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Abstract

This article describes thematic findings that emerged from an in-depth analysis of interview data collected from 44 informal caregivers in East Los Angeles, California. The research question addressed in this paper is “How do Mexican-origin women describe becoming oriented to or familiarized with the caregiving role and its associated responsibilities?” A cultural psychological perspective guided the study, which used a thematic analysis approach. Two main themes emerged from the data: (a) caregiving comes from within, and (b) caregiving is cultivated through early and continuous informal socialization. Women viewed caregiving as something that was unique to their character. Some women described having a natural ability or affinity for caregiving, and others described internal motivations for becoming caregivers. Adoption of the caregiver role occurred over time, often over the course of many years. The socialization process was gendered such that modeling behaviors and care expectations were directed at women in the family rather than men. Our findings suggest that the transition into the caregiving role is a complex process that can vary considerably across family and cultural contexts. The nature of caregiving motives and the timing of caregivers’ socialization to the caregiving role have implications for the caregiving experience and caregiver outcomes.

Keywords

informal caregiving caregiving motives Mexican cultural psychological perspective qualitative methods

Approximately 7.6 million Latino adults in the United States provide daily, informal care—defined as the physical, emotional, and financial support provided to ill, injured, or disabled individuals by unpaid and untrained individuals—to an adult, age 50 or older (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995; National Alliance for Caregiving & AARP Public Policy Institute, 2015). The number of Latino adults enlisted to provide informal, elder care will likely increase in the future because the Latino population, age 65 and older, is projected to become the largest racial/ethnic minority in this age group by 2060 (Federal Interagency Forum on Aging-Related Statistics, 2016). Furthermore, Latino caregivers, relative to other racial/ethnic minority groups, tend to underutilize formal care services (Gallagher-Thompson, Solano, Coon, & Arean, 2003; Hinton & Levkoff, 1999) and tend to delay the institutionalization of elders (Mausbach et al., 2004). This research reflects the important role families play in the provision of elder care in Latino populations, among other populations.

Relatively few studies have examined Latina caregivers’ processes of orientation to, or familiarization with, the caregiving role and its associated responsibilities (Flores, Hinton, Barker, Franz, & Velasquez, 2009; Gelman, 2014; Mendez-Luck, Geldhof, et al., 2016). As a result, relatively little is known about how Latina caregivers’ cultural knowledge and cultural context influence their caregiving motives and their orientation to caregiving behaviors and beliefs. Furthermore, because most research on caregiving in Latino families is not disaggregated by the Latino subgroup, even less is known about caregiving contexts and experiences within particular Latino subgroups. In an effort to address these gaps in the literature, we undertook the present qualitative study to examine the manners in which Mexican-origin caregivers become oriented to the caregiving role. In this article, we describe the views on caregiving motives and origins among a sample of Mexican-origin women currently providing care to an older adult relative.

Context of Care

The context of care is an important influence with respect to caregivers’ experiences and appraisals of caregiving. For example, in their meta-analysis of 116 empirical studies, Pinquart and Sörensen (2005) found that ethnic minority caregivers were younger, of a lower socioeconomic status, provided more care, and had stronger beliefs regarding filial obligation relative to their White caregiving counterparts. Latino caregivers, like their non-Hispanic White counterparts, have been found to be predominantly female and, on average, younger than non-Latino caregivers (Evercare & National Alliance for Caregiving, 2008). The majority of Latino caregivers (84%) provide care to a relative, and approximately 75% of Latino caregivers live with, or within 20 min of, their care recipient (Evercare & National Alliance for Caregiving, 2008). In addition, Latino caregivers tend to be in more burdensome or intense caregiving situations than their non-Latino caregiving counterparts (63% and 51%, respectively; Evercare & National Alliance for Caregiving, 2008). In their study evaluating informal care and its determinants for Latinos, Weiss, González, Kabeto, and Langa (2005) found that Latino care recipients receive more hours of informal care for functional limitations and disability than their non-Latino White and African American counterparts. This finding is supported by Evercare and the National Alliance for Caregiving (2008) who also reported that Latino caregivers tend to provide care for more hours per week and tend to assist their care recipient with a greater number of activities of daily living (ADLs) than other non-Latino caregivers (Evercare & National Alliance for Caregiving, 2008).

