The process of obtaining and using medical care for older adults is varied and complex, with certain vulnerable groups more likely to encounter obstacles to the optimal receipt of care. This pilot study will investigate the process of obtaining and using needed, prescribed medical care in two underserved populations, rural and African-American elders. These populations have been documented to be vulnerable to poor health outcomes and to insufficient medical care, particularly for life-threatening conditions. Congestive heart failure (CHF), which requires intense and constant interaction with medical professionals, will be used to examine experiential barriers that intervene in the provision of medical care and shape each individual's health care access trajectory. Utilizing the framework of an emerging experiential model of health care utilization, five older adults from each population will be """"""""shadowed"""""""" for a period of one year in order to describe the process of their access to health care. Emphasis will be placed on identifying subjective, interpersonal and contextual determinants of each individual's trajectory and documenting the manner in which the interaction of these factors evolves over time. Participant observation, event analysis, and repeated in-depth interviews with each elder and with selected key health care access decision-makers will be employed to validate and refine the emergent experiential model. The study will serve as a focus for theory building and the development of protocols for use in a large-scale study of the processes of health care access and the barriers to such access experienced by vulnerable elders.
