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. Author manuscript; available in PMC: 2025 Sep 23.
Published in final edited form as: Asian Am J Psychol. 2024 Sep 23;16(1):2–10. doi: 10.1037/aap0000352

Scale Validation of Filipino Cultural Values and Its Associations with Depressive Symptoms and Substance Use in Filipino Americans

Dale Dagar Maglalang a,b,*, Bongki Woo c, Carina Katigbak d, Michael Park e, Yoonsun Choi f, David T Takeuchi g
PMCID: PMC12341386  NIHMSID: NIHMS2056831  PMID: 40809095

Abstract

Cultural values influence health beliefs, attitudes, and behaviors. Given the history of pre-colonial Philippines and under Spanish, American, and Japanese colonization, Filipinos have unique cultural values that are understudied in relation to health outcomes. The objectives of this study are to (1) create and validate measurement scales of surface level Filipino cultural values and (2) examine its associations with depressive symptoms and substance use in a sample of Filipino Americans. We analyzed data from the Midwest Longitudinal Studies of Asian American Families (MLSAAF) collected in 2013 of Filipino American parents (n=376). We implemented factor analyses to create and validate the scales and ordinary least squares and logistic regressions to examine the associations between Filipino cultural values and depressive symptoms and substance use. Factor analyses produced five scales: hiya (dignity or shame) from parent, hiya in general, utang na loob (gratitude or solidarity), pakikisama (companionship), and bahala na (determination). Hiya from parent was positively associated with depressive symptoms and hiya in general was negatively associated with depressive symptoms and alcohol use until passing out. The findings demonstrate the nuanced and complex means that Filipino cultural values have influenced health outcomes in Filipino Americans. This study is the first of its kind to quantitatively measure surface level Filipino cultural values. Future studies should consider using the measurement scales to better understand how intergenerational trauma and resilience through cultural values influence other health beliefs, behaviors, and outcomes in Filipinos in the Philippines and in the diaspora.

Keywords: Filipino American, Filipino, cultural values, substance use, depressive symptoms

Introduction

Filipino Americans (FA) are the third largest Asian American (AA) group in the United States (U.S.) (US Census Bureau, 2021). Despite their large presence and long history in the U.S., and the colonization of the Philippines under Spanish, U.S., and Japanese rule (Bonus, 2000), how Filipino cultural factors influence their mental health and well-being have been understudied (David et al., 2022). FAs have elevated rates of mental illnesses such as depression (David, 2008; Rumbaut, 1994) and psychological distress (Nicdao et al., 2015), while having lower mental health help-seeking rates (Abe-Kim et al., 2007; Gong et al., 2003; Ying & Hu, 1994), compared to other AA ethnic groups and the general U.S. population. Cultural values can be one of several factors that may play a critical role in FA mental health disparities. Previous research suggested that connectedness to Filipino culture and ethnic community is important for the psyche of FAs (David et al., 2022). For example, Tuazon & Clemente (2022) found that acculturation and enculturation mediated the relationships between colonial mentality and mental health help-seeking attitudes of FAs. Colonial mentality is defined as internalized oppression through the perception of inferiority that favors American culture and characteristics over Filipino culture and characteristics for FAs (David & Okazaki, 2006). Another study found that different aspects of enculturation among FA caregivers affected the mental health of their children (So et al., 2023). For example, endorsing higher scores of interpersonal norms or social and cultural values of one’s ethnic group was positively associated with harsh discipline and youth internalizing and externalizing behaviors (So et al., 2023). These findings highlight the importance of better understanding the nuanced cultural experiences and values of FAs. This study contributes to the existing literature by focusing on specific Filipino cultural values and its effects on mental health and substance use.