Motives for Providing Care

Feeney and Collins (2003) assert that in order for caregiving to be effective, caregivers must be motivated to accept the role of caregiver and its associated responsibilities. Caregiving motives are defined as the meanings that direct particular caregiving-related behaviors or actions (Dilworth-Anderson et al., 2005; Ryan & Deci, 2000). Individuals’ caregiving motives may vary in terms of intensity, with some individuals being more or less motivated to provide care than others (Ryan & Deci, 2000). Motives for the provision of care also vary in terms of type, with the categories intrinsic motives and extrinsic motives used frequently in the caregiving literature (e.g., Lyonette & Yardley, 2003; Quinn, Clare, McGuinness, & Woods, 2012; Romero-Moreno, Marquez-Gonzalez, Losada, & Lopez, 2011). Intrinsic motives refer to caregiving inspired by an inherent, internalized drive to provide care, while extrinsic motives refer to caregiving inspired by external pressures and imposed social values (Quinn et al., 2012; Romero-Moreno et al., 2011).

A number of studies have examined caregiving motives and the influence of caregiving motives on a range of caregiving outcomes (e.g., caregiving behaviors, caregiver well-being, caregiver competence). Feeney and Collins (2003), for example, identified motives for providing care and not providing care to a partner and also identified some of the predictors and outcomes associated with those motives. The authors identified seven factors that they conceptualized as either altruistic motives, egoistic motives, or a combination of altruistic and egoistic motives. Love and concern was the only identified caregiving motive to be classified as purely altruistic while caregiver enjoyment of helping was considered to be a mixture of both altruistic and egoistic motives. According to the authors, the remaining five factors—caregiver feeling capable (i.e., possessing the skills needed to provide care), relationship motives (e.g., commitment), feelings of obligation, perception of the partner as being needy and incapable, and expects to receive some self-benefit—reflected egoistic motives. With respect to motives for not providing care, the authors identified the following: perceived lack of skills, dislike of (care recipient) distress, perceived lack of resources (e.g., time), lack of concern and responsibility, difficult to help and unappreciative of helping efforts, partner is too dependent, and (perception of the) partner as capable of handling the situation on their own.

Feeney and Collins (2003) also found that certain caregiving motives were associated with features of the caregiver, the caregiver-care recipient relationship, and caregiving patterns. For example, associations were observed between relatively egoistic motives and caregivers with an insecure attachment style, low self-esteem, depression, and an unsupportive relationship history with the care recipient. The authors found that caregivers who reported high levels of relationship satisfaction and trust cited more altruistic and less egoistic motivations for helping their care recipients. Finally, the authors found that caregiving motives were differentially associated with three different types of caregiving behavior: responsive caregiving, overinvolved caregiving, and controlling caregiving. Caregivers categorized as more responsive were those who reported helping their care recipients for relatively altruistic reasons, whereas less responsive and more overinvolved and controlling caregivers were those who reported helping for relatively egoistic reasons.

In addition, empirical evidence suggests that culture has the potential to influence caregivers’ motives to provide care, although additional research in this area is needed. In their mixed-method study examining caregiving motives in American and Greek female spousal caregivers, Kabitsi and Powers (2002) found both differences and similarities with respect to spousal caregiving motives between Greek caregivers and American caregivers. Greek caregivers and American caregivers were similar with respect to caregiving motives related to love and marital commitment and in the extent to which they engaged in self-sacrificing behaviors for the benefit of their spouse. With respect to motive-related dissimilarities, the authors found that financial reasons to give care were frequently reported by American caregivers whereas not cited at all by Greek caregivers. Furthermore, Greek caregivers, relative to American caregivers, reported being significantly more motivated to give care by their desire to maintain family harmony. Greek caregivers also reported wanting to please their spouses, their lack of support of care recipient institutionalization, and their belief that they had the ability to “provide the best possible care” as central motives to give care. Taken together, the motives reported by Greek caregivers aligned strongly with the cultural focus on the family within Greek culture and with the more traditional Greek cultural values of female subordinance to, and dependency on, male spouses.

In their study, Lee and Sung (1997) examined and compared the caregiving motives of American and Korean caregivers providing care to a parent with dementia. The authors found differences in terms of the cultural norms and values tied to caregiving motives between the two groups. More specifically, the authors found that relative to the American caregivers, Korean caregivers had significantly higher filial obligation scores and significantly lower affection scores. For Korean caregivers, parental caregiving was strongly motivated by a sense of filial responsibility, even in the context of low quality caregiver–care recipient relationships. American caregivers, in contrast, were strongly motivated by the nature of their relationship to the care recipient, with relational affection, rather than filial obligation, serving as a strong caregiving motive. The authors assert that cultural values instilled in Americans, such as the American cultural emphasis on “independent choice,” may have contributed to American caregivers’ relatively low sense of filial obligation. Similarly, the authors assert that the filial piety-related socialization of Korean individuals, from childhood on, likely serves to instill attitudes that support the provision of care for familial elders, particularly parents and parents-in-law.

