Complementary and alternative medicine (CAM) is widely used among older adults. However, overall levels of CAM use and specific modalities used among elders differ by ethnicity, gender and age. Neither the causes of ethnic differences in CAM use nor the effects of CAM use on ethnic differences in the health status or quality of life have been clearly identified. Few studies of CAM use are conceptually driven, and most do not explore the social or cultural factors related to CAM use. Studies have not examined specific CAM use behaviors; rather, they rely on self-reports of use in the past month or past year without trying to measure the actual frequency of CAM modality use or the predictors of specific CAM modality use. Population based studies of CAM use have not measured how specific CAM therapy use is related to health status or quality of life among older adults or minority group members. The overall goals of this project are to delineate ethnic differences in the CAM therapies used by rural elders and to determine ethnic differences in how these modalities are incorporated into health self-management. To attain these goals, this project will: (1) delineate the cognitive models of CAM among African American and white rural older adults that shape health self-management (components of these cognitive models include knowledge and beliefs about CAM modalities, information sources about CAM modalities, the purposes for which these modalities are used, the reasons for using these modalities, and how they are integrated into conventional health care); (2) determine the actual use of CAM modalities among African American and white rural elders; (3) delineate how the use of CAM modalities among African American and white elders affects the use of conventional medical care, and (4) determine the association of CAM modality use among African American and white rural elders with health-related quality of life. This research is structured by a conceptual framework that integrates concepts of health self-management with concepts from cognitive models of health. The design includes two components. First, in-depth interviews will be completed with 64 rural African American and white elders. Second, 6 times at monthly intervals structured interviews will be completed for 3 consecutive days with a sample of 200 rural African American and white elders. This project addresses health disparities by investigating why and how ethnic and racial minority populations use CAM. It reflects the recommendations of the lOM's Committee on the Use of Complementary and Alternative Medicine by the American Public to use quantitative and qualitative methods to examine sociocultural dimensions of illness and health care- seeking processes and preferences, how well CAM users adhere to treatment guidelines, and how individuals evaluate information about CAM modalities. ? ? ?
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