Community Mental Health Journal

, Volume 40, Issue 2, pp 151–166 | Cite as

Facilitators and Barriers to Support Group Participation for Family Caregivers of Adults with Mental Illness

  • David E. Biegel
  • Robert D. Shafran
  • Jeffrey A. Johnsen


Objective: Few low-income and minority caregivers of persons with serious mental illness participate in support groups. This study examined the facilitators and barriers to participation in support groups for families of persons with serious mental illness among lower socioeconomic African-American and Caucasian family caregivers. Three hypotheses were tested in a multivariate model which included need, enabling and predisposing variables utilizing a revised version of the Andersen model. Support group membership was hypothesized to be predicted by a higher perceived cost-benefit ratio (benefits minus costs) of group participation, fewer numbers of access barriers and higher levels of service use. Methods: A non-experimental cross-sectional design was used. Subjects were 145 lower socioeconomic status African-American and Caucasian family caregivers, 65 of whom were current support group members and 80 of whom had never participated in support groups. Results: Findings confirmed that support group members reported a more favorable cost-benefit ratio and fewer access barriers than did non-support group members, controlling for other variables. Level of non-support group service use was not significantly different for support and non-support group members. Conclusions: Non-members' assessments of support group participation may be based on inaccurate perceptions and/or incomplete knowledge. Educational campaigns, sponsored by support groups and mental health authorities focusing on both perceptions about support groups as well as structural impediments to participation, such as access barriers, should be undertaken.

