Familial roles of older African-American women with type 2 diabetes: Testing of a new multiple caregiving measure

Objective: This study describes the development and validation of a new multiple caregiving (MC) measure and examines how familial caregiving relates to family composition and psychosocial factors among older African-American women with type 2 diabetes. Research Design and Methods: The study sample included 345 African-American women with type 2 diabetes who participated in two lifestyle behavior interventions. A new 12-item survey of caregiving perceptions was tested for internal reliability and construct validity of two empirically defined scales (MC-role and MC-barriers). Multiple caregiving (MC) constructs were validated by using baseline measures of diabetes quality of life, social support, stress, diabetes competence, and self-care barriers. Correlational, analysis of variance, and multivariate analyses were used to examine the associations among familial MC variables and psychosocial and household factors. Results: Surveys were completed by 299 (87%) participants who were an average of 60 years of age, with 10 years of diagnosed diabetes and 11 years of education. Both MC-role and MC-barriers scores were positively associated with putting the family's needs first, difficulty saying "no" to family, and the number of adults living in the household. MC-barriers were associated negatively with quality of life, and positively with stress, barriers to diabetes self-care, and negative perceptions of diabetes competence. In a multivariate model, age and difficulty saying "no" to family seeking help were significant independent predictors of MC-barriers. Conclusions: Findings suggest that a better understanding of African-American women with diabetes in the context of family and caregiving roles may be important to identifying culturally meaningful strategies to improve self-care behaviors.