Use of Role Model Stories to Overcome Barriers to Hospice Among African Americans

Background and Purpose. Several studies have documented the disparities in hospice care among African Americans (Enguidanos, Yip, & Wilber, 2005; Jenkins, Chapman, Harshbarger, & Townsend, 2009; Kwak, Haley, & Chiriboga, 2008) and the corresponding increased likelihood of dying in a hospital (Johnson et al., 2005; Kwak et al., 2008; Lackan, Eschbach, Stimpson, Freeman, & Goodwin, 2009). Barriers to Hospice for African Americans include lack of experience, knowledge, and misconceptions of hospice (Chung, Essex, & Samson, 2009; Born et al., 2003; Reese et al.,1999). The purpose of this study was to develop and test theoretically driven role model stories and real stories of other African Americans use of Hospice in order to increase knowledge and improve attitudes and increase access to hospice care for seriously ill older African Americans. A role model brochure was developed from individual interviews with African Americans receiving hospice services and their family members. Stories were developed based on theoretical concepts, including Social Learning Theory and Theory of Reasoned Action that have been used with other health behaviors. These stories incorporate the language of the storytellers and carry the cultural values and imagery of the intended audience. Methods. A pre post design was conducted to determine the impact of the role model stories in improving knowledge, attitudes, and intentions toward hospice. Participants were recruited from several community-based organizations including senior centers, churches, and community activity groups (e.g., exercise and sewing). A survey, developed specifically for this project, was administered face-to-face before participants were provided the brochure and again after they read the brochure. Seventy-one African Americans aged 62 and older with two or more chronic conditions were surveyed. Paired t-tests and chi-squares analyses were conducted to determine change from pre to post. Results. Survey results demonstrated significant improvement in knowledge (t= -5.7, p<.001), with 63.6% scoring higher on knowledge at post test. A significant improvement in attitudes toward hospice was also found, with mean attitude scores increasing from 41.16 (sd=5.20) at pretest to 46.29 (sd= 5.45) at post test (t=-7.52, p< .001). Intentions to enroll family members and themselves also increased following review of the brochure (p<.05). Conclusions and Implications. Use of theoretically driven role models stories improved knowledge of and attitudes toward Hospice among this traditionally underserved population. Clinical implications of this study for social worker practice focus on the use of these culturally appropriate materials as a method to facilitate and improve end of life communications and education for traditionally underserved populations. Further research is needed to determine if increased intentions to enroll in hospice results in increased access.