The proposed research is a three-year study which will explore the differing patterns of health care responses to chronic illness of older African and white Americans residing in Allegheny County, Pennsylvania, specifically: l. To identify and describe differential patterns of response to chronic illness by African Americans and whites 65 years of age and over; that is their differential use of self care, informal care and formal care. 2. To identify barriers and incentives to the use of self, informal and formal care, and show how they contribute to the observed patterns of care among older African Americans and whites, 3. To describe the process of care as it develops over time, including the subjective and objectives factors which contribute to health care choices. 4. To make recommendations for interventions which could enhance access and use of all three forms of health care. These objectives will be accomplished through a survey using in-person interviews with a community sample of 500 black and 500 white persons 65 years of age and over who report one or more of the four chronic illnesses most commonly found in this age group: arthritis, heart disease, diabetes mellitus and chronic obstructive pulmonary disease (COPD). The respondents' various patterns of use of self, informal and formal care will be identified both in general and with regard to the four specific illnesses, and the determinants of these patterns analyzed. A sub-sample of 200 persons (100 African Americans and 100 white) will be selected by pattern of care response and other specific criteria for three additional in-depth interviews over the succeeding 18 months. These interviews will explore in greater detail the process of health care as it unfolds over time, including the role such factors as health knowledge, attitudes and beliefs, experiences with the health care system and social support play in health care choices. This in-depth portion of the research will both clarify and expand on the findings of the survey in order to present a multi-dimensional view of the problem.
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