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A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members

A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members [oral defense]

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A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members [oral defense]

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Content Ba Con Cafe (BCC)
a
Targeted Culturally-Informed
Approach
for
Caregiving Stress
among
Vietnamese Family Caregivers
● Oral Defense
● Date: July 24th 2024
● University of Southern California
● By Linda Nguyen

Introduction
● Who am I?
○ Miss Vietnam California 2024
○ Licensed Clinical Social Worker
○ Certified Nursing Assistant
○ Master of Social Work
○ Master of Arts in Gerontology
○ Doctoral Candidate for Doctorate of Social Work
● Capstone Project: Ba Con Cafe
○ BCC aims to address caregiver stress by proposing a targeted
solution that leverages community support and culturally
appropriate resources.
2

Grand Challenge of Social Work ● Eradicate Social Isolation and Loneliness (SI/L) ○ Social isolation (SI) as the absence of social
connection and consistent relationships, and
perceived loneliness (L) as the subjective feeling
of social disconnection (Academy of Social
Welfare, n.d).
○ SI/L is a complex and multifaceted wicked
problem, which can lead to adverse outcomes,
including the focus of this Capstone Project,
caregiver stress.
○ Family caregivers often suffer from caregiver
stress in solitude as they must attend to the
day-to-day demands of family members with
physical, mental, and cognitive limitations
(National Association of Chronic Disease
Directors, 2018)
3

Role of Family Caregiver: They support family recipients with
emotional and psychological needs such as listening,
empathizing, understanding, and providing reassurance to the
recipient through challenging times. They also provide physical
assistance through ADL and IADL activities such as bathing,
dressing, eating, meal preparation, and medication
management (CDC, n.d).
Define Caregiver Stress: high levels of stress resulting from the
emotional, mental and physical exhaustion of caregiving (Mayo
Clinic, n.d).
Description of the Problem: Vietnamese caregivers often face
unique challenges that contribute to heightened levels of stress.
These include cultural expectations, language barriers, and
limited access to resources. Caregiver stress not only affects
the caregivers' mental and physical health but also impacts the
quality of care they can provide.
Problem Statement
4

Caregiver Stress Statistics
● 65.7 million Americans serve as family caregivers for an ill or disabled relative (American
Psychological Association, 2011) and 43.5 million provide unpaid care estimated at 470 billion
dollars of unpaid care in 2013 (Family Caregiver Alliance, n.d).
○ The need for caregivers will grow as it is estimated that the 65+ population by 2030 will be 73 million people and that 70% of adults
65+ will require some form of caregiving supportive services before they die (HHS, n.d).
● Compared to their non-caregiving peers, 71% of family caregivers experience caregiver stress
(Lynch et al., 2018).
○ Caregiver stress resulted in 32.9% increase of MH problem (Johnson & Fertel, 2023).
○ 63% have higher mortality rates (HHS, n.d).
○ 51% reported they did not have time to take care of themselves (The National Institute Health, 2016).
○ 49% stated they were too tired to care for themselves (The National Institute Health, 2016).
● Only 25% of the sample who experienced significant emotional difficulty and health-related concerns
utilized caregiver support resources (Wolff et al., 2016).
● Studies have found that caregivers with caregiver stress had a higher chance of engaging in elder
mistreatment (Orfila et al., 2018)
Literature Review
5

Caregiver Stress Among Vietnamese Caregivers (TARGET)
● Vietnamese people feel powerless, lonely, and
socially isolated in Western society due to their status as
foreigners and refugees (Jang et al., 2022).
● Only 35% of foreign-born Vietnamese are English proficient (Budiman, 2021).
● Multiple cultural factors impact Asian caregivers’ readiness for help-seeking (Chan, 2020).
—> Three times LESS LIKELY than White Americans to seek mental health services (APA, n.d).
● Stakeholder interviews conducted through this Capstone Project revealed that Vietnamese family
caregivers find great difficulty in navigating, understanding, and following through with current family
caregiver interventions.
—> “I don’t understand.” -42 year old Vietnamese female family caregiver
—> “I don’t have any problems.” -49 year old Vietnamese female family caregiver
—>“I don’t need your help.” -55 year old Vietnamese male family caregiver
Literature Review
6

7

● While several interventions exist to
support caregivers, many do not
adequately address the specific
needs of Vietnamese caregivers.
● These barriers and gaps
underscores the necessity for
solutions that are both culturally
informed and practically applicable.
Solution Landscape
8
Barriers
For
Vietnamese
Caregivers
CULTURAL
EXPECTATIONS
LANGUAGE
LACK OF
TARGETED
RESOURCES
MISTRUST
LACK OF
SOCIAL
SUPPORT STIGMA
POOR
COMPREHENSION
OF
CAREGIVER STRESS
& RESOURCES

