Family history and its relationship with dementia stigma beliefs among Chinese Americans

A health promoting-lifestyle prediction model for dementia prevention among chinese adults: based on the health belief model

BACKGROUND

People's health belief is an important factor affecting health behavior. However, there has been little use of the health belief model (HBM) in determining the pathway effect of patients' beliefs on health behavior in dementia prevention in China. The aim of our study was to evaluate the impact of dementia prevention beliefs on health promoting lifestyle among Chinese adults.

METHODS

A cross-sectional study was conducted on line by convenience sampling from January to March 2020. A survey about dementia prevention knowledge, health belief of dementia prevention and health-promoting lifestyle was completed by 1201 adults in China. Data was analyzed using a structural equation model with the analysis of moment program.

RESULTS

The participants were aged 40.50 ± 12.72 years. About 70.3% of participants were female. The purposed model fit the data from the study well. Perceived barriers (total effect-0.322, P < 0.01) and perceived susceptibility (total effect -0.242, P < 0.01) had negative effects on lifestyle. Self-efficacy had promoting effects on lifestyle (total effect 0.207, P < 0.01). Perceived severity had positive effects both on perceived benefits (total effect 0.137, P < 0.01) and perceived barriers (total effect 0.202, P < 0.01), which had a contradictory effect in the formation of health belief. Perceived benefits, cues to action and self-efficacy played a partial mediating role between knowledge and health behavior. The belief of changing lifestyle to reduce the risk of dementia could explain 24.5% of health behavior (P < 0.05).

CONCLUSIONS

The findings indicate that in dementia prevention, dementia prevention health belief has important influences on health behavior. Community medical staff can develop targeted dementia prevention interventions based on the health belief model in the future.

Understanding Challenges and Coping Strategies Experienced by Chinese American Family Caregivers of Persons with Dementia

The purpose of this study was to explore the caregiving experience of Chinese American family caregivers of persons with dementia with a focus on challenges and coping strategies. Using a qualitative study design, we conducted semi-structured interviews with 26 Chinese American family caregivers and analyzed the data using thematic analysis. We also identified their caregiving experience specific to the COVID-19 pandemic. First, four themes were discovered: (1) filial obligations, (2) preference for utilizing home- and community-based supports, (3) relying on primary care doctors, and (4) helping behaviors. Two additional COVID-19-related themes were identified: (1) social isolation and (2) perceived discrimination. We suggested interventions at the individual, community, and societal level not only to support various challenges experienced by this ethnic group but also to promote their coping strategies.

The mediating effect of social support and coping strategies on the relation between family stigma and caregiver burden among Israeli Arab family caregivers of people with Alzheimer's disease (AD)

OBJECTIVES

Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer's disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support.

METHODS

Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28).

RESULTS

Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique - although modest - contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables.

CONCLUSIONS

Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.

Perceptions and Beliefs of Memory Loss and Dementia Among Korean, Samoan, Cambodian, and Chinese Older Adults: A Cross-Cultural Qualitative Study

Older adults who are Asian American and Pacific Islander (AAPI) represent one of the fastest growing populations in the United States and face a significant burden of Alzheimer's disease and related dementias (ADRD). Little is known about ADRD among AAPI subgroups. The current study aimed to: (a) explore perceptions and beliefs of memory loss and dementia among Korean, Samoan, Cambodian, and Chinese older adults in the United States; and (b) identify culturally relevant facilitators and barriers of participation in a brain health program among four AAPI subgroups. Seven focus groups comprising 14 Cambodian, 21 Chinese, 14 Korean, and 13 Samoan older adults were conducted. Data were analyzed using inductive and indigenous coding approaches. Similar and unique perceptions and experiences related to memory loss were identified. Future research could include developing and testing culturally tailored and language congruent strategies regarding ADRD education and resources to facilitate ADRD early detection among AAPI older adults. [Journal of Gerontological Nursing, 48(6), 40-48.].

Stigma Reduction Interventions of Dementia: A Scoping Review

Despite its global importance and the recognition of dementia as an international public health priority, interventions to reduce stigma of dementia are a relatively new and emerging field. The purpose of this review was to synthesize the existing literature and identify key components of interventions to reduce stigma of dementia. We followed Arksey and O'Malley's scoping review process to examine peer-reviewed literature of interventions to reduce dementia-related stigma. A stigma-reduction framework was used for classifying the interventions: education (dispel myths with facts), contact (interact with people with dementia), mixed (education and contact), and protest (challenge negative attitudes). From the initial 732 references, 21 studies were identified for inclusion. We found a variety of education, contact, and mixed interventions ranging from culturally tailored films to intergenerational choirs. Findings from our review can inform the development of interventions to support policies, programs, and practices to reduce stigma and improve the quality of life for people with dementia.

