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Perceptions of dementia among Asian Indian Americans

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Perceptions of dementia among Asian Indian Americans

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Content PERCEPTIONS OF DEMENTIA AMONG ASIAN INDIAN AMERICANS
Copyright 2004
by
Poomi Ganapathi-Raj Otilingam
A Thesis Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(PSYCHOLOGY)
December 2004
Poomi Ganapathi-Raj Otilingam
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UMI Number: 1424251
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Dedication
I dedicate my master’s thesis to S.B., without whom this project would
not have been possible.
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Acknowledgements
I would like to thank the following individuals: S.B. - my eternal gratitude in always
being here, there, and everywhere for me. My committee - M.G., B.M., J J. - for
your full support, encouragement, and enthusiasm. M.G. - for your undeniable
enthusiasm and support for this study, technical advice, mentoring, and draft
reviews. R.B.G.O., G.R.M.O., & V.R.G.O. - for all the love, prayers, and the
“mountains” of wisdom and encouragement. G. Y. - for the love, troubleshooting
prowess, comic relief, and encouragement to persist with the data collection when I
had enough uttapams; also for being the truest of friends, celebrating the triumphs
and for being there when things got rough. H.D. & B.O. - for your overwhelming
generosity through such loyal friendship, for being so engaged in this study, and for
making me have fun with all the surprises, love, and good thoughts. Your genuine
curiosity about this study did wonders for me. V.B. - for the encouragement,
support and comic relief. Thank you for coming into the picture when you did. J.D.
- for your tremendous support, dry wit, amazing therapeutic skills (even before
‘formal training’), and of course, your unwavering support of my frozen
confectionary penchants as reinforcements on the road to thesis completion. H.D.
and P.P. - for a much, much needed weekend break. Your actions helped to define
the word “kindness” in a completely new way. The G.S. staff, especially R.I., D.S.,
S.W. L.Y. and C.G. - for your support and for such enjoyable work memories. A.K.,
C.F. - for being wonderful friends & reliable late night phone resources. A. A. - you
may not know it, but you serve as a true academic inspiration to me. P.S.C., all
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Y.A.s, S.S., and J.P., S.N., and G.S. - for having the remarkable ability to wipe any
doubts away. S.N. - for reminding me what the term discipline really means. G.G.
- for the inspiration to run with this idea and for being so tuned into the public health
perspective. R.W., E.E., P.M. - for the support and always, the love. M.D., M.D.,
and K.G. - for your public health perspectives in all the work that I do. B.W., L.L.,
H.W., C.C. - for reminding me of my rationale to enter school again and not letting
me forget Austin. B.S. - for always encouraging me to combine my interests in
culture, mental health, and public health. N.J.T. - for always encouraging me to
pursue my dreams, and for giving me a dry run of what a thesis and a “presentation”
is like. B.Y. - for your listening ear, the encouragement, and the garden delights that
I would be remiss to forget, as they bring such a sense of home to work. M.M. - for
being brilliant, your unmatched kindness, statistical assistance and overall feedback,
encouragement, all the discussions, and the Scottish humor. A.F. - for your genuine
enthusiasm on this study, your feedback, encouragement, and for the gold star. B.M.
- for bouncing research ideas with me and for your solid input early on in the life of
this study. To all my labmates, past or present (including R.J., J.B., M.C., R.A., and
K.W.) - thank you for the sage advice and feedback throughout this study. Y.C. (or
is that Y.V.?), S.D., E.F., J.G. - for encouraging me to be true to my research
passions. N.I.A. - for supporting me in pursuing this research study. In addition, to
the faculty, all of my program mates, colleagues and friends at USC, especially in the
Department of Psychology, to my data collection sites, and last but certainly not
least, to all the participants who took part in this study: thank you.
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Table of Contents
Dedication........................................................................................................................... ii
Acknowledgements.......................................................................................................... iii
List of Tables.....................................................................................................................vi
Abstract............................................................................................................................. vii
Background......................................................................................................................... 1
Method...............................................................................................................................12
Results............................................................................................................................... 42
Discussion.........................................................................................................................56
Bibliography.....................................................................................................................67
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List of Tables
Table 1 - Number o f Participants Recruitment by S ite............................................. 14
Table 2 - Response Percentages, Mean Scores, SDs, and Factor Loadings for
Etiological Beliefs about Dementia...............................................................................18
Table 3 - Percentage of Responses for Knowledge of Dementia and Dementia
Symptoms.........................................................................................................................24
Table 4 - Mean Scores, SD, and Factor Loadings fo r Dementia Help-Seeking
Belief Items......................................................................................................................25
Table 5 - Response Percentages, Mean Scores, SDs, and Factor Loadings for
Dementia Treatment Beliefs...........................................................................................27
Table 6 - Mean Scores, SDs, and Factor Loadings for Sources o f Information 33
Table 7 - Mean Scores, SDs, and Factor Loadings for Traditional Family
Structures and Practices................................................................................................ 38
Table 8 - Participants’ Amount ofTtime Spent Residing in the U.S........................40
Table 9 - Correlation Matrix Between Acculturation Variables, Age, and
Education.........................................................................................................................41
Table 10 - Mean Scores for Study Scale Scores..........................................................43
Table 11 - Inter-correlations Between Study Variables............................................. 45
Table 12 - Mean Scores on Dementia Knowledge According to Personal
Relevance of Dementia and Acculturation...................................................................55
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Abstract
To date, there appears to be no available research which describes how Asian
Indian Americans (AIAs) conceptualize dementia. The medical anthropological and
public health literature have identified such explanatory disease models as
potentially affecting health seeking behavior and health service utilization.
Furthermore, acculturation has been associated with health beliefs. The purpose of
this study was to describe AIAs’ perceptions of dementia, and to understand if and
how acculturation was associated with these perceptions. Acculturation was
measured in two manners for this study: years spent residing in the United States
(U.S.), and endorsement on a scale that measured traditional family structure and
practices. After questionnaire items were pilot tested via focus group interviews, the
questionnaire was administered to a convenience sample (N = 255, age range 18 to
81 years; 69.29% male) to assess AIAs’ perceptions of dementia etiology,
symptomatology, treatment, and help-seeking. It was found that acculturation was
associated with differences in perceptions of dementia. When the construct was
measured as years spent residing in the U.S., acculturation was significantly
associated with treatment beliefs, general AD knowledge, and symptom specific AD
knowledge. When the construct was operationalized as the belief in traditional
family structure and practices, acculturation was significantly related to etiological
beliefs, general AD knowledge, symptom specific AD knowledge, help-seeking, as
well as treatment beliefs.
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The purpose of this study was to describe Asian Indian Americans’ (AIAs’)
perceptions of dementia. In addition, this study was concerned with how such
perceptions differ by varying levels of acculturation among AIAs. Perceptions of
dementia encompass beliefs about etiological factors for dementia; symptoms of
dementia; help-seeking for dementia; and efficacious treatments for dementia. The
term AIAs is used to refer to people of Indian heritage, either bom and/or currently
residing in the U.S.
The significance of this study draws upon the fact that AIAs were and
continue to be a severely understudied population in research investigations of
disease perceptions held by Asian Americans. Perceptions of particular diseases by
specific ethnic populations are critical to understand in order to build culturally-
appropriate health behavior and health promotion campaigns and to provide
culturally valid interventions in clinical settings. For example, Fosu (1981) showed
that in Ghanian culture, explanatory models affect health seeking behavior and
health service utilization. Moreover, changes in disease perceptions may be
associated with increased acculturation, and as such acculturation was also accounted
for in the current study.
Background
Significance of Studying Disease Perceptions
Medical anthropological and cross-cultural psychiatric research distinguishes
between two schools of thoughts in the consideration of diseases and disorders: the
etic, or “outsider” perspective, and the emic, or “insider” viewpoint. The etic
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approach in mental health is exemplified by psychiatric taxonomies, such as the
DSM-IV and the ICD-10, whereas the emic approach is guided by studies about
illness representation, illness behavior, and community attitudes towards health and
disease (Patel, 1995). While the Western biomedical model of dementia is clear, no
research has been found in the way of “insider” perspectives of dementia among
AIAs. The goal of this study is to offer an emic perspective of dementia perceptions
among AIAs. Such a conceptualization will serve as an “explanatory model”, a term
that Kleinman (1980) created to symbolize the “notions about an episode of sickness
and its treatment that are employed by all those engaged in the clinical process (p.
105)”. While explanatory models of other diseases and disorders exist in the
literature for AIAs, no information currently exists to the authors’ knowledge which
describes perceptions of dementia among AIAs. It is hoped that the explanatory
models drawn from this study can begin to help assist researchers and clinicians to
understand if and how these models influence health seeking behaviors and health
service utilization patterns of AIAs’ patients and their families.
Disease Perceptions Defined
The conceptualization of disease perceptions is akin to the construct of illness
representation, a term used in health psychology to illustrate individuals’
conceptualization of disease information (Leventhal et al., 1983, 1997).
Accordingly, the original four main components of illness representation are:
perceptions of causes, disorder identity (symptoms and labels), time line, and
consequences (Leventhal et al., 1997). Lau and Hartman (1983) proposed cure as a
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fifth component, which Leventhal and Narenz (1985) acknowledged as possibly
comprising an additional domain underlying illness representation. This study
includes the domains of perceived etiological causes and perceived symptomatology
consistent with Leventhal et al.’s (1997) illness representation model and cure in the
form of treatment consistent with Leventhal and Narenz’s work (1985). Questions
were adapted in part from earlier research on dementia perceptions (Roberts et al.,
2003). A perceived help-seeking domain was created for this study to measure
respondents’ behavioral intention to seek help. Based on health behavior literature,
intention to seek help was identified as the most salient predictor of actual help-
seeking (Azjen, 1991; Azjen and Driver, 1991; Azjen and Madden, 1986). As
Landrine and Klonoff (2001) describe in their review on culture and health
psychology, it bears attention that these domains are more culture-specific than
disease-specific. Therefore, other work about general illness representation beliefs
(not specific to dementia) that have been shown to be held specifically by AIAs may
be relevant to predicting beliefs about dementia, drawn with information from both
the Asian American and the southeast Asian American health beliefs literature.
AIAs’ illness representation beliefs often have been found to be in stark
contrast to those beliefs commonly held in western cultures. One explanation for
such discrepancy could be the differences found between the illness representation
beliefs held among sociocentric cultures, e.g., Asian cultures, as compared to those
held in more egocentric cultures, e.g., European and Northern American cultures
(Landrine & Klonoff, 2001). Whereas egocentric cultures underscore a biomedical
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disease model, sociocentric cultures, such as those found in various Asian cultures,
limit mind-body dualism and furthermore, often do not distinguish among medical,
religious, spiritual, emotional, and social practices. Instead, sociocentric cultures
emphasize illness as a consequence of imbalance and disharmony among
relationships, behavioral and moral wrongdoings, and negative emotions. In
addition, there is a belief in sociocentric cultures that illness not only occurs at the
physical level, but also at the social, psychological, and spiritual/moral levels
(Landrine & Klonoff, 2001). The implications associated with treatment that stem
from these different cultural perspectives are significant, and furthermore become
challenging if one operates under an egocentric paradigm to treat sociocentrically-
minded patients (Fabrega, 1974).
Perceived etiological factors. In general, there is a mind/body or
person/environment assumption of health commonly held among southeast Asian
Americans which emphasizes balance and holism (Landrine & Klonoff, 2001).
Moreover, Westermeyer (1988) has found that Asian Americans, particularly
immigrants from southeast Asia, often do not distinguish between religious and
medical beliefs in understanding disease. That is, there is an interaction between
spiritual and physical forces in traditional southeast Asian belief systems that is
considered uncommon in the west. Furthermore, Landrine and Klonoff (2001)
describe a hierarchy associated with different aspects of illness attribution, with the
most proximal cause being supernatural factors, followed by natural factors and
emotions, with the most distal cause said to be biomedical factors.
