Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-18T02:25:47.466Z Has data issue: false hasContentIssue false
  • English
  • Français

Cross-cultural differences in dementia: the Sociocultural Health Belief Model

Published online by Cambridge University Press:  14 December 2012

Philip Sayegh  and
Bob G. Knight
Philip Sayegh*
Affiliation:
Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, California, USA
Bob G. Knight
Affiliation:
Department of Psychology, Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
*
Correspondence should be addressed to: Mr. Philip Sayegh, Departments of Psychology and Preventive Medicine, University of Southern California, 3620 S. McClintock Avenue-SGM 501, M/C 1061, Los Angeles, California 90089, USA. Phone: +1 925-788-1657; Fax: +1 213-746-9082. Email: psayegh@usc.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Many minority ethnic (ME) older adults face several culturally associated and systemic barriers to timely dementia diagnoses that may result in delays to dementia care-seeking. We aimed to develop and propose a model illustrating variables that influence dementia care-seeking among ME older adults.

Methods: We conducted a literature review on the effects of these barriers on diagnostic delays and impairment levels at initial evaluation. We also strived to provide a basis for the Sociocultural Health Belief Model (SHBM) to guide future research and service planning pertaining to culture and dementia care-seeking.

Results: There was consistent evidence that ME older adults with dementia tended to have greater diagnostic delays and higher levels of cognitive impairment and behavioral and psychological symptoms of dementia at initial evaluation than their non-Hispanic White counterparts. We also found several barriers to dementia care-seeking among ME groups. These barriers included lower levels of acculturation and accurate knowledge about dementia, more culturally associated beliefs about dementia, such as the perception of memory loss as normal aging and stigma associated with dementia, and health system barriers.

Conclusions: The SHBM provides an empirically based conceptual framework for examining cross-cultural differences in dementia care-seeking among diverse groups. We provide recommendations for future research, such as the need for research with more diverse ethnic subgroups and the examination of group-specific cultural values. We conclude with a discussion of the clinical and service implications of our review, including potential interventions aimed at facilitating timely dementia diagnoses among ME older adults.

Keywords

dementiacognitive impairmentdiagnosiscross-cultural differencesethnicityethnic minoritiescultural valueshealthcare seeking
Type
Review Article
Information
International Psychogeriatrics , Volume 25 , Issue 4 , April 2013 , pp. 517 - 530
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Areán, L. and Gallagher-Thompson, D. (1996). Issues and recommendations for the recruitment and retention of older ethnic minority adults into clinical research. Journal of Consulting and Clinical Psychology, 64, 875–880. doi:10.1037//0022-006X.64.5.875.CrossRefGoogle ScholarPubMed
Ayalon, L. and Areán, P. A. (2004). Knowledge of Alzheimer's disease in four ethnic groups of older adults. International Journal of Geriatric Psychiatry, 19, 51–57. doi:10.1002/gps.1037.CrossRefGoogle ScholarPubMed
Boyle, L. L., Ismail, M. S. and Porsteinsson, A. P. (2006). The dementia workup. In Agronin, M. E. and Maletta, G. J. (eds.), Principles and Practice of Geriatric Psychiatry (pp. 137–153). Philadelphia, PA: Lippincott Williams and Wilkins.Google Scholar