When taken together, this body of research indicates that caregiving motives are influenced by culture and have the potential to profoundly influence the caregiving experience. More specifically, existing literature suggests that extrinsic and egoistic caregiving motives may have a negative influence on caregiver well-being and may contribute to the enactment of less responsive and more controlling caregiving behaviors, while intrinsic and altruistic motives may contribute to greater caregiving satisfaction and more effective caregiving-related coping.

Cultural Psychological Perspective

A number of tenets of the cultural psychological perspective provide useful insight into the manners in which Mexican-origin caregivers may form their understandings and interpretations of their caregiving experiences. Shweder and colleagues (2006) describe the cultural psychology of development as a discipline that focuses on the manners in which culture and psyche continuously “make one another up.” Cultural psychologists argue that because of the interconnected nature of culture and psyche, an individual’s values, norms, beliefs, and practices can only be understood through in-depth investigations of the surrounding contexts, whereby contexts are conceptualized as part of the psychological system, not simply as factors or conditions external to the individual (Shweder et al., 2006). This suggests then that to truly understand Mexican-origin caregivers’ conceptualizations and enactments of caregiving, the cultural values, beliefs, norms, goals, and practices specific to the Mexican-origin community must also be understood.

Shweder and colleagues (2006) describe culture as comprising two forms of mutually influential inheritances. Symbolic inheritance is described as the ideas and understandings regarding individuals, society, nature, and the metaphysical that an individual receives from their community, both implicitly and explicitly. This form of cultural inheritance is reflected in the meanings community members assign to their roles and experiences as a result of belonging to and participating in their community. The other component of culture, behavioral inheritance, is defined as the routine or institutionalized family life and social practices of a particular cultural community. This form of cultural inheritance asserts that individuals behave and act according to what is deemed true, good, and normal by their particular cultural community (Shweder et al., 2006).

According to the cultural psychological perspective, one potential explanation for the finding that Latina daughters and daughters-in-law tend to adopt the caregiving role and practices in their families (e.g., Harwood et al., 2000) may lie in the Latino culture’s symbolic inheritance. For example, within Latino culture, there is an expectation that female members of a family should consider their own wants, desires, and needs as secondary to the needs of the family, particularly the male members of the family (García & De Oliveira, 1997; Hubbell, 1993). This cultural expectation, referred to as marianismo, has been theorized to encourage certain culturally accepted manners of being while discouraging others (Mendez-Luck & Anthony, 2016; Mendez-Luck, Applewhite, Lara, & Toyokawa, 2016; Mendez-Luck, Kennedy, & Wallace, 2008, 2009).

The cultural value of familism, the allegiance, attachment, dedication, reciprocity, and solidarity within the family (Ruiz & Ransford, 2012), may also serve to support certain enactments of care and caregiving orientations while discouraging others. Research on Mexican American caregivers of cancer patients has found that cultural values influence the provision of care and caregivers’ perceived quality of life (Juarez, Branin, & Rosales, 2015). This symbolic inheritance may be reflected in Latino families’ tendency to hold the expectation that in addition to providing for the care recipient’s instrumental needs, the caregiver should also provide the care recipient with emotional support (Valle, 1989; Wells, Cagle, & Bradley, 2006). The symbolic inheritance may also be reflected in the finding that compared with their non-Latino White counterparts, Latino caregivers tend to delay their use of formal caregiving services (e.g., long-term living facilities; Gallagher-Thompson et al., 2003; Hinton & Levkoff, 1999; Min & Barrio, 2009). It could be that the Latino cultural values of loyalty to and responsibility for the family lead to higher expectations in terms of familial care in times of need, thereby discouraging the use of formal care services.

In sum, informal caregivers are thought to develop a sense of their cultural communities’ expectations regarding the provision of familial care through continuous processes of socialization. It is through this process of socialization that they are taught the values and behaviors associated with giving care deemed acceptable by their cultural community. Caregiving socialization is performed explicitly and implicitly, with caregiving-related symbolic inheritances transferred symbolically, through discussion of the meaning and significance of giving care to familial elders, and caregiving-related behavioral inheritances transferred overtly, through role modeling and through early experiences giving care (Ayalong, 2004). Caregivers then think and give care in certain ways, in the light of their particular cultural community’s goals, values, and understandings of the world.

