The Relationship between Familial Motivation Type and Caregiver Burden: Does Culture Play a Role? Alena Kwan
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amily caregivers of individuals with geriatric diseases (e.g., dementia) and/or serious illness (e.g., cancers) may often experience emotional distress (i.e., caregiver burden) such as stress, anxiety or depression, during the process of caregiving (Anngela-Cole & Busch 2011; Meyer et al. 2015; Ng et al. 2016; Parveen et al. 2013). This caregiver burden (CB) felt by relatives of the care recipient may arise from the loss of self, stress, and toll of attending to the recipient’s needs, as well as a felt obligation to support that relative (AnngelaCole & Busch 2011; Foley et al. 2002; Meyer et al. 2015; Parveen et al. 2013). Yet, caregiving may also have positive impacts and self-gain for the caregiver as the experience of supporting the recipient may be meaningful, fulfilling, or an act of love (Foley et al. 2002; Ng et al. 2016; Roberts et al. 2020; Sand et al. 2010). Willingness to care, or the motivation to support the care recipient, may influence the caregiver’s emotional state, and thus impact the caregiver’s response to coping with challenges that arise in caregiving (Kim et al. 2015; Ng et al. 2016). Caregiver Motivation One’s type of motivation may shed insight into the extent to which one feels fulfilled or burdened by caregiving. Intrinsic (i.e., autonomous) motivation is associated with improved quality of life, spirituality (Kim et al. 2015), and better adaptive responses to challenges encountered in family caregiving (Ng et al. 2016). Conversely, extrinsic (e.g., external social group value) motivation is observed with less control over challenges in caregiving (Ng et al. 2016). However, it has also been shown that individuals who have difficulty reconciling intrinsic and extrinsic motivation (i.e., conflict between self and social values) have the greatest tension in dealing with challenges (Ng et al. 2016). From the perspective of self-determination theory (SDT), the struggle in synthesizing motivations may be an example of introjected motivation (Kim et al. 2015). Introjected motivation is when compliance with an extrinsic motivation is based on social group and/
or self-approval or disapproval (Kim et al. 2015). An example of such an introjected motivation is when filial piety (i.e., obligation to family) is practiced only because the individual fears social disapproval if they do not display the value and/or behavior. Yet when the extrinsic social value is accepted by the individual and volitionally engaged in, it is known as an integrated motivation (Kim et al. 2015). This is seen when the individual accepts filial piety and familialism as important to their own self-values. The way in which these introjected and integrated motivation types impact caregiver burden may differ by one’s cultural background. Cultural Orientation and Filial Piety The felt social obligation to support and help others differs for individualist cultures, which tend to emphasize personal freedom, as compared to collectivist cultures, which emphasize welfare of the social group (Janoff-Bulman & Leggatt 2002). Among Swedish people and Americans (i.e., individualist cultures), closer relationships between relatives predicted increased involvement in caregiving, and motivations for caregiving emphasized its meaningfulness as an experience to the caregiver (Roberts et al. 2020; Sand et al. 2010). This example of the caregiving experience as meaningful is representative of intrinsic motivation. In contrast to individualist cultures, Chinese Americans, Japanese Americans, Vietnamese Americans, and Singaporeans (i.e., collectivist cultures) cited not only the meaningfulness of the caregiving experience, but also often noted filial piety (FP) or obligation to the family as motivations for caregiving (Anngela-Cole & Busch 2011; Meyer et al. 2015; Ng et al. 2016). In SDT, FP as a motivation can be interpreted as integrated or introjected (Kim et al. 2015; Ng et al. 2016), and integrated and introjected FP have both been observed and selfreported in Asians (Anngela-Cole & Busch 2011; Meyer et al. 2015; Ng et al. 2016). As obligation to family or FP may be expected to have priority over an individual’s needs in some collectivist cultures, the struggle to reconcile these opposing motivations may have an impact on mental health and ability to cope with challenges.