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Family history o f dementia and symptomatology. Though very little was
found relating to the effects of a family history of dementia on one’s perceptions of
the disease and treatment seeking, much was found relevant to family history of
disease in the cancer research literature. Among Caucasian study samples, though a
positive family history of cancer has been associated with increased perceived
susceptibility to breast cancer (Finney, 2001) and to prostate cancer (Lamonde,
2001), analyses in the latter study suggest that those most likely to have an intention
to screen are those that not only have a family history of the disease, but in addition
to their genetic risk, those who also perceive themselves susceptible to the disease
(where perceived susceptibility acted as a moderator) (Lamonde, 2001). Roberts et
al. (2003) has found that knowledge levels of first-degree relatives of individuals
with AD was higher as compared to a previous study which used similar measures as
Roberts et al., but in a general sample (Connell, 1996).
Perceived help-seeking. There is a mounting body of evidence to suggest
that there are help seeking and service utilization differences in ethnic minority
groups, as compared with their Caucasian counterparts (Mackenzie, 2001). For
example, when Asian-Americans seek help for mental health problems, their
symptoms tend to be more severe (e.g., Sue, Nakamura, Chung, & Yee-Bradbury,
1994).
In a Canadian study, those who had negative attitudes about seeking
psychological services expressed lower intentions to talk to a mental health
professional, family or friends, and higher intentions to take care of mental health
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problems on one’s own; however, these same attitudes had a minimal influence on
intentions to talk with a family physician or a member of the clergy (Mackenzie,
2001). In addition, higher personal willingness to use psychological services was
positively related with female gender, assimilation, age, and English fluency,
whereas it was negatively related with interpersonal distance and number of years in
residence in the U.S. among East Asian immigrants of Chinese, Japanese, and
Korean ethnicity (Barry & Grilo, 2002).
Among both Latinos and Asian-Americans seeking help for dementia,
physicians are reported as the preferred provider when help is obtained (Gallagher-
Thompson et al., 1997; Watari & Gatz, 2004). Barriers include stigma, family
burden, lack of services, and language (Gallagher-Thompson, Talamantes, Ramirez,
& Valverde, 1996; Henderson & Gutierrez-Mayka, 1992). In a study which
investigated help-seeking behaviors for Alzheimer’s disease among Korean
Americans, Watari and Gatz (2004) found that both for Korean and for Latino
patients, family paradoxically appeared to normalize and buffer symptoms, leading
to delays in seeking help until symptoms became much more severe, though
differences were not found between Korean American and non-Korean Americans
regarding underutilization of health services.
Perceived treatment. Treatment entails maintaining or restoring homeostasis
within emotional, bodily, interpersonal, spiritual, and universal aspects of the self
(Landrine & Klonoff, 2001). Westermeyer (1988) proposed that in combination with
these combined beliefs, southeast Asian Americans may also believe in folk medical
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schema, such as the traditional Hindu, or ayurvedic, medical system. Originating
from sacred Sanskrit texts written between the first and eighth centuries (Fleischman,
1976-1977), ayurveda purports that diseases are solely caused from an imbalance of
three vital elements in one’s body (kapha, or phlegm; pitta, or bile; and vayu, or
wind). Moreover, ayurveda only advocates limited means of treatment to restore a
healthy balance, with those treatments being to change one’s diet and to use herbal
remedies (Ghandi, 1965). Beyond dietary changes and herb consumption, other folk
cures said to be used by southeast Asians include magical rituals, tea consumption,
and meditation (Landrine & Klonoff, 2001).
Asian Indian Americans and Health
According to the 2000 U.S. Census, AIAs constituted the third largest Asian
group in the country with 1.9 million people reporting Asian Indian alone or in
combination with one or more other races or Asian groups. This statistic was
preceded by 2.4 million individuals who reported Filipino alone or in combination
with one or more other races or Asian groups and 2.7 million people who reported
Chinese alone or in combination with one or more other races or Asian groups (U.S.
Census Bureau, 2000).
Despite a growing AIA population, no known national epidemiological data are
available to capture dementia incidence and prevalence among AIAs, and research
shows that there is little in the way of well documented epidemiological data of
dementia for minority populations as a whole (Espino & Lewis, 1998), with existing
Asian/Pacific Islander data primarily focusing on eastern Asian Americans (White,
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1996; Lin, 1983). Furthermore, there is no reason at the current time to believe that
dementia is any less prevalent among AIAs. It is hoped that this study begin to
address this large gap in available data by following the emic perspective described
earlier; that is, the information gained from the identification of explanatory models
of dementia used among AIAs then can be integrated in future cross-cultural
epidemiological studies of dementia (Patel, 1995), and also can be utilized to
increase culturally awareness of clinicians during the clinical assessment, diagnostic,
and treatment procedures of dementia among the AIA population
As the United States becomes more ethnically and culturally diverse, increasing
attention has been placed on the ramifications of culture for physical and
psychological health and illness (Young & Zane, 1996). Despite a growing AIA
population, there is a tremendous absence of literature particularly with respect to
psychological disorders among Asian Americans (and specifically AIAs). To date,
very few studies have investigated the prevalence of mental disorders among AIAs
(Durvasula & Mylvaganam, 1994). Though the distinction between organic and
inorganic brain disorders is recognized, the authors were not able to find any
literature on dementia among AIAs. This severe dearth in the literature highlights
the need to not only conduct more epidemiological studies to document AIAs’
prevalence and incidence of mental disorders, but simultaneously, to begin to
conduct studies which examines AIAs’ perceptions of mental health, illness beliefs,
and mental health practices (Parekh, 2000), in addition to mental health status.
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Acculturation
Past research on the measurement o f acculturation. Historically,
acculturation was originally described as a process that generally occurs in the
context of an ethnic group’s exposure with a dominant culture (Redfield, Linton, &
Herskovits, 1936). More recently, acculturation was described as a process signified
by specific cultural changes involving personal values, ideals, attitudes, and a
person’s identity (Berry, Poortinga, Segall & Dasen, 1992). These cultural changes
were identified to be unique at both the macroscopic level (e.g., the characteristics of
the native-host countries), and at the microscopic level, such as the individual
person’s features, such as ethnicity, age, financial status (Berry, 1997). Other
individual-level factors related to acculturation include age at time of immigration,
where older adult immigrants are more likely to retain their traditional culture
(Nwadiora & McAdoo, 1996). The construct of acculturation can and is measured in
numerous manners (Salant & Lauderdale, 2003).
Acculturation in the present study. For this study, acculturation was
measured in two ways. The first method defined acculturation in terms of number
of years participants spent living in the U.S., with increased years in the U.S. as an
operationalized definition for increased acculturation. The main benefit of
measuring acculturation as a temporal index is that it offers greater flexibility in
teasing apart the separate dimensions of acculturation. Some weaknesses emerge
from such a construction of acculturation which include: one, the duration of
residence may be associated with acculturation in substantially divergent ways,
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depending on when the individual arrived (e.g., as an adult, or as a child) (Salant &
Lauderdale, 2003), and two, an underlying optimistic and perhaps, oversimplified
assumption exists with this constmction to indicate that increased time of residence
increases social contacts and interaction which leads to improved communication
skills and proficiency to navigate in the new society (Dawson, Crano, & Burgdoon,
1996). Second, based on Parekh’s (2000) postulation that family structure shifts
among AIAs (moving from extended families to nuclear families) is an important
consideration in investigating traditionalism and acculturation, this study also used a
composite score based on Parekh’s (2000) traditional family structure and practices
subscale. However, independent of measurement, it is important to note that both
traditionalism and that acculturation appear to be adaptive when acculturation is
viewed as a construct with multidimensional outcomes, and must be examined
within the context of specific behaviors, cultures, genders, and ages (Parekh, 2000).
Acculturation, health beliefs and help-seeking health. There is evidence to
indicate that acculturation is associated with health behavior, morbidity, and
mortality of all minority groups (Landrine & Klonoff, 2001), and more generally,
that culture influences illness representation (Cameron & Leventhal, 2003).
However, little is understood about the processes involved (Landrine & Klonoff,
2001; Salant & Lauderdale, 2003). Health beliefs are considered to be a ‘behind-the-
scenes’ concept that plays a role in determining the how and the why of the ‘main-
stage’ acculturative effect on health behavior (Landrine & Klonoff, 2001). AIAs’
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attitudes towards mental health treatment seeking do appear to be influenced
significantly by acculturation levels to the host culture (Sharma, 1995).
Information-Seeking
Health information will not affect health behavior unless the information is
conveyed by information sources respondents would use. One study indicated that
among a sample of influential AIA community leaders, the amount of interpersonal
interaction with members of the host culture was a stronger predictor of cultural
adaptation than the use of host mass communication channels, though the use of
information-oriented publications (e.g., magazines and newspapers) was also found
to be a significant predictor of cultural adaptation (Shah, 1991).
Present Study
The current study had three sets of research questions: 1) to describe AIAs’
perceptions of dementia’s etiological factors, symptoms, help-seeking and
efficacious treatments to reduce memory problems; 2) to determine how
acculturation and personal relevance of dementia is related to the aforementioned
domains of dementia perceptions; and 3) to learn the relationship between the
sources of information that AIAs would turn to further understand dementia and
AIAs’ perceptions as to which treatments are considered most effective. Whereas
the first question dealt solely with descriptive information, with respect to the second
set of questions, it was hypothesized that compared to respondents with lower
acculturation levels, individuals with higher levels of acculturation would have more
accurate perceptions of etiological factors and dementia symptoms, and would
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indicate an increased intention to seek help as well as to seek more modem types of
treatment. In addition, it was hypothesized that more acculturated respondents who
regarded dementia as personally relevant would depict dementia symptoms more
accurately than less acculturated individuals for whom the disorder was not
personally relevant. With regard to the third question, the final hypothesis for this
study was that individuals who endorse more modem sources of information will
also endorse more modern treatments as compared to individuals who endorse more
traditional sources of information.
Method
Overview of Design
A self-reported questionnaire was designed to examine AIAs’ perceptions of
dementia. Focus groups were recruited to pilot and refine the final questionnaire
items. Both the pilot testing and the questionnaire were approved by the USC-IRB.
Copies of the informed consent and the questionnaire were distributed to
interested participants. Confidentiality of responses was assured, and respondents
were requested to complete and return the informed consent and the questionnaire
back to the researcher on the same day.
Participants
Both the focus group and the survey participants were recruited in the San
Francisco Bay Area through a community convenience sampling (see Table 1).
Focus group and survey participants were recruited (via flyers and discussions
personally held by the researcher) through culturally-based locales, such as Indian
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restaurants, at cultural and religious/spiritual-based events, Indian community
centers, and at a workplace that employed a high number of AIAs in the San
Francisco Bay Area. In addition, the researcher’s longstanding association to the
Indian community in this geographic area aided this design, along with assistance
from community, cultural, and religious/spiritual organizations.
A total of 255 AIA adults completed the questionnaire. An adult was considered to
be 18 years old or older. Participants’ ages ranged from 18 to 81 (M = 33.69, SD =
11.48). Most participants self-reported as male (69.29%), being bom in India
(97.64%), having one’s biological mother alive (86.11%), having one’s biological
father alive (78.09%), having obtained a master’s degree (46.27%), married
(62.20%), religiously affiliated (86.11%), and having a reported annual income of
$80,000 or above (58.44%). Of those that responded (n=251), 7.97% reported
having a family member, living or not, who has had dementia.
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Table 1
Number o f Participants Recruitment by Site
Asian Indian Participants Gender
Females Males
Focus Groups 8 6
Survey (divided among 3 recruitment channels):
Cultural organizations (language and/or arts-based)
Indian restaurants 59 136
Community centers
Indian senior community center 2 11
Community events (includes religious/spiritual events) 14 14
Software company 3 14
Total Survey Participants = 255 78 175
(2 participants did not provide gender data)
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There were significantly more married participants among the males than
among the females, x2(5, N = 254) = 12.93, p <0.02. However, there were no
significant sex differences on age, t(183) = 1.55, p > 0.12, birth country (bom in U.S.
or not), x2 (l, N = 253) = 0.02, p > 0.89, education, t(252) = 1.23, p > 0.22, religious
affiliation, % 2(1, N = 251) = 1.05 p > 0.31, income, 229) = -0.63, p > 0.53, or family
history of dementia, x2 (l, N = 250) = 1.19, p > 0.28. In addition, having one’s
biological mother, x2 (l, N = 251) = 0.12, p > 0.73, or father alive, x2 (l, N = 250) =
0.41, p > 0.52, did not differ by sex.
