The increased globalization and mobility among countries provides more opportunities for health care providers to care for families of different ethnicity, culture and national origin. Thus, it is necessary for health care providers to understand family care cross-nationally. Different from many cross culture/nation comparison that focus on testing concepts developed in one culture/nation in another culture/nation. The intention of this study is to develop a cross-nation family care inventory and to test the model containing key family care concepts that have been developed previously by this research group both in Taiwan and the United States. Some of these concepts/instruments were uniquely found in each cultural, such as caregiving rewards and enrichment in the United States, and finding a balance point among competing needs in Taiwan. Others, such as role strain, predictability, and mutuality, are similar in both countries. In the proposed study, similarities and differences in family care processes in Taiwan and the US will be further elucidated and compared. Because of the extensive experience the research group has had with family caregivers for patients with Alzheimer's disease (AD), families of patients with Alzheimer’s disease will be selected as the target population for this study.

     The research design in this study will include three phases. Phase 1 will focus on assessing the cross-cultural equivalence of selected family care concepts and measures. In this phase, expert knowledge, literature review and qualitative data from 10 family caregivers in each nation will be used to develop a comparative descriptive framework. We will use symmetric translation, translation/back translation, and a formal equivalence check by 10 independent, bilingual reviewers to obtain evidence for language equivalence.

     In Phase 2, we will examine the new measures in terms of their reliability, validity, and responsiveness to change; we will also compare the psychometric qualities of the two versions of the new measures (English and Chinese) in Taiwanese and US samples (N=30 each). We will pilot test biological indicators (e.g. total antioxidant capacity and IL 6) to determine their utility for this population.

     In Phase 3, we will specify and test a conceptual framework containing family care variables in both countries. In a general model, we evaluate whether the direct effects of the family care situation variables on the outcomes are mediated by family care process variables. A sample of 200 subjects in each culture will be used to initially test, and modify the model via structural equation modeling approach. We will do the final phase validity and cross-nation comparison using a new sample of 200 families from each country. All 400 subjects in each nation will be followed longitudinally every 6 months to examine and compare the longitudinal changes of the phenomena. We will collect data in Taiwan and the US concurrently so that at the conclusion of Phase 3 we will have two parallel data sets ready for cross-national analyses. The findings will be able to provide an equal stand for cross-nation comparison and be expanded to also expand to different population and to include different countries such as Japan and Thailand in future. Our hope is that the study will serve as the basis for international collaboration in the development of interventions to strengthen and support family care.