Cross-sectional survey of the replacement of the Japanese term for dementia: Did it reduce discomfort in family members?

OBJECTIVES

Decreasing discrimination and stigma of dementia is an international issue. In 2004, the Japanese government changed the previous Japanese stigmatic term of dementia ("Chiho") to the present one ("Ninchi-sho") a meaning near "neurocognitive disorder." This study aimed to examine cross-sectionally if the present term functioned well or not from the viewpoint of families of people with dementia (PWD), and to discover variables influencing their feelings of the term: the feelings about people surrounding PWD, and the family members' and PWD's attributes.

METHODS

Questions regarding the feelings about the present Japanese term and people surrounding PWD were asked to 155 family members accompanying PWD who visited three hospitals. For analyses, the degree of the discomfort about the present Japanese term was shown descriptively. The relationship of constructs of the feelings extracted by exploratory factor analysis (EFA) and the attributes was analyzed using structural equation modeling (SEM).

RESULTS

71.6% agreed that the present term discomforted them less than the previous one. Only 13.2% thought that the present term was discriminatory. However, about one third of the participants felt discomfort when they used even the present term. Using the constructs extracted by EFA, the analysis of SEM revealed that the negative feelings of the terminology were affected by hesitation to disclose to surrounding people that their family member had dementia, which the attributes of younger family members, wives, husbands, and siblings influenced. Moreover, because of disclosing the dementia, the feelings of support from people alleviated the feelings of hesitation, influenced by sex (female).

CONCLUSIONS

It was suggested that overall, the present term successfully reduced discomfort in families, compared with the result of the previous term surveyed by the Ministry of Health, Labour, and Welfare. However, unignorable numbers of family members still feel stigma. New policies are necessary considering the influencing factors.

Social Stigma of People with Dementia

In a broad sense, the concept of social stigmatization (from the Greek word "stigma", or sign) refers to the attitude of social disapproval and the negative reception of a specific group of people due to the characteristic features of this group. The problem of stigma affects many people, and it is also present in medicine and affects people with dementia. Social stigma of people with dementia is a worldwide problem. The severity of this phenomenon depends on several factors, including gender, age, level of education, religiosity, cultural differences, and the severity of cognitive disorders. Stigmatization can have numerous negative consequences. It leads to rejection, discrimination, and exclusion of stigmatized people from participation in various areas of social life. It also affects close relatives. The main goal of this review paper is to present the problem of stigma among people with dementia, discuss the results of represented research that deals with this issue, to approximate the elements that make up this process, and to present the negative consequences of stigma. Detailed knowledge of this phenomenon provides opportunity to reduce the extent of stigma and improve the quality of life people suffering from dementia. It is worth emphasizing the role of an individual approach to the patient and the need to educate the public about dementia.

Understanding public-stigma and self-stigma in the context of dementia: A systematic review of the global literature

Stigma negatively impact quality of life of people with dementia and their family members. Yet the literature in stigma and dementia remains scant. This article systematically reviews manifestations of and associated factors with public-stigma and self-stigma in the context of dementia. After searching and screening on the three major databases of PubMed, Embase, and psycINFO, 26 articles, including 17 quantitative papers and nine qualitative papers, were selected for synthesis. Results show consistently limited knowledge, as well as stereotype, prejudice, and discrimination of public toward people with dementia and their family caregivers. Demographic characteristics of general public were found to be associated with the level of their stigma against dementia. People with dementia and their family caregivers also perceived negative stereotype, prejudice, and discrimination from general public and healthcare professionals. They reported negative feelings of themselves and tended to delay help-seeking. Psychological factors rather than sociodemographic factors shaped self-stigma of people with dementia and their families. This systematic review highlights the need of future studies in both public-stigma and self-stigma in dementia research in different contexts and cultures, as well as the development of evidence-based and culturally competent interventions and mass media campaigns to reconstruct public perception of dementia.