Measures
Vignette. The questionnaire began with a modified version of a vignette
describing a person with early dementia by Patel and Prince (2001). Instructions
associated with the vignette asked the participant to imagine a hypothetical relative
experiencing early symptoms that correspond to dementia. The vignette provided a
substantive backdrop from which participants were asked to answer the
questionnaire items (mostly close-ended) which followed.
Etiological beliefs about dementia. This construct was measured with 15
closed-ended questions, nine of which (stress, exposure to toxic materials like
aluminum, mental illness such as clinical depression, God’s will, genetics/heredity,
drinking alcohol too much, smoking too much, head injury, older age) were items
obtained from the Boston University Medical Center’s Alzheimer’s Disease
Treatment and Illness Perceptions Survey (Roberts et al., 2003), one of which (viral
infection) was an item obtained from a survey which was the precursor to the Boston
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University Medical Center’s Alzheimer’s Disease Treatment and Illness Perceptions
Survey (Green, Clarke, Thompson, Woodard, & Letz, 1997), four items which were
included based on focus group discussion (loneliness, karma, evil spirits,
supernatural forces), and one item which was included based on a current important
topic for researchers in the field (hormone replacement therapy). A five point
response scale was provided which ranged from 1 (not at all important) to 5
(extremely important). A ‘do not know’ response option was added following focus
group feedback. ‘Do not know’ responses were coded to zero for psychometric
analyses, and were recoded to missing for purposes of calculating scale scores.
The original goal for inclusion of these items was to encompass both conventional
and traditional modes of disease causation. To test whether the items reflected those
two dimensions, an orthogonally rotated exploratory factor analysis of the etiology
belief items was carried out. It resulted in the 15 items loading singularly onto one
of two factors. As seen in Table 2, the first factor (eigenvalue = 4.58) appeared
qualitatively to describe a more medical model, conventional western mode of
disease causation (stress, toxic material exposure, mental illness, loneliness, heredity,
too much smoking or drinking, head injury, age, hormone replacement therapy, or
viral infection), but with some items having better current empirical support than
others. On the other hand, the second factor (eigenvalue = 1.67) described a more
traditional, eastern mode of disease causation (karma, God’s will, evil spirits,
supernatural forces). Though toxins, virus and hormone replacement therapy loaded
onto both factors, they were not included in the second factor in subsequent analyses
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for ease of factor interpretability reasons. It is possible that these items loaded onto
the second factor because all the items on the second factor had a low endorsement
rate (reflected in the combination of “do not know” and “not at all important”).
Thus, two subscales were created, one for western medical beliefs and the other for
eastern karma beliefs of etiological factors.
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Table 2
Response Percentages, Mean Scores, SDs, and Factor Loadings for Etiological Beliefs about Dementia
Item
Not a t all
important
A little
important
Somewhat
important
Very
important
Extremely
important
D o not know
Mean
*
SD Factor
Loadings
(based on 2
factor
orthogonal
rotation)
Stress (n=236) 2.76 8.66 27.56 34.65 19.29 7.09 3.64 1.01 0.60 0.05
Exposure to
toxic materials
(like aluminum)
(n=172)
6.77 9.16 24.30 18.33 9.96 31.47 3.23 1.16 0.41 0.32
Mental illness
(such as clinical
depression)
(n=226)
2.76 4.72 27.95 29.53 24.02 11.02 3.76 1.01 0.65 0.14
Loneliness
(n=234)
1.98 6.32 21.74 35.18 27.27 7.51 3.86 0.99 0.58 0.14
Karma (past
misdeeds)
(n=204)
49.00 13.55 10.36 4.38 3.98 18.73 1.78 1.16 0.16 0.53
God’s will
(n=209)
43.25 13.89 10.71 6.75 8.33 17.06 2.07 1.37 0.04 0.54
Genetics/heredit
y (n=221)
5.58 14.74 26.69 24.70 16.33 11.95 3.36 1.15 0.43 0.19
00
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Table 2, Continued
Item
Not a t all
important
A little
important
Somewhat
important
Very
important
Extremely
important
D o not know
Mean
*
SD Factor
Loadings
(based on 2
factor
orthogonal
rotation)
Evil spirits
(n=214)
72.16 7.84 2.35 1.57 0.00 16.08 1.21 0.58 0.13 0.82
Supernatural
forces (n=216)
70.20 8.63 3.53 0.78 1.57 15.29 1.29 0.75 0.10 0.87
Drinking
alcohol too
much (n=212)
16.27 11.90 19.05 19.44 17.46 15.87 3.12 1.40 0.78 0.15
Smoking too
much (n=212)
15.87 9.92 24.21 17.06 17.06 15.87 3.11 1.37 0.77 0.13
Head injury
(n=225)
8.73 6.35 21.83 27.38 25.00 10.71 3.6 1.24 0.66 0.16
Older age
(n=244)
0.79 3.95 20.16 32.02 39.53 3.56 4.09 0.92 0.43 0.22
Viral infection
(n=252)
26.19 15.48 18.65 7.14 5.16 27.38 2.31 1.25 0.30 0.46
Hormone
replacement
therapy (n=123)
19.44 11.51 12.30 3.57 1.98 51.19 2.12 1.14 0.27 0.45
*The mean was calculated using only scores between 1 (not at all important) and 5 (extremely important).
Do not know responses were recoded to zero prior to reliability and factor analyses.
For the more Western etiological beliefs, items varied in their correctness
about the causes of dementia. However, what is accepted as factual is changing
rapidly, and some of these items reflect risk factors about which empirical evidence
is mixed and preliminary. A dichotomously-scored subscale was created for the
purposes of hypothesis testing, reflecting if individual’s etiological beliefs match
what current mainstream research supports empirically. For the items stress, toxins,
mental illness, loneliness, head injury, drinking and smoking too much, an
endorsement of “a little important”, “somewhat important”, or “very important” was
scored as “correct”, as evidence is not strong or amount of dementia explained is
small. For the items age and genetics/heredity, an endorsement of “very important”
or “extremely important” was scored as “correct”, as these are the two best supported
risk factors. For the item on viral infection, an endorsement of “not at all important”
or “a little important” was scored as “correct”, as there is not support for this factor.
The item on hormone replacement therapy (HRT) as an etiological factor was not
included in either of the subscales because it has yet to be determined if HRT is an
etiological factor of dementia. The scoring reflects the best reading of scientific
knowledge at the time. Cronbach alpha for “western medical belief’ items was 0.84.
The second subscale on eastern traditional beliefs was calculated based on
summing participants’ responses to four etiological items (karma, God’s will, evil
spirits, and supernatural forces), excluding do not know responses. Cronbach alpha
for “eastern karma belief’ items was 0.78.
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General knowledge o f dementia and dementia symptoms. These constructs
were measured with 18 close-ended questions from the Boston University Medical
Center’s Alzheimer’s Disease Treatment and Illness Perceptions Survey (see Table
3; Roberts et al., 2003). The original items used the disease term “Alzheimer’s
disease” (AD). Although the present study was interested in dementia as a whole,
the word choice was preserved given focus group data which indicated dementia was
not an easily identified concept by focus group participants. Eleven items concerned
general knowledge, and 7 items described symptoms. The original items on Roberts
et al.’s (2003) measure only carried a two point response scale (true/false or yes/no).
However, during the pilot testing that occurred during the focus group phase of this
study, it was determined that many participants were not endorsing either of the
choices. Feedback obtained from focus group participants indicated that that they
were leaving the items blank because they did not know the response. Hence, a ‘do
not know’ response category was added. For presenting item distributions, ‘do not
know’ (DNK) responses were retained as a separate response category. For scoring
the scale, DNK responses were included with incorrect responses. Both sets of
items, one testing general AD knowledge and the other investigating specific AD
symptom knowledge, were used in hypothesis testing. The Cronbach alpha for the
general Alzheimer’s disease knowledge items was 0.79. The Cronbach alpha for the
specific symptom items also was 0.79.
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Dementia help-seeking beliefs. As shown in Table 4, six out of 14 belief
items, all written for this study with consultation from three researchers in clinical
health psychology, clinical geropsychology, and social psychology formed one factor
(eigenvalue = 1.88) in an orthogonally rotated exploratory factor analysis, which
subsequently formed the help-seeking scale. A five point response scale was
provided which ranged from 1 (strongly disagree), 2 (somewhat disagree), 3
(neutral), 4 (somewhat agree), and 5 (strongly agree). Factor loadings for these six
items ranged from 0.41 to 0.66. The standardized Cronbach alpha for these six items
given unit weights and summed was 0.73.
Dementia treatment beliefs. This was measured with 20 modified items from
Roberts et al. (2003) and Parekh (2000) listing potential treatments for dementia, as
well as items created based on focus group discussion. As shown on Table 5, the
items encompassed both modem and traditional treatments. The responses were
based on a five point scale which ranged from 1 (not effective) to 5 (extremely
effective). A ‘do not know’ response option was added following focus group
feedback. ‘Do not know’ responses were coded as zero for psychometric analyses
and were coded missing to calculate scores.
Determining what treatments are modem and traditional is arbitrary, given that
medical advice is now encouraging diet, physical exercise, and stress reduction as
modem ways to prevent or delay dementia. Moreover, what might perhaps be
considered more “ alternative’ from the western perspective may actually be
considered more ‘mainstream’ in the AIA community (particularly with respect to
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dietary habits). Consequently, an orthogonally rotated exploratory factor analysis
was carried out, which resulted in the retention of three factors. The first factor
(eigenvalue = 7.75) consisted of 11 items with a holistic bent: prayer, meditation,
fasting, increasing peace, yoga, vegetarian diet, increasing happiness, increasing
sleep, spiritual healer, change in environment, and seeking a place of worship.
Because these items appear to be based in the traditional eastern practices of vedic
medicine, the first factor was called “eastern”. The second rotated factor (eigenvalue
= 1.10) was comprised of nine items, four treatment items (increase physical activity,
increase mental activity, eat a proper and healthy diet, and reduce emotional stress)
which appear to place control of the outcome in the hands of an individual, and
would be recommended by western medical experts as ways of maintaining good
brain health, combined with five additional items (meditation, increasing peace,
yoga, increasing happiness, increasing sleep) which were double loaded on factor 1.
Thus, factor two appears to combine eastern and western treatments, and was named
“east/west”. Despite the double loadings, factor two was seen as an important factor
to retain in the treatment continuum which spans from traditional treatments, as seen
in factor one, to modem western treatments, as seen in factor three below.
The third rotated factor had an eigenvalue of 0.85 but given its appearance at
the break, or “elbow” of the scree plot, it was retained during analysis (Cody &
Smith, 1997). The third factor consisted of five treatment items (vitamins,
estrogen/hormone replacement therapy, herbs, eating nuts, and fasting) that largely
reflect consumption of alternative medicines. Eating nuts, particularly almonds, is
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considered to be a treatment approach for memory problems in many Indian
subcultures. Fasting is also double loaded on factors 1 and 3. None of the items on
this factor were rated on average above the middle of the scale (“somewhat
effective”). The third factor was named “western”. Interestingly, use of
medications did note load strongly onto any of the factors.
When formed into subscales, the Cronbach’s alphas for each of the factors
were 0.90, .90, and 0.75, respectively.
