Understanding complexity of Asian American family care practices

The role of family caregiving in the management of individuals with mental illnesses and the outcome of family-based interventions for mental illnesses in China: a scoping review

The effects of China's rapid economic development and urbanisation on family caregivers' responsibilities for providing essential practical, social, and psychological support to family members with mental illnesses are unclear. This scoping review identified 176 relevant studies published from 1 January 2000 to 31 December 2023 in six English-language and three Chinese-language databases. Most studies focus on family caregiving for individuals with schizophrenia (63 studies), autism (40 studies), or dementia (39 studies). Family caregiving-subclassified as informational, concrete, or psychological-was beneficial both for patients and their family members, but providing support often necessitated substantial sacrifices by family caregivers, many of whom experience psychological distress and financial difficulties. The type and intensity of the support provided are influenced by the severity of the patient's symptoms, financial and other resources of the patient's family, community members' beliefs about mental illnesses, and the local availability of mental health and social welfare services. Results from intervention studies indicate that different methods of enhancing family caregiving improved outcomes for individuals with mental illnesses. However, the methodological quality of the intervention studies was poor, and most of the studies were conducted in inpatient settings, so the benefits of these family-based strategies remain uncertain. Rapid economic development and urbanisation in China are resulting in fundamental changes in the relative responsibilities of different stakeholders for providing social welfare services-individuals, families, communities, and governmental agencies. Understanding and enhancing the role that families play in the support of community members with mental illnesses will require improving the quality of research about this issue, expanding the range of mental health conditions considered, and, most importantly, developing a dynamic overarching theoretical framework that integrates the many factors influencing ongoing changes in the structure and functioning of Chinese families.

Family Involvement in Routine Services for Individuals With Severe Mental Illness: Scoping Review of Barriers and Strategies

OBJECTIVE

The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment.

METHODS

Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used.

RESULTS

Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies.

CONCLUSIONS

A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.

Uncommon Sociodemographic Factors Are Associated With Racial Disparities in Length of Stay Following Oncologic Elective Colectomy

INTRODUCTION

Although outcome disparities by race have been identified in colorectal cancer, these patterns are challenging to explain using variables that are commonly available in databases. In a single institution serving a diverse community, length of stay (LOS) varies by race following elective oncologic colectomy. We investigated previously unexplored variables that may explain the relationship between race and LOS following elective resection of colorectal neoplasms.

METHODS

Retrospective, single institution cohort study from January 2015 to December 2020 for adult patients undergoing elective colorectal cancer resections. Baseline demographic variables and intraoperative factors were analyzed for changes in LOS following elective colorectal resection. Additional retrospective chart review was carried out to determine household member composition and distance from home to hospital. Bivariate analysis was conducted to determine which variables should be included in multivariable analyses. All analyses were conducted using SAS Academic.

RESULTS

Most patients (n = 383) were Asian (40%), Black (12%), or Hispanic (26%). Race and LOS were associated with age (P = 0.001 and P < 0.001 for race and LOS, respectively), American Society of Anesthesiologists class (P = 0.004 and P < 0.001), enhanced recovery after surgery protocols (P = 0.006 and P < 0.001), household members (P = 0.009 and P = 0.002), and discharge disposition (P = 0.049 and P < 0.001). In multivariable analysis, household members (P = 0.021) independently remained associated with LOS after controlling for race (P = 0.008) and discharge disposition (P < 0.001).

CONCLUSIONS

Household member composition varies with LOS, suggesting that level of support at home may influence decisions regarding discharge disposition, which lead to differences in LOS.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Worcester Refugee Assistance Project: An Example of Strengths-Based, Community-Based, Culturally Sensitive Care

Refugee populations are diverse and can present with a variety of unique and complex circumstances. The purpose of this article is to examine an organization that provides care to refugee youth, the ways in which this is accomplished, and a few of the challenges that have been faced. Specifically, the work of this organization will be examined using a Systems of Care philosophy to demonstrate how using these concepts can assist in providing sensitive, high-quality care.

