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ItemEthno-Cultural Differences in Later-Life Caregiving Expectations, Caregiver Burden, Family Dynamics, and Healthcare Decision-Making Factors(University of Hawaii at Manoa, 2016-05)Background: In the qualitative literature, Asians and Pacific Islanders (APIs) were generalized to highly value collectivism, suggesting that APIs may have more caregiving responsibilities and obligations, caregiver burden, and group decision-making compared to the general population. Methods: A stratified random sample of Euro-American, Japanese, Chinese, and Native Hawaiian children-generation participants (n=106) from the 1970s Hawaiʻi Family Study of Cognition cohort was surveyed on measures of family dynamics, caregiver burden, caregiving expectations, actual caregiving responsibilities, importance of healthcare decision-making factors, proximity to parents, communication with parents, and demographics. A subset of survey participants (n=10) was interviewed by phone to provide further context on their families’ caregiving and healthcare decision-making. Results: APIs were significantly more likely to perceive an expectation to be a family caregiver compared to Euro-Americans. Also, there was a trend for Native Hawaiians being more likely to have actual caregiving and/or decision-making responsibilities compared to Euro-Americans. Qualitative findings, such as a theme for reluctance to use nursing services among APIs, supported these quantitative results. Qualitative analyses provided additional insights into family caregiving and decision-making, including a theme for caregiving duties to be delegated based on circumstantial considerations, and only when caregiving needs arose. Discussion: Since some API ethnic groups are more likely to have caregiving expectations and/or caregiving duties, culturally-competent support services for API caregivers may be needed. Qualitative findings also suggest that prevention/intervention strategies for caregiver burden may be helpful for all families, including outreach programs that facilitate long-term planning for later-life healthcare services and caregiving.