The Health of African American Grandmothers Raising Grandchildren: A Growing Social Problem

Abstract

The study explored the experiences of African-American grandmothers residing in rural communities caring for their grandchildren, while suffering from chronic health issues. The research examined their physical and emotional health, physical functioning, well-being, social support, and resources of these grandmothers from a Family Development approach. Given the trends of providing care for a grandchild, it is widely recognized that caregivers may experience stress, burden, and the disruption of their well-being and social activities as well as the pressure associated with caregiving roles, responsibilities, and tasks. The grandmothers reported challenges that included stressors such as health issues, financial difficulties, limited support, transportation difficulties, and disruption in social activities. A major finding was that the grandmother’s health did not negatively impact their ability to care for their grandchildren.

Keywords

grandparents raising grandchildren caregiver health rural grandparenting kinship care grandmothers raising grandchildren

Introduction

The phenomenon of grandparent caregiving is prevalent among African-American grandparents: Approximately 8 million grandchildren live in households headed primarily by grandparents, and these numbers are rapidly growing. Among this group, 2.7 million grandparents serve as primary caregivers or custodial grandparents to their grandchildren, with a quarter of these caregivers reporting a chronic illness, and over 20% with incomes at or below the poverty level (Generations United, 2017).

Frequently, guardians are in this role due to circumstances in which their own adult children are unable or unwilling to perform their role as qualified parents to their children. Social forces that appear to have contributed to the incidents of grandparents caring for grandchildren include substance abuse, child welfare involvement, placement in temporary foster care, teen pregnancy, divorce, poverty, unemployment, mental illness, HIV/AIDS, incarceration of parents, parental incapacity, and death (Wichinsky et al., 2013). Given these circumstances, it is widely recognized that caregivers may experience burden, stress, and the disruption of their own well-being and social activities as well as the pressure associated with caregiving roles, responsibilities, and tasks. The contemporary problem of kinship care can be interpreted in terms of the psychological stresses and sociological strains created whenever different agency principles are applied or combined to resolve the social dilemma of alternative care by relatives (Denby et al., 2017).

The purpose of this phenomenological study was to explore the experiences of African American grandmothers residing in rural communities caring for their grandchildren, while suffering from chronic health issues. The research examined the lived experiences of the grandmothers, specifically their physical and mental health, physical functioning, well-being, social support, and resources.

This area of study is significant because rural areas typically have fewer options for obtaining health care and limited availability for transportation. These aspects of living in rural areas create unique challenges for these grandmothers. Based on these challenges and health issues of grandmothers raising grandchildren (specifically rural grandparenting). It is very important to understand who these grandmothers are, these challenges, and what assistance, resources, or services they may need

Research Questions

The research questions were developed to address the gap in the literature and to explore whether the selected theoretical framework, family development theory, accurately predicted the findings. The research questions are as follows: (a) What is the perceived impact of chronic health issues on African American grandmothers raising their grandchildren in rural communities?; (b) What is the perceived impact of mental health issues and stress on African American grandmothers raising their grandchildren in rural communities? And (c) Do perceptions of social support and life transitions impact grandmother’s health?

Theoretical Perspective: Family Development

Some theorists focus on stress within the context of the family. Hill (1958) described a process in which an interaction among stressors, family resources, and the perception of the stressor determine whether the family will go into a state of crisis. Patterson & McCubbin’s (1983) Model extends Hill’s conceptualization to encompass adaptation after the crisis period is over, when demands continue.

The theoretical framework that informed the study was family development theory (Hill & Rodgers, 1964 as cited in Laszloffy, 2002). This framework was chosen as the theoretical base for the study as it addresses family changes over time as well as positive versus negative family accommodation to stress and illness.

This framework examines stressors in the family life cycle with individuals as well as the child and family caregiving process. The theory delineates a normative order of developmental processes for individuals and families. Divergence from this order may lead to stress. Family development theory supports the framework that individuals and their families become healthier in their relationships and interactions as they mature and grow. It is assumed that families will increase their positive productive interactions and behaviors as time goes on (O’Brien, 2005).

Family development theory emphasizes changes in role expectations in the family over time as a function of changes in family membership, individual developmental needs, and direct societal expectations. Two key tenets of family development theory are that individuals and families construct their expectations and behaviors according to family stage requirements. Furthermore, family stages have qualities that introduce life uncertainties that alter their perceptual frame for current and future behaviors and decisions. The theory predicts differences in behavioral expectations and decision-making contingencies for children and adults in the family based on differences in societal expectations (O’Brien, 2005).