Method

Study Design

The present study utilized interview data from a larger study conducted by the second author. The development of the larger study was guided by a social constructionist framework, which was used to understand the lived experiences of Mexican-origin caregiving women living in East Los Angeles, California. The social constructionist framework uses hermeneutic approaches of interpretation and originates from the micro-level analytic traditions of symbolic interactionism and phenomenology (Creswell & Poth, 2018). The larger study is described in detail in Mendez-Luck, Applewhite, and colleagues (2016). The selection criteria included the following: (a) female, (b) at least 18 years of age, (c) of Mexican descent, (d) a resident of the greater East Los Angeles metropolitan area, and (e) responsible for the day-to-day care of a dependent, elderly relative. “Dependent” was defined as an individual who needed help with one or more ADLs (Katz, 1983) or instrumental activities of daily living (IADLs; Lawton & Brody, 1969). ADLs and IADLs have been used in many empirical studies to aid in the assessment of the extent of care recipients’ caregiving needs (i.e., care recipients’ functional status) and to aid in the assessment of the burden experienced by informal caregivers (Deeken, Taylor, Mangan, Yabroff, & Ingham, 2003).

The research team, comprising the second author and three native-speaking research assistants, spent a considerable amount of time establishing a presence and developing trust in the community. More than 63 visits to the community were documented for the first 35 interviews, for a total of 318 hr, not including the time spent conducting interviews. Multiple approaches were utilized to recruit study participants, including flyers, person-to-person recruitment at health fairs, direct referrals from community partners, recruitment events hosted by community-based organizations, and snowball sampling and purposive sampling. Additional information regarding the recruitment strategies utilized for the larger study is described in Mendez-Luck et al. (2011).

Sample

The sample consisted of 44 Mexican-origin female caregivers. Twenty-six participants were born in Mexico, and 18 participants were born in the United States. Table 1 describes the characteristics of the study sample. The average age of participants was 53 years, with participants’ ages ranging from 23 to 89 years. The mean educational attainment of participants was 10 years; however, the educational attainment of the sample ranged considerably, from 0 to 21 years of education. The majority of participants were long-time residents of their East Los Angeles neighborhoods. At the time of their interviews, 30 participants had been living in East Los Angeles, and 14 had been living in communities adjacent to East Los Angeles. The household monthly income of participants ranged from US$700 to US$5,400, and the median household monthly income of the sample was US$1,630. The vast majority of participants (84%) did not work outside of the home.

Table 1.

Sample (Caregiver) Characteristics (N = 44).

Characteristic	M	Range	n	%
Age (years)	52.6	23-89
Education (years)	10	0-21
U.S. born			18	40.9
Employed outside of the home			8	18.2
Years providing care	8.3	67-62

Table 2 describes the contexts of care for the sample. At the time of their interviews, 12 of the 44 participants were giving care to their husbands, and the remaining 32 participants were providing care to a nonspousal relative, such as a parent, parent-in-law, or grandparent. Care recipients’ ages ranged from 55 to 93 years of age, with an average care recipient age of 73 years. The health conditions of care recipients varied widely. While some caregivers reported that their care recipients were completely free of illness, others reported that their care recipients were suffering from severe health conditions, such as cancer and congestive heart failure. The most frequently reported health conditions of care recipients were diabetes, dementia, and physical impairments that compromised care recipients’ mobility (e.g., foot pain).

Table 2.

Characteristics of Care Recipients and the Caregiving Context (N = 44).

	M	Median	Range	n	%
Care recipient age (years)	73.4		55-93
Care recipient relationship to caregiver
Parent				23	52.3
Husband				12	27.3
Other				7	15.9
Mother-in-law				2	4.5
Caregiver and care recipient share household				35	79.5
Household monthly income (U.S. dollars)		1,630	700-5,400

Materials and Data Collection

The Institutional Review Board of Oregon State University approved all study protocols and materials. The study involved one-time, semistructured interviews with the Mexican-origin, female caregivers. This technique for collecting data has been described as particularly useful for gathering in-depth data on the lived experiences of individuals and on the meaning individuals attach to those lived experiences (Adams, 2010). The interview guide covered the following topic areas: the story of becoming a caregiver; the conditions and activities of caring; the feelings and beliefs about being a caregiver; caregiving, economic, and social trends; and social and cultural beliefs about the elderly. Interview guide questions included, “Why were you chosen [to give care] instead of other members of your family?” and “Can you tell me what things you do to help your relative?” The interview guide primarily comprised open-ended interview questions and probes that were designed to simultaneously encourage participants to talk in depth about their experiences giving care while creating opportunities for the interviews to go in unforeseen, although meaningful, directions.