Background

Cultural values can influence the health beliefs and behaviors of individuals from similar cultures. Cultural values have been associated with medical adherence, decision-making, health-seeking related to substance use, HIV and AIDS, cancer, depressive symptoms, and nutrition (N.-Y. Choi et al., 2019; Iwelunmor et al., 2014; Katigbak et al., 2018; Shahin et al., 2019), though the direction to which cultural values impacted health outcomes varied. The PEN-3 cultural model (Airhihenbuwa, 1989, 1990) frames how cultural values influence health beliefs and behaviors. This model centers culture in the center of understanding health beliefs and behaviors, and the design and implementation of health interventions (Airhihenbuwa, 1990; Iwelunmor et al., 2014). The model is composed of three domains and factors: cultural identity (Person Extended Family Neighborhood), relationships and expectations (Perceptions Enablers Nurturers), and cultural empowerment (Positive Existential Negative) (Airhihenbuwa, 1990; Iwelunmor et al., 2014). Cultural identity pertains to proximal figures that influence the health beliefs and behaviors of an individual (Airhihenbuwa, 1990; Iwelunmor et al., 2014). For example, among FAs, seeking formal mental health services has been perceived negatively by family members, which deter FAs from procuring mental health services, thus, intervening on the familial level can be an effective point of entry for intervention (Martinez et al., 2020). The relationships and expectations domain refers to the accepted health beliefs within an individual’s family, community, and society and the structures that exist that can facilitate or hinder health behaviors (Airhihenbuwa, 1990; Iwelunmor et al., 2014). The availability of FA identified community health workers were helpful for FAs with hypertension in managing their blood pressure and medical adherence (Ursua et al., 2014). The cultural empowerment domain identifies cultural factors that are facilitators, barriers, or harmless to health beliefs, behaviors, and outcomes (Airhihenbuwa, 1990; Iwelunmor et al., 2014). Given the history of Spanish colonization in the Philippines, a large percentage of FAs practice Catholicism which has been found to positively help FAs find support through prayer that they deem promoted positive well-being (Alviar & del Prado, 2022). As suggested by PEN-3 cultural model and empirical evidence that tested the model (Airhihenbuwa, 1990; Iwelunmor et al., 2014), the present study aims to explore and highlight cultural values and beliefs and its potential influence to the well-being of specific cultural groups.

Among Filipinos, cultural values play an imperative role in shaping health beliefs and behaviors. The father of Filipino Psychology, Virgilio G. Enriquez, conceptualized Filipino psychology and cultural values into three tiers: surface values, core, and societal (Yacat, 2013). Surface level values are easily distinguishable values, even for non-Filipinos, that precede the core value, kapwa (shared identity), these values are hiya (propriety/dignity), utang na loob (gratitude or solidarity), pakikisama (companionship), bahala na (determination), sama/lakas ng loob (resentment/guts), and pakikibaka (resistance) (David, 2013; Pe-Pua & Protacio-Marcelino, 2000; San Juan, 2006). Pakikiramdam (shared inner perception) is the pivotal mediating interpersonal value that engenders the emotional requirement to be able to connect surface level values to kapwa (San Juan, 2006). At the core of Filipino values is kapwa or shared identity, the belief that an individual is not different from any other individual (Pe-Pua & Protacio-Marcelino, 2000; San Juan, 2006). Kagandahang-loob (shared humanity) is the cultural value that links sociopersonal values to societal values (Yacat, 2013). This cultural value helps an individual acknowledge the needs of society that values karangalan (dignity), katarungan (justice), and kalayaan (freedom) (Yacat, 2013). These tiers are interrelated and work together and guide how Filipinos see themselves and how they interact with others.

Filipino Cultural Values

This study focuses on surface level values – hiya, utang na loob, pakikisama, and bahala na. Hiya pertains to one’s dignity or idea of self-worth (San Juan, 2006), however, it has been conflated with nakakahiya, which translates to having a sense of embarrassment to other people and walang hiya, which translates to being shameless (Tolentino et al., 2022). Thus, the cultural value of hiya can be associated with the idea of saving face or avoiding the loss of face (i.e., shame, humiliation). It is based on the notion that individuals need to represent oneself or their family in the most honorable way (Nadal, 2020). As hiya entails that individuals have to be conscious of how others would feel or say before taking action (Tuazon & Clemente, 2022), it has been identified as a barrier to help-seeking behaviors (Gong et al., 2003; M. Park et al., 2023; Tuliao, 2014). Similarly, studies on AAs suggest that the experience of losing face were perceived as failure to meet expectations from their family, community, and society, and, in turn, associated with higher levels of emotional distress and depressive symptoms (Kalibatseva et al., 2017; Leong et al., 2008). These imply that hiya can negatively affect an individual’s mental health or help seeking behaviors. However, hiya can also play an adaptive role to one’s mental health as it motivates individuals to behave according to social expectations and can promote self-control for the sake of their interpersonal relationships (Aruta et al., 2021; Lasquety-Reyes, 2016).