Table 3
Percentage of Responses fo r Knowledge of Dementia and Dementia Symptoms
Item False/No
(%)
True/Yes
(%)
Don’t
Know
(%)
The primary symptom of
AD is memory loss
(true) (n=252)
2.38 66.27 31.35
Most people with AD
live in nursing homes
(false) (n=252)
35.32 11.11 53.57
The first signs of AD
usually occur before age
60 (false) (n=251)
20.72 19.12 60.16
Men are more likely to
develop AD than women
(false) (n=251)
9.56 19.12 71.31
Scientists have
discovered a gene that
causes most types of AD
(false) (n=250)
8.00 13.20 78.80
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Table 4
Mean Scores, SD, and Factor Loadings for Dementia Help-Seeking Belief Items
Item Mean SD Factor Loadings
For the first factor
I believe that my relative needs to seek help at some 4.43 0.90 0.65
point*
I believe that nothing can cure my relative of what she is 2.38 1.08 -0.09
experiencing (R)
I believe that my relative’s condition will continue to 4.30 1.02 0.66
worsen if no help is sought*
I believe that my relative should seek help within one 4.13 1.19 0.54
year*
I believe that my relative will get better on her own (R)* 1.70 1.01 -0.47
If necessary, I would be willing to be this relative’s 3.84 0.97 0.03
primary caregiver
It is possible that what this person is experiencing can 4.01 0.91 0.10
occur in my family
Having health insurance will determine if this relative 3.15 1.46 0.05
seeks treatment
It is important to have a family member at home to care 4.16 0.95 0.14
for this relative
to
L/l
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Table 4, Continued
My family and I would be reluctant to admit what this 1.86 1.17 -0.05
family member was experiencing for fear of social
consequences (R) (n=254)
This relative would feel more comfortable seeking care 3.36 1.31 0.16
or treatment in the U.S. if she spoke English fluently
It is important to get an early diagnosis for whatever ails 4.51 0.83 0.51
her*
Whatever is ailing this relative can be prevented 3.30 1.04 0.07
It is not necessary to seek help unless or until the 1.97 1.22 -0.41
symptoms become more serious (R) (n=255)*_______________________________________________
Note: (R) indicates an item that was subsequently reverse coded for reliability analysis (but not for factor analysis)
and for creating a total scale score for the first factor. An asterisk (*) indicates an item that was used to compute this scale’s score.
t o
ON
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Table 5
Response Percentages, Mean Scores, SDs, and Factor Loadings for Dementia Treatment Beliefs
Item
o
3
o
*
<
SB
X
2-
vT
Mean*
3
O
E f
o
3
SD Factor Loadings
(based on 3 factor orthogonal
rotation)
Medications
(such as
Aricept,
Exelon,
Reminyl)
(n=252)
3.17 9.92 37.70 26.19 7.94 15.08 3.30 0.93 0.05 0.21 0.22
Vitamins
(such as
Vitamin E)
(n=249)
2.81 14.06 28.11 10.84 3.61 40.56 2.97 0.93 0.09 0.23 0.60
Keeping
physically
active
(n=252)
0.79 7.94 25.40 37.30 19.05 9.52 3.73 0.92 0.19 0.75 0.26
Keeping
mentally
active
(n=243)
1.23 3.29 20.58 38.27 28.81 7.82 3.98 0.90 0.20 0.72 0.18
to
< 1
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Prayer and/or 12.85 17.27 26.51 14.86
religious
ceremonies,
rituals
(n=249)
Estrogen 16.21 11.07 11.46 4.35
replacement
therapy
(n=253)
Herbal, 9.92 12.70 25.40 9.13
natural, or
dietary
supplements
(such as
gingko)
(n=252)
Eating a 2.76 9.06 24.41 37.01
proper,
healthy diet
(n=254)
Keeping 1.18 6.30 20.87 35.43
emotional
stress low
(n=254)
Eating nuts 14.46 10.84 16.06 7.23
(such as
almonds)
(n=249)
Meditation 1.98 11.46 25.30 28.85
to (n=253)
o o -----------------------------------------------------
13.25
0.40
4.37
18.11
29.13
5.22
21.74
15.26 2.98 1.27 0.63 0.16 0.27
56.52 2.12 1.06 0.17 0.06 0.62
38.49 2.76 1.11 0.18 0.20 0.57
8.66 3.64 1.00 0.26 0.60 0.31
7.09 3.92 0.96 0.38 0.69 0.15
46.18 2.59 1.28 0.34 0.19 0.55
10.67 3.64 1.05 0.59 0.44 0.11
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Fasting 45.45 9.09 11.07 3.56
regularly
(n=253)
Increasing 3.97 9.92 26.59 23.02
inner peace to
promote
positive
health
(n=252)
Practicing 5.10 8.63 26.67 27.45
yoga
regularly
(n=255)
Eating a 17.39 11.86 17.00 15.81
vegetarian
diet (n=253)
Increasing 2.77 7.51 14.23 33.99
happiness in
life (n=253)
Increasing 2.43 11.34 25.51 26.32
sleep level
(n=247)
Seeking the 50.98 11.76 12.16 2.75
advice of a
spiritual
astrologer
(n=255)
A change of 10.20 15.69 30.98 15.29
environment
(n=255)
1.98
22.62
18.04
12.65
30.43
16.60
2.35
10.59
to
VO
28.85 1.70
13.89 3.59
1.08 0.39 0.15 0.40
1.13 0.61 0.43 0.07
14.12 3.52 1.11 0.56 0.43 0.10
25.30 2.93 1.41 0.56 0.26 0.32
11.07 3.92 1.06 0.60 0.54 0.16
17.81 3.53 1.05 0.41 0.42 0.35
20.00 1.67 1.04 0.42 0.07 0.37
17.25 3.00 1.18 0.53 0.34 0.30
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Attending a 13.33 17.65 27.06 14.12 10.20 17.65 2.88 1.23 0.72 0.10 0.27
place of
worship (such
as a temple or
church)
(n=255)__________________________________________________________________________________________________________
*The mean was calculated using only scores between 1 (strongly disagree) and 5 (strongly agree). Do not know responses were
recoded to zero prior to reliability and factor analyses.
u >
o
Sources of information. This was measured with 12 items listing
different sources of information (see Table 6). Eight questions reflecting
current information sources in the western culture were obtained from the
Boston University Medical Center’s Alzheimer’s Disease Treatment and
Illness Perceptions Survey (Roberts et al., 2003) (family, friends and
acquaintances, physicians and other health professionals, the Alzheimer’s
Association, television or radio, books/newspapers/or magazines, the
internet, and support groups), and four items based on traditional Indian
culture were added as a result of focus group discussion (turning to
religious figures, spiritual astrologer, astrologer, spiritual leader/healer for
health information). A dichotomous response scale was provided (yes or
no).
An orthogonally rotated factor analysis of the information seeking scale
resulted in the 13 items loading onto three factors with values that ranged
from 0.37 to 0.89 (Table 6). Three factors were retained reflecting
traditional, formal and informal sources when gathering health information.
Because one of the three factors produced an eigenvalue below 1, a
combination of eigenvalues, scree plots, and ease of interpretation was used
to retain the three factors. The first factor (eigenvalue = 2.72) consisted of
four items that were spiritual or religious (seek a religious figure such as a
priest or pundit; spiritual astrologer; astrologer; spiritual leader/healer).
“Pundit”, in the Indian culture, is a title given to a Hindu Brahmin, typically
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a male, who has correctly memorized not only a substantial portion of the
Vedas (ancient Hindu scriptures) in the Sanskrit language, but also is often
well versed in other fields such as the Hindu religion, the sciences, and the
law. The second factor (eigenvalue = 2.14) consisted of six items
(physicians or other health professionals; the Alzheimer’s Association;
television or radio; print media; the internet; and support groups) which can
be seen as formal and organized sources of information. The third factor
(eigenvalue = 0.71) but appeared at the break, or “elbow” of the scree plot,
and thus was retained (Cody & Smith, 1997). The third factor consisted of
two items (family, friends and acquaintances) which may be viewed as
informal avenues to seek information. Cronbach alpha for religious or
spiritual information sources was 0.88; Cronbach alpha for formal and
organized information sources was 0.74; Cronbach alpha for informal
information sources (family, friends) was 0.74.
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Table 6
Mean Scores, SDs, and Factor Loadings for Sources o f Information
Item Mean SD Factor Loadings
(based on 3 factor orthogonal rotation)
My family (n=246) 0.73 0.45 -0.01 0.18 0.67
My friends and
acquaintances (n=247)
0.68 0.47 0.15 0.23 0.68
Physicians or other
health professionals
(n=253)
0.93 0.26 0.00 0.48 0.14
The Alzheimer’s
Association (n=245)
0.78 0.42 -0.04 0.62 0.00
Television or radio
(n=250)
0.43 0.50 0.01 0.41 0.11
Books, newspapers, or
magazines (n=251)
0.78 0.41 0.04 0.70 0.06
The Internet (World
Wide Web) (n=252)
0.89 0.31 -0.02 0.57 0.21
Support groups
(n=250)
0.58 0.49 0.06 0.51 0.10
Religious figure (e.g.,
priest, pundit) (n=251)
0.12 0.33 0.78 -0.02 0.11
Spiritual astrologer
(n=248)
0.07 0.26 0.91 0.00 0.01
Astrologer (n=250) 0.06 0.23 0.83 0.09 -0.03
Spiritual leader, healer
(n=249)
0.11 0.31 0.69 0.00 0.06
NOTE: Mean corresponds to percent saying that the source was used.
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Acculturation. There were two items that measured acculturation: one,
amount of time spent living in the U.S., and two, endorsement of traditional family
structure and practices (see Table 7).
Amount of time residing in the U.S. ranged from 0.01 years to 38 years. More than
sixty percent of the total participants indicated that they have lived in the U.S. less
than seven years (Table 8). The mean score for number of years spent residing in the
U.S. was 7.88 years (SD=7.3). The variable pertaining to amount of time spent
living in the U.S. was dichotomized at the mean number of years. This led to 156
participants who were more recent immigrants and 88 participants who have lived in
the U.S. for more than 7.88 years.
There was a moderate correlation between amount of time spent living in the
U.S. and participants’ age (r = 0.48, n = 243, p < 0.0001), and a low correlation with
participants’ highest education level (r = 0.13, n = 244, p < 0.04). Female
respondents had lived in the U.S. for an average of 8.18 years, and male participants
had resided in the country for an average of 7.71 years. A t-test showed that
participants’ gender did not significantly differentiate amount of time spent living in
the U.S.,t(241) = -0.46, p < 0.65.
Among participants who resided in the U.S. for 7.88 years or less, the mean
scores for age, highest education level, and beliefs in traditional family structure and
practices were: 29.95 (8.22), 6.90 (1.58) (between bachelor’s degree and some
graduate school), and 25.76 (4.82) respectively. Among participants who resided in
the U.S. for more than 7.88 years, the average age, highest education level, and
34
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beliefs in traditional family structure and practices were: 40.49 (13.40), 7.36 (1.53)
(between some graduate school and a master’s degree), and 23.84 (5.24)
respectively. T-tests showed that participants who had lived in the U.S. for 7.88
years or less significantly differed from participants who had lived in the U.S. for
more that 7.88 years with regard to age, r(123) = -6.67, p < 0.0001, education, t(242)
= -2.23, p < 0.03, and traditional family structure and beliefs t(240) =2.88, p <
0.0043.
Traditional family structures and practices were measured with 11 items
taken from the Traditional Asian Indian Family Structures and Practices subscale
from the Acculturation Scale for Asian Indians (ASAI) (Parekh, 2000). The ASAI
was designed to measure acculturation levels among Asian Indians who spoke
English as one of their main languages. Nine items, as measured on the original
subscale, were originally given on a 7-point response scale where an endorsement of
“I totally disagree” was indicated by a response of 1 to 2, an endorsement of “I sort
of agree” was indicated by a response of 3, 4, or 5, and an endorsement of “I strongly
agree” was indicated by a response of 6 to 7. However, to maintain consistency of
other responses scales that were used in the remaining sections of this study, the
response scale for these nine items was collapsed from the 7-point to a 5-point
response scale (strongly disagree, somewhat disagree, neutral, somewhat agree,
strongly agree). Two additional items from the ASAI (Parekh, 2000) were included
which were measured on a dichotomous response scale (yes/no). The 11 items were
collectively analyzed as the traditional family structure and practices subscale.