The interviews were conducted by members of the research team knowledgeable about the population and trained in qualitative interviewing methods. Interviews were conducted in the preferred language of the participant, with 19 interviews conducted in English and 25 interviews in Spanish. Interviews were held in a location of the participant’s choice and lasted 84 min, on average. Interviews were audio-recorded and subsequently transcribed in the language of the interview (i.e., English or Spanish).

Data Analysis

The interview transcripts, interviewer notes, and postinterview memos comprised the data analyzed for the present study. These multiple sources of data allowed the research team to triangulate their findings on the processes of orientation to the caregiver role and caregiving motives. Atlas.ti (Friese, 2012) was used to organize and manage the data. The first author analyzed the data in the original language of the interview, either English or Spanish.

The main research question in this study was as follows:

Research Question 1: How do Mexican-origin women become oriented to or familiarized with the caregiving role and its associated responsibilities?

The cultural psychological perspective served as the guiding theoretical framework for the analysis. Specifically, the first author approached the analysis by examining the symbolic and behavioral inheritances of caregiver role orientation in women’s discussions of their lived experiences as caregivers.

The first author examined the data repeatedly, using a thematic analysis approach (Braun & Clarke, 2006; Longhofer, Floersch, & Hoy, 2013). The first examination of the data consisted of the line-by-line, open coding of each transcript. A reflective memo was drafted every 10 transcripts to document interpretations, impressions, and ideas related to the cultural inheritance of caregiving. A summative memo was drafted after examining all 44 transcripts to identify, discuss, and reach agreement on emerging constructs and coding. The process of memo writing addresses the important issue of reflexivity in a thematic analysis approach (Braun & Clarke, 2006; Creswell & Miller, 2000; Morrow, 2006). The second examination of the data involved a review of all the coded text. More reflective memos were drafted to document emerging themes. Codes were then combined to build thematic content.

The first and second authors met to discuss the coding and memos during and after each pass of the data. The second author randomly reviewed 50% of the first author’s work as a validation check. We continued this iterative process until we reached consensus on the final themes.

Results

Two overarching themes emerged from our in-depth analysis of the data: caregiving comes from within, and caregiving is cultivated through early and continuous socialization. These themes are described below in detail.

Caregiving Comes From Within

The first theme that emerged from our analysis referred to women’s innate characteristics that prompted them to become caregivers. This theme had two domains: inherent caregiving ability and intrinsic caregiving motives.

Inherent caregiving ability

Many women described having an inherent ability to provide care that involved more than simply a set of skills or functions one was trained to do. These women believed they had a natural affinity for caregiving that emerged at some point in their lives. In some cases, caregiving unfolded over the course of their lives, with care-related responsibilities increasing gradually over time. A few caregivers expressed that they had always served as their family’s primary caregiver.

Diana was 51 years old and cared for her 87-year-old grandmother. She reported that her sense of caregiving-related responsibility came from within her, stating, “That’s just the way I am, I guess. I don’t know. I just take care of her.” Similarly, Lupe had been caring for her 84-year-old mother for 1.5 years at the time of the interview. When asked how she learned to care for her mother, the 66-year-old responded,

. . . one isn’t taught that, my girl, that [ability] comes from your heart, you will never learn that, I tell you that from experience and from my 66 years, no one will teach you to care for [or] love people, [it’s up to] you alone.

Carmen shared a similar viewpoint to Diana and Lupe. The 31-year-old woman, who had been caring for her 62-year-old mother for 5 years at the time of the interview, shared, “I always helped my mom around the house, but lately I have to do a little bit more.”

Intrinsic caregiving motives

Some of the caregivers in the sample reported freely adopting the caregiver role, emphasizing that, for them, the provision of care was an autonomous choice rather than a choice driven by social and/or obligation-based norms and expectations. For example, in discussing her role as her mother’s caregiver, 33-year-old Margarita shared, “I’m doing it because I want to. I want to be here with her.” Similarly, Lucy, a 57-year-old caring for her mother stated, “No, I don’t have to take care [of her]. I could choose not to. You know I don’t have to and so that’s why it’s not an obligation . . . I want to do it.” Finally, Alejandra, a 55-year-old woman caring for her father, shared, “I’m doing it because he’s my father and I love him and I will do all what I can to take care of him at home.”

