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a Department of Social Work and Gerontology, Shippensburg University, PA
b Center for Work and Family, Boston College, Newton, MA
Correspondence: Helen B. Miltiades, PhD, Department of Social Work and Gerontology, Shippensburg University, 1871 Old Main Drive, Shippensburg, PA 17257-2299. E-mail: HBMilt{at}wharf.ship.edu.
Decision Editor: Laurence G. Branch, PhD
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Abstract |
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Key Words: Race • Caregiving burden • Caregiving satisfaction
Caregiving satisfaction and burden have been described as the two most important elements in the caregiving process (Lawton, Moss, Kleban, Glicksman, and Rovine 1991
). The caregiving studies that have contrasted Black and White caregivers indicate that White caregivers report higher levels of burden and less caregiving satisfaction than do Black caregivers (Lawton, Rajagopal, Brody, and Kleban 1992; Mui 1992; Pruchno, Patrick, and Burant 1997; Valentine, McDermott, and Anderson 1998). This is of interest particularly because Black caregivers typically have lower incomes (Hinrichsen and Ramirez 1992), are less well educated (Staples 1981; Young and Kahana 1995), are in poorer health (Gibson and Jackson 1987; Markides 1989; Mui 1992; Young and Kahana 1995), are more likely to be widowed (Hinrichsen and Ramirez 1992; Mui 1992), and care for relatives with higher levels of impairment (Mui 1992; Young and Kahana 1995) than do White caregivers. Although caregiving research has consistently documented a litany of emotional and physical effects as a function of assuming dependent care for an elderly family member (for excellent reviews see Brody 1990; Schulz, Visintainer, and Williamson 1990), relatively little attention has been paid to the effects that life-long caregiving has on older women who have an adult child with mental retardation.
Parents traditionally have been the primary providers and caretakers for their young children with mental retardation (Bigby 2000; Roberto 1993). However, recent medical and technological advances have resulted in the expectation that large numbers of children with mental retardation will not only live to adulthood but will also reach old age (Ansello and Janicki 2000; Janicki and Wisniewski 1985; Sison and Cotton 1989). Because their children are living longer and fuller lives, the parents are aging in place as caregivers. The central role played by the aging mothers in the lives of their children is not surprising. A sense of parental obligation, a lifetime of caregiving responsibilities, and the tendency for women to outlive their husbands create the situation in which aging women serve as primary caregivers for their child with mental retardation. Researchers have begun to examine the stresses and gratifications (Grant 1988; Greenberg, Seltzer, and Greenley 1993; Pruchno, Patrick, and Burant 1996; Pruchno et al. 1997) associated with this "perpetual parenthood" (Rowitz 1988), but many questions remain. This article explores the association between race and religion as a possible explanation for the differences in caregiving appraisals for a sample of aging mothers who live with an adult child with mental retardation.
Attempts to explain why Black caregivers experience better psychological outcomes than do their White counterparts, despite experiencing more stressors and having fewer resources, have taken several approaches. There have been suggestions that studies may be contrasting the most fit Blacks, those who have survived to old age, with a more heterogeneous group of Whites (Gibson 1982; J. J. Jackson, Chatters, and Neighbors 1982; Manton, Poss, and Wing 1979; Markides and Black 1996; Taylor 1985). A second, related explanation posits that Blacks may be more resilient to the psychological effects of caregiving than Whites are because they are more likely to have experienced a lifetime of adversity (Neighbors, Jackson, Bowman, and Gurin 1983; Rodgers-Rose 1980; Spurlock 1984; Taylor and Chatters 1986). In fact, some researchers have suggested that Black caregivers may even derive unique benefits and satisfactions from the caregiving role (Dilworth-Anderson and Anderson 1994; Lawton et al. 1992). A third approach examines various cultural traditions that result in the empowerment of Black but not White caregivers. One potential culturally linked factor is the role of religion (Ellison 1997; Taylor 1993).