Alzheimer's Disease Warning Signs: Gender and Education Influence Modifiable Risk Factors-A Pilot Survey Study

OBJECTIVE

The aim of this research was to determine the relationships among diabetes, Alzheimer's disease warning signs, and lifestyle factors such as fruit and vegetable intake and physical activity.

METHOD

Adults over the age of 50 (N = 147) responded to a survey about their health, family history, and experience of Alzheimer's warning signs in the previous year.

RESULTS

Pearson's correlation revealed significant relationships between fruit and vegetable intake and education, gender, and physical activity. Alzheimer's warning signs were associated with relatives having an Alzheimer's disease diagnosis. Other results were nonsignificant.

CONCLUSIONS

Diabetes impacts one-third of older adults in the United States and increases the risk of Alzheimer's disease. This survey revealed that women, who are more at risk for Alzheimer's disease, are less likely to engage in physical activity, a behavior that could decrease their risk. Similarly, those with higher education were more likely to consume colorful fruits and vegetables, potentially decreasing their risk of Alzheimer's disease.

Perceived stigma towards Alzheimer's disease and related dementia among Chinese older adults: do social networks matter?

In mainland China, as the population ages, Alzheimer's disease and related dementia (ADRD) is estimated to increase among Chinese older adults. Chinese older adults tend to hold stigmatising beliefs about ADRD that in turn affect their help-seeking behaviour and receipt of prevention and treatment. The Framework Integrating Normative Influences on Stigma provides a rationale for Chinese older adult's stigma about ADRD. Questionnaires were administered in person to 754 older adults (42% male, mean age = 69.54 years) from two urban communities in mainland China. We examined ADRD stigma and the associations with real-life exposure, knowledge of ADRD, health conditions and social networks. This study found that Chinese older adults who had good family quality, lower depression (as measured by the Center for Epidemiological Studies Depression Scale) and better cognitive health (as measured by the Montreal Cognitive Assessment) were more likely to have lower perceived stigma. Conversely, those individuals who experienced neglect and had more ADRD knowledge exhibited higher levels of perceived stigma. Social networks moderated the associations between cognitive scores and perceived stigma. This research suggested that the quality of one's social networks is essential to reduce perceived stigma among Chinese older adults. Future research should continue to explore ADRD stigma among Chinese older adults to help guide relevant interventions, services and supports for this population.

The Roles of YouTube and WhatsApp in Dementia Education for the Older Chinese American Population: Longitudinal Analysis

Background

Dementia remains a stigmatized topic in the Chinese community.

Objective

This study aims to analyze and compare the usage of dementia educational YouTube videos and the modalities of video sharing over a 6-year period.

Methods

Dementia educational videos were uploaded to YouTube. Data was collected over a 6-year period. Results from the first 3 years were compared to those from the second 3 years using descriptive statistics and chi-square analysis.

Results

Over 6 years, the dementia educational videos generated a total watch time of 269,388 minutes, 37,690 views, and an average view duration of 7.1 minutes. Comparing the first and second 3-year periods of video performance data, there was a longer watch time (59,262 vs 210,126 minutes), more total views (9387 vs 28,303 views), and a longer average view duration (6.3 vs 7.4 minutes). Furthermore, WhatsApp has become a leading external traffic source and top sharing service, accounting for 43.5% (929/2137) and 67.0% (677/1011), respectively.

Conclusions

Over 6 years, YouTube has become an increasingly popular tool to deliver culturally sensitive dementia education to Chinese Americans. WhatsApp continues to be the preferred method of sharing dementia education and has become a top external traffic source to dementia educational videos. Taken together, these social media platforms are promising means of reducing the disparity in dementia knowledge in linguistically and culturally isolated populations.

Dementia-Related Products on an e-Commerce Platform

Dementia is a neurocognitive disorder, which affects older adults. There are currently no medication treatments available to cure dementia, but a number of biomedical technologies could be useful in assisting patients with dementia. With the continued growth of electronic commerce (e-commerce), online shopping for aging and health-related products will only continue to increase. Using the Tmall marketplace as an example, the purpose of this viewpoint is to describe the current trends of dementia-related products and devices available on an e-commerce platform. Feedback and critiques in the form of consumer reviews should be used to improve the design of dementia-related products. Online medical product consumers, however, must be vigilant about the effectiveness and risks of these biomedical devices.