Utang na loob can be translated to debt of gratitude or the sense of duty to return a favor that promotes individuals to do what is good for the family or the collective (Rungduin et al., 2015). Given that utang na loob may create pressure to pay one’s parents or caregivers back, previous research found that utang na loob has been associated with embracing filial piety or providing care to one’s elders and family members (David et al., 2017). While filial piety may create familial obligations that could lead to caregiver depression (Sayegh & Knight, 2011), it could also play a protective role by adjusting caregiving burden and increasing the positive appraisals of their caregiver role (Lai, 2010; Pan et al., 2022). Beyond parent-child relationships, utang na loob has also been extended as a social responsibility that Filipinos embrace as a commitment to the extended family members or larger community (Rungduin et al., 2015). A study of FA nurses found that their strong commitment to utang na loob led them to prioritize their financial duty to share their earnings with their nuclear or extended family, or community back in the Philippines over their pursuit of higher educational degrees (Nagtalon-Ramos, 2019). As such, utang na loob promotes a sense of responsibility or obligation that may result in financial or psychological burden. In contrast, it also can deepen one’s commitment and ties to their family and community that can function as coping mechanisms and protect them from mental health problems (Nagtalon-Ramos, 2019; Rungduin et al., 2015).

Pakikisama refers to companionship. Pakikisama is seen as an equalizer among groups of people that creates a safe and welcoming environment for people of different backgrounds (Villero et al., 2014). For instance, in a study of Filipina Americans living with breast cancer, researchers utilized this cultural value to guide the creation of their community advisory board (CAB) to create a conceptual model in providing support for Filipina Americans with breast cancer (Villero et al., 2014). While pakikisama can be leveraged to create a harmonious environment among groups, other studies found that it can also be abused and foster hierarchies in formal and informal spaces by upholding comradeship and cohesiveness over addressing unfairness (Licuanan-Galela, 2001). While pakikisama can foster positive relationships that can lead to positive mental health, exploiting this cultural value to create unequal relationships and power imbalances among groups of people can also result to poor mental health.

While bahala na was conceptualized as a value pertaining to a sense of determination, it has also been envisaged with a negative connotation that refers to a belief of fatalism. Bahala na predates pre-colonial Philippines, defined as leaving it to Bathala’s (omnipotent being) will (Jocano, 1981; Menguito & Teng-Calleja, 2010). Other scholars have also defined bahala na as courage that is maneuvered to deal with challenges and obstacles even if they may not succeed (Menguito & Teng-Calleja, 2010). Within the literature, bahala na has been discussed in relation to health. For example, a study on Filipina American breast cancer survivors delineated how the respondents have taken comfort in bahala na by embracing that their faith in God will heal them, but they also accepted that if it’s their time, as determined by God, then they were also willing to receive their fate (Lagman et al., 2014). Thus, depending on the evaluative perception of the individual regarding the concept of bahala na in relationship to their health condition can influence their health decision, behavior, and outcome.

The extant literature suggest that Filipino cultural values play a significant role in FA psychology. However, to date, most of the studies on Filipino cultural values are qualitative or conceptual. Moreover, more studies need to further examine how Filipino cultural values shape health behaviors and outcomes that can help address and mitigate health issues in the community. The purpose of this paper is two-fold; first, this paper aims to quantitatively measure Filipino cultural values through the creation and validation of measurement scales. Second, it aims to examine how Filipino cultural values are associated with depressive symptoms and substance use in FAs.

Methods

Data

We conducted a secondary data analysis of the Midwest Longitudinal Studies of Asian American Families (MLSAAF). The objective of MLSAAF is to examine the development of AA youth through understanding the parent-child relationship (Y. Choi et al., 2018, 2021). The study recruited Filipino and Korean parent-child dyads (N=680) from Chicago and the greater Midwest area. Research participants responded to self-administered surveys collected in person, by mail, or online. The surveys were available in English, Korean, and Tagalog. Further information about the study procedure has been published elsewhere (Y. Choi et al., 2021). This study analyzed the baseline data of Filipino parents (n=376) only collected in 2013. The study has been approved by the Institutional Review Board of the University of Chicago.

Scale Development

The scales were developed through a 1) vast review of the extant literature, 2) data from focus groups, 3) creation of initial survey items, and 4) feedback from expert panels and the research team. As a result, 14 items were tested for psychometric properties for this study.