Historically the church and religion have played a prominent role in the lives of Blacks (Lincoln and Mamiya 1990). Researchers have referred to the bond between Black families and the church as an "enduring institution" (Berry and Blassingame 1982). Current theories of the Black religious experience indicate that religion is an integral component of cultural values and beliefs (Spencer 1990). These religious beliefs underlie family values (Lincoln and Mamiya 1990) and provide meaning for life experiences (Taylor and Chatters 1986). The influence of religion may be one reason Blacks express higher levels of filial obligation than Whites (Cox 1995). Research indicates religion is more highly associated with overall life satisfaction for Blacks than for Whites (Thomas and Holmes 1992). Additional research finds that Blacks report higher levels of religiosity (Chatters, Levin, and Taylor 1992), are more likely to claim a church affiliation (Hill 1993), attend church more frequently (Nelsen, Yokley, and Nelsen 1971; Sasaki 1979), and pray and read the Bible more regularly (Hirsch, Kent, and Silverman 1972).
Recent reviews of empirical research on religion (Koenig and Futterman 1995; Levin 1994; Worthington, Kurusu, McCullough, and Sandage 1996) reveal an overall positive association between religion/spirituality and mental health. However, the caregiving literature is just beginning to explore the effect of religion/spirituality in caregiver's lives. Wykle and Segall 1991 studied a small sample of dementia caregivers. In response to an open-ended question, "Identify one special way you have used to deal with caring for your relative," Black caregivers were more likely than White caregivers to report using a religious coping strategy. Cox 1993 assessed service use by dementia caregivers. Black caregivers were more likely to report turning to clergy for support than were White caregivers. An indirect effect of religion on perceived caregiver rewards was found for Black caregivers, but not for White caregivers (Picot, Debanne, Namazi, and Wykle 1997). This led the authors to suggest that Blacks may use religion as a resource when dealing with stressful situations. A similar conclusion was drawn by Wood and Parham 1990, who studied Alzheimer's caregivers. They found that Blacks were more likely to use prayer as a coping strategy than were Whites, and suggested that religion may play a salient role as a coping resource in Black culture.
In a recent study of White caregivers of elders with dementia, Chang, Noonan, and Tennstedt 1998 found that elders who used religion as a coping mechanism were more likely to have a positive relationship with the care recipients than were elders who did not use religious coping. Additionally, religious coping had a positive though indirect effect on depression and role submersion through the caregiver–care recipient relationship. Chang and colleagues 1998(p. 469) concluded that "religion plays a critical role in sustaining human relationships that are often strained by the everyday realities and necessities of providing and receiving care." In a study of mother–child relations, Pearce and Axinn 1998 found a positive association between mother's reports that religion was important to them and the quality of the mother–child relationship.
The literature on mental retardation that focuses on religion and/or race is scare and fragmented (Glidden, Kiphart, Willoughby, and Bush 1993; Rogers-Dulan and Blacher 1995). In a study consisting of 57 primarily White caregivers of adults with mental retardation, Kaufman, Campbell, and Adams 1990 found that parents who attended church once a week or more had lower levels of caregiving stress than did parents who did not attend church as frequently. Kaufman and colleagues concluded that it was plausible that either the social or spiritual aspects of religious participation had a buffering effect on the parent's stress level. Rogers-Dulan 1998 reached a similar conclusion in a sample of 59 Black mothers of school-aged children with a developmental disability. She found that mothers who reported higher levels of religiosity experienced less caregiving stress. In a study of residential planning of older caregivers for their adult child, Heller and Factor 1988 noted that the elder Blacks reported higher levels of religiosity than did Whites. Given that religion/spirituality appears to be associated with positive caregiving appraisals, it is not surprising that Glidden and colleagues suggested empirical research pay more attention to religion/spirituality and its possible role as a resource in the lives of caretakers.
