Research That Matters (January 17 - 20, 2008)

Background: According to the National Institute of Health (NIH) (2002), African Americans experience substantial disparities in the burden of disease and death when compared to White Americans. Although many scholars have focused on inadequate insurance coverage and lack of access to health care as the major contributing factors to health disparities, the Institute of Medicine (2002) report suggest that the problem is more complex. The report shows that health disparities exist even when income, access and insurance status of African Americans are comparable to those of the white population (Lavizzo-Mourey, 2002). The literature on health disparities has largely focused on the issues of socioeconomic and access to health care while neglecting the effects of culture and discrimination on service utilization. Objectives: This study explores the influence of culture and discrimination on care-seeking behaviors of elderly African Americans in Alabama. Methods: This is a qualitative phenomenological study which involved in-depth interviews with 15 African American men and women ages 60 and older in Alabama. The sample size of 15 is adequate for the phenomenological method (Creswell, 1998) of this study. While this is a small exploratory study and is not intended for any generalizations, it does provide a unique opportunity to hear the voices, the concerns and the stories of elderly African Americans, which has often been overlooked in the literature. Results: The following themes emerged from the analysis of data: lack of trust in modern medicine, lack of trust in prescription medications (particularly psychotropic medications), reliance on home remedies, perception of sickness as loss of independence, fear of doctors and hospitals, importance of pain management, implicit expressions of discrimination, perceptions of modern health care as “impersonal” and “un-caring”, importance of god and spirituality on health illness and healing. Conclusions: The study findings suggest that the well documented health disparities among African Americans may be explained by factors beyond the often cited issues of access and socio-economics. This study raises important questions about the role of culture and discrimination in the care seeking behaviors and service utilization of African Americans.

Key words: Health disparities, health culture, African Americans, care seeking, alternative medicine, spirituality, qualitative research.