Development refers to the progression through the life cycle, along with the multiple tasks and tension that need to be resolved, at each life stage. Similar to individual development, families also undergo developmental stages that require families to progressively adapt their structures and functions to the various evolving changes with members. Family evolution is embedded in historical, social, and cultural contexts, and is expressed through the narratives that are derived from families, their individual members, and the larger social cultural worlds. These stories organize and prescribe the multiple ways in which to cope with the challenges posed by development, both in individuals and families (Connolly et al., 2017).

Issues that arise in intergenerational families are often defined by transitions within the life cycle. These transitions may involve births, illnesses, and deaths, as well as the adjustment of grandparents becoming parents for a second time (Purcal et al., 2014).

Families tend to hit snag points when they are faced with several stressors within a relatively short period, commonly referred to as a stressor pile-up. Such pile-up is associated with a corresponding increase in a family’s level of stress. As stress increases, a snag point is likely to emerge, thereby interfering with a family’s capacity to make necessary adaptations, and thus leading to a crisis. Hence, an essential process mediating between stressors and crises is stress management, or the ability to access and utilize resources to cope effectively with the stress that stressors generate, thereby averting a crisis (Boss, 1988).

The goal of research into individual and family development is to understand the processes by which individuals and families adapt successfully to the challenges that confront them, particularly when considering non-normative roles such as raising children in late adulthood. Family development theory offers a different way of thinking about and studying families because of its emphasis on the evolution of families over time, the developmental tasks facing families and their individual members, and the recognition of family stress and illness at critical periods of development (Duvall, 1988). As a result, family development theory may provide implications of parenting again and life cycle issues; specifically examining the stressors of second time around parenting issues (Connolly et al, 2017).

The grandmothers presented in this study are not only caring for a grandchild but doing so with a chronic health issue. The health issues affect family issues across the life span in terms of intergenerational caregiving in the family. The research is applicable and will strengthen family development theory in considering this phase of family development (individual life cycle health issues and parenting a second time around).

Methodology

Design

An exploratory phenomenological design was used involving collecting and analyzing the data. Through phenomenology, the accounts of events of caregiving, experiences, and challenges were understood. This study sought to expand human service professionals’ understanding of intergenerational caregiving, specifically parenting again from the grandmother caregivers’ perspectives. It also allowed the grandmothers an opportunity to share their stories, which permitted a more personal view in their world.

Sample

A local grandparent’s support group granted permission to recruit the participants from their program. Flyers describing the study as well as the criteria were also disseminated to local public libraries and grocery stores in an attempt to recruit participants. The requirements for the study included being an African American grandmother between the ages of 35 and 65, caring for at least one grandchild, being diagnosed with a chronic health issue and residing in rural communities. Purposeful criterion-based sampling, convenience sampling as well as snowball sampling were used in selecting the eight participants for the study. All the participants were from different rural communities. A sample size of eight participants provided enough information to reach a level of saturation of the data. Saturation was reached when participants began to report reoccurring information throughout the study and themes began to emerge (Saunders et al., 2018).

All the grandmothers had been diagnosed with chronic health issues and suffered from more than one chronic illness. Four of the grandmothers suffered from diabetes, four had high blood pressure, three had arthritis, one had high cholesterol, three were overweight, one had a heart condition, one was a breast cancer survivor, and one had a sinus condition. All eight women were caring for their daughter’s children. They categorized themselves as Christians and reported a strong sense of spirituality.

Instrumentation/Measures

Data were collected through semi-structured in-depth interviews. These participants were asked about caregiving responsibilities for their grandchildren, their health, grandchild caregiving activities, circumstances leading to custodial grand parenting, grandmother–grandchild relationship, challenges of parenting a second time, positive and negative effects of caregiving, and resources in a rural area.

Data Analysis

In this study, the interviews were audio taped and detailed field notes were taken. Transcripts were reviewed several times and compared to the audio tapes to ensure accuracy. To give validity and credibility to the six themes of this study, member checking was conducted. During this second interview, the participants were given their transcripts for review. Participants validated that the data collected at the initial interviews were what they expressed.

