The Verification Of Family Resilience Model Under Chinese Culture In The Family Care Of Patients With Dementia

Background:Dementia is a priority for global public health.A total of 9.5 million people suffer from dementia in China.Providing care for patients with dementia has laid a heavy burden on families with dementia patients.The promotion of family adaptation for dementia patients will help ensure the quality of life of dementia patients.The Family Resiliency Model,proposed by McCubbin et al.5 was based on the family stress theory and family strength research.The model can put a light on the key factors and process of family adaptation in patients with dementia.Considering culture variations,the model warrants localization and verification before the application to our country.Objectives:(l)To clarify the core concepts,definitions and conceptual framework of"Resiliency Model Family Adjustment and Adaptation(abbreviation:Family Resiliency Model)" under Chinese culture(2)To test the fitness of meta-construct of family resiliency,Family Resiliency Model in the family care of dementia patients in China under Chinese culture.Methods:This research included two parts:(1)Part ? On the basis of literature review,group discussion by research members,and translation of core concepts,the localization of Family Resiliency Model under Chinese culture was accomplished by means of Experts Argumentation.Eight experts with more than 10 years of research experience in Cultural Psychology,Family Sociology,Geriatric Sociology,Community Nursing(Geriatric Nursing)were invited for the Experts Argumentation.Through e-mail communication,first global feedback,personal communication and final feedback constituted the Experts Argumentation.Finally,the core concepts,core concept definitions and conceptual framework of Family Resiliency Model under Chinese culture were clarified.(2)Part ? A cross-sectional study was adopted.203 families of patients with moderate and severe dementia were enrolled in accordance with the inclusion criteria from Memory specialist clinic and Geriatric psychiatric clinic of Peking Union Medical College Hospital,Xuanwu Hospital Capital Medical University,China-Japan Friendship Hospital,Beijing Anding Hospital.The General Information Questionnaire was used to measure the information of patients and their families.The Revised Memory and Behavior Problems Checklist,Activity of Daily Living,Family Inventory of Life Events and Changes were used to measure family stressor,Family Inventory of Resources for Management,Multidimensional Scale of Perceived Social Support,self-designed Social Support Scale,Family Schema-Ethnic Index,Family Coping Coherence Index,the self-designed Family Paradigm Scale,Positive Aspect of Caregiving,Zarit Burden Interview,Family Crisis-Oriented Personal Evaluation Scale were used to measure family resilience factors,the Family Adaptation Scale was used to measure family adaptation.Family Inventory of Life Events and Changes,Family Inventory of Resources for Management,Family Schema-Ethnic Index,Family Coping Coherence Index,Family Crisis-Oriented Personal Evaluation Scale and Family Adaptation Scale were translated from English version.Multidimensional Scale of Perceived Social Support,Positive Aspect of Caregiving,Zarit Burden Interview,and Family Adaptation Scale were modified.Social Support Scale and Family Paradigm Scale were self-designed.The data were brought into the Model of meta-construct of "Family Resilience".Structural Equation Model was used to verify the Model.Then,the conceptual framework of the "Family Resiliency Model under Chinese culture" clarified by the Part ? was verified and modified.Results:(1)Part ? ?The model of Family Resiliency Model under Chinese culture consisted of 4 "major core concepts",namely stressor,family crisis,family resiliency and family adaptation."Family resilience" acted as the meta-construct and consisted of 11 "subordinate core concept".They were situational appraisal,family schema,family coherence,family paradigm,meanings,family resources,family support,kinship support,community support,social support,problem solving and coping.There were 15 core concepts in total.?For the total 15 core concepts,the contents of family schema,family paradigm,community support,and social support were revised under Chinese culture,while there were only verbal adjustments for other concepts under Chinese culture.?The conceptual framework was based on the family adaptation phase of McCubbin5s Family Resiliency Model."Subordinate core concepts" which interact with each other constitutes "family resilience".The correlated concepts,including family support,kinship support,community support,social support constituted support system while the correlated concepts,including family schema,family coherence,family paradigm,meanings constituted cognition system.Except for the deletion of the concepts of "family patterns of functioning" and"pile-up of demands" in the model,there were no other changes.(2)Part ? A total of 223 families of elderly patients with dementia participated in the survey.203 valid questionnaires were retrieved for data analysis,and the effective response rate was 91.03%·?The overall indices of model fitting for "meta-construct”of Family Resiliency under Chinese culture was achieved,namely ?2/df=2.485,GFI=0.929,NFI=0.886,IFT=0.929,CFI=0.927,TLI=0.888f PGFI=0.507,RAMSEA=0.086.Most of these indices of model fitting met the requirements,meaning the model fits with the actual data.?The overall indices of model fitting for Family Resiliency Model under Chinese culture was achieved,namely ?2/df=1.885,GFI=0.919,NFI=0.875,IFI=0.937,CFI=0.935,TLI=0.907,PGFI=0.559,RMSEA=0.066,These indices of model fitting met the requirements,meaning the model fits well with the actual data.?In the final Family Resiliency Model under Chinese culture,the support system was divided into "internal support system" and"external support system".The direct effect of stressor on problem solving and coping,congnition system and external support system were deleted,as well as the direct effect of problem solving and coping,congnition system and external support system on family adaptation.The some of direct effects between "subordinate core concepts"were deleted too.While the effect of internal support system on congnition system and problem solving and coping on external support system were added.Conclusions:(1)Family Resiliency Model under Chinese culture mainly retains core concepts of the McCubbin's Family Resiliency Model.The model consists of 15 core concepts in total,namely stressor,family crisis,family resiliency and family adaptation as the "major core concepts" and situational appraisal,family schema,family coherence,family paradigm,meanings,family resources,family support,kinship support,community support,social support,problem solving and coping as the "subordinate core concept".(2)Family Resiliency Model under Chinese culture mainly retains conceptual framework of "family resilience" in the McCubbin's Family Resiliency Model.The effectiveness of this model has been proved in family of patients with dementia under Chinese culture.?the conceptual framework is based on the family adaptation phase of McCubbin's Family Resiliency Model·?The meta-construct of "family resilience" consistes of 3 systems and 3 "Subordinate core concepts" which interacts with each other.?The subordinate core concepts/systems of "family resilience" meta-construct play an intermediate role in the relationship between stressors and family adaptation.(3)Chinese culture plays a key role in the definition of some of the core concept and the relationship between them.?Of the total 15 core concepts,the definition of family schema,family paradigm,community support,and social support are revised under Chinese culture·?In the Family Resiliency Model under Chinese culture,the support system was divided into"internal support system" and "external support system".?Direct effect of stressor on problem solving and coping,congnition system and external support system were deleted,as well as direct effect of problem solving and coping,congnition system and external support system on family adaptation.Some of direct effects between"subordinate core concepts" were deleted too.While the effect of interaal support system on congnition system and problem solving and coping on extermal support system were added.