The initial review of the literature used in the scale development were based on discussions of familial, character, and cultural values present in Filipino and FA populations (Nadal, 2011) including Panukat ng Pagkataong Pilipino (PPP) (Enriquez & Guanzon-Lapeña, 1985), Panukat ng Ugali at Pagkatao (PUP) (Enriquez & Guanzon-Lapeña, 1985), and the Enculturation Scale for Filipino Americans (del Prado & Church, 2010). To include additional feedback that may not be present in the literature, eight focus groups were conducted consisted of FA parent groups and youth groups – four with parents and four with youth. Parents were predominantly mothers but one of the focus groups included both fathers and mothers (they were not couples). All youth groups included both genders. The number of participants in each group varied from group to group, from 8 – 11, with a total of 75 (37 parents and 38 youth). They were not all parent-child dyads, although a small number of dyads participated. Each group was recruited from different places including schools, social service agencies, or community groups. Parents received $30 and youth $15 for participating in focus groups. The data gathered from these focus groups were provided both in English and Tagalog and translated. After the initial set of scale items (over 300 items) were established, a five-member panel of FAs with bilingual and bicultural capacity, has a background as a Filipino parent and/or working with FA parents and youth in the FA community, and an understanding of the research process were recruited to review the scale items, applicability, and accuracy of the translation. The reviewed and updated scale items were pilot-tested with five FA parent-child dyads that were further refined and updated based on the feedback from the participants. A more detailed discussion of the phases of scale development associated with the MLSAAF study can be found elsewhere (Y. Choi et al., 2021).

Statistical Analysis

Mean and standard deviations of each item and entire scales and internal consistency within the scale were calculated. The measurement testing of each cultural scale was conducted in the following three steps. First, exploratory factor analysis (EFA) was performed among each cultural value scale (i.e., Hiya, Utang na Loob, Pakikisama) to identify the number of latent constructs and the underlying factor structure within each scale. Principal component analysis (PCA) was used, followed by Promax rotation to allow factors to be correlated. An item was considered to load on a factor if the factor loading was 0.40 or greater (Guadagnoli & Velicer, 1988; Stevens, 2002). Second, PCA was conducted for all cultural value scale items, followed by Promax rotation. PCA analyses were conducted among randomly splitted sample (N=188). Third, multi-factor confirmatory factor analysis (CFA) was conducted for all scales in a single CFA model by specifying each scale identified in the previous steps as a distinct factor. CFA analysis was conducted among the other half of randomly splitted sample (N=188). The fit indices and modification indices were checked. Then, correlation among the cultural scales were used to examine if each item was loaded to its designated factor and if each scale was reasonably correlated yet distinct from others.

Multiple regression analyses were conducted to examine the associations between the finalized cultural value scales and depressive symptoms, controlling for age (years), sex (0=male, 1=female), length of stay in the U.S. (years), and household income (1=less than $25,000 – 6=$150,000 or more). Response categories for Hiya were measured using a 5-point Likert scale of Strongly Disagree (1), Disagree (2), Neutral (3), Agree (4), and Strongly Agree (5). Response categories for Utang na Loob, Pakikisama, and Bahala Na were measured using a 5-point Likert scale of Not at all (1), Not much (2), Somewhat (3), Much (4), and Very Much (5). For each cultural value scale, mean scores were calculated. Depressive symptoms were measured by 20-item Center for Epidemiologic Studies of Depression (CES-D) Scale (ɑ=0.85) that asked the frequency of symptoms during the past week (e.g., “I was bothered by things that usually don’t bother me”; “My sleep was restless”). The CES-D scale was widely used to measure depressive symptoms among FAs (David, 2008; David & Nadal, 2013; S.-Y. Park, 2017). Each item ranged from 1 (rarely) to 4 (most of the time). The mean score of the 20 items were calculated. In addition, logistic regression analyses were conducted to examine the associations between cultural values and different types of substance use, controlling for the same covariates. Substance use was separately measured by if the respondents ever used cigarettes (0=no, 1=yes), used alcohol until passing out (0=no, 1=yes), and marijuana (0=no, 1=yes). We further combined these three items to create a variable that measures whether the respondents ever used one or more of these three substances or not (0=no, 1=yes). The substance use measures were consistent with previous studies that used similar items in measuring substance use (Y. Choi et al., 2020). As over 90% of the study participants provided complete data, we used complete case analyses to handle missing data. Stata 18 was used for all the data analyses.

