The Evolving Conceptualization and Operationalization of Familism Internationally

Purpose: To review the literature regarding how the construct of familism (the cultural norm of family needs being more important than individual needs, including caring for an ill older member) has been operationalized and presented in different research cultural contexts; to assert how familism in the context of acculturation affects equity and access; and to present a synthesis of two integrative reviews focused on the state of the science of world-wide familism in multicultural individuals. Background: Values are embedded in culture and different values determine if the culture is individualistic or collectivistic. Individual and collective values/ perspectives mold individual self-conceptions and identities. Although familism as a concept may not have been explicitly measured in some studies, international caregiving research integrates familism and filial piety (respect and care for older family members) in study results and discussions.

Methods: A review of Pub Med and CINAHL databases using keywords “filial piety,” “familism,” “caregivers,” “family,” and “Hispanic/Latino” between 2009-2014 produced 48 studies involving Puerto Rican, Mexican, Mexican American, Black Caribbean, African, Chilean, Central or South American; i.e., Argentinian, Guatemalan, Spanish, Columbian, Cuban, of the U.S. Virgin Islands; and Anglo participants (e.g.: Flores et al, 2009; Hinojosa et al., 2009). A review using  the same keywords minus “Hispanic/Latino” between 2013-2014 produced 27 studies from mainland China, Greek-Australia, Taiwan, Japan, Norway, Spain, USA, Asian-Indian in USA, Singapore, South Korea, Brazil, Canada, Thailand, UK, Germany, Chili, Pakistan, Finland, Portugal, Luxembourg, and USA (e.g.: Arora & Wolf, 2014; Hsueh et al., 2014; Liu et al., 2014). We extracted definitions, purposes, sample characteristics, familism measures or key words if no measures, and, for the Latin countries, whether acculturation was considered and/or measured.

Results: International studies noted the common threads of need and presence of family balance; shifts in expectations of family; degrees of negative and positive effects of social support for caregivers, and stress and guilt, which caregiving exerts on families caring for older adults. Definitions of familism related to the strong attachment and identification of individuals to their nuclear and extended families. Purposes included explication of the mutualistic perspective of an interdependent view of self as part of a larger social network that includes one’s family, co-workers, and others to whom older adults and their caregivers are socially connected. Many studies focused on families finding balance, shifts in expectations of family, less social support for caregivers, stress, guilt, caregivers' suicidal ideation, caregiver PTSD; elder abuse in the context of filial piety, rewards of caregiving, caregiver mastery, mutuality, spiritual well-being; issues for spouse vs adult-child caregivers; and use of an array of community-based services. Samples included spouse and adult children of older adults with chronic conditions; e.g.: heart failure, CVA, dementia, Parkinson's Disease, cancer. Measures of familism constructed as early as 1959 are not specific for assessing today’s caregiving families and their constant change due to social and economic pressures. The literature called for needed instruments that measure these numerous aspects of family caregiving. Acculturation was frequently mentioned by studies conducted in the Latin countries but most studies did not measure it.

Conclusion: Although not all countries explicitly use the key words of ‘familism’ or ‘filial piety’, the findings refer to the family relationship as an integral component of providing care of elders. Researchers and clinicians should be sensitive to the possibility of familistic characteristics of family caregivers but assumptions should be clarified, and attempts should be made in construction of a transcultural comprehensive familism measure with sensitivity to social diversity and complexity as well as to social influence in how families provide care to elders. As the world population ages, and more older adults survive with chronic conditions, the role of the family caregiver is becoming increasingly important; however, families may not be available or willing to provide traditional supports. Caregiving within families is imbedded in cultural values and the concept of familism is key to this research. This poster invites collaboration on this topic to influence future measures, interventions, and policy to improve equity and access toward distal outcomes of improved older adult and family well-being.