Some caregivers described their motivation to provide care as emanating from a personal desire to maintain or strengthen their relationship with the care recipient. These caregivers viewed the caregiving role as an opportunity to fulfill their genuine desire to express love, care, and compassion to their family members and to ensure that their family members did not feel alone or abandoned. For example, 69-year-old Marta had a history of caregiving with her parents and at the time of the interview, she was caring for her 73-year-old sister. She shared, “I wanted them to feel, the person that I was taking care of, I wanted them to feel the love.” Similarly, when asked what she liked most about caring for her mother, another participant responded,

. . . telling her often how much I love her, how very happy I am that she’s in my life. Like I give her a hug, whenever I feel like it. I give her a hug and that’s it. You know, that’s what I like about it [caregiving], that I get to show my affections towards my mom.

Some caregivers described the provision of care as providing them with a sense of utility and a sense of meaningful contribution to the care recipient and to the broader family. These women described caregiving as a manner of fulfilling their desire to “repay” their parents or other family members for past nurturance and care. When asked what she liked most about caregiving, Alma, a 26-year-old caring for her 62-year-old mother, stated,

Just helping her out, to clean and knowing that I’m doing something for her like she’s tooken [sic] care of me all of my years, like sort of like giving back what she gave to me.

Many others echoed this sentiment, including Paz, a 71-year-old woman who had been caring for her 92-year-old mother for 2 years at the time of the interview. Paz shared,

So, to me, it’s not a duty. It’s . . . she’s my mother. I just do it . . . it’s like she did it for us. I mean, it wasn’t my mother’s duty. She did it because she loved us. You know what I mean? We were her children. She taught us how to walk, how to talk.

Another woman, Paula, who was caring for her mother with diabetes, believed that caring for an ailing parent is part of being a good child. She shared,

Well, I think because we are their children, we have to take responsibility for them. Like they gave their lives for us and all, brought us up as children. Now, we have to keep an eye out for them.

These excerpts illustrated that caregiving for many women was an endeavor that emanated from within themselves. While some women described having a natural ability or affinity for caregiving, others described internal motivations for becoming caregivers. In either case, women viewed caregiving as something that was unique to their character.

Caregiving Is Cultivated Through Early and Continuous Informal Socialization

The second overarching theme that emerged from our analysis was the informal process of familiarization and adoption of the caregiving role over time, often over the course of many years. This theme reflected a fostering of caregiving through cultural and familial socialization. This fostering was accomplished through exposure from other caregivers and active hands-on experiences. Moreover, the socialization process was gendered such that the modeling and expectations of care behaviors were most frequently directed at women rather than men in the family; wives, eldest adult daughters, and adult daughters who were unmarried or childless were the primary targets of the socialization process.

Fostering of caregiving through exposure

The majority of women reported receiving little to no formal preparation or training for the caregiving role, such as ADL assistance training or first-aid training. Instead, consistent with the cultural psychological perspective (Shweder et al., 2006), women were socialized by both their immediate and extended families to adopt the behavioral and symbolic inheritances of their cultural community, as it related to caregiving. Women were exposed to the practice of giving care early on in their lives, often years before their actual adoption of the role. In this regard, “caring” was a learned process from continued observation of close relatives’ caregiving behaviors and skills over the span of years. Most of these women reported having observed their mothers modeling caregiving behaviors toward elderly relatives; some reported having also observed aunts and grandmothers in caregiving roles. For example, Esmeralda, a 59-year-old woman caring for her 73-year-old husband with multiple ailments, including dementia, Parkinson’s disease, and vision and hearing impairments, shared that in her family, the caregiving role had been passed from female relative to female relative. She shared,

I always saw the way my grandmother took care of my uncles and my aunts. And the way my mom . . . my mom ended up . . . So I’ve always seen the way mothers, the females take care of the family. . . So I could see a lot of the nurturing was done by my mom and my grandma. So it has carried down.

On the other hand, male relatives were not described as having modeled caregiving-related behaviors or as having instilled care-related values. Instead, male family members, when present, were described as contributing to the family through employment and financial contributions rather than hands-on caregiving.