Results

Table 1 reports the sociodemographic characteristics of the study sample. They had a mean age of 46.19 ± 5.78, and most were women (93.62%). Given the dyadic parent-child sample, it is common for these studies that mothers are most likely to respond because they are considered the primary caregiver in Filipino culture (Abalos et al., 2018). The majority were born outside of the U.S. (90.96%) and have lived in the U.S. for 23.23 ± 12.10 years. Approximately 7.58% of the respondents reported an annual household income of less than $25,000, while 18.26% reported a household income of $150,000 or more. The mean score of depressive symptoms was 1.76 (range 1–4), and 28.72% reported lifetime substance use.

Table 1.

Demographic characteristics of the sample (N=376)

Percentage / Mean (SD)
Age 46.19 (5.78)
Female 93.62%
Foreign-born 90.96%
Years in the U.S. 23.23 (12.10)
Household income
 Less than $25,000 7.58%
 $25,000 – $49,999 14.61%
 $50,000 – $74,999 15.45%
 $75,000 – $99,999 17.13%
 $100,000 – $149,000 26.97%
 $150,000 or more 18.26%
Depressive symptoms (range: 1 – 4) 1.76 (0.29)
Lifetime Substance use 29.78%
Lifetime cigarette smoking 23.10%
Lifetime being drunken alcohol until passing out 5.96%
Lifetime marijuana use 13.90%
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Table 2 reports the means and standard deviations of each item and the entire scales, coefficient alpha, and factor loadings from the EFA of each scale with Promax rotation. The coefficient alpha of each scale was 0.79, 0.74, and 0.61 for Hiya, Utang na Loob, and Pakikisama, respectively, suggesting acceptable to good internal consistency reliability. For the 7-item Hiya scale, the proportion of variance explained by each factor and scree plot suggested two meaningful factors. Factor 1 had four factor loadings ranging from 0.50 to 0.90 (items 3, 5, 6, and 7), which theoretically could be described as Hiya from a parental perspective (Hereafter, Hiya from parent). Factor 2 had three factor loadings ranging from 0.70 to 0.90 (items 1, 2, and 4), which theoretically could indicate the meaning of Hiya in general (Hereafter, Hiya in general). For both 3-item Utang na Loob and Pakikisama scales, the proportion of variance explained by each factor suggested one meaningful factor, respectively.

Table 2.

Measures of Filipino cultural values and Exploratory Factor Analysis of each scale

Mean (SD)
(N=376)		 Alphaa
Item-testb
(N=376)		 Factor Loading
(N=188)c
Factor 1 Factor 2
Hiya 3.42 (0.72) 0.79
 1. Family reputation is important. 4.42 (0.79) 0.55 −0.13 0.90
 2. It is important not to bring hiya (shame) to the family. 4.22 (0.89) 0.65 0.02 0.88
 3. A personal failure is a letdown for the entire family. 2.95 (1.15) 0.71 0.50 0.35
 4. Individual or family problems should stay and be handled within the family. 3.95 (1.01) 0.53 0.04 0.70
 5. If my child is delinquent, people I know will think I am a bad parent. 3.04 (1.15) 0.73 0.76 0.07
 6. Because I am self-conscious of how others may view me, I pressure my child to do better. 2.67 (1.24) 0.75 0.90 −0.06
 7. I would feel embarrassed if my child does not go to a good college. 2.72 (1.27) 0.71 0.88 −0.12
Utang na Loob 3.22 (0.94) 0.74
 8. I consider the kindness and help extended to me from others as a personal debt. 3.50 (1.22) 0.80 0.77 —
 9. If a relative or a friend got me a job when I needed it, I would remain in the job no matter what, due to my indebtedness to them. 2.72 (1.10) 0.83 0.84 —
 10. If I am unsure about how much I need to repay someone who has done me a favor, I keep trying to pay back the favor so that I do not look ungrateful. 3.46 (1.14) 0.81 0.81 —
Pakikisama 3.49 (0.85) 0.61
 11. Conflict with others should be avoided. 3.97 (1.11) 0.70 0.60 —
 12. It is impolite to criticize, complain about or question others face to face. 3.39 (1.13) 0.79 0.70 —
 13. I try to please others even if it is inconvenient to me. 3.11 (1.15) 0.76 0.65 —
D. Bahala Na N/A
 14. Believing in a “bahala na” (come what may) perspective helps me cope with events in my life that are outside of my control. 2.74 (1.15) N/A N/A N/A
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Note: Bold numbers indicate loadings ≥ 0.40.

a

Cronbach alpha for scale

b

Item-test correlations

c

Explolatory factor analyses was conducted among randomly splitted sample.