Does family-centred education improve treatment adherence, glycosylated haemoglobin and blood glucose level in patients with type 1 diabetes? A randomized clinical trial

AIM

To investigate the effect of family-centred education on treatment adherence, glycosylated haemoglobin and blood glucose level in patients with Type 1 Diabetes Mellitus.

DESIGN

Randomized controlled trial.

METHODS

Sixty patients with Type 1 Diabetes Mellitus were randomly allocated into the intervention and control group. Data were collected using demographic and Modanloo Adherence to Treatment Questionnaires. The patients received 12 family-centred educational sessions in the intervention group.

RESULTS

A significant difference was found in the mean score of treatment adherence between the two groups after the intervention (p < 0.001). The mean score of treatment adherence significantly increased in the intervention group after family-centred education. The mean score of Fasting Blood Glucose and Glycosylated Haemoglobin A1C significantly decreased in the intervention group after the intervention (p < 0.001).

CONCLUSION

Relevant authorities need to consider family-centred education as one of the most important education methods in Type 1 Diabetes Mellitus patients.

TRIAL REGISTRATION

IRCT20131112015390N4; August 21, 2020.

Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color

Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.

Family Support: A Caregiver Experience in Caring for Nasopharynx Cancer Patients in Yogyakarta

BACKGROUND: Increasing the incidence of nasopharyngeal cancer causes an increase mortality in sufferers. Family support is an important aspect of the treatment of patients that very helpful to strengthen psychologically and make patients more enthusiastic about undergoing treatment. Patients who have high enthusiasm will improve their quality of life so that family support is needed in treating patients. AIM: This study aims to explore family experiences in providing support in the care of nasopharyngeal cancer patients in Yogyakarta. METHODS: This research uses qualitative method with phenomenological approach. Data collected through in-depth interviews. Informants in this study amounted to 12 people consisting of patients and families determined by purposive sampling. This research was conducted in Sleman Regency from January to April 2019. Data validity uses source triangulation, member checking, and peer debriefing. Analysis of the data in this study using the help of OpenCode 4.02 software. RESULTS: The results showed that the treatment of patients with nasopharyngeal cancer was influenced by several factors, namely, family perceptions in caring for patients, family knowledge about the disease, and family information sources. These factors will affect the family process in providing care to patients including family support, family communication, and medication that have been undertaken. Family support is provided in the care of nasopharyngeal cancer patients in the form of emotional, informational, instrumental, appreciation, and spiritual support. In addition, in carrying out patient care, there are several obstacles, namely, transportation, administrative, and financial obstacles. CONCLUSION: The family is expected to always provide support to patients in the form of emotional support, informational, instrumental, and appreciation as well as spiritual support for the success of treatment of the patient.

The Effect of Family Empowerment Model on Self-care in Hemodialysis Patients of Zahedan, Iran

Background: Self-care is one of the important aspects of treatment in hemodialysis patients. This study was done to determine the effect of the family-centered empowerment model on the self-care of hemodialysis patients. Methods: This study was performed on 100 hemodialysis patients referring to the Zahedan hemodialysis department in 2018. For the intervention group, the family-centered empowerment model was executed in four stages, including understanding the threat, problem-solving, educational participation, and evaluation according to the steps of the model, and the control group received the usual care of the department. The data collection tools were the demographic information questionnaire and self-care questionnaire. Data were analyzed using SPSS V.22 by analysis of variance (ANOVA), independent t-test, repeated measures t-test, and Chi-square test. Results: Based on the independent t-test, the mean self-care score of patients in the intervention and control group was significantly different (P < 0.001). There was a significant difference in the "main caregiver relation" variable (P = 0.006). The results of the "time" and "intervention" effects of this test also showed that these two variables had a significant effect on mean self-care scores (P < 0.001). The results of ANOVA showed that self-care score changed in the two groups there was an increase in the self-care score in the intervention group compared with the control group (P < 0.001). Conclusions: Implementing the family-centered empowerment model in hemodialysis patients by strengthening the ability of the patient and their families to care provides a platform for their promotion and maintenance of their self-care.

