ABSTRACT
OBJECTIVES: To investigate factors affecting the uptake of health and social services by elderly Asian Gujarati. METHODS: Four hundred and five Hindu Gujaratis and 381 whites aged 65 years and over residing in Leicester were randomly sampled from the Leicestershire District FHSA list by a computerized method based on linguistic analysis of the patient's name. One hundred and fifty Hindu Gujaratis and 152 whites were interviewed with response rates of 72% for the Asian Gujaratis and 80% for the white groups. The outcome measures were the activities of daily living (ADLs), incontinence, auditory/ visual deficits, cardiovascular disease, cognitive impairment (measured by the Mini-mental State Examination), depression, use of GP and hospital services, knowledge of community health and social services, willingness to use, suitability and cultural accessibility. RESULTS: The poorer uptake of services by elderly Asian Gujarati could not be explained by better health. They were significantly more likely to be dependent in six of the 14 ADLs and had higher rates of diabetes and impaired vision. Significantly more Asian Gujaratis than whites lived with others (84 versus 52%, p < 0.0001) with a greater availability of alternative sources of help and support. The knowledge and understanding of services were significantly poorer in the Gujarati group; fewer Asian Gujaratis knew how to apply for services and of those applying, fewer had been successful. Where services had been obtained, the levels of dissatisfaction were higher in the Gujarati group. The literacy rates were low in the Gujarati sample with 79% being unable to read or write in English and 27% unable to read or write in their mother tongue. CONCLUSIONS: The lower uptake of services by elderly Asian Gujarati is not the result of better health but may be explained by greater family support together with a lack of knowledge of and dissatisfaction with what is available. Health services will need to reappraise and revise some of their practices if they are to cater adequately for this growing population with many needs as yet unmet.
Subject(s)
Aged/psychology , Emigration and Immigration , Health Knowledge, Attitudes, Practice , Health Services Accessibility/standards , Health Services/statistics & numerical data , Social Work/standards , White People/psychology , Aged, 80 and over , Educational Status , England , Female , Geriatric Assessment , Health Care Surveys , Health Services/standards , Health Status , Humans , India/ethnology , Male , Patient Satisfaction , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The principal aim of this pilot study was to evaluate the performance of a Gujarati version of the MMSE as a screening instrument for dementia. The effect of ethnicity on MMSE performance was also examined. DESIGN: Two-stage cross-cultural survey. SETTING: Elderly immigrant Gujarati and British-born white communities in Leicester. SUBJECTS: First stage: 149 Gujaratis and 148 whites. Second stage: 27 Gujaratis and 42 whites. MEASURES: English and Gujarati versions of the MMSE, validated against clinical diagnosis following psychiatric interview (ICD-10 criteria). RESULTS: Mean MMSE scores were lower in the Gujarati group, but most of this difference was due to the effects of age, education and visual impairment. Ethnic group had an independent effect on three orientation items; when these were omitted, there was no difference in the mean MMSE scores of the groups after adjustment for age, education and visual impairment. The MMSE performed comparably in both groups as a screen for moderate-severe dementia, but was less efficient at detecting milder and less certain cases in the Gujarati group. The estimated prevalence of confirmed dementia was higher in the Gujarati group, but this was not statistically significant. CONCLUSIONS: This Gujarati version of the MMSE performed adequately as a screen for dementia in this immigrant community population. Further evaluation of its performance is required in larger community samples, clinical samples and in native Indian Gujaratis.
Subject(s)
Cross-Cultural Comparison , Dementia/ethnology , Geriatric Assessment , Mass Screening/standards , Neuropsychological Tests/standards , Psychometrics/standards , Aged , Analysis of Variance , Confidence Intervals , Cross-Sectional Studies , Dementia/epidemiology , England/epidemiology , Evaluation Studies as Topic , Female , Humans , India/ethnology , Logistic Models , Male , Mass Screening/methods , Orientation , Pilot Projects , Prevalence , Prospective Studies , Reproducibility of Results , Sampling Studies , Sensitivity and Specificity , Severity of Illness Index , TranslatingABSTRACT
Uptake of screening services in inner-city communities has been low, particularly in older age groups, lower social classes, and ethnic minorities. In Leicester City, where up to 25% of the population belong to ethnic minorities, this may have important implications for breast screening. We randomly sampled 701 inner-city women aged 45 to 64 years, stratified by neighborhood and by women's "likely home language." Trained interviewers succeeded in interviewing 79% of those eligible, and we report here a preliminary analysis of 413 respondents. Knowledge of breast cancer and screening varied markedly and significantly by actual language: 60.4% of English-speaking and 12.5% of non-English-speaking women correctly answered 10 or more questions (of 14) about breast cancer and screening (chi 2(1) = 89.884; P = .000). Despite that, 80% or more women stated their intention to attend for screening and assessment if necessary, irrespective of neighborhood, language, age, or social class. We suggest that the difference in knowledge between language groups arose from indirect discrimination in the way in which health-related information is disseminated in British society. However, after providing appropriate screening information, we report similarly high intended acceptance rates in the two language groups.