The next steps in the study of race, religion and aging as outlined by Levin, Taylor, and Chatters 1994 are comparative. However, studies in the gerontological tradition comparing racial differences in religiosity have been few for two primary reasons: lack of useful data sources and an absence of religious indicators in appropriate data files (Levin et al. 1994). Additionally, studies comparing Black and White samples often have difficulty separating socioeconomic, educational, cultural, and historical effects from racial differences (Hinrichsen and Ramirez 1992; Lawton et al. 1992; Mui 1992; Stanford 1990). Mutran 1985 advocated controlling for socioeconomic factors, as a racial interpretation of effects is only possible if the spurious effects of exogeneous and mediating variables are controlled. Additionally, Mutran (p. 388) suggested that before a cultural interpretation of results can be entertained, variables that measure "customs, beliefs, or attitudes" should be included in the model. Hinrichsen and Ramirez 1992(p. 380) noted that efforts to ensure a cultural interpretation of race differences in caregiving studies will require "creative and sophisticated approaches to theory, measurement, and methodology."
The present study used the theoretical model of caregiving appraisals developed by Lawton and colleagues 1991 to extend the research of Chang and colleagues 1998 in two important ways. First, in addition to including a measure of psychological distress, that is, caregiving burden, we included a measure of caregiving satisfaction. Second, our sample consisted of an equal number of Black and White caregivers. As noted earlier, Black and White caregiving samples often differ greatly on demographic characteristics (Haley et al. 1995), which may be one reason why difficulties abound in separating racial/cultural effects from socioeconomic effects. We had the unique opportunity to select individuals from a larger database and match them on demographic characteristics known to affect caregiving appraisals, thus creating a sample of caregivers who did not differ by race on a host of demographic characteristics. Using a matched sample allowed us to avoid using race as a statistical control (J. S. Jackson 1989; Lawton et al. 1992) and to instead focus on the link between race, religion, relationship quality, and caregiving appraisals, without confounding historical, social, and cultural characteristics within the construct of race.
The conceptual framework for predicting caregiving burden and satisfaction is based on the model developed by Lawton and colleagues 1991. Subjective caregiving burden was defined by Lawton and colleagues 1991 as "the perception of psychological distress, anxiety, depression, demoralization, and generalized loss of personal freedom attributed directly to caregiving." Caregiving satisfaction, on the other hand, is the perceived benefit of providing care and represents positive affect received from caregiving.
The caregiving appraisals are affected by the stressors and resources available to the caregiver. Stressors are conceptualized as being external to the caregiver and include the degree of disability and demands ensuing from the care recipient (Cantor 1983; Lawton et al. 1991). In this model, the adult child's maladaptive behavior is viewed as a stressor. The resources the individual has are generally viewed as being independent of the stressors. They are the characteristics that enable or impede an individual's ability to cope with the stressors that life presents. They include the strengths that a caregiver possesses internally or can access from the environment. Consistent with definitions of resources used by Lawton and colleagues 1991 and Greenberg and colleagues 1993, resources include the physical health of the caregiver. Including a measure of health status also avoids misspecification error in models examining the relationship between religion and well-being (Levin, Chatters, and Taylor 1995). Additionally, religion is conceptualized as a resource that acts to reduce the adverse effects of stress (Krause and Van Tran 1989). Research indicates religious coping strategies have been used in times of acute stress (Kaye and Robinson 1994; Salts, Denham, and Smith 1991). The final resource, relationship quality, is conceptualized as a mediating variable between religious coping and the caregiving appraisals. The hypotheses, depicted graphically in Fig. 1 are:
1. The higher the level of maladaptive behavior exhibited by the adult child, the poorer the quality of the mother–child relationship (Pruchno et al. 1996
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Figure 1. Theoretical model.