Braun, K. L., Takamura, J. C. and Mougeot, T. (1996). Perceptions of dementia, caregiving, and help-seeking among recent Vietnamese immigrants. Journal of Cross-Cultural Gerontology, 11, 213–228. doi:10.1007/BF00122702.CrossRefGoogle ScholarPubMed
Chapleski, E., Lamphere, J. K., Kaczynski, R., Lichtenberg, P. A. and Dwyer, J. W. (1997). Structure of a depression measure among American Indian elders: confirmatory factor analysis of the CES-D scale. Research on Aging, 19, 462–485. doi:10.1177/0164027597194004.CrossRefGoogle Scholar
Chen, S., Sullivan, N. Y., Lu, Y. E. and Shibusawa, T. (2003). Asian Americans and mental health services: a study of utilization patterns in the 1990s. Journal of Ethnic and Cultural Diversity in Social Work, 12, 19–42. doi:10.1300/J051v12n02_02.CrossRefGoogle Scholar
Clark, P. C.et al. (2005). Impediments to timely diagnosis of Alzheimer's disease in African Americans. Journal of the American Geriatrics Society, 53, 2012–2017. doi:10.1111/j.1532-5415.2005.53569.x.CrossRefGoogle ScholarPubMed
Cohen, C. I. and Magai, C. (1999). Racial differences in neuropsychiatric symptoms among dementia outpatients. The American Journal of Geriatric Psychiatry, 7, 57–63. doi:10.1097/00019442-199924710-00008.CrossRefGoogle ScholarPubMed
Connell, C. M., Roberts, J. S. and McLaughlin, S. J. (2007). Public opinion about Alzheimer disease among Blacks, Hispanics, and Whites: results from a national survey. Alzheimer Disease and Associated Disorders, 21, 232–240. doi:10.1097/WAD.0b013e3181461740.CrossRefGoogle ScholarPubMed
Cooper, C., Tandy, A. R., Balamurali, T. B. S. and Livingston, G. (2010). A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research. The American Journal of Geriatric Psychiatry, 18, 193–203. doi:10.1097/JGP.0b013e3181bf9caf.CrossRefGoogle ScholarPubMed
Danner, D. D., Smith, C. D., Jessa, P. and Hudson, J. (2008). African Americans with memory loss: findings from a community clinic in Lexington, Kentucky. Nursing Clinics of North America, 43, 437–447. doi:10.1016/j.cnur.2008.04.002.CrossRefGoogle ScholarPubMed
Dilworth-Anderson, P. and Anderson, N. (1994). Dementia caregiving in Blacks: a contextual approach to research. In Light, E., George, N. and Lebowitz, B. (eds.), Stress Effects on Family Caregivers and Alzheimer's Patients: Research and Interventions (pp. 385–409). New York, NY: Springer.Google Scholar
Dilworth-Anderson, P. and Gibson, B. E. (2002). The cultural influence of values, norms, meanings, and perceptions in understanding dementia in ethnic minorities. Alzheimer Disease and Associated Disorders, 16, S56–63. doi:10.1097/00002093-200200002-00005.CrossRefGoogle ScholarPubMed
Dilworth-Anderson, P., Hendrie, H. C., Manly, J. J., Khachaturian, A. S. and Fazio, S. (2008). Diagnosis and assessment of Alzheimer's disease in diverse populations. Alzheimer's and Dementia, 4, 305–309. doi:10.1016/j.jalz.2008.03.001.CrossRefGoogle ScholarPubMed
Elliott, K. S. and Di Minno, M. (2006). Unruly grandmothers, ghosts, and ancestors: Chinese elders and the importance of culture in dementia evaluations. Journal of Cross-Cultural Gerontology, 21, 157–177. doi:10.1007/s10823-006-9030-2.CrossRefGoogle ScholarPubMed
Gaines, A. D. (1989). Alzheimer's disease in the context of black (Southern) culture. Health Matrix, 6, 33–38. PMID:10318202.Google Scholar
Gallagher-Thompson, D., Solano, N., Coon, D. and Aréan, P. (2003). Recruitment and retention of Latino dementia family caregivers in intervention research: issues to face, lessons to learn. The Gerontologist, 43, 45–51. doi:10.1093/geront/43.1.45.CrossRefGoogle ScholarPubMed
Gelman, C. R. (2003). Learning from recruitment challenges: barriers to diagnosis, treatment, and research participation for Latinos with symptoms of Alzheimer's disease. Journal of Gerontological Social Work, 53, 94–113. doi:10.1080/01634370903361847.CrossRefGoogle Scholar
