Caregiving as Work: A Qualitative Study of Dementia Caregiving Among Mexican American Families Using SEIPS 3.0

Background: Informal dementia caregiving constitutes a substantial yet underrecognized form of work that places significant demands on family caregivers. Mexican American families, who experience disproportionate dementia burden and structural barriers to care, often rely on intensive family-based caregiving. While prior research has examined cultural values, stigma, and resource barriers separately, less attention has been paid to how these factors interact within a work system to shape caregiver burden. Objective: We characterized informal dementia caregiving among Mexican American families as work performed within a sociotechnical system, and examined how work system components interact to shape caregiver outcomes using the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. Methods: We conducted semi-structured interviews with 15 Mexican American dementia caregivers in a U.S.-Mexico border community. Using constructivist grounded theory, we analyzed informal caregiving as work embedded within everyday contexts through the SEIPS 3.0 lens. Analysis examined interactions among person characteristics, caregiving tasks, organizational supports, tools and resources, and the broader cultural and linguistic environment. Findings: Caregiving labor was sustained by strong cultural commitment but its structure limited delegation and support access. Cultural beliefs framing care as a non-delegable family responsibility, stigma inhibiting disclosure, demanding physical and emotional labor, language barriers restricting organizational access, and uneven distribution of care within families collectively imposed burden on individual family members, most often daughters or wives. Caregivers actively sought information and resources, yet system-level barriers constrained utilization. These interacting conditions produced predictable outcomes: exhaustion, declining health, and burnout. Conclusions: Viewing dementia caregiving as work clarifies why relationally meaningful care becomes unsustainable without supportive systems. Caregiver burden emerges from interactions within the caregiving work system rather than isolated cultural or individual factors. This perspective highlights stigma reduction and language-concordant services as key intervention leverage points through system-level approaches that sustain family caregiving without relying on individual endurance.