2. Caregiving burden will be predicted by the physical health of the mother. On the basis of findings by Bradburn 1969
3. Religious coping will have a positive effect on relationship quality (Chang et al. 1998
4. The better the quality of the relationship between mother and child, the more positive the caregiving appraisals (Pruchno et al. 1996
5. Black mothers will report higher religiosity (Chatters et al. 1992
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Methods |
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The sample for the analyses that follow was created to ensure that we were not comparing a relatively disadvantaged sample of Blacks to a more heterogenous sample of Whites in terms of demographic characteristics. We followed the example of Haley and colleagues 1995, who matched a sample of caregivers and noncaregivers on demographic characteristics. We created a sample that did not differ by race on key demographic variables known to influence caregiving appraisals. The sample was matched by race on age, education, marital status, employment status, and per capita income, creating a group of 142 women, 71 who are Black and 71 who are White. For example, respondent #90338, a Black 55-year-old married mother who had a high school education and an annual per capita income of $4,999, was matched with respondent #85, who has the exact same demographic characteristics with the exception of being White. The educational categories were less than high school education, high school education, 2 years of college, 4 years of college, master's degree, and PhD/MD. Marital status was categorized as married, widowed, or divorced. Employment status was categorized as employed or not employed. A distinction was not made between full- or part-time employment. Per capita income was created by dividing the total household income by the number of persons residing in the household. Age was the most difficult demographic characteristic to match. Therefore we allowed the mothers to differ on age by plus or minus 10 years. An exact match was made on the other demographic characteristics (education, marital status, employment status, and per capita income). In the few cases in which more than one White mother matched a Black mother, the White mother was selected using a random number table. Cases in which two or more Black mothers matched one White mother did not occur.
Levin and colleagues 1994 suggested that the impact of race on religion may be conditional on demographic characteristics. By matching, we created a sample in which race did not predict socioeconomic status. In other words, the value of the demographic characteristics did not vary with race. In so doing, we controlled for the direct causal relationship between race and the demographic characteristics. Naturally, any indirect effects race may have on the model variables through the demographic characteristics were also controlled. In short, any racial effects in this model are not due to demographic characteristics. Because our focus is on the cultural effects of race, matching allowed us to concentrate on the theoretical model rather than untangling the relationship between race and demographic characteristics.
Respondents
The age of the mothers ranged from 50 to 84 (M = 64.18, SD = 7.42). Half of the mothers were married (51%); 23% were widowed, 25% were divorced, and the rest (1%) were never married. Thirty-five percent of the mothers were employed. Their total household annual income, measured in increments of $5,000, ranged from $4,000 to $70,000 (M = 12.74, SD = 2.93; variable was coded from 1 to 17 using increments of $5,000). The sample was predominately Protestant (66%) and Catholic (27%), with 2% Jewish, 6% of unspecified religion, and less than 1% without any religious affiliation. Respondents had a mean of 13.66 years of education (range = 8–18, SD = 2.26). The age of the adult child ranged from 21 to 58 (M = 34.49, SD = 7.12). Of the 119 mothers who knew the level of their adult child's retardation, 28% reported it as mild, 36% as moderate, and 36% as severe/profound retardation.
Measures
Caregiving appraisals.
Indicators of caregiving appraisals include both positive (caregiving satisfaction) and negative (burden) evaluations. Caregiving satisfaction was measured with a six-item scale developed by Lawton, Moss, Fulcomer, and Kleban 1982. This scale has been used in several caregiving studies (Lawton et al. 1991; Pruchno, Burant, and Peters 1994; Pruchno and Resch 1989). Mothers indicated the extent to which they felt a sense of satisfaction from helping their child, enjoyment from being with their child, closer to their child due to helping, a self-esteem boost because of caregiving, pleasure over child's pleasure, and that caregiving added meaning to their life. Each item was rated on a 5-point Likert-type scale ranging from 0 (never) to 5 (nearly always). Scores ranged from 15 to 30 (M = 25.35, SD = 3.91), with a higher score indicating greater caregiving satisfaction. Coefficient alpha for the scale was .78.
Subjective burden was measured by the nine-item scale developed by Lawton, Kleban, Moss, Rovine, and Glicksman 1989. Subjective burden experienced from the caregiver role included the caregiver's perception of the extent to which her health, well-being, social life, and personal relationships had been negatively affected because of the demands of the caregiver role. Respondents reported the extent to which their lives were affected by their caregiver role using a 5-point scale, ranging from 0 (never) to 5 (nearly always). Higher scores indicated more burden. The scale ranged from 9 to 37 (M = 18.96, SD = 6.64). The Cronbach alpha was .86.
Stressors.
