"Is it half full or half empty?" Affective responses to chronic illness.

Using a combined qualitative/quantitative approach, we interviewed 132 older African-Americans and whites with either osteoarthritis of the hip or knee (OAK/OAH) or ischemic heart disease (IHD) to address two questions: 1) What types of reactions to illness are expressed by this group of older adults who have OA or IHD? 2)? Are there differences in the characteristics of the respondents who respond more positively than those who respond more negatively? The responses were coded to illustrate those that reflected positive, negative, or combined (positive/negative) statements. The majority of the respondents, who were categorized as positive or combined, approached the illness experience with statements illustrating their ability to cope with their illness and adapt their lifestyles to the limitations imposed by the disease such as acceptance, feeling that others were worse off, or changing their lifestyles to adapt to their limitations. Those expressing negative reactions to their illness were fewer in number and responded with terms reflecting loss of identity, physical limitations, and other disease symptoms. The differences were more pronounced between the positive and negative groups where the latter were somewhat more likely to be African-American and female and significantly more likely to have less income, greater perceived disease severity, and more disability. We should look to the larger group in both the positive only and combined responses to explore how culture may play a role in perceptions of subjective well-being and the importance of "the local worlds of experience" experienced by both men and women, and African-Americans and whites. This study illustrates that using a simple, open-ended question that stimulates older people to narrate their reactions to having a chronic illness may allow clinicians to identify the persons most at-risk and intervene appropriately.

Trust in the health care system and the use of preventive health services by older black and white adults.

OBJECTIVES: We sought to find racial differences in the effects of trust in the health care system on preventive health service use among older adults. METHODS: We conducted a telephone survey with 1681 Black and White older adults. Survey questions explored respondents' trust in physicians, medical research, and health information sources. We used logistic regression and controlled for covariates to assess effects of race and trust on the use of preventive health services. RESULTS: We identified 4 types of trust through factor analysis: trust in one's own personal physician, trust in the competence of physicians' care, and trust in formal and informal health information sources. Blacks had significantly less trust in their own physicians and greater trust in informal health information sources than did Whites. Greater trust in one's own physician was associated with utilization of routine checkups, prostate-specific antigen tests, and mammograms, but not with flu shots. Greater trust in informal information sources was associated with utilization of mammograms. CONCLUSIONS: Trust in one's own personal physician is associated with utilization of preventive health services. Blacks' relatively high distrust of their physicians likely contributes to health disparities by causing reduced utilization of preventive services. Health information disseminated to Blacks through informal means is likely to increase Blacks' utilization of preventive health services.

Daily temporal self-care responses to osteoarthritis symptoms by older African Americans and whites.

Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the USA. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This patient-centered descriptive study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African Americans and whites, but African Americans used them in different proportions than whites. This study contributes to our knowledge of the dynamic and changing nature of self-care actions even within a single day. By defining how self-care is used in one illness by two different ethnic groups, we may be able to design appropriate educational programs that are more culturally specific to better meet the needs of patients with OA.

Defining optimal self-management in osteoarthritis: racial differences in a population-based sample.

The aim of this study was to examine optimal self-management in osteoarthritis and its association with patient-reported outcomes. We recruited a population-based sample of Medicare beneficiaries (n = 551) residing in Allegheny County, PA, USA and elicited an expanded set of self-management behaviors using open-ended inquiry. We defined optimal self-management according to clinical recommendations, including use of hot compresses on affected joints, alteration of activity, and exercise. Only 20% practiced optimal self-management as defined by two or more of these criteria. Optimal and suboptimal self-managers did not differ in sociodemographic features. Both white and African-Americans who practiced optimal self-management reported significantly less pain, but the benefit was greatest in severe disease for whites and for mild-moderate disease among African-Americans. This backdrop of naturally occurring self-management behaviors may be important to recognize in planning programs that seek to bolster self-management skills.

Self-care and professionally guided care in osteoarthritis: racial differences in a population-based sample.