Comparison between the health-related quality of life of children/adolescents with asthma and that of their caregivers: a systematic review and meta-analysis

OBJECTIVE

To evaluate the health-related quality of life (HRQoL) of children/adolescents with asthma and that of their caregivers, comparing the two.

METHODS

This was a systematic review and meta-analysis based on the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, with a strategy of searching five health-related databases (MEDLINE/PubMed, EMBASE, ScienceDirect, SciELO, and LILACS). We included studies that evaluated the HRQoL of children/adolescents with asthma and that of their caregivers with the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire, respectively, using the total scores and the scores on the domains activity limitation, symptoms (children/adolescents only), and emotional function.

RESULTS

We identified 291 articles, and we evaluated 133 of those. A total of 33 articles, collectively including 4,101 subjects, were included in the meta-analysis. An analysis stratified by study design showed no differences between the HRQoL of the caregivers and that of the children/adolescents in the activity limitation domain and in the total score. However, the mean emotional function domain scores were significantly higher (better) among children/adolescents with asthma than among their caregivers in longitudinal studies-Δ = 0.82 (0.21-1.44)-and randomized clinical trials-Δ = 0.52 (0.29-0.79)-although not in cross-sectional studies-Δ = -0.20 (-0.03 to 0.43).

CONCLUSIONS

The total HRQoL scores proved to be similar between children/adolescents with asthma and their caregivers. However, the two groups differed in their perception of their emotional function, the caregivers scoring significantly lower than the children/adolescents in that domain.

Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness

BACKGROUND

Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI. Central questions are: 1) What are the main barriers to FI reported by the different key stakeholders (i.e. the persons with SMI, their families and the professionals, and 2) What are the differences and similarities between the various stakeholders' perspectives on these barriers.

METHODS

A systematic search into primary studies regarding FI was conducted in four databases: Medline/Pubmed, Cinahl, PsychInfo and Web of Knowledge with the use of a PICO scheme. Thematic analysis focused on stakeholder perspectives (i.e. which stakeholder group reports the barrier) and types of barriers (i.e. which types of barriers are addressed).

RESULTS

Thirty three studies were included. The main barriers reported by the stakeholder groups reveal important similarities and differences between the stakeholder groups and were related to: 1) the person with SMI, 2) the family, 3) the professionals, 4) the organization of care and 5) the culture-paradigm.

DISCUSSION

Our stakeholder approach elicits the different stakeholders' concepts, presuppositions and experiences of barriers to FI, and gives fundamental insights on how to deal with barriers to FI. The stakeholders differing interpretations and perceptions of the barriers related to FI is closely related to the inherent complexity involved in FI in itself. In order to deal better with these barriers, openly discussing and reflecting upon each other's normative understandings of barriers is needed.

CONCLUSIONS

Differences in perceptions of barriers to FI can itself be a barrier. To deal with barriers to FI, a dialogical approach on how the different stakeholders perceive and value FI and its barriers is required. Methods such as moral case deliberation or systematic ethics reflections can be useful.

Factors that influence the diagnoses of Asian Americans in mental health: an exploration

PURPOSE

This 10-year review of Asian Americans focuses on factors that impede adequate psychiatric diagnosis and treatment.

CONCLUSION

Asian Americans are the fastest growing ethnic group in the United States, with a high prevalence of domestic violence, alcohol abuse, and significant distress. However, Asian Americans consistently underutilize mental health services because of stigma, misconceptions of Western treatment, and cultural interpretations of mental health problems.

PRACTICE IMPLICATIONS

Knowledge of the diversity of the Asian American population and an understanding of cultural interpretations of psychiatry will better prepare clinicians to treat and engage these patients.

