Paper from the Emerging Researchers Ageing Conference, Brunel University, May 2008

There has been an implicit assumption in research on support that minority ethnic groups provide greater levels of support because of cultural values which emphasise familism and respect for elders (Campos et al., 2008). Concomitantly, it has been assumed that White families do not provide as high levels of support for their older relatives. This assumption has filtered down to practitioners (Murray & Brown, 1998) and may result in informal carers from minority groups receiving little support from services (Katbamna et al., 2004). My PhD, currently being undertaken, aims to address these assumptions and therefore may have important implications for service provision for older people from all ethnic groups in Britain.

Social support has been understood to be an important contributor to health and psychological wellbeing in the general population (Cobb, 1976) and among older people specifically (Moren-Cross & Lin, 2006). Care for frail older people is one aspect of social support, and the majority of this care is carried out by informal sources e.g. family and friends (Victor, 2005). Many of these informal carers are moreover older themselves: over 2.8 million people aged 50 years and over in Great Britain provide informal care (ONS, 2005).

The three ethnic groups in Britain which provide the highest levels of care for a family member are the White British, White Irish, and Indian groups (ONS, 2004). It is interesting to compare the age profiles of these three groups: the White British group includes 17% of people aged 65 years and over; the White Irish group is older with 24.8% of people aged 65 years and over; and the Indian group is younger with only 6.6%. However, the Indian population, along with the other minority ethnic groups, is ageing at a faster rate than the general population (Age Concern, 2002). This means that the demographic makeup of an older population in Britain will soon be much more ethnically diverse than it is now.

A reasonable explanation for the high level of informal care provided by the White British and White Irish groups could be their older age. An alternative explanation for the high level of informal care provided by Indian people is the suggestion that Southern & Eastern cultures have higher levels of filial responsibility than do Northern & Western cultures (Clarke & Neidert, 1992; Yeo & Gallagher-Thompson, 2006). Combined with this is the idea that people from South Asian cultures tend to have large extended families or multi-generational households, and the UK census data does indeed show that South Asian families live in the largest households (ONS, 2004). Such ideas lead neatly (Murray & Brown, 1998), but possibly erroneously (Katbamna et al., 2004), to the assumption that informal support is greater among minority ethnic groups in Britain than among the White British.

Research questions

Although there has been interest in the topic of support among minority ethnic older people in Britain (Atkin, 1992; McCalman, 1990; Moriarty & Butt, 2004; Sin, 2007), currently no research has carried out a nationally representative analysis of levels of support among the different ethnic groups. Moreover, the cultural, economic and social factors which predict support provision have not been sufficiently well explored. My PhD aims to address the following research questions:

• Do older people from minority ethnic groups provide and receive more support than people from majority ethnic groups?
• What demographic and social factors are associated with the support given to (and received from) older people?
• Do the factors which predict support interact with ethnicity?
• What are the cultural values which influence support?

A mixed methods design was chosen in order to address these research questions. Specifically, the questions about levels and predictors of support can best be approached with quantitative methods, while the question about cultural influences on support can best be approached with qualitative methods.

Conceptual framework

The majority of the literature on social support has examined the pathways involved between social support, stress and health (Sandler & Barrera Jr., 1984; Takizawa et al., 2006). What have yet to be fully explored (Broese van Groenou et al. 2006; House et al., 1988) are those factors which determine support being provided in the first place. In order to clearly examine these predictive factors an adaptation of Andersen’s behavioural model will be used.

Andersen’s behavioural model was originally designed to predict health service use (Andersen, 1968; Andersen & Newman, 1973). The model has two levels of predictive factors; societal and individual. The societal factors include the availability of services and the national health policy; the three individual level factors are predisposing, need and enabling factors. Predisposing factors are those which make the need for services more likely, such as age and sex. Need factors are those which require services, such as illness or disability. Finally, the enabling factors are those which promote or oppose the use of health services. This means that one can have the predisposition and need to use health services, but if one is not enabled to use those services there is less chance of obtaining them. Such enabling factors include income and family size.

Since its publication in 1968 Andersen’s behavioural model has become one of the most widely used frameworks to predict healthcare use (Phillips et al., 1998). Recently, it has been used to predict social support, with socio-economic status as a variable which interacted with each of the three individual factors, rather than simply as one of the enabling factors (Broese van Groenou et al., 2006). While ethnicity is usually considered a predisposing factor, the current study will position ethnicity as a variable which interacts with each of the three individual factors (see Figure 1). Support for this move is that ethnicity is known to have clear patterns of disparity in terms of, for example, ill health (need), age (predisposing), and income (enabling) (ONS, 2004). The cultural value of familism will be expressed in the model via enabling factors, such as family size and living arrangements.

Methodology

This study has two strands to examine support.

1. Quantitative strand

The Home Office Citizenship Survey (HOCS) will be used as the data source for this research. The HOCS is a biennial survey which began in 2001, and is now co-ordinated by the Department of Communities and Local Government. Each survey contains a nationally representative sample of approximately 15,000 people living in private households in England and Wales, which includes a booster sample of approximately 5,000 minority ethnic participants. The HOCS questions include demographic characteristics, informal support given to and received from relatives and friends, and help received from a group or service.

This study will use the HOCS datasets to explore the factors associated with support among the different ethnic groups in England and Wales, with the Andersen model as the conceptual framework. Multinomial logistic regression models will be used to determine the factors which are associated with informal and formal support. Interactions between variables in the conceptual framework will also be explored. This will allow questions from the literature, such as whether it is socio-economic status or ethnicity which more strongly determines support, to be examined.

