, along with manageability/mastery and informal coping resource use. Only formal coping resource use had no direct relationship to well-being. Additionally, there were some indirect relationships to well-being as mediated through formal coping resource use, informal coping resources use, and manageability/mastery. Race was a moderating variable in the model and revealed no significant relationship with well-being. However, African Americans were more likely to use formal coping resources and had a sense of manageability/mastery in the caregiving role. There also existed a significant correlation between formal and informal coping resources use in the model. Overall, this model fit well with the observed data and thus supported the research question for this study that levels of caregiving stress and strain, levels of formal and informal coping resources, and manageability/mastery can be integrated to predict well-being for caregivers. Further, this model explained 34% of the variance in well-being. Finally a comparison model of White and African American caregivers indicated only one significant predictor on well-being which consisted of the direct effect of intensity of care demands (stress) on well-being, indicating that White caregivers experienced more stress in the care role when compared to African Americans.
Several implications were identified regarding methodology, research, and practice. First, the ABC-X model was a useful tool for studying the stress process and predicting the relationships of certain causal factors on well-being but had limitations when it came to the diverse challenges often faced by caregivers in the care role especially racial/ethnic minorities. Second, more research is needed that focus on difference and similarities among White and African American caregivers that are done on larger samples and are longitudinal in nature. Third, an effort must be made to move from theory to practice in the field with caregiving families, as well as with public policy that address the changing demands required in caregiving considering our aging and increasingly chronically ill/disabled population. Although this study had limitations relative to the use of cross-sectional secondary data, it indicated positive and negative well-being can co-occur and that the degree to which people appraise caregiving as positive or negative may require specific measures or a variety of measures to determine the true impact of stressors, coping resources, and appraisals/perceptions on the well-being of caregiving families in general and racially diverse caregiving families in specific. (Abstract shortened by UMI.)