Perceived threat of Alzheimer's disease and related dementias in Chinese older adults: The role of knowledge and perceived stigma

OBJECTIVES

This study focused on perceived threat of Alzheimer's disease and related dementias (ADRD) in Chinese older adults and investigated its associations with their perceived stigma and knowledge of ADRD.

METHODS

We examined Chinese older adults' perceived threat of ADRD and its associations with perceived stigma, knowledge of ADRD, family variables and health variables. Data for this cross-sectional study were collected by student interviewers in 2016. The participants (N = 754) were recruited from two urban communities in mainland China and their ages ranged from 60 to 89 (M = 69.54, SD = 7.35).

RESULTS

Hierarchical regression analyses indicated that those who are younger, have more depressive symptoms and lower levels of family cohesion are more likely to worry about ADRD. More ADRD knowledge and higher levels of perceived stigma are significantly associated with perceived threat of ADRD. Community site moderated the relationship between stigma and perceived threat of ADRD.

CONCLUSIONS

Intervention or service programs need to promote ADRD knowledge and awareness in a culturally sensitive way as well as address stigma and fear toward ADRD in the older population. Future studies are needed to incorporate more cultural and environmental factors to fully understand Chinese older adults' attitudes toward and literacy of ADRD.

Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review

BACKGROUND

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population.

OBJECTIVE

The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans.

METHODS

The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus.

RESULTS

The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities.

CONCLUSION

To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.

Perceptions of and Attitudes Toward Diabetes Among Chinese Americans

Context

Type 2 diabetes mellitus is a global health issue among Asians, with rising prevalence and increasing disparities in proper disease management. However, studies on the perceptions of and attitudes toward diabetes, conducted to improve diabetes disparities, are disproportionately limited in Asian populations compared with other minority populations in the United States.

Objective

To determine Chinese Americans' perceptions of and attitudes toward diabetes.

Methods

Chinese Americans from the greater Los Angeles, California, area were asked to complete a survey. The survey was a self-administered 15-item true/false questionnaire to assess the respondents' perceptions of and attitudes toward diabetes. The results of the questionnaire were grouped by age: younger adults (aged <55 years) and older adults (aged ≥55 years). A subset of respondents in each age group was matched based on gender and education, and their responses were analyzed for differences in attitudes toward diabetes. Two-tailed t test and χ2 test were used to compare continuous variables and categorical variables, respectively. Results with P<.05 were considered significant.

Results

A total of 449 of 485 Chinese Americans (93%) completed the survey. Among matched respondents (n=91 in each age group), more older respondents than younger respondents believed that (1) research on diabetes is solely beneficial for profiting pharmaceutical companies (23.1% vs 6.6%; P=.002) and (2) health insurance policies should not cover any costs of diabetes-related illnesses (28.6% vs 15.4%; P=.032).

Conclusions

Older Chinese Americans were more likely to hold stigmatized negative perceptions of and attitudes toward diabetes in relation to pharmaceutical companies and health insurance policies. Considering that an individual's belief system largely influences self-care behaviors, actions should be taken to minimize negative perceptions of and attitudes toward diabetes.

Comparison of Online Dementia Information in Chinese and in English Languages

Introduction

There is a deficit of avenues for obtaining dementia information in the Asian American community. This study aims to compare the content and quality differences between websites providing information on dementia as found by a Google search conducted both in simplified Chinese characters and in English.

Methods

A Google search was performed for the phrase “dementia” in simplified Chinese characters and in English. The resultant websites were categorized by whether they were commercial in nature, the type of website, and whether the website provided an explanation of dementia signs and symptoms. The quality of the websites was assessed via readability and the Health on the Net Code of Conduct (HONcode). Chi-squared analyses were performed to establish differences between the English and simplified Chinese results.

Results

The simplified Chinese search websites were more likely to be commercial (p=0.045) and were more likely to not meet HONcode standards (p=0.008). No statistical significance was observed between the types of websites (p=0.127), the prevalence of signs and symptom explanations (p=0.073), and the readability of the website (p=0.151).

Conclusion

The quality of websites obtained from the simplified Chinese character Google search was lower than those obtained from searches using the English language. Given the limited sources of language and culturally appropriate information on dementia, improvement of Internet resources may help to improve health outcomes of dementia patients in the Asian American population.