The frequency of maladaptive behaviors was assessed using a measure that was based on the American Association of Mental Retardation Adaptive Behavior Scale: Residential and Community–Part 2 (Nihira, Leland, and Lambert 1993). The mothers reported the frequency (never, rarely/occasionally, frequently) with which their child exhibited 19 behaviors during the month preceding their interview. Behaviors assessed included threatening physical violence, inconsiderate behavior, rebellious attitude, poor reactions to criticism/frustration, attention-demanding behavior, and emotional instability. Behaviors were summed to form a composite measure of maladaptive behavior. Higher scores indicated that the child was more likely to exhibit each behavior. The range was 0 to 25 (M = 6.41, SD = 5.31). The coefficient alpha for the scale was .85.
Resources.
The mother's self-rated health was measured with a four-item scale. The first item, "How would you rate your overall health?" ranged from 4 (excellent) to 1 (poor). The remaining items, "Is your health now better, about the same, or not as good as it was three years ago?" "Does your health stand in the way of your doing things?" and "Would you say that your health is better, about the same, or not as good as most people your age?" ranged from 3 (not at all) to 1 (a great deal). The final scale ranged from 4 to 13 (M = 9.18, SD = 2.06). Coefficient alpha was .76.
The quality of the relationship between mother and child was measured using three questions developed by Gronvold 1988. Each question was measured on a 4-point Likert scale. Questions included assessments of the quality of the current relationship, the extent to which mothers feel close to their child, and the extent to which they get along with their child. An additional item, with responses ranging from 1 (never) to 5 (nearly always), asked how often the mother felt that she loved her child very much. Scores ranged from 12 to 17 (M = 15.64, SD = 1.46), with higher scores indicating a better relationship. Coefficient alpha was .69.
Religious coping was measured with an eight-item scale. Six questions were measured on a 5-point Likert scale. These questions asked how often during the month the mothers prayed for guidance, sought God's help, prayed for strength, found comfort in religion, put their trust in God, and prayed more than usual when dealing with problems with their child. The remaining two questions, measured on a 4-point Likert scale, asked whether the mother believed her religion helped her to accept her child's disability and whether having a child with a developmental disability had brought the mother closer to God. Scores ranged from 6 to 32 (M = 26.11, SD = 6.17), with higher scores indicating higher religious coping. Coefficient alpha was .91.
Procedures
Structural analysis using the AMOS program (Arbuckle 1995) was used to test the hypothetical model depicted in Fig. 1. The proposed model, which includes seven constructs, is complex, and the latent constructs have only one indicator. The concern is that a model having only one indicator for a construct may be underidentified empirically and may have constructs that correlate too low or factor loadings that are too small (Kenny 1979). This was not the case with the current model as indicated by the significant correlations (see below) and paths of the indicators of these constructs. However, the recommendation made by Liang, Lawrence, Bennett, and Whitelaw 1990 to estimate measurement error (rather than combining measurement and structural models in one analysis), enabling single indicators of model elements to be used rather than multiple indicators, was followed. The procedure for adjusting measurement error used the formula developed by Werts, Linn, and Joreskog 1974 and Wheaton, Muthen, Alwin, and Summers 1977 in which the measurement error variances are fixed as variance times (1 - reliability). These procedures result in squared multiple correlations that were equal to the reliability estimates and correct for known unreliability among measured variables. Because race is a relatively objective measure, the decision was made to treat the variable as not having random error.
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We conducted t tests to determine if the mean levels of the model variables differed by race. Of particular interest to this study is that the mean levels of caregiving burden and caregiving satisfaction did not differ by race. The maladaptive behaviors exhibited by the adult child also did not differ by race. The matched sample however exhibited some differences. Blacks had higher mean levels of religious coping and relationship quality than Whites did. The mean level of the mother's self-reported health was lower in the Black sample than in the White sample. The results of the t tests for the model variables are in Table 1 .
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Bivariate correlations for the matched sample are found in Table 2 . Being Black was associated with lower self-rated health, higher relationship quality, and higher levels of religious coping. Higher burden was associated with more maladaptive behaviors, mother's self-rated health, poorer relationship quality, and being White. Higher caregiving satisfaction was associated with lower levels of maladaptive behavior, religious coping, better relationship quality, and being Black.