Other women were socialized from listening to family members’ own accounts of previous caregiving experiences. Jany, a 50-year-old woman caring for her 93-year-old mother with dementia and diabetes, shared,

I did hear it from a very early age of how my father took care of his mom and dad, how he would hand over everything [money] he had to his mom and dad, and he would only keep a little bit. I mean, he wasn’t telling me that that’s what I had to do, but I got that message.

Fostering of caregiving through active participation

Some women also became oriented to the caregiving role by actively participating in general family caretaking activities early on in their lives. For example, women reported taking care of siblings and cousins, preparing family meals, and maintaining the family home in late childhood, adolescence, and adulthood. In addition, women shared that their female relatives (e.g., mothers, grandmothers) encouraged their participation in these kinds of family activities, which exposed them to the caregiver role at an early age. For example, Laura, an 83-year-old woman caring for her husband, a man living with both dementia and diabetes, reported that her family openly expressed their caregiving-related expectations. She stated,

I was raised—I’m the oldest of a family of 10—therefore, I knew what we were brought up to do, what our obligations were, and that was taking care, cooking, cleaning, so it’s something that comes natural . . . Being the oldest, I had to see that things were done, the responsibility, and I was the first one to drive; therefore, the responsibility of taking mother to her doctor . . . I think I was brought up with responsibilities.

Discussion

In this study, we used the cultural psychological perspective as a frame for understanding how Mexican-origin caregivers become oriented to the caregiving role and the motives that underlie their adoption of the role. Our thematic analysis yielded two main themes with respect to becoming a caregiver—Caregiving comes from within, and caregiving is a process of early and continuous socialization. Many aspects of the cultural psychological perspective were supported in this analysis, including the centrality of context, the cultural community’s ability to influence an individual’s developmental pathway, and the manners in which behavioral and symbolic inheritances of a cultural community are received and transmitted across generations. For example, the process of caregiving socialization described by many of the women is consistent with the cultural psychological perspective, which asserts that cultural expectations and responsibilities are learned through continuous socialization. In addition, women’s descriptions of the familial and cultural influences contributing to their understanding and adoption of the caregiving role also support the cultural perspective’s assertion that both the symbolic and behavioral inheritance of a cultural community serve to influence individuals’ development by either constraining or promoting certain developmental pathways.

Our findings are consistent with other research showing that women predominate as caregivers in the Latino family (Flores et al., 2009; Mendez-Luck & Anthony, 2016; Mendez-Luck, Applewhite, et al., 2016; Robles-Silva, 2000) and that culture plays an important role in caregiving among Mexican-origin women (Flores et al., 2009; Gelman, 2014; Jolicoeur & Madden, 2002; Ruiz & Ransford, 2012). Our findings are also consistent with prior research showing that caregiving can be a positive experience that gives meaning and purpose to caregivers (Brown, Nesse, Vinokur, & Smith, 2004; Wells, Cagle, Bradley, & Barnes, 2008). In addition, our findings reflected the Latino cultural value of marianismo (Mendez-Luck & Anthony, 2016; Mendez-Luck et al., 2008, 2009). Although the interview guide did not include questions on marianismo specifically, gender was identified by many women as a powerful influence with respect to some women’s adoption of the caregiving role.

We move this body of literature forward by examining the process by which Mexican-origin women enter into caregiving and their motivations for becoming caregivers. Our findings suggest that the transition into the caregiving role is a complex process that can vary considerably across family and cultural contexts. An important point is the seeming paradoxical themes identified in our analysis, specifically that caregiving is innate yet is encouraged and instilled in women continuously from an early age. From a cultural psychological perspective, these findings are actually not contradictory but rather highlight the interconnectedness of culture and psyche in the caregiving experience. Thus, women’s caregiving beliefs and contexts of care intertwine to make up their psychological systems, or orientation to caregiving.

Our findings may help shed light on the heightened burnout, stress, and burden experienced by Latino caregivers (Knight et al., 2002; Mendez-Luck et al., 2008; Pinquart & Sörensen, 2005). Our findings indicate that some Mexican-origin women formulate their expectations and motives related to the caregiving role early in life, years before adopting the role. Because, for some, a substantial amount of time passes between the development of caregiving conceptualizations and the actual adoption of the caregiving role, it could be that some Mexican-origin caregivers’ expectations of caregiving are incongruent with their lived experiences of giving care. This incongruence potentially negatively influences their self-efficacy and their subjective well-being. Future research efforts should aim to elucidate the degree to which Mexican-origin women’s expectations of caregiving differ from their lived experiences of giving care.