Cultural differences in professional help seeking: a comparison of Japan and the u.s

Previous research has found cultural differences in the frequency of support seeking. Asians and Asian Americans report seeking support from their close others to deal with their stress less often compared to European Americans. Similarly, other research on professional help seeking has shown that Asians and Asian Americans are less likely than European Americans to seek professional psychological help. Previous studies link this difference to multitude of factors, such as cultural stigma and reliance on informal social networks. The present research examined another explanation for cultural differences in professional help seeking. We predicted that the observed cultural difference in professional help seeking is an extension of culture-specific interpersonal relationship patterns. In the present research, undergraduate students in Japan and the United States completed the Inventory of Attitudes toward Seeking Mental Health Services, which measures professional help seeking propensity, psychological openness to acknowledging psychological problems, and indifference to the stigma of seeking professional help. The results showed that Japanese reported greater reluctance to seek professional help compared to Americans. Moreover, the relationship between culture and professional help seeking attitudes was partially mediated by use of social support seeking among close others. The implications of cultural differences in professional help seeking and the relationship between support seeking and professional help seeking are discussed.

Filial piety and parental responsibility: an interpretive phenomenological study of family caregiving for a person with mental illness among Korean immigrants

Background

Despite the strong influence of culture on family involvement in disease management, few studies have examined how immigrant families care for persons with mental illness. The purpose of this study was to examine how immigrant families organize their world to care for a mentally ill person in the United States. The current analysis focused on how Confucian notions of filial piety and parental obligation shape caregiving in Korean immigrant families.

Methods

Participants in this interpretive phenomenological study were comprised of six Korean immigrant women caring for a family member with mental illness. Participants provided narratives that illustrate challenges and opportunities in caring for their mentally ill family member.

Results

Three family caregiving patterns were discerned. Insulating from the outside world describes a family’s effort to accept a member's illness and to manage it within the family. Prioritizing education over well-being concerns parental commitment to the Confucian priority of educating one’s children. Reciprocating the sacrifice describes how a family adapts and enacts filial piety.

Conclusion

The findings of this study warrant further study to examine the influence of Confucianism among Korean American families. The three patterns of caregiving are strongly aligned with Confucian notion of family and family engagement. These patterns may help health providers to anticipate the needs of and provide individualized, culturally appropriate mental health care for patients with mental illness and their families of Korean origin.

Utilization of the supports intensity scale with psychiatric populations: psychometric properties and utility for service delivery planning

In agreement with the new paradigm of supports, this study examines the adequacy and psychometric properties of the Supports Intensity Scale (SIS) in a sample of 182 participants with severe mental illness (mean Global Assessment of Functioning [GAF] score = 60.2). The measure focuses on identifying the profile and intensities of support needs and on the planning and service delivery rather than on weaknesses and limitations. Internal consistency indexes ranged from .83 to .97; interrater reliability indexes ranged from .67 to .98. Intercorrelations among SIS subscales supported its construct validity. SIS scores correlated to GAF scores and length of disease. Discriminant analysis correctly classified 60.9% of participants. Therefore, the SIS demonstrated adequate reliability and validity, and it can be used by nursing professionals to plan for required supports in this population.

Creating a new whole: helping families of people with schizophrenia

Collaboration between psychiatric nurses and family members is considered an important part of caring for people with schizophrenia either in hospital or at home after discharge. Studies have demonstrated family involvement in terms of caring for patients who have been discharged early from hospital. An extensive review of the literature and related studies regarding nursing interventions have been done, but there have been limited studies on what psychiatric nurses actually do when working with the families of people with schizophrenia in Thailand. The purpose of the present study was to explore relationships between Thai psychiatric nurses and families in terms of administering nursing care to patients. Grounded theory methodology was used to examine the processes through which psychiatric nurses work with families. Data were collected by 16 psychiatric nurses through in-depth interviews, observations, and field notes. Data were analyzed using constant and comparative methods of other studies, which revealed the process by which nurses can create a new whole between families, patients, and Thai psychiatric nurses. The process consists of four major stages: establishing trust, strengthening connections, promoting readiness to care, and supporting family.