35
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A principal components analysis with one factor is shown in Table 7. Seven
of the 11 items loading singularly onto one factor (eigenvalue = 2.07). These seven
items, which were used in the data analysis (Cronbach alpha = 0.72), appeared to
cluster around the notion of beliefs towards older adults and extended family. The
items that did not load onto the factor were the two items coded dichotomously
(when young, did extended relatives live with participant; when young, did one
touch the feet of elders as a sign of respect), as well as two other Likert scale items (a
daughter once married is no longer part of one’s family, and Asian Indians are more
family oriented than non-Indians).
Among participants who resided in the U.S. for 7.88 years or less, the mean
scores for beliefs in traditional family structure and practices was 25.76 (SD = 4.82).
Among participants who resided in the U.S. for more than 7.88 years, the average
beliefs in traditional family structure and practices was 23.84 (SD = 5.24). A t-test
showed this difference to be significant, t(240) = 2.88, p < 0.0043.
Endorsement of traditional family structure and practice beliefs was slightly
negatively correlated with amount of time spent residing in the U.S. (r = -0.24, n =
242, p < 0.0002). This and other correlational data between age, education, and the
two acculturation variables are provided in Table 9. Moreover, there was no
significant correlation between traditional family structure and practice beliefs and
either participants’ age (r = 0.03, n = 252, p > 0.67), or participants’ highest
education level (r = -0.01, n = 253, p > 0.90). In addition, a t-test showed that
36
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participants’ gender did not significantly differentiate beliefs in family structure and
practices, t(250) = -0.10, p > 0.92. .
Personal relevance of dementia. This construct was measured with one close-ended
question modified from the Boston University Medical Center’s Alzheimer’s Disease
Treatment and Illness Perceptions Survey (Roberts et al., 2003). The item, “do you
have a family member, either living or not, who has had dementia”, which originally
pertained to Alzheimer’s disease, was modified to relate to dementia, and was asked
on a dichotomous yes/no scale. Though the term “Alzheimer’s disease” was used for
the knowledge items based on focus group data as mentioned earlier, the term
“dementia” was used to assess personal relevance under the assumption that the term
would be more familiar to participants who were affected by the disorder. Though
the advantage in this rationale is that it potentially may minimize false positive
endorsements, it also carries a potential danger for increasing false negative
responses, as it has the possible disadvantage of assuming that even people whose
families are affected by the disease would know the disorder by the term ‘dementia’.
Demographical information. Demographic items were created for this study and
were placed at the end of the questionnaire. They included age, sex, race, marital status,
education level, birth country, amount of time spent living in the U.S., religious affiliation,
language fluency, and household income.
37
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Table 7
Mean Scores, SDs, and Factor Loadings for Traditional Family Structures and Practices
Item Mean SD Factor Loadings
(based on a 1
factor principal
factor analysis)
One should always respect one’s elders* 4.46 0.83 0.44
A child should never call a grown man or
woman by his/her first name, they should
always be called Uncle or Auntie*
3.37 1.25 0.51
The eldest son and his wife must always take
care of one’s family*
2.67 1.28 0.49
One’s home is always open to extended family
members*
3.68 1.05 0.52
One should not place one’s aging parents in a
nursing home/old age home*
4.07 1.17 0.41
A marriage is an alliance between two
families*
3.87 1.23 0.55
When a woman gets married her new in-laws
become her new and primary family*
3.00 1.35 0.65
u >
o o
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Table 7, Continued
A daughter, once married, is no longer part of 1.39 0.84
one’s family*
Asian Indians are more family-oriented than 3.63 1.18
non-Indians*
When I was young, my cousin, aunt, or 0.74 0.44
grandmother or other relative often lived with
me and my family for awhile* (yes/no)
When I was little I would often touch the feet 0.75 0.43
of my elders as a sign of respect* (yes/no)_______________________________________
NOTE: First 9 items scored on 5 point scale; last two items dichotomous, so mean reflects percent agreeing.
An asterisk (*) indicates an item that was used to compute this scale’s score.
0.23
0.34
0.12
0.21
u >
VO
Table 8
Participants’ amount of time spent residing in the U.S.
Time in Frequency (%)
U.S.
(years)
0 to 2 29.92
3 to 6 34.02
7 to 10 15.16
11 to 14 7.38
15 to 18 5.74
19 to 22 2.87
23 to 26 0.82
27 to 30 2.46
31 to 34 0.82
35 to 38 0.82
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Table 9
Correlation matrix between acculturation variables, age, and education
Age Education Years in U.S. Traditional
Family
Practices
Age 1.00 0.10 0.49 0.03
(n.s.) (p<0.0001) (n.s.)
Education 0.10 1.00 0.13 -0.01
(n.s.) (p<0.04) (n.s.)
Years in U.S. 0.49 0.13 1.00 -0.24
(p<0.0001) (p<0.04) (p<0.0002)
Traditional Family 0.03 -0.01 -0.24 1.00
Practices (n.s.) (n.s.) (p<0.0002)
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Results
Perceptions o f Dementia
The first research question pertained to obtaining descriptive information on
participants’ perceptions of dementia in terms of the disease’s causes, symptoms,
help-seeking, and treatment. Tables 2, 3,4, and 5 contain beliefs about the disease’s
causes, symptoms, help-seeking, and treatment, respectively. Notable was an
accurate appreciation that Alzheimer’s disease entailed memory loss and was a
disease of old age, but ratings of loneliness and mental illness as more important than
genetics as causes of Alzheimer’s disease, and greater reliance on keeping mentally
and physically active, increasing happiness, and keeping emotional stress low as
treatments than on the approved medications.
The overall mean scores of the twelve scale scores computed for this study is
provided in Table 10. In addition, means calculated by average length of time spent
living in the U.S. also are shown in Table 10. Table 11 provides correlations
between each of the fourteen variables described above. Information describing each
of the measures used in this study is presented below.
42
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Table 10
Mean Scores for Study Scale Scores
Scale Name
(Scale Score Range)
Overall Mean Score
(SD)
Mean Score By Years Spent Living in U.S. (n, SD)
7.88 years or less More than 7.88 years
Help-Seeking 25.72 (4.02) 25.66 (3.84) 26.03 (4.00)
(6-30) (n=249) (n=152) (n=86)
Eastern Treatment Beliefs 32.92 (9.09) 34.57 (9.47) 30.55 (8.36)
(11-66) (n=127) (n=74) (n=49)
East/West Treatment Beliefs 33.66 (7.02) 34.62 (7.06) 32.32 (7.02)
(9-54) (n=154) (n=90) (n=59)
Western (“Pills/Supplements”) 11.87 (3.56) 11.89 (3.67) 11.78 (3.57)
Treatment Beliefs (n=78) (n=45) (n=31)
(5-30)
Spiritual and/or Religious 0.35 (0.95) 0.33 (0.91) 0.37(1.05)
Information Sources (n=248) (n=150) (n=87)
(0-4)
Organized and Formal 4.38(1.59) 4.36(1.64) 4.47(1.47)
Information Sources (0-6) (n=240) (n=144) (n=85)
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Table 10, Continued
Scale Name
(Scale Score Range)
Overall Mean Score
(SD)
Mean Score By Years Spent Living in U.S. (n, SD)
7.88 years or less More than 7.88 years
Informal Information 1.41 (0.81) 1.39 (0.83) 1.46 (0.78)
Sources (0-2) (n=244) (n=148) (n=85)
Western Medical Etiological 6.50 (2.20) 1.35 (2.15) 6.57 (2.34)
Beliefs (0-10) (n=129) (n=75) (n=49)
Eastern Karma Etiological 6.07 (2.82) 6.07 (2.80) 6.02 (2.87)
Beliefs (4-20) (n=190) (n=119) (n=65)
Traditional Family Practices 25.11 (5.02) 25.76 (4.82) 23.84 (5.24)
(7-35) (n=253) (n=155) (n=87)
General AD Knowledge 3.31 (2.69) 2.51 (2.52) 4.67 (2.46)
(0-11) (n=255) (n=156) (n=88)
Specific AD 2.89 (2.11) 2.30 (2.13) 3.92(1.63)
Symptomatology Knowledge (n=255) (n=156) (n=88)
(0-7)
Table 11. Correlation Matrix o f Study Variables
Help
Seek
Beliefs
Eastern
Tx
Beliefs
East/West
Tx
Beliefs
Western
Tx
Beliefs
Spiritual
/ Relig.
Info
Formal
/ Org.
Info
Informal
Info
Help
Seek
Beliefs
1.00 -0.05
(n.s.)
0.05
(n.s.)
0.07
(n.s.)
0.06
(n.s.)
0.35a 0.03
(n.s.)
Eastern
Tx
Beliefs
-0.05
(n.s.)
1.00 0.87a 0.74a 0.23d -0.16
(n.s.)
0.08
(n.s.)
East/West
Tx
Beliefs
0.05
(n.s.)
0.87a 1.00 0.66a 0.13
(n.s.)
-0.10
(n.s.)
0.13
(n.s.)
Western
Tx
Beliefs
0.07
(n.s.)
0.74a 0.66a 1.00 0.21
(n.s.)
0.00
(n.s.)
0.00
(n.s.)
Spiritual /
Relig.
Info
0.06
(n.s.)
0.23u 0.13
(n.s.)
0.21
(n.s.)
1.00 0.04
(n.s.)
0.11
(n.s.)
Formal /
Org. Info
0.35a -0.16
(n.s.)
-0.10
(n.s.)
0.00
(n.s.)
0.04
(n.s.)
1.00 0.30a
Informal
Info
0.03
(n.s.)
0.08
(n.s.)
0.13
(n.s.)
0.00
(n.s.)
0.11
(n.s.)
0.30a 1.00
West
Etio.
Beliefs
East
Etio.
Beliefs
Tradition.
Family
Beliefs
General
AD
Know.
AD
Sympt.
Know.
Age Yrs in
U.S.
Help
Seek
Beliefs
-0.04
(n.s.)
0.08
(n.s.)
-0.19° 0.17b 0.14d 0.02
(n.s.)
0.10
(n.s.)
Eastern
Tx
Beliefs
-0.21* 0.31* 0.40 A -0.35 A -0.28 b -0.00
(n.s.)
-0.24 u
East/West
Tx
Beliefs
-0.25* 0.17* 0.31A -0.25 c -0.18* -0.11
(n.s.)
-0.17*
Western
Tx
Beliefs
0.02
(n.s.)
0.33c 0.28 u -0.21
(n.s.)
-0.18
(n.s.)
0.10
(n.s.)
-0.01
(n.s.)
Spiritual /
Relig.
Info
-0.15
(n.s.)
0.27 c 0.14* -0.06
(n.s.)
-0.08
(n.s.)
0.02
(n.s.)
0.00
(n.s.)
Formal /
Org. Info
-0.06
(n.s.)
-0.09
(n.s.)
-0.23* 0.14* 0.20 c 0.04
(n.s.)
0.06
(n.s.)
Informal
Info
0.07
(n.s.)
0.07
(n.s.)
0.01
(n.s.)
-0.12
(n.s.)
-0.09
(n.s.)
-0.05
(n.s.)
0.00
(n.s.)
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Table 11. continued
Help
Seek
Beliefs
Eastern
Tx
Beliefs
East/West
Tx
Beliefs
Western
Tx
Beliefs
Spiritual
/ Relig.
Info
Formal
/Org.
Info
Informal
Info
West Etio
Beliefs
-0.04
(n.s.)
-0.21“ -0.25“ 0.02
(n.s.)
-0.15
(n.s.)
-0.06
(n.s.)
0.07
(n.s.)
East Etio
Beliefs
0.08
(n.s.)
0.31 0.17“ 0.33 c 0.27 “ -0.09
(n.s.)
0.07
(n.s.)
Tradition.
Family
Beliefs
-0.19c 0.40 A 0.31A 0.28 u 0.14“ -0.23 c 0.01
(n.s.)
General
AD
Know.
0.17u -0.35 A -0.25 c -0.21
(n.s.)
-0.06
(n.s.)
0.14“ -0.12
(n.s.)
AD
Sympt.
Know.
0.14“ -0.28“ -0.18“ -0.18
(n.s.)
-0.08
(n.s.)
0.20 c -0.09
(n.s.)
Age 0.02
(n.s.)
-0.00
(n.s.)