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) and the root mean square error of approximation (RMSEA). Browne and Cudeck 1993 stated that a value equal to or less than .05 indicates a close fit of the model. Whereas the summary statistics in the theoretical model, 
2(9, N = 142) = 12.89, p = .17, comparative fit index (CFI) = .99, RMSE = .06, suggest a relatively good fit of the data to the model, four of the paths (from child behavior problems to caregiving satisfaction, race to caregiving satisfaction and burden, and religious coping to relationship quality) were not significant. Additionally, modification indices indicated a direct relationship between religious coping and caregiving satisfaction. The nonsignificant paths were dropped one at a time, and a path was added from religious coping to caregiving satisfaction. Reestimation of these paths resulted in a better fitting model, 2(12, N = 142) = 13.68, p = .32, CFI = 99, RMSE = .03. The model explained 33% of the variance in caregiving burden and 65% of the variance in caregiving satisfaction. The standardized total effects of race on burden and satisfaction were .06 and .07, respectively. The standardized total effect of religious coping on caregiving satisfaction was .22. The standardized total effects of child behavior problems on caregiving burden and satisfaction were .43 and -.24, respectively. The standardized total effects for relationship quality on caregiving burden and satisfaction were -.29 and .77, respectively. Results are shown in Fig. 2.
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The direct relationship between race and caregiving satisfaction and burden was not substantiated. Similarly, the adult child's maladaptive behaviors did not predict caregiving satisfaction. The adult child's maladaptive behaviors were associated with higher levels of caregiving burden and lower levels of relationship quality. Finally, being Black was associated with worse physical health. Lower levels of physical health were associated with higher levels of burden.
The relatively small sample size of 142 participants suggests the potential for instability in the model. The extent of instability, however, is testable using the Hoelter critical N (CN). Hoelter 1983 CN is the largest sample size that should be used to accept the model. The general rule of thumb suggested by Hoelter is that a CN of 200 or greater yields a satisfactory fit at a .05 significance level. The final model yielded a CN of 217, indicating a satisfactory fit.
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The model provides some support for a cultural effect of religious coping. Blacks are more likely to use religious coping. Blacks also experience higher levels of caregiving satisfaction because of the indirect influence of religious coping. For some mothers religion may give meaning to having a child with a disability (Krauss and Seltzer 1993) by providing a framework for explaining nonnormative events. Researchers in the field of mental retardation have suggested religion may play an important role in the parent's acceptance of a child with a disability (Crnic, Friedrich, and Greenberg 1983). Religious coping in our model, which includes a measure of religious acceptance, is positively associated with caregiving satisfaction. Our model findings indicate that as a resource, religious coping frames the caregiving experience in a positive manner.
However, religious coping does not directly or indirectly influence caregiving burden. Religious coping does not appear to act as a buffer against everyday stress. Perhaps religious coping is a useful resource in times of acute stress or illness (Wheaton 1985). It is surprising that religious coping does not reduce caregiving burden for Black mothers. Proctor 1995(p. 24) explained that Black people "carved out a distinctive style of Biblical interpretation." For them, faith was a means of transcending pain and oppression. Blacks believe that God will help them bear their daily burdens, and that they are not struggling through life alone. Thus, religion helps Blacks accept burden, but may not reduce burden. An alternate explanation suggested by Rosenthal 1986 is that caregiving demands are so strenuous that cultural factors do little to alleviate the feelings of caregiving burden.
These results are consistent with previous research which shows that the positive and negative aspects of the caregiving experience have differing antecedents (Bradburn 1969; Lawton 1983). Specifically, "uplifts" (DeLongis, Coyne, Dakof, Folkman, and Lazarus 1982) create a positive caregiving experience and are associated with caregiving satisfaction, but not caregiving burden. Religious coping, then, may also be conceptualized as an uplift. In this respect religious coping is seen as an inner resource that helps the mothers frame caregiving in a positive light.