Gray, H. L., Jimenez, D. E., Cucciare, M. A., Tong, H. and Gallagher-Thompson, D. (2009). Ethnic differences in beliefs regarding Alzheimer disease among dementia family caregivers. The American Journal of Geriatric Psychiatry, 17, 925–933. doi:10.1097/JGP.0b013e3181ad4f3c.CrossRefGoogle ScholarPubMed
Hargrave, R., Stoeklin, M., Haan, M. and Reed, B. (2000). Clinical aspects of dementia in African-American, Hispanic, and white patients. Journal of the National Medical Association, 92, 15–21. PMID: 10800282.Google ScholarPubMed
Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A. and Evans, D. A. (2003). Alzheimer disease in the US population: prevalence estimates using the 2000 Census. Archives of Neurology, 60, 1119–1122. doi:10.1001/archneur.60.8.1119.CrossRefGoogle ScholarPubMed
Hinton, L., Franz, C. E. and Friend, J. (2004). Pathways to dementia diagnosis: evidence for cross-ethnic differences. Alzheimer Disease and Associated Disorders, 18, 134–144. doi:10.1097/01.wad.0000127444.23312.ff.CrossRefGoogle ScholarPubMed
Hinton, L., Franz, C. E., Yeo, G. and Levkoff, S. E. (2005). Conceptions of dementia in a multiethnic sample of family caregivers. Journal of the American Geriatrics Society, 53, 1405–1410. doi:10.1111/j.1532-5415.2005.53409.x.CrossRefGoogle Scholar
Hinton, L., Guo, Z., Hillygus, J. and Levkoff, S. (2000). Working with culture: a qualitative analysis of barriers to the recruitment of Chinese-American family caregivers for dementia research. Journal of Cross-Cultural Gerontology, 15, 119–137. doi:10.1023/A:1006798316654.CrossRefGoogle Scholar
Hinton, W. L. and Levkoff, S. (1999). Constructing Alzheimer's. Narratives of lost identities, confusion, and loneliness in old age. Culture, Medicine and Psychiatry, 23, 453–475. doi:10.1023/A:1005516002792.CrossRefGoogle ScholarPubMed
Hughes, T., Tyler, K., Danner, D. and Carter, A. (2009). African American caregivers: an exploration of pathways and barriers to a diagnosis of Alzheimer's disease for a family member with dementia. Dementia, 8, 95–116. doi:10.1177/1471301208099048.CrossRefGoogle Scholar
Hui, C. H. and Triandis, H. C. (1985). Measurement in cross-cultural psychology: a review and comparison of strategies. Journal of Cross-Cultural Psychology, 16, 131–152. doi:10.1177/0022002185016002001.CrossRefGoogle Scholar
Ibrahim, F., Ohnishi, H. and Sandhu, D. S. (1997). Asian American identity development: a culture specific model for South Asian Americans. Journal of Multicultural Counseling and Development, 25, 34–50. doi:10.1002/j.2161-1912.1997.tb00314.x.CrossRefGoogle Scholar
Jang, Y., Kim, G. and Chiriboga, D. (2010). Knowledge of Alzheimer's disease. feelings of shame, and awareness of services among Korean American elders. Journal of Aging and Health, 22, 419–433. doi:10.1177/0898264309360672.CrossRefGoogle Scholar
Janz, N. K., Champion, V. L. and Strecher, V. J. (2002). The Health Belief Model. In Glanz, K., Rimer, B. K. and Lewis, F. M. (eds.), Health Behavior and Health Education: Theory, Research, and Practice, 3rd edn, (pp. 45–66). San Francisco, CA: Jossey-Bass.Google Scholar
Jett, K. F. (2006). Mind-loss in the African American community: dementia as a normal part of aging. Journal of Aging Studies, 20, 1–10. doi:10.1016/j.jaging.2005.05.002.CrossRefGoogle Scholar
Jones, R. S., Chow, T. W. and Gatz, M. (2006). Asian Americans and Alzheimer's disease: assimilation, culture, and beliefs. Journal of Aging Studies, 20, 11–25. doi:10.1016/j.jaging.2005.01.001.CrossRefGoogle Scholar