-0.11
(n.s.)
0.10
(n.s.)
0.02
(n.s.)
0.04
(n.s.)
-0.05
(n.s.)
Yrs in
U.S.
0.10
(n.s.)
-0.24 u -0.17“ -0.01
(n.s.)
0.00
(n.s.)
0.06
(n.s.)
0.00
(n.s.)
West
Etio.
Beliefs
East
Etio.
Beliefs
Tradition.
Family
Beliefs
General
AD
Know.
AD
Sympt.
Know.
Age Yrs in
U.S.
West Etio
Beliefs
1.00 -0.11
(n.s.)
-0.09
(n.s.)
-0.03
(n.s.)
0.00
(n.s.)
0.03
(n.s.)
0.10
(n.s.)
East Etio
Beliefs
-0.11
(n.s.)
1.00 0.20 c -0.05
(n.s.)
-0.04
(n.s.)
0.12
(n.s.)
0.04
(n.s.)
Tradition.
Family
Beliefs
-0.09
(n.s.)
0.20 c 1.00 -0.23“ -0.16“ 0.03
(n.s.)
-0.24“
General
AD
Know.
-0.03
(n.s.)
-0.05
(n.s.)
-0.23“ 1.00 0.72“ 0.25 A 0.42 A
AD
Sympt.
Know.
0.00
(n.s.)
-0.04
(n.s.)
-0.16“ 0.72 A 1.00 0.24 A 0.32 A
Age 0.03
(n.s.)
0.12
(n.s.)
0.03
(n.s.)
0.25 A 0.24 A 1.00 0.48 A
Yrs in
U.S.
0.10
(n.s.)
0.04
(n.s.)
-0.24“ 0.42 A 0.32 A 0.48 A 1.00
46
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Etiological beliefs about dementia. As shown in Table 2, old age, loneliness,
mental illness, stress and head injury were seen as the most influential etiological
factors. The traditional eastern items - karma, God’s will, evil spirits, and
supernatural forces—on average—were seen as not important or only a little
important. The most “do not know” answers were given to hormone replacement
therapy followed by exposure to toxic materials.
General knowledge o f dementia and dementia symptoms. Individual items
and percentage of participants who endorsed true, false, and do not know responses
are given below in Table 3. Most of the items were answered correctly by fewer
than half of the respondents. Items that were most likely to be answered correctly
included knowing that memory loss is a symptom of Alzheimer’s disease and that
getting lost or wandering is a symptom of Alzheimer’s disease. A very high rate of
“don’t know” answers was apparent. There was a moderately high correlation (r =
0.72, p < 0.0001) between the general Alzheimer’s disease knowledge items (first 11
items shown in Table 3) and the specific Alzheimer’s disease symptom knowledge
items (last 7 items shown in Table 3).
Dementia help-seeking beliefs. As shown in Table 4, descriptive results
indicate that respondents most strongly endorsed the importance of an early
diagnosis (M = 4.51, SD = 0.83), the need to seek help at some point (M = 4.43, SD =
0.90), and believing that the condition will continue to worsen if no help is sought
( .M = 4.30, SD = 1.02). They were close to neutral as regards whether health
47
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insurance would influence treatment seeking (M = 3.15, SD = 1.46), and they did not
see social consequences as a major barrier to seeking help (M = 1.86, SD = 1.17).
Dementia treatment beliefs. Responses indicated (as depicted in Table 5) that
those treatments regarded as the most effective included keeping mentally active (M
= 3.98, SD = 0.90), keeping emotional stress low (M = 3.92, SD = 0.96), increasing
happiness in life (M = 3.92, SD = 1.06), and keeping physically active (M = 3.73, SD
- 0.92). The approved dementia medications were rated as between somewhat and
very effective (M = 3.30, SD = 0.93). Other treatments were perceived as having
limited effectiveness, including estrogen replacement therapy (M = 2.12, SD = 1.06),
eating nuts (M = 2.59, SD = 1.28), and herbal supplements (M = 2.76, SD = 1.11).
The items receiving the most “do not know” responses included estrogen
replacement (56.52%), eating nuts (46.18%), vitamins (40.56%), and herbal
supplements (38.49%).
Sources o f information. Most study participants indicated (as described in
Table 6) that they would seek physicians (93%), followed by the internet (89%),
followed by an equal endorsement for both the Alzheimer’s Association (78%) and
print media such as books, newspapers, magazines (78%,).
In addition, though focus group participants urged the inclusion of the
following sources, a very low percent of survey participants endorsed seeking
dementia information from religious figures , spiritual astrologers , astrologers , or
spiritual leaders or healers .
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Traditional family structure and practices. Means and standard deviations of
individual items are presented in Table 7. Eight of the nine Likert scale items had
means above the middle of the scale, indicating greater agreement than disagreement
of traditional family values.
Acculturation and Perceptions
The results from testing hypotheses from the second set of research questions
are given below. Where relevant, hypotheses which examined the construct of
acculturation were tested with the use of both acculturation measures.
Acculturation and etiological beliefs about dementia. Two separate t-tests
were conducted to determine if beliefs in the two etiological beliefs subscales
differed by the amount of time spent living in the U.S. The mean score of the
western etiological beliefs was 1.35 {SD = 2.15) for respondents who had lived in the
U.S. for 7.88 years or less, compared with a mean score of 6.57 {SD = 2.34) for
respondents who had resided in the U.S. for more than 7.88 years (see Table 10).
This difference was not statistically significant, /(74)= 0.14, p > 0.59.
The mean score of the eastern etiological beliefs was 6.07 {SD = 2.80) for
respondents who had lived in the U.S. for 7.88 years or less, compared with a mean
score of 6.02 {SD = 2.87) for respondents who had resided in the U.S. for more than
7.88 years (Table 10). This differences was also not statistically significant, t{ 129) =
0.12, p > 0.91. Two Pearson product-moment correlations were computed to test if
there was a relationship between traditional family practices and more accurate
beliefs about etiological factors affecting dementia. There was not a significant
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relationship between lower traditional family practices and higher scores on the
western etiological beliefs subscale (r = -0.09, n = 129, p > 0.28). The Pearson
product-moment correlation indicated a small, but statistically significant positive
correlation between higher agreement of traditional family practices and greater
endorsement of eastern etiological beliefs (r = 0.20, n = 190, p < 0.005).
Acculturation and dementia knowledge. The mean score of the general AD
knowledge scale was 2.51 (SD = 2.52) for respondents who had lived in the U.S. for
7.88 years or less, compared with a mean score of 4.67 (SD = 2.46) for respondents
who had resided in the U.S. for more than 7.88 years (see Table 10). A t-test showed
that respondents who had lived in the U.S. for more than 7.88 years had a
significantly higher level of general AD knowledge, as compared to those
respondents who had resided in the U.S. for 7.88 years or less f(242) = -6.47, p <
0.0001).The mean score of the symptom specific AD knowledge scale was 2.30 (SD
= 2.13) for respondents who had lived in the U.S. for 7.88 years or less, compared
with a mean score of 3.92 (SD = 1.63) for respondents who had resided in the U.S
for more than 7.88 years (see Table 10). Again, a t-test found that respondents who
had lived in the U.S. for more than 7.88 years also had a significantly higher level of
AD symptom specific knowledge, in contrast to respondents who had lived in the
U.S. for 7.88 years or less (t(242) = -6.17, p < 0.0001).
A Pearson product-moment correlation was done to determine if agreement
on traditional family structure and practices related to levels of general knowledge.
A small but statistically significant negative relationship emerged, where lower
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endorsement of traditional family structure and practices negatively correlated with
higher levels of general AD knowledge (r= -0.23, n = 253, p < 0.0002).Again, a
Pearson product-moment correlation was conducted to determine if there was a
relationship between traditional family structure and practices with symptom specific
AD knowledge. Again, a small but statistically significant relationship was found,
where lower agreeability of the traditional family structure and practices subscale
inversely correlated with increased level of symptom specific AD knowledge (r = -
0.15, n = 253, p < 0.01).
Acculturation and dementia help-seeking. The mean score of the dementia
help-seeking scale was 25.66 (SD = 3.84) for respondents who had lived in the U.S.
for 7.88 years or less, compared with a mean score of 26.03 (SD = 4.00) for
respondents who had resided in the U.S. for more than 7.88 years (see Table 10). A
t-test showed that individuals who have been living in the U.S. longer than 7.88
years did not indicate an intention to seek help for dementia significantly more than
individuals who had been living in the U.S. for 7.88 years or less, f(236) = -0.70, p >
0.48). With the use of the other acculturation measure, a Pearson product-moment
correlation resulted in a small, but significant negative correlation between lower
levels of traditional family structure and practices endorsement and higher levels of
dementia help-seeking (r = -0.19, n = 247, p < 0.0023).
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Acculturation and dementia treatment. The mean score of the eastern
treatment beliefs scale was 34.57 (SD = 9.47) for respondents who had lived in the
U.S. for 7.88 years or less, compared with a mean score of 30.55 (SD = 8.36) for
respondents who had resided in the U.S. for more than 7.88 years (see Table 10).
The mean score of the east/west treatment beliefs scale was 34.62
(SD = 7.06) for respondents who had lived in the U.S. for 7.88 years or less,
compared with a mean score of 32.32 (SD = 7.02) for respondents who had resided
in the U.S. for more than 7.88 years (see Table 10).
The mean score of the western treatment beliefs scale was 11.89 (SD = 3.67)
for respondents who had lived in the U.S. for 7.88 years or less, compared with a
mean score of 11.78 (SD = 3.57) for respondents who had resided in the U.S. for
more than 7.88 years (see Table 10).
Three separate t-tests were conducted to determine statistical differences
between groups within each treatment beliefs scale. Individuals who were living in
the U.S. for a shorter period of time indicated significantly greater belief that eastern
treatments were efficacious than individuals who had lived in the U.S. for a longer
period of time, f(121) = 2.41, p < 0.02. Time spent living in the U.S. did not
significantly differentiate beliefs towards the effectiveness of east/west treatments,
t(\A7) = 1.95, p > 0.05, nor western approaches to treatment, t(74) = 0.14, p > 0.05.
Mean scores for each treatment type subscale by amount of time spent living in the
U.S. is provided in Table 10. A Pearson product-moment correlation was used to
test if there was a relationship between traditional family practices and treatment
52
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efficacy beliefs. Individuals who scored higher on the traditional family structure
and practices subscale significantly more highly endorsed the efficacy of all three
treatment types, with eastern treatments (r = 0.40, n = 126, p < 0.0001), east/west
treatments (r = 0.31, n = 153, p < 0.0001), and western treatments (r = 0.28, n = 78, p
< 0.01). Given that there was a positive correlation between traditional family
structure and practices and beliefs in the efficacy of all three types of treatments
(eastern, east/west, and western), a post-hoc test was done to investigate if there was
a relationship between belief in the efficacy of medications (considered to be the
most “western” of the treatment items) and respondents’ level of traditional family
structure and practice. A Pearson product-moment correlation did not result in a
statistically significant correlation between levels of traditional family scores and
endorsement of the efficacy of medications to treat symptoms of memory loss (r = -
0.09, n = 212, p > 0.19).
Personal dementia relevance, acculturation, and dementia knowledge. As
reported in the “Methodology” section under “Survey Participants”, 7.97% indicated
having a relative (living or not) who has or had dementia. Table 12 below provides
mean scores (and standard deviations) of each of the two knowledge scales
constructs used in this research question by personal relevance of dementia and
acculturation. Two two-way analyses of variance were conducted to determine if
there was empirical support for the research question, with both amount of time
spent living in the U.S. and personal dementia relevance as independent variables
and AD knowledge scores as dependent variables.
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A chi-square analysis determined that the two independent variables were
related. There was a higher prevalence of dementia in the families of respondents
who had lived in the U.S. longer than 7.88 years, x2 (l, N = 240) = 5.20, p < 0.02.
13% of those living in the U.S. longer reported AD in the family versus 5% for those
living in the U.S. less long.