The individual textual descriptions in Table 1 consisted of participants’ verbatim statements regarding their lived experiences. The emerging textural themes are provided in the sample quotations further and are in the grandmother’s own words. They include the circumstances leading to care which focused on the parent’s substance abuse issues, the grandmother’s health and their ability to provide care, their struggles as a result of a lack of resources, money/transportation, the parental responsibility and lack of support from the parents, suddenly becoming a parent again, and the strong sense of spirituality of all eight participants.

Table 1.

Textural Themes and Universal Constituents.

Theme	Invariant Constituents	Sample Quotations
Circumstances surrounding care	Most of the grandmothers took on the parenting role due to the substance abuse of the mother. They explained that they assumed the care of their grandchildren to prevent placement in the foster care system.	“The kid’s mama was using crack and leaving the kids home; she came back when she came back” “My oldest was on drugs and on the street all the time.”
Ability to provide care/health	Each grandmother was providing care to the best of their ability. They all admitted to suffering from more than one health issue	“I’m tired from my heart problems and my high blood pressure. I just don’t move as fast as I used to but I’m doing alright.” “I have all these issues (diabetes and arthritis) and I feel bad sometimes, but I do what I can with them grandkids.”
Financial hardship/ Resources	Most of the participants reported being on a fixed income. They all stated that they were receiving some financial assistance from their local social service agency.	“I am on a fixed income. I just don’t have the money. If I could I would pay to put Jawan in Prime Time.” “Things are expensive. It costs a lot to raise children. I’m not proud of it but we get help from social services. We need it.”
Parenting again	The grandmothers had taken on the parenting role unexpectedly. They all had views of what grandparenting should be.	“Grandkids are supposed to come visit, not live with us.” “I’m 64 years old. I’m supposed to be retired. Taking care of these kids is a lot of sacrifice.”
Parental responsibility/ social support	Most of the participants felt that it was the parent’s responsibility to provide care. Most admitted to getting minimal informal or formal support.	“Help, if they helped me I could do more, but I will continue to do what I need to do. My sister helps out when she can. The mama could get herself together if she wanted to. She states that she does not have a lot of support outside the church and does need anything she can get.” She says, “My daughter hurt everybody. She is just selfish and, I mean, she wasn’t raised like that.”
Spirituality	All participants admit that caring for their grandchildren had been challenging yet a blessing. They all shared a strong sense of spirituality.	“When things get rough, I go to my favorite scripture: We learned this when I was a little girl. Trust in the LORD with all your heart and lean not on your own understanding. “It’s hard sometimes. I don’t always see it this way, but the Pastor says God gave me a second chance. I thank God every day.”

Continuing the data analysis process included reviewing the meaning units for textural themes and then assessing the textural themes for universal structures. The structural descriptions consisted of descriptions participants provided regarding the setting or context in which their experiences took place (Mertens, 2010). These universal structures resulted in the following and are listed in Table 2: the unwavering sense of family obligation, determination to provide care even though they were not in the best of health, frustration and resentment with the parents as they provided the least amount of support, a sense of their own loss, and their amazing ability to cope and find strength.

Table 2.

Structural Themes and Invariant Constituents.