EFA with all 14 items suggested four meaningful factors that mirror the results of EFA of each scale. As shown in Table 3, Factor 1, Hiya from parent, had four factor loadings bigger than 0.40 from items 3, 5, 6, and 7. Factor 2, Hiya in general, had items 1, 2, and 4. Factor 3 had three factor loadings bigger than 0.40 from the original three Pakikisama items (items 11, 12, and 13). Factor 4 had three factor loadings bigger than 0.40 from the original Utang na Loob items (item 8, 9, and 10) and item 14, developed to capture Bahala Na.

Table 3.

Exploratory Factor Analysis of all Filipino cultural value scale items (N=188)

Factor Loading
Factor 1 Factor 2 Factor 3 Factor 4
Hiya
 1. Family reputation is important. −0.08 0.91 −0.13 0.10
 2. It is important not to bring hiya (shame) to the family. 0.07 0.84 −0.0001 0.12
 3. A personal failure is a letdown for the entire family. 0.45 0.31 0.13 0.17
 4. Individual or family problems should stay and be handled within the family. 0.14 0.56 0.31 −0.19
 5. If my child is delinquent, people I know will think I am a bad parent. 0.79 0.09 −0.02 −0.14
 6. Because I am self-conscious of how others may view me, I pressure my child to do better. 0.90 −0.02 −0.12 −0.02
 7. I would feel embarrassed if my child does not go to a good college. 0.85 −0.06 −0.05 0.02
Utang na Loob
 8. I consider the kindness and help extended to me from others as a personal debt. −0.12 0.27 −0.14 0.76
 9. If a relative or a friend got me a job when I needed it, I would remain in the job no matter what, due to my indebtedness to them. −0.10 0.02 0.11 0.79
 10. If I am unsure about how much I need to repay someone who has done me a favor, I keep trying to pay back the favor so that I do not look ungrateful. 0.10 0.06 0.17 0.67
Pakikisama
 11. Conflict with others should be avoided. −0.20 0.21 0.74 −0.04
 12. It is impolite to criticize, complain about or question others face to face. −0.02 −0.11 0.80 0.01
 13. I try to please others even if it is inconvenient to me. 0.12 −0.27 0.52 0.46
Bahala Na
 14. Believing in a “bahala na” (come what may) perspective helps me cope with events in my life that are outside of my control. 0.11 −0.10 −0.13 0.52
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Note: Bold numbers indicate loadings ≥ 0.40. Explolatory factor analyses was conducted among randomly splitted sample.

Multi-factor CFA was conducted for the Hiya from parent, Hiya in general, Utang na Loob, and Pakikisama scales in a single CFA model, with each scale specified as a discrete factor. The fit indices of the initial multi-factor CFA model were χ2 = 132.22, p < 0.001, CFI = 0.91, RMSEA = 0.08. Modification indices suggest some of the error terms of items covary (e.g., item 1 and item 2; item 3 and item 4). These modifications significantly improved the model fit (χ2 = 74.81, p < 0.05, CFI = 0.97, RMSEA = 0.05).

The results of pair-wise correlations among the finalized four scales (i.e., Hiya from parent, Hiya in general, Utang na Loob, Pakikisama) and Bahala Na (single item) are presented in Table 4, along with the mean score of each scale. Overall, the scales were significantly and positively correlated with one another, with one exception between Bahala Na and Hiya in general. The magnitudes of significant correlations ranged from 0.20 to 0.43, suggesting a weak to moderate association between each.

Table 4.

Correlations among Filipino cultural values

1 2 3 4 5
1. Hiya from parent —
2. Hiya in general 0.36*** —
3. Utang na Loob 0.27*** 0.23*** —
4. Pakikisama 0.23*** 0.33*** 0.43*** —
5. Bahala Na 0.20*** 0.07 0.21*** 0.21*** —
Mean (SD) (Range 1–5) 2.85 (0.96) 4.09 (0.73) 3.22 (0.94) 3.49 (0.85) 2.74 (1.15)
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*

p<0.05;

**

p<0.01;

***

p<0.001

Table 5 reports the associations between cultural value scales and depressive symptoms, and lifetime substance use. Ordinary Least Squares (OLS) regression coefficients are reported for depressive symptoms, and the odds ratios (OR) are reported for substance use while controlling for all covariates. The results show that Hiya from parent was positively associated with depressive symptoms (b=0.05, p<0.01), while Hiya in general was negatively associated with depressive symptoms (b=−0.07, p<0.01). Hiya in general was negatively associated with alcohol use until passing out (OR= 0.45, p<0.05). Other coefficients and odds ratios did not reach statistical significance.

