UPDATE ON MEASURES OF FAMILISM IN THE CONTEXT OF ACCULTURATION
Background: Latino elders and caregivers make decisions together; for example, whether to use home care or palliative care services. Latino elders use available health care services less frequently compared to Anglo elders, even though functional problems are more prevalent in Latino elders at earlier ages. The literature is equivocal about whether the role of familism is a barrier or predictor for accessing services; and whether acculturation affects familism-based influences. Although there is general agreement on how familism is conceptualized, there is variation in how familism is operationalized (measured) and used and whether it is considered vis-à-vis acculturation.
Methods: An extensive and critical integrative review of articles found through the PubMed and CINAHL databases. Key words were familism, familismo, filial obligation, and family caregiving. The initial database search yielded 129 articles. After delimiting them to the last 5 years, we reviewed 48 articles, dated from 2009 to 2014. We extracted purpose/designs, sample characteristics, familism measures or key words if no measures, and whether acculturation was considered and/or measured. This poster reports the summarized extractions from the articles and exemplar familism and acculturation measures to describe current knowledge and implications for equity and access.
Results: Purpose/designs were descriptive/exploratory quantitative (n=24); exploratory qualitative (n=7); mixed methods (n=1); intervention (n=3); instrument development (n=4), including a filial piety scale; concept development (n=2), and other (n=3). Sample characteristics were (n=1-1,9800); elders and caregivers; med-surg, psychiatric and palliative care clients, of the following origins: Filipino, 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. States of the USA were southwestern, southeastern, central south, northeastern, and eastern seaboard. Familism was measured in only 4 articles with 4 different scales, plus one on filial piety being developed. Articles measuring acculturation = 8, using 7 different measures; of the articles not measuring acculturation, 7 mentioned it as possibly affecting familism in the background or discussion sections.
Implications: Familism is operationalized in many ways; articles often do not use the specific word ‘familism’ or explicitly measure it. This review for the past 5 years adds to the literature review we presented on familism in 2009. At that time, we had found that definitions of this construct related to the strong attachment and identification of individuals to their nuclear and extended families and that familism scales had been formulated as early as 1959 but were not sufficiently specific for assessing caregiving families. In this review we found similar definitions but less frequent measurement of the construct, and frequent mention of acculturation without measurement. A comprehensive familism measure with sensitivity to acculturation needs to be proposed and disseminated. The poster invites collaboration on this topic to influence future measures, interventions, and policy to improve equity and access.