Empowering African American Women Informal Caregivers: A Literature Synthesis and Practice Strategies
Chadiha, Letha A., Adams, Portia, Biegel, David E., Auslander, Wendy, Gutierrez, Lorraine, Social Work
Informal caregivers are people who provide unpaid care for elderly people in the home, involving much time and energy for long periods and requiring assistance with tasks that may be physically, emotionally, socially, or financially challenging (Biegel, Sales, & Schulz, 1991). Most informal caregivers are women--primarily family members (National Alliance for Caregiving & American Association of Retired Persons [AARP], 1997; Older Women's League, 2001). Elderly African Americans rely heavily on the informal system of care (Chadiha, Proctor, Morrow-Howell, Darkwa, & Dore, 1995; Stommel, Given, & Given, 1998). African American women caregivers, under demanding circumstances of social, economic, and health challenges, demonstrate strengths through strong coping abilities in providing care to elderly African Americans (see reviews by Dilworth-Anderson, Williams, & Gibson, 2002, and Janevic & Connell, 2001). Yet, being able to cope does not mean that these women are also able to transform stressful caregiving situations into positive change. Power is the ability to access and influence control over resources to improve deleterious environmental conditions (Lee, 2001).
Caregiving can be gratifying (Kramer, 1997; Miller & Lawton, 1997). African American caregivers report high rewards and low burden in caring for elderly African Americans (Knight, Silverstein, McCallum, & Fox, 2000; Picot, 1995; Picot, Debanne, Namazi, & Wykle, 1997). These reports of high rewards and low burden are a testament to the personal strengths of African American women as a resource in caregiving. However, literature suggests the personal gains that caregivers receive may be insufficient to offset the economic, social, and psychological costs of caregiving (Arno, Levine, & Memmott, 1999). Informal caregiving, according to Arno and colleagues, may not only strain individual and family resources of the caregiver, but also may increase the caregiver's risk poor health, family destabilization, and impoverishment. Research indicates that caregiving is a known risk factor for women's hypertension, mortality, low immunity levels, and low levels of physical activity (Grason, Minkovitz, Misra, & Strobino, 2001). Unemployed caregivers run the risk of being uninsured and losing income and social insurance benefits (Arno et al., 1999). Strained resources, poverty, lack of health insurance, lost income, and poor health may also contribute to caregivers' feelings of low self-efficacy and potential powerlessness.
Sparked by social work literature on an empowerment approach to practice with vulnerable groups such as women and people who are members of ethnic and racial groups, we used an empowerment approach to address group practice with African American women caregivers.
Pinderhughes (1983) proclaimed that "knowing how power and powerlessness operate in human systems is a key to effective intervention. Strategies based on this knowledge offer both client and worker opportunity for constructive management of powerlessness on individual, familial, and social system levels" (p. 331).
The significance of an empowerment approach to social work practice with African American women is threefold. First, it emphasizes the need for social workers to work with clients who are vulnerable to oppression, marginality, and disenfranchisement such as women, people of various minority ethnic and racial groups, and people who are impoverished (Gutierrez, 1990; Lee, 2001). Second, it recognizes people's transactions in social, economic, and political environments as a contributing factor to individual stress, need for coping, feelings of low self-efficacy, and, in turn, feelings of powerlessness. For example, Lee regarded coping as an individual strength--a resource that clients use as an adaptive response to oppressive environmental conditions. Third, an empowerment approach emphasizes the need for social workers and other professionals to help build clients' capacity through mobilizing resources to change oppressive environmental conditions into positive change (Gutierrez, Parsons, & Cox, 1998; Lee; Simon, 1994; Solomon, 1976). …