Theme	Invariant constituents	Sample Quotation
Family obligation	All of the participants expressed that they loved their grandchildren and it was their obligation to take care of their grandchildren.	“The CPS (child protective services) they called me after they were put in jail. They wanted to give me temporary custody. I, I asked myself if I could live with myself if I didn’t help take those children and the answer was no.” “I never made a decision to take the children. I never thought about it. I had to do it.”
Determination	Each participant was determined to care for their grandchildren even though they were not in the best of health.	She explained that taking care of these kids is added stress on her but she states, “I will take care of these kids, I am their grandmother.” While clenching her hands together she states with assurance, “it tires me out sometimes, but I takes good care of them kids; yes mam.
Frustration	Most of the participants verbalized a frustration with services in a rural community.	“Everything is so far. We walk to the store. I depend on my sister for rides. I don’t always have money to pay her. The three-year old has a lot of Dr.’s appt. in town. Transportation will take us, but they are always too early. They don’t take me to my doctor’s appointments, so I have a hard time matching my sister’s schedule to go to the doctor. I get stressed out trying to get to places so sometimes I don’t make my appointments. Things are expensive. It costs a lot to raise children. I’m not proud of it but we get help from social services. We need it. We have a car, but everything is so far away. We have to go to town to the doctor or for any appointments. Sometimes I just don’t feel like the long ride.”
Resentment	Each participant reported that they received minimal support from family. Each specifically resented the mothers for the lack of support they provided.	“The mama doesn’t really help. She’ll have to deal with that when it’s time for her to meet her maker.” She says her daughter hurt everybody. “She is just selfish and wasn’t. I mean, she wasn’t raised like that.” She felt compelled to add that she will do what she has to do with or without her daughter.
Sense of loss	All the participants were caring for their grandchildren unexpectedly. They all expressed the losses associated with their new role.	“I’m 64 years old. I’m supposed to be retired. Taking care of these kids is a lot of sacrifice. I don’t have money to go to lunch on Saturdays with my club members. I can’t even pay the dues. I used to make excuses all the time; now they just, just don’t even ask anymore.” “We don’t have private time. My marriage is not like it was. It’s been hard for us. At this age it was supposed to be just us two. Now it’s us and the children. They, they just take so much of my time. I don’t know when was the last time I bought something for myself or gone out to eat with my husband. I get frustrated sometimes.”
Coping and strength	All the participants reported that God is their one constant source of strength and use the power of prayer as a coping mechanism.	“I have relied on my trust and faith in God.” “My granddaughter is why I’m here. My daughter went to heaven but I have a part of her. My granddaughter was placed with me for God’s purpose.”

Results

The results of the study support the body of scholarly findings cited in the literature relevant to the experiences of African-American grandmothers with chronic health issues raising their grandchildren in rural communities (Carter & McGoldrick, 2009; Connolly et al., 2017; Denby et al., 2017; Doley et al., 2015; Harnett et al., 2014). All the participants in this study had assumed the additional responsibility of care for at least one grandchild. The findings were consistent with studies that African-American relative caregivers assume the role of caregiving for their relative children due to substance abuse, death of the parent, homelessness, parental incarceration, mental illness, HIV/AIDS, and poverty (Wichinsky et al., 2013). For this study, substance abuse was the main factor in the grandmothers taking on the parenting role. They were providing care due to their adult children’s substance abuse and involvement with the child welfare system. The participants felt a strong family obligation to prevent long-term placement in the foster care system. A lack of social support and spirituality were also recurring themes. Most of the findings are consistent with other studies that report many challenges for grandmothers including chronic health issues, a lack of resources in their rural communities, and limited social support.

Even though the grandmothers in this study indicate connections between their level of social support, fiscal resources, and health, they did not report any impacts on the quality of care they provided to their grandchildren. These findings are unexpected and contribute to the existing research about the phenomenon of African=American grandmothers with chronic health issues raising grandchildren in rural communities.

Discussion

This research examined the issues related to caregiver health, social support, and resources in rural communities. The results from this study indicate there is a connection between caregivers’ social support and health, as well as caregivers’ resources and health.

Studies have found that the responsibilities of caregiving impact many aspects of a caregiver’s life and they suffer from role overload and role confusion. Overload is caused by the increased or added parenting duties. Grandmothers also have the added burden of clarifying their role as parent to a grandchild while balancing their other roles in the same family unit. Not surprising, caregivers also experience other life changes including limited time for self and friends (Johnson-Garner & Meyers, 2003). All participants in this study had assumed the additional responsibility of care for at least one grandchild.

When seeking social support, researchers have found that caregivers often turn to family, friends, and even religious organizations for this support (Ruiz & Carlton-LaNey, 2007; Smithgall, et al., 2004). This study is consistent with existing research findings with family and friends being the primary providers of social support for caregivers. Ironically, many of the caregivers identified the parents of the children as providing the least consistent support.

The findings from a 2000 study revealed that grandmothers viewed their role as being under the control of a higher being and used this as a coping mechanism. However, they saw their role more as a parenting than grand parenting role. They assumed the daily caregiving tasks related to their grandchildren. The majority of the grandmothers were thrust into the custody of their grandchildren without adequate notice. This finding is consistent with The report that most grandmothers assumed a grand parenting role without advanced planning.

Traditionally, grandmothers expect to spend short time segments with their grandchildren. When grandchildren visit grandparents during vacations or special occasions, they stay for a short while. In this study, the grandmothers had hopes that the parents would get help and again take on the parenting role, but the grandmothers perceived their roles as long term.