2. Qualitative Strand

The fourth research question, about cultural influences on support, will be explored using qualitative methods. Individual in-depth interviews will be carried out with older people from three ethnic groups: White British, White Irish, and Indian. These are the three groups which provide the greatest levels of informal care. South Asians have been labelled with the ‘look after their own’ assumption, and the Indian group has been chosen as it is the South Asian group with the highest levels of informal care. The White Irish group is included because ‘invisible’ (Chance, 1996) minority groups are often overlooked in research on ethnicity in Britain, and the Irish have been shown to exhibit supportive behaviour more like that of a communalistic culture rather than that of an individualistic culture (Glaser et al., 2004). The White British group has been included to represent an individualistic culture, and to act as a comparison for the two migrant groups. The cultural influences on support, and understandings of supportive behaviour will be explored in the interviews.

Conclusion

It is hoped that this research will clarify both the extent of informal support and the resulting need for formal support among older people from different ethnic groups in Britain. It will identify the factors which make it most likely that informal support will be provided, and also those that make it most likely that formal support is needed. The models derived from this study can be used to assess the relative need for formal services by going beyond simplistic comparisons between ethnic group, social class or health status. I would welcome hearing from people who are working on similar topics.

Supervisors: Dr Karen Glaser and Dr Debora Price (King’s College London)

References

Age Concern. (2002). Black and minority ethnic elder's issues. An Age Concern policy position paper. London: Age Concern England.

Andersen, R. (1968). Behavioral model of families' use of health services. Research Series No. 25. Chicago, IL: Center for Health Administration Studies, University of Chicago.

Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 51(1), 95-124.

Atkin, K. (1992). Similarities and differences between informal carers. In J. Twigg (Ed.), Carers: Research and Practice. London: HMSO.

Broese van Groenou, M., Glaser, K., Tomassini, C., & Jacobs, T. (2006). Socio-economic status differences in older people's use of informal and formal help: A comparison of four European countries. Ageing and Society, 26(5), 745-766.

Campos, B., Dunkel-Schetter, C., Abdou, C. M., Hobel, C. J., Glynn, L. M., & Sandman, C. A. (2008). Familialism, social support, and stress: Positive implications for pregnant Latinas. Cultural Diversity and Ethnic Minority Psychology, 14(2), 155-162.

Chance, J. (1996). The Irish: Invisible settlers. In C. Peach (Ed.), Ethnicity in the 1991 Census (Vol 2): The Ethnic Minority Populations of Great Britain. London: HMSO.

Clarke, C. J., & Neidert, L. J. (1992). Living arrangements of the elderly: An examination of differences according to ancestry and generation. The Gerontologist, 32(6), 796-804.

Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38(5), 300-314.

Glaser, K., Tomassini, C., & Grundy, E. (2004). Revisiting convergence and divergence: Support for older people in Europe. European Journal of Ageing, 1(1), 64-72.

House, J. S., Umberson, D., & Landis, K. R. (1988). Structures and processes of social support. Annual Review of Sociology, 14, 293-318.

Katbamna, S., Ahmad, W., Bhakta, P., Baker, R., & Parker, G. (2004). Do they look after their own? Informal support for South Asian carers. Health and Social Care in the Community, 12(5), 398-406.

McCalman, J. A. (1990). The Forgotten People: Carers in Three Minority Ethnic Communities in Southwark. London: King's Fund Centre.

Moren-Cross, J. L., & Lin, N. (2006). Social networks and health. In R. H. Binstock & L. K. George (Eds.), Handbook of Aging and the Social Sciences (6th ed., pp. 111-126). London: Elsevier.

Moriarty, J., & Butt, J. (2004). Social support and ethnicity in old age. In A. Walker & C. H. Hennessy (Eds.), Growing Older: Quality of Life in Old Age. Maidenhead: Open University Press.

Murray, U., & Brown, D. (1998). "They look after their own, don't they?" Inspection of Community Care Services for Black and Ethnic Minority Older People. London: Social Services Inspectorate, Department of Health.

ONS. (2004). Focus on Ethnicity and Identity. Retrieved 27/7/07, from http://www.statistics.gov.uk/downloads/theme_compendia/foe2004/Ethnicity.pdf

ONS. (2005). Older People: Health & Social Care. Retrieved 14/5/2008, from http://www.statistics.gov.uk/CCI/nugget.asp?ID=1268&Pos=2&ColRank=1&Rank=160

Phillips, K. A., Morrison, K. R., Andersen, R., & Aday, L. A. (1998). Understanding the context of healthcare utilization: Assessing environmental and provider-related variables in the behavioral model of utilization. Health Services Research, 33(3), 571-596.

Sandler, I. N., & Barrera Jr., M. (1984). Toward a multimethod approach to assessing the effects of social support. American Journal of Community Psychology, 12(1), 37-52.

Sin, C. H. (2007). Older people from white-British and Asian-Indian backgrounds and their expectations for support from their children. Quality in Ageing, 8(1), 31-41.

Takizawa, T., Kondo, T., Sakihara, S., Ariizumi, M., Watanabe, N., & Oyama, H. (2006). Stress buffering effects of social support on depressive symptoms in middle age: Reciprocity and community mental health. Psychiatry and Clinical Neurosciences, 60, 652-661.

Victor, C. (2005). The Social Context of Ageing: A Textbook of Gerontology. London: Routledge.

Yeo, G., & Gallagher-Thompson, D. (Eds.). (2006). Ethnicity and the Dementias (2nd ed.). New York: Routledge.