In the ANOVA with the general AD knowledge subscale, only the main
effect pertaining to amount of time spent living in the U.S. was statistically
significant F (1, 236) = 10.82, p < 0.001, whereas the main effect for personal
dementia relevance was not significant F (l, 236) = 0.10, p > 0.75, and the interaction
between amount of time spent living in the U.S. and personal dementia relevance
was not significantly supported F (l, 236) = 0.00, p > 0.96. The values reported are
from Type III sum of squares calculations, which were used to control for uneven
sample sizes in the model’s different cells. With regard to the specific AD symptom
knowledge subscale, again only the main effect relating to amount of time spent
living in the U.S. was significant F( 1, 236) = 6.47, p < 0.01, whereas the main effect
for personal dementia relevance was not significant F(l, 236) = 2.91, p > 0.09, and
the interaction between amount of time spent living in the U.S. and personal
dementia relevance was not significantly supported F(l, 236) = 0.55, p > 0.46.
Although specific knowledge means appeared somewhat higher for those with
affected family members, the relationship between personal relevance and
acculturation left the difference nonsignificant. Again, the values reported are from
Type III sum of squares calculations.
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Table 12
Mean scores on dementia knowledge according to personal relevance o f dementia
and acculturation
Dementia in family No dementia in family
N General AD Symptom N General AD Symptom
knowledge Specific AD knowledge Specific
(SD) Knowledge
(SD)
(SD) AD
Knowledge
(SD)
Lived in 7 2.86 (2.19) 3.57 (2.51) 146 2.55 (2.54) 2.29 (2.10)
U.S.<
7.88
years
Lived in 11 4.91 (2.84) 4.45 (1.57) 76 4.66 (2.43) 3.89(1.59)
U.S.>
7.88
years
Total 20 4.10(2.90) 4.05 (2.19) 251 3.29 (2.66) 2.84 (2.07)
Sources of Information
This research question examined if respondents’ choice of information source
correlated with treatment efficacy beliefs. Seeking dementia information from
spiritual and/or religious information sources positively correlated with higher
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eastern treatment scores (r = 0.23, p < 0.01). This correlation, though small, is
interesting to note. Other information channels did not correlate with treatment
beliefs. In addition, there was a statistically significant positive correlation between
different information sources. Seeking information from informal sources (family,
friends and acquaintances) positively correlated with seeking information from
formal sources, such as physicians, the Alzheimer’s Association, television, books,
and the internet (r = 0.30, p < 0.0001). Neither correlated significantly with seeking
information from spiritual nor religious sources.
Discussion
This study addressed the absence of research about AIAs’ perceptions of
dementia and the associations that acculturation has with such perceptions.
Perceptions of dementia encompassed dementia help-seeking, treatment beliefs,
information sources, etiological beliefs, acculturation, and knowledge (of
Alzheimer’s disease). Results showed that relationships do exist between
acculturation and participants’ beliefs about dementia. For instance, compared to
respondents that were living in the U.S. for a longer period of time, study
participants who have lived in the U.S. for a shorter period of time endorsed beliefs
in eastern treatments more highly, and had lower scores of general and symptom
specific Alzheimer’s disease knowledge. Those who scored higher on the traditional
family scale endorsed all treatment subscales (eastern, west/east, and western) more;
had lower levels of intention to seek help for dementia; and had lower levels of both
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general and symptom specific AD knowledge; and had greater beliefs in eastern, or
karmic etiological beliefs of dementia.
Across all levels of acculturation, participants accurately endorsed that
Alzheimer’s disease does involve loss of memory and is a disease of old age, though
interestingly loneliness and mental illness were reported as more important than
genetics as causes of dementia, and there was a greater reliance on keeping mentally
and physically active, increasing happiness, and keeping emotional stress low as
treatments for dementia than on approved medications. Documenting these
perceptions enables developing culturally-valid education and intervention.
Acculturation was measured via two indices, one temporal and the other
attitudinal: as the amount of time spent living in the U.S., and agreement with items
on a scale of traditional family structure and practices. Regardless of which
acculturation measure was used, there was an association between acculturation and
the different facets of dementia perceptions. At the same time, there were also some
areas where perceptions were more highly correlated with the traditional family
structure and practices scale than with time in the U.S.
The process in which acculturation associates itself with disease perceptions
in general is an important one to consider thoroughly in future research. This is a
particularly salient consideration when working with various Asian cultures, which
generally speaking, are known to be more sociocentric than egocentric (Landrine &
Klonoff, 2001). Such a sociocentric perspective involves a continual interaction with
one’s environment to include viewing spiritual and physical forces as common
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etiological factors, in stark comparison to western etiological perspectives. In doing
so, sociocentric perspectives thus blur the lines between the interplay between
religious and medical beliefs in disease conceptualization (Westermeyer, 1988).
Furthermore, the emic perceptions of dementia treatment among this sample are
worth noting. Along with restoring holistic balance (Landrine & Klonoff), other
treatments sought include those derived from ayurvedic, or traditional Hindu medical
systems of care (Westermeyer, 1988; Fleischman, 1976-1977).
Intention to seek help was slightly lower for those with a higher endorsement
of the traditional family structure and practices subscale, but did not differ according
to amount of time spent living in the U.S. This finding supports previous research by
Sharma (1995) whose work has shown a positive relationship between acculturation
levels and AIAs’ attitudes towards mental health help-seeking. This finding also
supports findings from Watari and Gatz (2004) which found that family has a
paradoxical effect on help-seeking until symptoms escalate in severity. Stigma may
or may not have a role in this, insofar as stigma may be higher among less
acculturated and may block help seeking and information seeking. Endorsing
traditional family structures and practices also may be consistent with not viewing
the symptoms of dementia even as a disorder, but instead seeing it just as a normal
part of aging.
Accuracy of western medical etiological beliefs was not related to
acculturation, measured either as years spent living in the U.S., or as endorsement of
traditional family structure and associated practices. The latter indicator of
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acculturation was found to be slightly positively correlated with endorsement of the
importance of eastern etiological beliefs. For those with traditional family structure
and practices, etiology may not be only medically viewed, but instead could be seen
as karmic in nature which may not be able to be treated by conventional western
treatments.
Knowledge of Alzheimer’s disease in general and its symptomatology were
higher among those who were more acculturated. Living in the U.S. may also be
related to greater ease and accessibility to public health information about the
disorder, which would lead to greater knowledge. The knowledge scores from this
study are in sharp contrast to the AD knowledge levels among first-degree relatives
reported by Roberts et al. (2003). For example, only 34.7% agreed that there is no
cure for AD, compared to 93.1% in Roberts et al. Similarly, 18.7% agreed that there
is no blood test for AD, compared to 92.1%; 35.3% agreed that most people with
AD did not live in nursing homes, compared to 86.7%; 66.27% agreed that the
primary symptom of AD is memory loss, compared to 86.2%; 40.87% correctly
believed that there are drugs available to treat the symptoms of AD, compared to
80.3%; and 23.9% correctly believed that senility is not a normal part of aging as
compared to 81.3% respectively among first degree relatives in Roberts et al.. It is
important to note that there were a large number of ‘do not know’ responses to these
general AD items in the current study, and that Roberts et al. did not have a “do not
know” category. However, it remains evident that there is a need for public health
education of AD, and more generally dementia, among the ALA population.
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A higher prevalence of dementia was found in the families of respondents
who had lived in the U.S. for a longer period of time. Often, after adult children
become settled and established in the U.S., a common cultural practice is to bring
over one’s older adult parents from India. One’s parents will often stay for as long
as six months (the usual maximum amount of time granted by temporary visas for
citizens of India to the U.S.). During their stay, the likelihood is that the older adults
will have access to medical care (Kalavar, 1998). That being said, there has been
growing research in India to show that assessment and diagnosis of dementia often
gets overlooked or misdiagnosed, and as of late, there is growing research to send
trained lay community health workers to literally do “case-finding” (Shaji, 2002).
Thus, the likelihood of a dementia diagnosis (not dementia per se) may be greater in
the U.S. than in India, and may be associated with available resources. Moreover,
those that have an intention to screen for dementia may or may not have family
history of the disorder, but also may need to perceive themselves as susceptible to
dementia, and thus perhaps paralleling previous research on the intentions to screen
for prostate cancer (Lamonde, 2001). When time in the U.S., and family history of
dementia were considered simultaneously, the only main effect found for knowledge
scores was the amount of time spent living in the U.S., but personal dementia
relevance and the interaction were not significant. Specifically, individuals who had
or have a family member with dementia have higher AD symptom knowledge
compared to individuals without AD in the family. No difference was found for the
general AD knowledge score, which potentially could relate to a large number of
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missing responses, or to the fact that having personal experience exposes one to
symptoms but not necessarily to the types of information on the general knowledge
scale.
Findings regarding treatment efficacy showed mixed findings. That is
individuals who had been living in the U.S. for a shorter period of time significantly
believed that traditional, or “eastern” treatments were efficacious to a greater extent
than individuals who had lived in the U.S. for a longer period of time. Also, scores
on all treatment subscales, encompassing both more “eastern” and more “western”
items, were positively correlated with scores on traditional family structures and
practices. It is noteworthy to mention that all the treatments on both of the treatment
scales (eastern and western) were to some degree also classified as an ‘alternative’
treatment under the east/west treatment factor. Interestingly, no such difference
existed to use medications for the treatment of dementia (see Table 5).
There was a small, but statistically significant positive correlation between
seeking dementia information from spiritual and/or religious information sources and
seeking eastern treatments. No statistically significant relationship existed between
reliance on formal information and endorsement of more modem treatments. The
latter finding argues against Shah’s (1991) research, which indicated that
interpersonal interaction with the host culture was a strong predictor of adapting to
the host culture. One explanation for the present findings could be that individuals in
this sample could have stronger reliance on spiritual and religious information
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sources, in which case formal information sources potentially may have a
challenging time attempting to diffuse their messages into this population.
Strengths and Weaknesses o f the Present Study
This study has several limitations which warrant addressing in future
research. One such consideration is the potential limited generalizability of the
sample. Although many attempts were made to collect data at as culturally diverse
and at many locales as possible, logistical considerations prevented the researcher
from increasing the number of data collection sites. Another point, related to the
above, is a possible sampling bias. Over three quarters of the respondents were
sampled at one of two Indian restaurants, one a vegetarian restaurant, the other a
non-vegetarian restaurant. Within the restaurant-recruited sample, most respondents
came from the vegetarian restaurant. Though it is not to say that every patron in
each restaurant is either a pure vegetarian or a carnivore respectively, it is important
to note that some of the findings from the study may potentially relate to lifestyle
preferences which are individualized in nature, and thus may not be shared by all
AIAs. That is, it seems possible that those who choose to eat vegetarian may also be
attentive to other lifestyle factors and might have a bias toward endorsing lifestyle
factors as relevant to disease etiology. A third consideration is that oftentimes at
these restaurants, respondents wished to fill out the questionnaires at their dining
tables instead of at the research participants’ table the researcher had set up. Thus,
there was no way to ensure for certain in the community sampling that discussion did
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not ensue about the questionnaire items between respondents or between respondents
and non-respondents.
Fourth, some aspects of scale development also posed a challenge. One
limitation was the use of several measures that had not yet been validated on this
study population. An additional limitation is the scoring of the etiological items,
which though summed into two subscales in this study, should only be considered a
first approximation. Roberts et al. (2003) did not create any type of scale(s) from
these items, nor did they score for correctness or for any other criteria. Another
constraint is that the treatment belief scales contain, in terms of raw numbers, close
to six times the number of traditional treatments as compared to modem treatments.
Thus, there is not a good evaluation of extent of reliance on western medical
treatment. Another limitation centers around the challenges associated with the
definition, operationalization and measurement of acculturation.
Strengths of the study also bear mentioning. The questionnaire in its entirety
was pilot-tested among focus group participants before being administered to a large
sample within the community at large. Pilot testing ensured that the items were
revised to become more respondent-friendly. In addition, results from the pilot
testing provided feedback on culturally-relevant items and response format.