In addition, the finding that some women in the sample became familiarized with caregiving informally, often years before adopting the caregiving role, while others received little to no formal or informal caregiving-related training, has important implications for the quality of care provided to care recipients. Our findings suggest that some Mexican-origin caregivers may be ill equipped for the caregiving role to the extent that they rely solely on their inherent caregiving abilities or on acquiring informally caregiving-related knowledge and information. Funding for the National Family Caregiver Support Program has been flat over the past decade (Administration for Community Living, n.d.), and the availability of caregiver education and training for family caregivers varies tremendously by state (Family Caregiver Alliance, 2004). Thus, a lack of formal preparation could potentially negatively affect the quality of care caregivers provide to their care recipients. This is particularly concerning for Latino caregivers, who are more likely than their non-Latino White counterparts to have fewer financial resources yet be in higher intensity caregiving situations (Evercare & National Alliance for Caregiving, 2008). Future research efforts should clarify whether, and to what extent, Mexican-origin caregivers’ lack of formal caregiving preparation or training affects the quality of care provided to care recipients and care recipients’ health and well-being over time. Moreover, existing caregiver support, training, and education programs may not be salient to Mexican-origin caregivers to the extent that these services conflict with caregivers’ cultural motivations, ideals, and expectations related to caregiving.

This analysis is not without limitations. First, we did not explicitly examine the nativity status of participants in our analysis, a potentially influential factor with respect to the caregiving experience and outcomes of informal caregivers. Second, this study was part of a larger study that investigated Mexican-origin caregivers’ conceptualizations of elder caregiving in terms of role functioning, social norms, cultural beliefs, and familial obligations. Thus, the interview data analyzed in this study were collected for the purpose of answering research questions other than the one for the present study. Despite the breadth of the interview guide, certain interview questions were not asked that could have been useful in addressing the present study’s research question (e.g., How were you prepared for the caregiving role?).

Our findings elucidate some of the sources of influence—including caregiving motives, implicit and explicit caregiving socialization, inherent caregiving abilities, familial and cultural caregiving-related values and expectations—underlying Mexican-origin women’s transition into the caregiving role. Caregiving motives are an important area of inquiry because caregiving motives have the potential to influence the caregiving experience, the quality and nature of care recipient care, and caregiver outcomes (Feeney & Collins, 2003; Romero-Moreno et al., 2011; Sayegh & Knight, 2010). Future efforts to develop caregiver support programs for Latino caregivers need to consider the underlying cultural orientations to caregiving to create culturally relevant and acceptable supportive services for caregivers in this population.

Footnotes

Authors’ Note

Earlier versions of this work were presented at the 2013 American Public Health Association Annual Meeting and the 2013 International Conference on Aging in the Americas, where it received the Best Student Poster Award.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of California, Los Angeles (UCLA), Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly, under the National Institute on Aging at the National Institute of Health (P30-AG02-1684 to C.A M.-L.); a career development award from the National Institute on Aging at the National Institutes of Health (1K01AG033122-01A1 to C.A.M.-L.); the Aetna Foundation (20072361 to C. A. M.-L.); and the Drew/UCLA Project Export (2P20MD000182-06).

Author Biographies

Elizabeth McDermott, MS, MPH, is a predoctoral candidate of Human Sciences and Family Sciences in the Oregon State University College of Public Health and Human Sciences. Her research interests focus on caregiving and aging in Latino populations. This work was the culmination of her masters thesis.

Carolyn A. Mendez-Luck, PhD, MPH, is an associate professor of Health Management and Policy / Human Development and Family Sciences at Oregon State University. Her research addresses aging-related health disparities and long-term care in Latino and other vulnerable adult populations. Her primary research interests are the social and cultural factors associated with elder caregiving and chronic disease management in Mexican-origin families and the quality of care in nursing facilities in Oregon.

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The Processes of Becoming a Caregiver Among Mexican-Origin Women: A Cultural Psychological Perspective

Abstract

Keywords

Context of Care

Motives for Providing Care

Cultural Psychological Perspective

Method

Study Design

Sample

Materials and Data Collection

Data Analysis

Results

Caregiving Comes From Within

Inherent caregiving ability

Intrinsic caregiving motives

Caregiving Is Cultivated Through Early and Continuous Informal Socialization

Fostering of caregiving through exposure

Fostering of caregiving through active participation

Discussion

Footnotes

Authors’ Note

Declaration of Conflicting Interests

Funding

Author Biographies

References