African Americans have the highest morbidity and mortality rates of all American racial and ethnic groups, yet are reported to utilize health care less often than non-minority Caucasians. Understanding reasons for low utilization of health care has promise for reducing these health disparities. Andersen’s Behavioral model of predisposing, enabling and need factors that influence health care utilization was used to investigate group differences in self-care, health responsibility, provider problems, geographic access, and appointment availability in low income African American and Caucasian elders. The study examined whether these variables differentially predicted health care utilization after controlling for health status, age, gender, financial comfort, and education. A sample of 101 non-minority Caucasian and 103 African American low-income elders were recruited. Data were collected using the Health Utilization Questionnaire, the SF-36, and a seven-day daily dairy of self-care behavior. Analysis of covariance and blocked stepwise multiple regression analyses were performed. Caucasians were significantly older than African Americans, yet enjoyed a greater degree of financial comfort and better self-rated health. Compared to Caucasians, African Americans reported significantly more problems with providers, geographic access, and appointment availability as well as greater personal health responsibility, but they did not differ in the degree to which they utilized health care or engaged in self-care. Health status and level of self-care were significant predictors of health care utilization for African Americans, while health status and age were significant predictors for Caucasians. Study findings suggest that health disparity among African Americans is more from problems with health care and how it is delivered, rather than from the amount of health care that is being utilized. As health care providers, nurses need to respond to African American’s dissatisfaction with their providers and promote policies to improve geographic access and appointment availability for low income African American elders.
Session #1203 - Health Disparities
The 29th Annual MNRS Research Conference (April 1-4, 2005)