OBJECTIVE: The aim of this study was to examine the prevalence of self-management practices among older White and African American persons with osteoarthritis. Self-management was defined broadly to include all behaviors adopted to reduce morbidity, whether recommended by physicians or not. METHODS: A population-based sample of Medicare beneficiaries (N = 551) was recruited. An expanded set of self-management behaviors using structured and open-ended inquiry, along with use of arthritis-specific medications was elicited. RESULTS: Few differences in self-care behaviors between race groups were found. However, older African American persons were significantly less likely to have prescriptions for nonsteroidal anti-inflammatory agents (NSAIDs) and more likely to use over-the-counter nonprescription analgesics. DISCUSSION: Older White and African American persons made similar use of self-care strategies to reduce disease morbidity. African Americans without access to prescription pain relievers substituted nonprescription analgesics. A broader view of self-management is valuable for assessing the ways people may move between professionally guided care and self-care.

The role of spirituality in the self-management of chronic illness among older African and Whites.

This study used data from in-depth interviews collected from 88 African American and White men and women aged 65 years and older who reside in Allegheny County, Pennsylvania. The purpose of this study was to understand the role of spirituality in the self-management of chronic illness among this population. Thematic content analysis addressed two specific questions: (1) how do older adults use spirituality to help manage their chronic illness, and (2) are there any racial differences in the use of spirituality. Several core themes emerged from the linkage of spirituality and self-management: God: the healer, God: the enabler through doctors, faith in God, prayer as a mediator, spirituality as a coping mechanism, combining conventional medicine and spiritual practices, and empowering respondents to practice healthy eating habits. These results display racial differences in the use of spirituality in the self-management of chronic illness. African American elders were more likely than White elders to endorse a belief in divine intervention. White elders were more likely than African America elders to merge their spirituality in various self-management practices. Despite these differences, spirituality can play an integral part in a person's health and well-being of chronically ill elders.

Do managed care plans reduce racial disparities in preventive care?

This study was designed to determine whether managed care plans reduce racial disparities in use of influenza vaccination, mammography, and prostate-specific antigen screening. The study analyzed the use of three types of preventive care in a population-based sample of adults who were 65 years or older and were enrolled in a Medicare managed care (MMC) or fee-for-service (FFS) plan in Allegheny County, Pennsylvania. The study sample included 463 African Americans and 592 whites. Fewer African Americans than whites reported having had an influenza vaccination (64.4% versus 76.5%; p < 0.01) or a prostate-specific antigen test (64% versus 71.2%; p = 0.09) during the previous year. Slightly more African Americans than white women reported having had a mammogram (66.1% versus 63.8%). Logistic regression showed that, regardless of health plan type, African Americans were significantly less likely than whites to have an influenza vaccination (p < 0.05). A MMC plan did not narrow racial differences in preventive care. Reducing disparities may require interventions developed for specific racial/ethnic groups.

Tailoring interventions: understanding medical practice culture.

This article describes the results of a study that used intensive direct observations of eight medical practices to assess the factors affecting the barriers and facilitators to adult immunization for influenza and pneumonia. The study aimed to describe the culture of these practices by identifying key features that facilitate or deter the immunization process. The article presents profiles of six of the eight practices describing their cultural and organizational frameworks. Six features that are critical to an understanding of the cultures of these practices, particularly as they relate to receptivity to influenza immunization for diverse practices and patient populations, are highlighted. These include policies and procedures, funding source, physician philosophy, patient receptivity to provider recommendation, and physical environment and social environment. The article also discusses strategies for applying knowledge about the culture of each practice to introduce appropriate and feasible interventions aimed at increasing immunization rates.

The role of qualitative methods for investigating barriers to adult immunization.

In 1999, the Agency for Healthcare Research and Quality funded a study of barriers to immunization, which included a short-term qualitative data collection to assess the organizational and cultural features of selected primary care practices and to explore their impact on adult immunization rates. The authors describe the short-term qualitative data collection system and the contributions made by the qualitative study to the parent project. They address previously held concerns about qualitative research and provide a system that can be replicated or modified for use for projects designed to assess complex attitudes and behaviors that affect health outcomes.

Women's Retirement.

Women's work related issues such as retirement have not traditionally interested researchers. Social research has recently produced new information on women's work and retirement. However, such work has been quantitative, focusing on measurements of attitudes, satisfaction with retirement, and economic stability. This a proach has resulted in gaps in the record which we feel may be crosed through a case study approach. Pilot data from our research on women's retirement using such an approach suggests that women's decisions regarding retirement and its process may be more complex than previously reported in areas of family health problems, retirement planning and spouse's retirement.