Finding positives in caregiving: The unique experiences of Chinese spousal caregivers of persons with young-onset dementia

The experience of taking care of spouses with young-onset dementia has been identified as unique and merits considerations. However, current knowledge about this area in Chinese spousal caregivers is scarce. A qualitative descriptive study was therefore conducted to explore the experience of spousal caregivers of persons with young-onset dementia in Hong Kong. A total of six spousal caregivers of persons diagnosed with dementia before the age of 65 participated in this study. Three major categories were identified: coming to terms with an unexpected diagnosis; multiple unanticipated and ‘early’ losses and finding positives and meaning. This study has highlighted the influence of sociocultural values on the spousal caregiving experience in young-onset dementia caregiving. The findings also have significant implications for the development of interventions to facilitate the spousal caregivers to accept and sustain their caregiving role.

Comparison of Mental Health Service Utilization by Asian Americans and Non-Hispanic Whites versus Their Cardiovascular Care Utilization

INTRODUCTION

This study will determine whether racial/ethnic disparities persist in various psychiatric disorders among Asian Americans.

METHODS

Secondary analyses of data from the second largest public health system in the US (total N=22294) were performed. Chi-squared statistics were used to compare the race for mental health service utilization for five psychiatric diagnoses. Cardiovascular care utilization by Asian Americans and non-Hispanic whites was used as a proxy for overall healthcare utilization rates between the two racial groups and constituted the expected values for the analysis.

RESULTS

Asian Americans were less likely to utilize mental health services for bipolar disorder, schizophrenia, anxiety, depression, and intellectual disabilities.

CONCLUSION

The results of this study call for ways to increase mental health service utilization on par with cardiovascular healthcare utilization among Asian Americans.

Newspaper Coverage of Alzheimer's Disease: Comparing Online Newspapers in Hebrew and Arabic across Time

The aim of the present study was to examine the objective characteristics and the portrayal of Alzheimer's disease and of persons with Alzheimer's disease in Hebrew and Arabic online newspapers across time. The sample included 180 articles published in seven national online newspapers between 2010-2011 and 2014-2015 and dealing specifically with the topic. The majority of the articles in both periods and languages were published in the Health section of the newspapers, had a neutral tone, and experts or researchers as the main sources of information. Stigmatizing elements were infrequent. While small differences were found across time, significant differences were found between Hebrew and Arabic online newspapers, with Arabic newspapers concentrating more on objective, health-related and expert-based information. As the use of online newspapers increases, policy makers should consider the use of this media as a viable way for improving knowledge and awareness about AD and dementia.

Dementia Health Promotion for Chinese Americans

Introduction This study aims to describe the results of a dementia awareness campaign in the Chinese American community.  Methods The campaign consisted of a health fair, four dementia seminars, radio shows, television episodes, and a YouTube series. Descriptive statistics and qualitative data were obtained from various health communication channels.    Results There were 156 and 313 participants in the health fair and dementia seminars, respectively. The participants in each component of the campaign also provided qualitative data on barriers and effective ways to disseminate awareness of dementia and brain health.  Conclusion A dementia awareness campaign may be an effective way to reduce health disparities and dementia in the Chinese American community.

Examining the differences in the stigma of dementia and diabetes among Chinese Americans

AIM

One of the major barriers in making a diagnosis and managing dementia in the Chinese American population is the stigma surrounding the disease. The goal of the present study was to examine differences in the stigma and perceptions of dementia and diabetes among Chinese Americans.

METHODS

A total of 449 Chinese Americans answered one survey with two self-administered, true/false questionnaires assessing stigma and perceptions toward dementia and diabetes. Higher total scores were associated with increased stigma and negative perceptions. The results of the two questionnaires were compared to assess for any differences in attitudes.

RESULTS

For the dementia questionnaire, the mean score was 5.58 (95% CI 5.37-5.79) with a standard deviation of 2.31. For the diabetes questionnaire, the mean score was 2.01 (95% CI 1.85-2.18) with a standard deviation of 1.76. Statistical analysis showed that Chinese Americans were more likely to hold stigmatized views toward dementia than diabetes (t = 33.9, d.f. = 448, P < 0.01).

CONCLUSIONS

The higher average score in the dementia questionnaire shows that there are greater stigma and negative perceptions of dementia in comparison with diabetes among Chinese Americans. Considering that stigma delays access to healthcare for dementia-related symptoms, efforts should be taken to minimize negative attitudes associated with dementia. Geriatr Gerontol Int 2017; 17: 760-764.