Knight, B. G. and Sayegh, P. (2010). Cultural values and caregiving: the update sociocultural stress and coping model. Journal of Gerontology: Psychological Sciences, 65B, 5–13. doi:10.1093/geronb/gbp096.CrossRefGoogle ScholarPubMed
Lee, S. E., Lee, H. Y. and Diwan, S. (2010). What do Korean American immigrants know about Alzheimer's disease (AD)? The impact of acculturation and exposure to the disease on AD knowledge. International Journal of Geriatric Psychiatry, 25, 66–73. doi:10.1002/gps.2299.CrossRefGoogle Scholar
Leong, F. T. and Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research, 3, 201–214. doi:10.1023/A:1013177014788.CrossRefGoogle ScholarPubMed
Miles, T. P. (1999). Living with chronic disease in ethnic minority populations. In Miles, T. (ed.), Full-Color Aging: Facts, Goals and Recommendations for America's Diverse Elders (pp. 53–63). Washington, DC: Gerontological Society of America.Google Scholar
Morgan, R. O.et al. (2008). Does poorer familiarity with Medicare translate into worse access to health care? Journal of the American Geriatrics Society, 56, 2053–2060. doi:10.1111/j.1532-5415.2008.01993.x.CrossRefGoogle ScholarPubMed
Morhardt, D., Pereyra, M. and Iris, M. (2010). Seeking a diagnosis for memory problems. The experiences of caregivers and families in 5 limited English proficiency communities. Alzheimer Disease and Associated Disorders, 24, S42–S48. doi:10.1097/WAD.0b013e3181f14ad5.CrossRefGoogle ScholarPubMed
Mukadam, N., Cooper, C. and Livingston, G. (2011). A systematic review of ethnicity and pathways to care in dementia. International Journal of Geriatric Psychiatry, 26, 12–20. doi:10.1002/gps.2484.CrossRefGoogle ScholarPubMed
Neary, S. R. and Mahoney, D. F. (2005). Dementia caregiving: the experiences of Hispanic/Latino caregivers. Journal of Transcultural Nursing, 16, 163–170. doi:10.1177/1043659604273547.CrossRefGoogle ScholarPubMed
Ortiz, F. and Fitten, L. J. (2000). Barriers to healthcare access for cognitively impaired older Hispanics. Alzheimer Disease and Associated Disorders, 14, 141–150. doi:10.1097/00002093-200007000-00005.CrossRefGoogle ScholarPubMed
Ortiz, F., Fitten, L. J., Cummings, J. L., Hwang, S. and Fonseca, M. (2006). Neuropsychiatric and behavioral symptoms in a community sample of Hispanics with Alzheimer's disease. American Journal of Alzheimer's Disease and Other Dementias, 21, 263–273. doi:10.1177/1533317506289350.CrossRefGoogle Scholar
Otilingam, P. G. and Gatz, M. (2008). Perceptions of dementia among Asian Indian Americans. AAPI Nexus: Asian Americans and Pacific Islanders Policy, Practice and Community, 6, 45–65.CrossRefGoogle Scholar
Phinney, J. S. (1996). When we talk about U.S. ethnic groups, what do we mean? American Psychologist, 51, 918–927. doi:10.1037/0003-066X.51.9.918.CrossRefGoogle Scholar
Roberts, J. S., Connell, C., Cisewski, D., Hipps, Y., Demissie, S. and Green, R. (2003). Differences between African Americans and Whites in the perceptions of Alzheimer disease. Alzheimer Disease and Associated Disorders, 17, 19–26. doi:10.1097/00002093-200301000-00003.CrossRefGoogle ScholarPubMed
Rogers, S. L., Farlow, M. R., Doody, R. S., Mohs, R., Friedhoff, L. T. and the Donepezil Study Group (1998). A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology, 50, 136–145. doi:10.1212/WNL.50.1.136.CrossRefGoogle ScholarPubMed
Rosenstock, I. M., Stretcher, V. J. and Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15, 175–183. doi:10.1177/109019818801500203.CrossRefGoogle ScholarPubMed
Salman, E., Diamond, K., Jusino, C., Sanchez-Lacay, A. and Liebowitz, M. R. (1997). Hispanic-Americans. InFriedman, S. (ed.), Cultural Issues in the Treatment of Anxiety (pp. 59–80). New York, NY: Guilford Press.Google Scholar