support groups family caregivers facilitators barriers 


  1. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1-10.Google Scholar
  2. Andersen, R. M., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly, 51(1), 95-124.Google Scholar
  3. Bass, D. M., & Noelker, L. S. (1987). The influence of family caregivers on elder's use of in-home services: An expanded conceptual framework. Journal of Health and Social Behavior, 28(2), 184-196.Google Scholar
  4. Biegel, D. E., Milligan, E., Putnam, P., & Song, L. (1994). Predictors of burden among lower socioeconomic status caregivers of persons with chronic mental illness. Community Mental Health Journal, 30(5), 473-494.Google Scholar
  5. Biegel, D. E., Shafran, R. D., Johnsen, J. A., & Friedman, S. (2001). Facilitators and Barriers to Support Group Participation. Final Report to the Office of Program Evaluation and Research, Ohio Department of Mental Health. Cleveland: Cuyahoga County Community Mental Health Research Institute, Mandel School of Applied Social Sciences, Case Western Reserve University.Google Scholar
  6. Biegel, D. E., & Song, L. Y. (1995). Facilitators and barriers to caregiver support group participation. Journal of Case Management, 4(4), 164-171.Google Scholar
  7. Biegel, D. E., Song, L. Y., & Chakravarthy, V. (1994). Predictors of caregiver burden among support group members of persons with chronic mental illness. In E. Kahana, D. E. Biegel, & M. Wykle (Eds.), Family caregiving across the lifespan. Newbury Park, CA: Sage.Google Scholar
  8. Biegel, D. E., & Yamatani, H. (1987). Self-help groups for families of the mentally ill: Roles and benefits. International Journal of Family Psychiatry, 8(2), 151-173.Google Scholar
  9. Bulger, M. W., Wandersman, A., & Goldman, C. R. (1993). Burdens and gratifications of caregiving: Appraisal of parental care of adults with schizophrenia. American Journal of Orthopsychiatry, 63(2), 255-265.Google Scholar
  10. Brook, R. H., Ware, J. E., Jr., Davies-Avery, A., Stewart, A. L., Donald, C. A., Rogers, W. H., et al. (1979). Overview of adult health status measures fielded in Rand's Health Insurance Study. Medical Care, 17, 1-119.Google Scholar
  11. Burks, V. K., Lund, D. A., & Hill, R. D. (1991). Factors associated with attendance at caregiver support group meetings. Activities, Adaptation and Aging, 15(3), 93-108.Google Scholar
  12. Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92-100.Google Scholar
  13. Chou, K. R., Liu, S. Y., Chu, H. (2002). The effects of support groups on caregivers of patients with schizophrenia. International Journal of Nursing Studies, 39(7), 713-722.Google Scholar
  14. Citron, M., Solomon, P., & Draine, J. (1999). Self-help groups for families of persons with mental illness: Perceived benefits of helpfulness. Community Mental Health Journal, 35(1), 15-30.Google Scholar
  15. Cook, J., Heller, T., & Pickett-Schenk, S. (1999). The effect of support group participation on caregiver burden among parents of adult offspring with severe mental illness. Family Relations, 48(4), 405-410.Google Scholar
  16. Cook, J. A., & Knox, J. I. (1993). NAMI outreach strategies to African-American and Hispanic families: Results of a national telephone survey. Innovations and Research, 2(3), 25-32.Google Scholar
  17. Cox, C. (1995). Comparing the experiences of Black and White caregivers of dementia patients. Social Work, 40(3), 343-349.Google Scholar
  18. Dixon, L., Adams, C., & Lucksted, A. (2000). Update on family psychoeducation for schizophrenia. Schizophrenia Bulletin, 26(1), 5-20.Google Scholar
  19. Goldman, C. R., Breen, R. J., Tichenor, M., et al. (1993). Providing respite for families of seriously mentally ill adults and training for mental health professionals: A collaborative model. Innovations & Research in Clinical Services, Community Support and Rehabilitation, 2(4), 19-25.Google Scholar
  20. Goodman, C. C. (1991). Perceived social support for caregiving: Measuring the benefit of self-help/support group participation. Journal of Gerontological Social Work, 16(3–4), 163-175.Google Scholar
  21. Goodman, S. (1991). Patterns of participation in support groups for dementia caregivers. Clinical Gerontologist, 10(4), 23-34.Google Scholar
  22. Greene, V. L., & Monahan, D. J. (1989). The effect of a support and education program on stress and burden among family caregivers to frail elderly persons. The Gerontologist, 29(4), 472-477.Google Scholar
  23. Heller, T., & Factor, A. (1991). Permanency planning for adults with mental retardation living with family caregivers. American Journal on Mental Retardation, 96(2), 163-176.Google Scholar
  24. Heller, T., Roccoforte, J. A., & Cook, J. A. (1997). Predictors of support group participation among families of persons with mental illness. Family Relations, 46(4), 437-442.Google Scholar
  25. Henderson, J. N., Gutierrez-Mayka, M., Garcia, J., Boyd, S. (1993). A model for Alzheimer's disease support group development in African-American and Hispanic populations. The Gerontologist, 33(3), 409-414.Google Scholar
  26. Hollingshead, A. B. (1975). Four-factor index of social status. Unpublished working paper. New Haven, CT: Yale University.Google Scholar
  27. Kosloski, K., & Montgomery, (1993). Perceptions of respite services as predictors of utilization. Research on Aging, 15(4), 399-413.Google Scholar
  28. Kramer, K. D., & Nash, K. B. (1994). The sickle cell mutual assistance movement. Special Issue: Psychosocial aspects of sickle cell disease: Past, present, and future directions of research. Journal of Health and Social Policy, 5(3–4), 203-214.Google Scholar
  29. Lawton, M. P., Kleban, M. H., Moss, M., Rovine, M., & Glicksman, A. (1989). Measuring caregiving appraisal. Journals of Gerontology: Psychological Sciences, 44(3), P61-P71.Google Scholar
  30. Lieberman, M. A., & Snowden, L. R. Problems in assessing prevalence and membership characteristics of self-help group participants, in T. J. Powell (Ed.), Understanding the self-help organization: Frameworks and findings. Thousand Oaks, Sage.Google Scholar
  31. Mannion, E., Meisel, M., Solomon, P., & Draine, J. (1996). A comparative analysis of families with mentally ill adult relatives: Support group members versus non-members. Psychiatric Rehabilitation Journal, 20(1), 43-50.Google Scholar
  32. Marsh, D. T., & Johnson, D. L. (1997). The family experience of mental illness: Implications for intervention. Professional Psychology: Research and Practice, 28(3), 229-237.Google Scholar
  33. Molinari, V., Nelson, N., Shekelle, S., & Crothers, M. K. (1994). Family support groups of the Alzheimer's Association: An analysis of attendees and nonattendees. Special Issue: Research translation in gerontology: A behavioral and social perspective. Journal of Applied Gerontology, 13(1), 86-98.Google Scholar
  34. Monahan, D. J. (1994). Caregiver support groups: Efficacy issues for educators. Special Issue: Caregiving: A classroom resource. Educational Gerontology, 20(7), 699-714.Google Scholar
  35. Monahan, D. J., Greene, V. L., & Coleman, P. D. (1992). Caregiver support groups: Factors affecting use of services. Social Work, 37(3), 254-260.Google Scholar
  36. Nash, K. B., & Kramer, K. D. (1993). Self-help for sickle cell disease in African American communities. Special Issue: Advances in understanding with self-help groups. Journal of Applied Behavioral Science, 29(2), 202-215.Google Scholar
  37. Noelker, L. S., & Bass, D. M. (1994). Relationships between the frail elderly's informal and formal helpers. In E. Kahana, D. E. Biegel, & M. L. Wykle (Eds.), Family caregiving across the lifespan. Thousand Oaks, CA: Sage.Google Scholar
  38. Norton, S., Wandersman, A., & Goldman, C. R. (1993). Perceived costs and benefits of membership in a self-help group: Comparisons of members and nonmembers of the Alliance for the Mentally Ill. Community Mental Health Journal, 29(2), 143-160.Google Scholar
  39. Pickett-Schenk, S. A. (2002). Church-based support groups for African American families coping with mental illness: Outreach and outcomes. Psychiatric Rehabilitation Journal, 26(2), 173-180.Google Scholar
  40. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.Google Scholar
  41. Ramsey, P. W. (1992). Characteristics, processes, and effectiveness of community support groups: A review of the literature. Family and Community Health, 15(3), 38-48.Google Scholar
  42. Saunders, J. C. (2003). Families living with severe mental illness: A literature review. Issues in Mental Health Nursing, 24, 175-198.Google Scholar
  43. Segall, M., & Wykle, M. (1998). The Black Family's Experience with Dementia. Journal of Applied Social Sciences, 13(1), 170-191.Google Scholar
  44. Simoni, J. M., & Perez, L. (1995). Latinos and mutual support groups: A case for considering culture. American Journal of Orthopsychiatry, 65(3), 440-445.Google Scholar
  45. Song, L. Y., Biegel, D. E., & Milligan, S. E. (1997). Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental Health Journal, 33(4), 269-286.Google Scholar
  46. U. S. Department of Housing and Human Development. (2000). Area median family incomes for Cuyahoga County, Ohio–1998. [Electronic data file:]. Washington, DC: U. S. Department of Housing and Urban Development.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2004

Authors and Affiliations

  • David E. Biegel
    • 1
  • Robert D. Shafran
    • 1
  • Jeffrey A. Johnsen
    • 2
  1. 1.Mandel School of Applied Social SciencesCase Western Reserve UniversityCleveland
  2. 2.Cuyahoga County Community Mental Health BoardUSA

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