Family development theory was appropriate as it provides implications of parenting a second time around and life cycle issues—specifically, examining the stressors of parenting a second time around. The theory examines stressors in the family life cycle with individuals as well as the child and family caregiving process (O’Brien, 2005).

African-American grandmothers tend to place their own lives and happiness behind that of their grandchildren. Grandparents put their lives on the “back burner” to provide for their grandchildren. These roles are described as reciprocal obligations (Ruiz, 2008). The health issues of caregivers in this study paralleled health issues reported in other studies (Petras, 1999; Ruiz & Carlton-LaNey, 2007; Smithgall, et al., 2004). The research shows caregivers experience high levels of stress. One study found that grandmothers’ stress level increased while caring for their grandchild. Other studies found increasing stress levels with increasing caregiving responsibilities.

These caregivers suffered from many chronic diseases, including diabetes, heart disease, arthritis, high cholesterol, obesity, and high blood pressure. The findings of this study are consistent with studies that focused on the multitude of issues grandparent caregiver face because of their decisions to parent a second time. While it is important to consider these life changing decisions of the grandparents, we must also consider how these grandparents perceive their role of parenting for a second time around.

Conclusion

While the focus of this article has been on kinship care, it is acknowledged that an age-related approach might also be relevant across care-giving types, such as to support the particular needs of foster parents. Practice frameworks provide a means through which research, ethical principles, and experiential knowledge can be brought together to support practitioners in particular areas of practice (Connolly et al., 2017). Although most of the findings are consistent with other studies that report many challenges for grandmothers including chronic health issues, a lack of resources in their rural communities, and limited social support, this study found that their health did not impact their caregiving roles. Using social support and spirituality as coping mechanisms were key for the grandmothers. In fact, these grandmothers viewed their spirituality and the social support provided by their religion and their religious communities as essential coping components to their survival as caregivers.

Family development theory may provide implications of parenting again and life cycle issues—specifically, examining the stressors of second time around parenting issues. The unexpected role gain of being a primary parent to a grandchild changes the timing of one’s life course events, such as experiencing retirement and the freedom from the costs associated with child rearing. Becoming a second time-around parent requires a recycling of family development stages (Hill, 1999) that prolongs the time one spends in the parenting stages and the time until one enters the empty nest stage. As there are many transitions and losses associated with the role of parenting again, the grandmothers must learn to adapt to their role, and their changing needs and demands, as well as attending to tasks that are necessary to ensure family survival. This unique perspective that Family development theory provides has contributed to human services practitioners’ understanding and ability to work effectively with families (Carter & McGoldrick, 2009).

This framework addresses life-span issues and family changes over time as well as positive versus negative family accommodation to stress and illness. These grandmothers have been forced to deal with both negative and positive aspects of their caregiver role (Martin, 2018). Developing health education programs and other formal supports may have a positive influence on grandmother’s perceptions of their changing physical and mental health and support. Providing these grandmothers with an active role in problem solving and acquiring support and resources can be an effective coping strategy for these grandmothers.

Further research

The issues affecting this caregiving population are complex and can benefit from comprehensive policy approaches. A family development approach can aid human services, health care professionals, and education- and policy makers in understanding these families and their unique needs; particularly with minority populations. Based on the literature to date, it is clear that further research is needed in the areas of rural intergenerational caregiving, health, mental health, and child welfare policies. Promoting the health of these grandmothers will serve to strengthen this critical family resource (Bigbee et al., 2011).

Limitations

The current study has some limitations and should be acknowledged. First, the sample is small. The study was limited to those individuals who were currently caring for their grandchild, had been diagnosed with a chronic illness, and lived in rural communities. Although this study examined the experiences of grandmothers raising grandchildren, two rural counties and a limited number of participants were involved. As a result, the design did not produce results that were generalizable.

Implications

Examining the literature on this growing social problem was important in addressing the gap in research. Considering the intergenerational caregiving context and multifaceted needs from a Family development framework was important in examining their unique challenges. Additional research is needed to further understand the impact of their physical and mental health issues as well these challenges. Continued research in the area of intergenerational caregiving, specifically rural custodial grand parenting and their physical health, is vital to ensure that research, teaching, and practice are all informed by the best evidenced based information.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Tamara Woods

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