● Addresses gaps in literature and solution landscape: ■ Safe and inclusive space ■ Education on caregiver stress ■ Community and social support ■ Culturally sensitive material and resources ■ Skills to navigate community resources
Ba Con Cafe (BCC):
A Targeted Culturally Informed Approach for Caregiver Stress
Among Vietnamese Caregivers of Family Members
9
Mission Statement: Ba Con Cafe recognizes the significant
impact of caregiver stress on the wellbeing of family
caregiver. It seeks to create a community and safe space to
learn, express, and resolve caregiver stress through
evidence-based support groups and a culturally informed
curriculum that respects their traditions, values, and belief
systems with the goal of eradicating social isolation and
loneliness and caregiver stress. (Translation of Ba Con Cafe: grandparent, grandchildren,
parent, children and community Cafe)

1. Program Goals:
○ Increase awareness of caregiver stress.
○ Decrease caregiver stress through meaningful
social networking and stress management
techniques.
○ Increase utilization and knowledge of community
resources for caregiver stress.
2. Evaluation:
○ APA’s Caregiver Self-Assessment:
i. Frequency: Administered at the end of
each session.
ii. Purpose: Monitor program outcomes and
participant progress.
○ Post-Module Questionnaire:
i. Frequency: Administered at the end of
each session.
ii. Purpose: Gather feedback for continuous
improvement.
○ Data Collection:
i. Responsibility: Program Manager.
ii. Metrics: Number of participants, referrals,
participant return rate, and improvement in
self-assessment scores.
BCC: Goals, Key Metrics and Evaluation
10

Post-Module Questionnaire
11

1. Classroom Setup: ○ Location: Buddhist Temple in San Jose, CA ○ Comfortable seating arranged in a circle to
encourage interaction.
○ Posters displaying stress management
techniques and cultural symbols will be displayed
2. Program Materials: ○ Handouts with key information and stress
management exercises.
3. Cultural Sensitivity: ● Language: ○ Bilingual materials and facilitators fluent in
Vietnamese.
○ Use of culturally appropriate expressions and
examples.
● Activities: ○ Incorporation of traditional practices like Zen
meditation.
○ Group discussions reflecting Vietnamese values
and experiences. 12
BCC: Physical Space Design

This five-week, facilitator-led social support group leverages evidence-based tools (Powerful Tool of
Caregiving PTC and Stress Busting Program SBP) and a culturally informed curriculum
1. Week 1: Introduction to Family Caregiver Stress
○ Content: Overview of family caregiver stress, including signs, symptoms, and negative
outcomes.
○ Special Focus: How caregiver stress uniquely affects Vietnamese family caregivers due to
cultural factors.
2. Weeks 2-5: Culturally Adapted Curriculum
○ Content: Following the four-week PTC curriculum (Self-Care Behaviors, Emotion Management,
Self-Confidence, Community Resources), there will be an additional 30-minute session each
week for special focus discussion and practice.
○ Special Focus: Applying topics to the unique experiences and needs of Vietnamese family
caregivers.
○ Activities: Discussion questions, practice of stress management skills targeting this
population.
○ SBP: Utilization of stress management techniques that is culturally tailored
BCC: Program Structure
13

High-Fidelity Prototype
14

15

Design Thinking and Process and Design Justice
Framework ● The design thinking process involved iterative
cycles of empathy, definition, ideation,
prototyping, and testing. ○ Participants included Vietnamese
caregivers, community leaders, and
healthcare professionals.
○ Data collection methods comprised
interviews, focus groups, and design
labs to identify key needs and
preferences.
● Design thinking and a design justice framework
were chosen to ensure the intervention is
user-centered and culturally relevant.
● These methodologies facilitate inclusive
participation and empower caregivers to
contribute to the design of solutions that
directly impact them.
Methodology
16

Theoretical Framework and Theory of Change
Family Resilience Theory
The family resilience theory underpins this
project, emphasizing the importance of
strengthening family units to cope with
stress and adversity. This theory aligns well
with Vietnamese cultural values, which
prioritize family cohesion and mutual
support. By focusing on resilience, this
project aims to empower caregivers to
manage stress more effectively and sustain
their caregiving roles.
The Theory of Change provided a
comprehensive roadmap outlining the
steps necessary to achieve our long-term
goals. It includes understanding the
problem, identifying key interventions, and
mapping out the expected outcomes and
impact
17

18

● To ensure scalability, the project will
leverage technology to expand
reach, including online workshops
and a resource-rich website.
● Partnerships with national
Vietnamese organizations will
support broader implementation.
● Feedback from end users and the
evaluation will facilitate changes in
the program such as updating the
community resource tool kit.
Scaling Plan
19