Schwartz, S. J., Unger, J. B., Zamboanga, B. L. and Szapocznik, J. (2010). Rethinking the concept of acculturation: implications for theory and research. American Psychologist, 65, 237–251. doi:10.1037/a0019330.CrossRefGoogle ScholarPubMed
Serra, L.et al. (2010). Are the behavioral symptoms of Alzheimer's disease directly associated with neurodegeneration? Journal of Alzheimer's Disease, 21, 627–639. PMID:20555138.CrossRefGoogle ScholarPubMed
Sink, K. M., Covinsky, K. E., Newcomer, R. and Yaffe, K. (2004). Ethnic differences in the prevalence and pattern of dementia-related behaviors. Journal of the American Geriatrics Society, 52, 1277–1283. doi:10.1111/j.1532-5415.2004.52356.x.CrossRefGoogle ScholarPubMed
Smedley, B. D., Stith, A. Y. and Nelson, A. R. (eds.) (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press.Google Scholar
Stansbury, K. L., Marshall, G. L., Harley, D. A. and Nelson, N. (2010). Rural African American clergy: an exploration of their attitudes and knowledge of Alzheimer's disease. Journal of Gerontological Social Work, 53, 352–365. doi:10.1080/01634371003741508.CrossRefGoogle ScholarPubMed
Steinberg, M.et al. (2004). The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 19, 19–26. doi:10.1002/gps.1025.CrossRefGoogle ScholarPubMed
Suárez-Orozco, M. M. and Páez, M. M. (2002). Introduction. InSuárez-Orozco, M. M. and Páez, M. M. (eds.), Latinos: Remaking America (pp. 1–43). Berkeley, CA: University of California Press.Google Scholar
Sue, S. (1994). Mental health. InZane, N., Takeuchi, D. and Young, K. (eds.), Confronting Critical Health Issues of Asian and Pacific Islander Americans (pp. 266–288). Thousand Oaks, CA: Sage.Google Scholar
Traphagan, J. W. (1998). Localizing senility: illness and agency among older Japanese. Journal of Cross-Cultural Gerontology, 8, 81–98. doi:10.1023/A:1006566300463.CrossRefGoogle Scholar
US Census Bureau (2000). The Black Population: 2000. Available at: http://www.census.gov/prod/2001pubs/c2kbr01-5.pdf; last accessed 13 September 2011.Google Scholar
US Census Bureau (2002). The Asian and Pacific Islander Population in the United States: March 2002. Available at: http://www.census.gov/prod/2003pubs/p20-540.pdf; last accessed 25 January 2011.Google Scholar
US Census Bureau (2008). An Older and More Diverse Nation by Midcentury. Available at: http://www.census.gov/newsroom/releases/archives/population/cb08-123.html; last accessed 1 October 2010.Google Scholar
Wackerbarth, S. B. and Johnson, M. M. S. (2002). The carrot and the stick: benefits and barriers in getting a diagnosis. Alzheimer Disease and Associated Disorders, 16, 213–220. doi:10.1097/00002093-200210000-00002.CrossRefGoogle ScholarPubMed
Watari, K. F. and Gatz, M. (2004). Pathways to care for Alzheimer's disease among Korean Americans. Cultural Diversity and Ethnic Minority Psychology, 10, 23–38. doi:10.1037/1099-9809.10.1.23.CrossRefGoogle ScholarPubMed
Williams, C. L., Tappen, R. M., Rosselli, M., Keane, F. and Newlin, K. (2010). Willingness to be screened and tested for cognitive impairment: cross-cultural comparison. American Journal of Alzheimer's Disease and Other Dementias, 25, 160–166. doi:10.1177/1533317509352333.CrossRefGoogle ScholarPubMed
Yeo, G., Gallagher-Thompson, D. and Lieberman, M. (1996). Variations in dementia characteristics by ethnic category. InYeo, G. and Gallagher-Thompson, D. (eds.), Ethnicity and the Dementias (pp. 21–30). Washington, DC: Routledge.Google Scholar
Zarit, S. H. and Zarit, J. M. (2007). Mental Disorders in Older Adults, 2nd edn.New York, NY: The Guilford Press.Google Scholar
Zhan, L. (2004). Caring for family members with Alzheimer's disease: perspectives from Chinese American caregivers. Journal of Gerontological Nursing, 30, 19–29. PMID:15359526.CrossRefGoogle ScholarPubMed