Although the correlations indicate a positive association between being White and burden, bivariate correlations do not control for the other variables in the model. Thus, contrary to previous research (Connell and Gibson 1997), we find a positive relationship between being Black and caregiving burden. The structural equation model indicates that the indirect effect of race on burden is positive. This is due to the relationship between race and self-rated health. Black mothers are more likely to rate their health as poor, and mothers in poor health are more likely to experience higher levels of burden. This suggests that Blacks may experience higher levels of caregiving burden than do their White counterparts. Whereas theoretical concerns have been expressed regarding the double jeopardy hypothesis (Markides and Mindel 1987), this research indicates that caregiving may be more difficult for Black mothers. Even after ensuring that the Black mothers were not disadvantaged in socioeconomic terms, we found that they still had fewer resources, in terms of physical health, than the White mothers. This work highlights the importance of considering whether race is a proxy variable for socioeconomic status and the need to consider the interaction between race and socioeconomic status (J. S. Jackson 1989). Furthermore, this research indicates a need for an in-depth exploration of cultural or other factors that explain the negative relationship between being Black and caregiving burden given their relatively disadvantaged status.
As in any cross-sectional study, interpretations of causality must be made with caution (Kenny 1979). As Lee and Hershberger 1990 and MacCallum, Wegener, Uchino, and Fabrigar 1993 noted, it is quite possible to fit models with different directions of causation to the same correlational data. It is somewhat encouraging, however, that the data provide support for the proposed theoretical model. These findings are limited by the voluntary nature of the sample and the inherent bias associated with self-selection. Because the sample is nonrandom, generalizability of findings from these analyses is limited by characteristics of the people participating in the study. The mothers in this sample had an unusually high educational level. This may be an artifact of the matching process, as we did not have many White mothers with lower educational levels. Additionally these findings are limited to mothers whose children have some degree of cognitive impairment.
Although these analyses focus on the effects of race and cultural values, intraracial differences were not specified. Thus, the tremendous diversity that characterizes the Black population (Taylor, Chatters, Tucker, and Lewis 1990) was not captured in this model. Future work should focus on variation within cultural groups to validate the substantive findings. Similarly, religion is a multidimensional concept (Chatters et al. 1992). Whereas other dimensions of religious involvement may influence caregiving appraisals, we choose to focus on religion as a coping mechanism. From a conceptual standpoint, if religion aids in accepting the child's disability, then the mother–child relationship should be strengthened through the use of religious coping strategies. Future research should explore the multidimensional nature of religion and its effect on the various elements of the caregiving process. It is possible that organizational religion, for example, would have an effect on caregiving appraisals particularly if the mother's social support network is composed of church friends. Additionally, future work should consider developing culturally sensitive measures of religion and/or spirituality.
Another limitation is the lack of variability in the measure of relationship quality. Because the observed ranges were so small, it is difficult to find significant relationships. Relationships may have been underestimated. This may be another reason why a significant link was not found between religious coping and relationship quality.
Lastly, even after matching on the demographic characteristics, it is still possible that we might not be measuring cultural and racial differences (Hinrichsen and Ramirez 1992). Researchers have suggested that race may even be a proxy variable for other factors, such as family structure (Young and Kahana 1995). As such, there may be unspecified factors that explain the model results.
Nevertheless, these findings have important implications for practice. These analyses show that Blacks do experience negative outcomes from the caregiving situation. Although they do draw on inner resources to help them view the caregiving experience in a positive light, their religious strength does not buffer against burden. Blacks remain a relatively underserved population from the perspective of the social service delivery system. Because Blacks may experience higher levels of burden because of their poor health, they should not be marginalized from "best practices" in service provision. Their tendency to draw on religious strengths indicates that outreach efforts should be developed that are culturally and racially sensitive. Faith-based organizations may be an important cultural resource that is often overlooked.
Practice Concepts
The Forum
Book Reviews
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Acknowledgments |
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Helen B. Miltiades thanks Frank Porell for his advice on statistical methods.
Received for publication March 30, 2001. Accepted for publication August 23, 2001.
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