Furthermore, acculturation was measured by two variables, one of which (the
traditional family structure and practices subscale) stemmed from a larger multiple
dimension acculturative scale that demonstrated an attentiveness of the complexity
involved in the acculturative process (Salant & Lauderdale, 2003). The small
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negative correlation between the two acculturation variables was informative. Also,
it was noted that there was no statistical significance between age, education, gender,
and the traditional family structure and practices subscale. However, the there was
statistical significance between age, education, and the amount of time spent living
in the U.S. (as a dichotomized variable).
Future Research
This study provided a broad overview of the data, and described initial
findings. It particularly would be interesting in future research to study the
relationships between study constructs (e.g., help-seeking, etiology, treatment
beliefs, etc) within the framework of a larger statistically-based model. In addition,
it would be important to understand where AIAs continue to draw dementia
information from (not only to include symptoms, but also treatment, etiology, help-
seeking); then, to target specific dementia public health awareness campaigns, and
finally to see if there is an increase in awareness within a follow-up design to assess
level of knowledge retention. It also would be helpful to assess for generational
information, and in the future, identify if generational status change perceptions of
dementia in light of culture and acculturation. In addition, it would be helpful to
researchers, clinicians, public health workers, and most notably to community health
outreach workers who provide service outside of a clinic or hospital would be to
examine if there is a causal relationship between traditional family structure and
practices with the outcome variables. Lastly, it would be rather fascinating to see the
differences over time in perceptions of dementia between Asian Indians living in the
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U.S. and Asian Indians living in India. Moreover, this would be particularly
interesting in light of increasing western influences in India, and the association
between such influences and changes in perceptions of dementia etiology, treatment,
help-seeking, cultural shifts, etc.
Conclusion
There is medical anthropological and public health research indicating that
disease perceptions disease may potentially affect health seeking behavior and health
service utilization. In addition, culture and more specifically, acculturation, has been
associated with disease perceptions and health behavior. This study found that
acculturation was associated with differences in perceptions of dementia. When the
construct was measured as years spent residing in the U.S., acculturation was
significantly associated with treatment beliefs, general AD knowledge, and symptom
specific AD knowledge. When the construct was operationalized as the belief in
traditional family structure and practices, acculturation was significantly related to
treatment beliefs, general AD knowledge, symptom specific AD knowledge, help-
seeking, as well as etiological beliefs.
With a growing ALA population in the U.S. it is hoped that this study not only
can serve as a contribution to the field of disease perception literature, but also to add
to the mental health and culture literature related to AIAs, and moreover to have the
findings from this study be applied in clinical and community interventions. In
addition, within group considerations (e.g., AIAs) are as important to consider as
similarities and differences between groups (e.g., Asian Americans). Findings from
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this study can help to inform research and health behavior interventions in other
ethnic minority populations as well.
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Bibliography
Azjen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and
Human Decision Processes, 50, 179-211.
Azjen, I. & Driver, B.L. (1991). Prediction of leisure participation from behavioral,
normative, and control beliefs: an application of the Theory of Planned
Behavior. Leisure Sciences, 13, 185-204.
Azjen, I. & Madden, T J. (1986). Prediction of goal-directed behavior: attitudes,
intentions, and perceived behavioral control. Journal of Experimental Social
Psychology, 22,453-474.
Barry, D.T. & Grilo, C.M. (2002). Cultural, psychological, and demographic
correlates of willingness to use psychological services among East Asian
immigrants. Journal o f Nervous & Mental Disease, 190, 32-39.
Berry, J.W. (1997). Immigration, acculturation, and adaptation. Applied
Psychology: An International Review, 46, 5-68.
Berry, J.W., Poortinga, Y.H., Segall, M.H., & Dasen, P.R. (1992). Cross-cultural
psychology research and applications. New York: Cambridge University
Press.
Cameron, L.D., & Leventhal, H. (eds). (2003). The self-regulation of health and
illness behaviour. New York, NY: Routledge.
Cody, R.P. & Smith, J.K. (1997). Applied statistics and the SAS programming
language, 4th edition, (p. 257). Upper Saddle River, NJ: Prentice Hall.
Connell, C.M. (1996). Knowledge, attitudes, and beliefs about Alzheimer’s disease.
Paper presented at the annual meeting of the Gerontological Society of
America, Washington, DC, November 20, 1996.
Dawson, E.J., Crano, W.D., & Burgdoon, M. (1996). Refining the meaning and
measurement of acculturation: Revisiting a novel methodological approach.
International Journal of Intercultural Relations, 20, 97-114.
Durvasula, R.S. & Mylvaganam, G.A. (1994). Mental health of Asian Indians:
Relevant issues and community implications. Journal of Community
Psychology, 22, 97-108.
67
R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.
Espino, D.V. & Lewis, R.L. (1998). Dementia in older adult minority populations:
issues of prevalence, diagnosis, and treatment. American Journal of
Geriatric Psychiatry, 6, S19-S25.
Fabrega, H. (1974). Disease and social behavior. Cambridge, MA: MIT Press.
Finney, L.J. (2001). Health beliefs, message framing, and mammography screening
compliance: Measurement development and theory testing. Dissertation
Abstracts International: Section B: The Sciences & Engineering, 62(3-B),
September 2001, 1641.
Fleischman, P. (1976-77). Ayurveda. International Journal o f Social Psychiatry,
22, 282-287.
Fosu, G.B. (1981). Disease classification in rural Ghana: framework and
implications for health behaviour. Social Science and Medicine, 15B, 471.
Gallagher-Thompson, D., Talamantes, M., Ramirez, R., Valverde, Irene. (1996).
Service delivery issues and recommendations for working with Mexican
American family caregivers. In Yeo, G. & Gallagher-Thompson, D. (Eds).
Ethnicity and the dementias, (pp. 137-152). Philadelphia, PA: Taylor &
Francis.
Gallagher-Thompson, D., Leary, M.C., Ossinalde, C., Romero, J.J.; Wald, M.J.;
Femandez-Gamarra, E. (1997). Hispanic caregivers of older adults with
dementia: Cultural issues in outreach and intervention. Group, 21, 211-232.
Ganguli, M., Chandra, V., Gilby, J.E., Ratcliff, G., Sharma, SD., Pandav, R.,
Seaberg, E.C.,Belle, S. (1996). Cognitive test performance in a community-
based nondemented elderly sample in rural India: the Indo-U.S. Cross-
National Dementia Epidemiology Study. International Psychogeriatrics, 8,
507-24.
Ghandi, M.K. (1965). Nature cure. Bombay: Pearl.
Green, R.C., Clarke, V.C., Thompson, N.J., Woodard, J.L., Letz, R. (1997). Early
detection of Alzheimer Disease: methods, markers, and misgivings.
Alzheimer Disease and Associated Disorders, 11, Supplement 5, SI -S 5 .
Henderson, J.N.; Gutierrez-Mayka, M. (1992). Ethnocultural themes in caregiving
to Alzheimer's disease patients in Hispanic families. Clinical Gerontologist,
11, 59-74.
68
R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.
Kalavar, J.M. (1998). The Asian Indian elderly in America: An examination of
values, family, and life satisfaction (Garland Studies on the Elderly in
America). New York: Garland Publishing.
Kleinman, A. (1980). Patients and Healers in the Context of Culture: An
Exploration of the Borderland between Anthropology, Medicine, and
Psychiatry. Berkeley: University of California Press.
Lamonde, L.A. (2001). Application of protection motivation theory to the study of
prostate cancer screening. Dissertation Abstracts International: Section B:
The Sciences & Engineering, 61 (8-B), 4412.
Landrine, H. & Klonoff, E.A. (2001). ‘Cultural diversity and health psychology’ in
Baum, T.A. Revensen and J.E. Singer (eds.). Handbook of Health
Psychology. Mahwah, NJ: Lawrence Erlbaum Associates, 851-891.
Lau, R.R. & Hartman, K.A. (1983). Commonsense representations of common
illnesses. Health Psychology, 2, 167-185.
Leventhal, H., Benyamini, Y., Brownlee, S., et al. (1997). Illness representations:
theoretical foundations. In: Petrie, K.J., Weinman, J.A., eds. Perceptions of
health and illness. Amsterdam: Harwood Academic Publishers, 19-46.
Leventhal, H. & Narenz, R.D. (1985). The assessment of illness cognition. In
Karoly, P. (ed.), Measurement Strategies in Health Psychology, New York,
Wiley, pp. 517-554.
Leventhal, H., Safer, M.A., Panagis, D.M. (1983). The impact of communications
on the self-regulation of health beliefs, decisions, and behavior. Health
Education Quarterly, 10, 3-29.
LinT.Y. (1983). Psychiatry and Chinese culture. Western Journal o f Medicine, 139,
862-867.
Mackenzie, C.S. (2001). The relationship between attitudes toward seeking
professional psychological help and intentions to use mental health services.
Dissertation Abstracts International: Section B: The Sciences and
Engineering, 61(10-B), May 2001, 5571.
Nwadiora, E. & McAdoo, H. (1996). Acculturative stress among Amerasian
refugees: Gender and racial differences. Adolescence, 31, 477-487.
69
R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.
Parekh, B.R. (2000). Culture and health in Asian Indians. Dissertation Abstracts
International: Section B: The Sciences and Engineering, 61 (3-B), September
2000, 1699.
Patel, V. (1995). Explanatory models of mental illness in Sub-Saharan Africa.
Social Science and Medicine, 40, 1291-1298.
Patel, V. & Prince, M. (2001). Ageing and mental health in a developing country:
who cares? Qualitative studies from Goa, India. Psychological Medicine, 31,
29-38.
Redfield, R., Linton, R., & Herskovits, M. (1936). Memorandum on the study of
acculturation. American Anthropologist, 38, 149-152.
Roberts, J.S., Connell, C.M., Cisewski, D., Hipps, Y.G., Demissie, S., Green, R.C.
(2003). Differences between African Americans and Whites in their
perceptions of Alzheimer disease. Alzheimer Disease and Associated
Disorders, 17, 19-26.
Salant, T. & Lauderdale, D.S. (2003). Measuring culture: a critical review of
acculturation and health in Asian immigrant populations. Social Science and
Medicine, 57, 71-90.
Shah, H. (1991). Communication and cross-cultural adaptation patterns among
Asian Indians. International Journal of Inter cultural Relations, 15, 311-321.
Shaji, K.S., Aran, Kishore N.R., Lai, K.P., Prince, M. (2002). Revealing a hidden
problem. An evaluation of a community dementia case-finding program from
the Indian 10/66 dementia research network. International Journal of
Geriatric Psychiatry, 17, 222-225.
Sharma, P. (1995). Asian Indian attitudes toward seeking professional
psychological help. Dissertation Abstracts International: Section B: The
Sciences and Engineering, 55(10-B), April 1995, 4614.
Sue, S., Nakamura, C.Y., Chung, R.C., & Yee-Bradbury, C. (1994). Mental health
research on Asian Americans. Journal of Community Psychology, 22, 61-67.
U.S. Census Bureau. (2000). The Asian Population: Census 2000 Brief. Accessed
on the World Wide Web on 1 February 2004
[http://www.census.gov/population/www/cen2000/briefs.html].
70
R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.
Watari, K., & Gatz, M. (2004). Pathways to care for Alzheimer’ s disease among
Korean Americans. Cultural Diversity and Ethnic Minority Psychology, 10,
23-38.
Westermeyer, J. (1988). Folk medicine in Laos: A comparison between two ethnic
groups. Social Science and Medicine, 27, 769-778.
White L, Petrovitch H, Ross GW, et al. (1996). Prevalence of dementia in older
Japanese-American men in Hawaii: the Honolulu-Asia aging study. Journal
of the American Medical Association, 276, 955-960.
Young, F., & Zane, N. (1996). Ethnocultural influences in evaluation and
management. In P. Nicassio & T. Smith (Eds.) Managing chronic illness
(pp. 163-206). Washington DC: American Psychological Association.
71
R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.

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Creator Otilingam, Poorni Ganapathi-Raj (author)

Core Title Perceptions of dementia among Asian Indian Americans

Degree Master of Arts

Degree Program Psychology

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

Tag health sciences, mental health,health sciences, public health,OAI-PMH Harvest,psychology, clinical,sociology, ethnic and racial studies

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