The proposed four-year study is a patient-centered longitudinal study to describe and compare the long term changes in self care behaviors of older African Americans and whites residing in Allegheny County, Pennsylvania who have at least one of two chronic illness prevalent in this population: osteoarthritis and ischemic heart disease. Specifically, we propose to: 1) describe the process by which self care behaviors are adopted, maintained and changed by conducting a longitudinal investigation of stability and change in self care behaviors among older adults with chronic illnesses. We will examine how decisions are affected by a variety of factors including the characteristics of the individual, characteristics of the disease, and characteristics of the environment; 2) describe and analyze the effects of self care behaviors on an individual's assessment and satisfaction with their illness care and the effects of this care on their health related quality of life, disease symptoms, depression and anxiety level and sense of control and efficacy; and 3) document and describe the differences in self care process and effects between African Americans and whites. We will conduct four in-person in-depth interviews with 1200 individuals, 50 percent African American and 50 percent white over a 30-month period at 10-month intervals to obtain information on their health status, current self care strategies, coping styles, identification of additional stressors that would contribute to the modification of these strategies. Secondly, we will conduct telephone interviews five months after the initiation of each longitudinal interview with the entire group to monitor these changes and trigger the need for additional questions to capture the formulation of new self care behaviors or changes in old behaviors or a total of seven interviews. At each interview, we will assess the determinants of self care stability on change (e.g., race, social support, income, gender, age grouping and cultural preferences). The research will be guided by a preliminary model informed by theoretical perspectives directed at the individual's decision making and their socio-cultural context.