Next Steps
20

● BCC underscores the importance of
culturally sensitive interventions in
addressing caregiver stress. By
leveraging design thinking principles,
a justice-informed framework, and
the theory of change, we can create
meaningful and lasting change for
Vietnamese family caregivers.
● It has the potential to serve as a
best practice in the field of inclusive
caregiver stress programs, where
other ethnic groups and populations
can innovate and create specialized
interventions for specific
populations.
Conclusions and Implications
21

Acknowledgments
22

References
American Psychological Association. (2011). Who are family caregivers?
https://www.apa.org/pi/about/publications/caregivers/faq/statistics
Budiman, A. (2021, April 29). Vietnamese in the U.S. fact sheet. Pew Research Center.
https://www.pewresearch.org/social-trends/fact-sheet/asian-americans-vietnamese-in-the-u-s-fact-sheet/
Chan, A. (2020, October 26). Asian countries do aged care differently. Here’s what we can learn from them. The Conversation.
https://theconversation.com/asian-countries-do-aged-care-differently-heres-what-we-can-learn-from-them-148089
Family Caregiver Alliance. (2006). Caregiver health. https://www.caregiver.org/resource/caregiver-health/
Jang, Y., Park, J., Choi, E. Y., Cho, Y. J., Park, N. S., & Chiriboga, D. A. (2022). Social isolation in Asian Americans: Risks associated with
socio-demographic, health, and immigration factors. Ethnicity & Health, 27(6), 1428–1441.
https://doi.org/10.1080/13557858.2021.1881765
Johnson, M., & Fertel, H. (2023, February). Elder abuse. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK560883/
Lynch, S., Shuster, G., & Lobo, M. (2018). The family caregiver experience—Examining the positive and negative aspects of compassion
satisfaction and compassion fatigue as caregiving outcomes. Aging & Mental Health, 22(11), 1424–1431.
https://doi.org/10.1080/13607863.2017.1364344
Mayo Clinic Staff. (n.d.). Caregiver stress: Tips for taking care of yourself. Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/caregiver-stress/art-20044784
National Association of Chronic Disease Directors. (2018). Caregiving for family and friends—A public health issue [Brief]. Centers for
Disease Control and Prevention, U.S. Department of Health and Human Services.
https://www.cdc.gov/aging/caregiving/pdf/caregiver-brief-508.pdf
Wolff, J. L., Spillman, B. C., Freedman, V. A., & Kasper, J. D. (2016). A national profile of family and unpaid caregivers who assist older adults
with health care activities. JAMA Internal Medicine, 176(3), 372–379. https://doi.org/10.1001/jamainternmed.2015.7664
23

Abstract (if available)

Abstract Family caregiver stress is not only prevalent in the United States where it impacts 71% of the 41.8 million family caregivers providing services to adults over the age of 50, but also has significant consequences for the aging system and health care system, and the health and safety of caregivers and their care recipients. The American Academy of Social Work and Social Welfare has emphasized eradicating social isolation and loneliness (SI/L); research has found SI/L to be a root cause of family caregiver stress. Effective evidenced-based interventions like the Powerful Tool of Caregivers (PTC) and Stress-Busting Program for Family Caregivers have promising outcomes of reduction of caregiver stress. However, the current research and solution landscape have focused on the general caregiver population, which has created barriers and gaps in services. For example, Vietnamese family caregivers are not utilizing these resources, have reported poor comprehension of the resources, and are not always aware that the resources exist. In response to these issues, this Capstone Project developed the Ba Con Café (BCC) (Translation: parent, children, grandparent, grandchildren, and community Café). The BCC is a culturally-informed approach for Vietnamese family caregivers caring for family members who can independently live in the home and who only need assistance with daily living activities. BCC provides prevention and self-care options for caregiver stress through education and community support. BCC recognizes the effectiveness of current models to address caregiver stress while being mindful of the unique challenges and belief systems that Vietnamese family caregivers face. BCC seeks to bridge the gaps in support services and knowledge about caregiver stress by creating culturally-informed solutions.

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Asset Metadata

Creator Nguyen, Linda (author)

Core Title A targeted culturally-informed approach for caregiver stress among Vietnamese caregivers of family members [oral defense]

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-08

Publication Date 07/26/2024

Defense Date 07/24/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag and culturally responsive social supports,caregiver stress,family resiliency,Loneliness,OAI-PMH Harvest,social isolation,Vietnamese caregivers

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Smith-Maddox, Renee (committee chair)

Creator Email lindanguyen.thu@gmail.com,lnguyen3@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC1139990GP

Unique identifier UC1139990GP

Identifier etd-NguyenLind-13294-Oral-Defense.pdf (filename)

Legacy Identifier etd-NguyenLind-13294-Oral-Defense

Document Type Capstone project

Format theses (aat)

Rights Nguyen, Linda

Internet Media Type application/pdf

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