Table 5.

Regression Analysis for Depressive Symptoms and Substance Use

Depressive symptoms Cigarette use Alcohol until passing out Marijuana use Any use of substances
Coefficient [95% CI] Odds Ratio [95% CI] Odds Ratio [95% CI] Odds Ratio [95% CI] Odds Ratio [95% CI]
Hiya in family 0.05** [0.02, 0.08] 1.16 [0.85, 1.59] 1.13 [0.62, 2.06] 1.07 [0.69, 1.64] 1.10 [0.82, 1.48]
Hiya in general −0.07** [−0.12. −0.02] 1.06 [0.70, 1.61] 0.45* [0.21, 0.93] 0.97 [0.56, 1.68] 0.95 [0.65, 1.38]
Utang na loob −0.01 [−0.05, 0.02] 1.07 [0.78, 1.47] 1.28 [0.72, 2.28] 1.03 [0.68, 1.55] 0.88 [0.66, 1.18]
Pakikisama 0.02 [−0.02. 0.06] 0.95 [0.66, 1.37] 1.20 [0.62, 2.30] 1.05 [0.64, 1.72] 1.07 [0.77, 1.50]
Bahala na 0.01 [−0.02, 0.04] 0.82 [0.64, 1.06] 0.99 [0.65, 1.51] 1.04 [0.75, 1.44] 0.94 [0.75, 1.19]
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*

p<0.05;

**

p<0.01

CI: Confidence interval

Covariates: age, sex, years in the US, and household income

Discussion

The objectives of this study were to develop Filipino cultural value scales and examine its associations with depressive symptoms and substance use. Data collected from MLSAAF was able to produce five scales that measure surface level Filipino cultural values, namely – Hiya (Hiya from parent and Hiya in general), Utang na Loob, Pakikisama, and Bahala Na. Findings showed that Hiya from parents was positively associated with depressive symptoms and Hiya in general was negatively associated with depressive symptoms and alcohol use until passing out.

Starting with the extensive literature review, focus groups, and rounds of investigative analyses and pretests, the present study sets out 14 items categorized into 5 measures of Filipino cultural values. Except for a single-item Bahala Na, each scale demonstrated acceptable to high reliability. The low alpha coefficient for Pakikisama (α=0.61) may be due to having only three items in the scale. The results of rigorous measurement testing, such as EFA and multi-factor CFA, suggest that these scales demonstrated a good model fit of the measurement models, indicating that each scale is robust enough to be used as latent constructs for structural equation modeling (Y. Choi et al., 2021). It is notable that EFA of the 7-item Hiya scale resulted in two factor structure involving Hiya from parent and Hiya in general. Four items of Hiya from parent scale focus on the ways that Filipino parents feels embarrassment or shame that they may extend or project to how their Filipino child behaves and succeeds (e.g., “If my child is delinquent, people I know will think I am a bad parent”). Whereas three items of Hiya in general scale demonstrate the ways individuals value the family reputations perceived by others or a larger society and try to keep family problems from external society (e.g., “It is important not to bring hiya (shame) to the family”). The difference between the two Hiya scales show the complexity of this cultural value that reflects how scholars have attempted to demonstrate the duality of Hiya as shame and temperance (Lasquety-Reyes, 2016). The items associated with Hiya in this study pertain more towards its interpretation as minimizing shame rooted from the reputation of parents and the family. This harkens back to larger Asian and AA values of saving face since the family’s reputation is imperative as a form of social mobility within Asian and AA spaces (Kalibatseva et al., 2017; Nadal, 2020). Overall, no item was discarded in the process of testing, and the scales are ready for use and further enhancement, particularly among Filipino adults.

Interestingly, the associations between Filipino cultural values and depressive symptoms and substance use only showed statistical significance with the two Hiya scales and depressive symptoms and alcohol use until passing out with inverse outcomes. Hiya from parent was positively associated with depressive symptoms that may be a result of an individualized or co-parental sense of responsibility of the behavior and reputation of their child or children. Given that the participants are from the U.S., perhaps how Hiya from parent has been embodied is a result of the Model Minority Myth where AA parents and – by extension – FA parents pressure their children to academically succeed to be seen within the proximity of whiteness, and thus, less threatening than other communities of color (Kim, 1999; Wu, 2014). Therefore, if the Filipino child is not succeeding or behaving not in accordance to fit within the Model Minority Myth, Filipino parents perceive this as a failure within themselves that may lead to poor negative health.

On the other hand, Hiya in general was negatively associated with depressive symptoms and alcohol use until passing out which may be because of the items associated with this scale that contextualizes Hiya from a broader perspective of avoiding bringing shame to the family’s reputation and not associating shame as a parental failure. The detachment from the personal responsibility of the parent for their child’s success may help in reducing poor mental health outcomes. When considering the role and reputation of the family in relation to the larger society, Hiya in general can potentially have differing results if it’s within the context of the FA and AA community given that saving face is an influential factor in this population, while it may not necessarily have a stronger influence when comparing to non-FA and AA communities. It is imperative to highlight that Hiya was theorized by Filipino psychologists as a value of dignity and self-worth (San Juan, 2006), however, within the FA diaspora, Hiya has been internalized and used as a form of survival for FA parents to ensure that their child or children will be discriminated less by a predominantly white society (Woo et al., 2020). This suggest that perhaps FAs need to continue to work towards decolonization and embrace Filipino cultural values in how it was practiced pre-colonially as a strength-based cultural value. Decolonization can include learning about pre-colonial Filipino history, traditions, and languages and sharing it intergenerationally and conducting studies that use measurements presented in this paper, existing measurements (e.g., Colonial Mentality Scale), and the development of other scales that measure other aspects of Filipino values such as kapwa or shared identity. Moreover, for FA parents who have experienced racism and internalized colonial mentality, this may have possibly engendered intergenerational trauma between parents and their children which studies on intergenerational trauma have seen to manifest as depression at the individual level (Hankerson et al., 2022).

Limitations

This study should be considered with several limitations. First, while the study employed rigorous review of the literature, feedback from FAs and panel experts, pilot-testing, and translation to create the scales (Y. Choi et al., 2021), translating concepts from another culture and language may not always be accurate in English and within a Western context. Other studies should consider creating similar scales in Tagalog and other Filipino languages among Filipinos living in the Philippines. Another limitation is that the Filipino cultural values measured in this study are considered to be surface level values (Yacat, 2013). Researchers should consider also developing measurement scales for core and societal level values. Nevertheless, the strength of this study was being able to quantitatively develop measurable scales of some Filipino cultural values that can provide a pathway towards understanding the nuances of cultural values and its influence on health. The study only analyzed the associations of Filipino cultural values with depressive symptoms and substance use. Future studies should also consider examining its associations with other health behaviors and outcomes. Studies should also consider evaluating the role of colonial mentality in relation to cultural values and its associations with depressive symptoms and substance use. Finally, this study was conducted among FAs living in the Midwest in the U.S. and predominantly women and foreign-born which may not be generalizable to other FAs in the diaspora and Filipinos living in the Philippines, men and other genders beyond the binary, and U.S. born parents. Future studies should consider broadening the sample of the characteristics of the participants.

Conclusion

This study created Filipino cultural value scale measurements that can be used in partnership with qualitative methods to better understand how Filipino cultural values influence health behaviors and outcomes in the FA population. In addition, the study also found a positive association between Hiya from parent and depressive symptoms and a negative association between Hiya in general and depressive symptoms and alcohol use until passing out. These findings show the nuances and complexities of Filipino cultural values as it is understood and practiced by FAs in the diaspora. Implications for practice can encourage researchers and educators to explore the integration of Ethnic Studies in other fields such as Public Health, to inform FAs about pre-colonial Filipino cultural values especially to younger populations to help develop critical consciousness and stronger ethnic identity formations that may serve as a protective factor from racism and other forms of oppression in the U.S.

What is the public significance of this article?

This study found through the creation and validation of Filipino cultural values measurement scales that hiya (dignity or shame) from parent was positively associated with depressive symptoms and hiya in general was negatively associated with depressive symptoms and alcohol use until passing out. The findings from the study demonstrate the need for researchers and practitioners to understand how Filipino cultural values influence other health beliefs and behaviors among Filipino Americans.

Funding:

Dr. Maglalang was supported in part by the Center of Biomedical Research Excellence (COBRE) under Grant P20GM130414 (PI: Monti). This study was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development under Grant NICHD R01 HD073200 (PI: Choi).

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