Exploring the Activity Spaces and Healthcare Utilization of Aging African Americans and Hispanics in Houston, Texas: A Geoethnographic Approach

Background and Purpose: Despite increased attention on racial/ethnic health disparities, older minorities still face significant barriers and difficulties in accessing the health system. With the majority of individuals wanting to “age-in-place,” communities and neighborhoods—and thus, community-based health services—can play a critical role in enhancing the health and well-being of older adults. This is particularly the case for aging minorities who are more likely to be concentrated in specific geographic areas, e.g. ethnic enclaves. The goal of this pilot study was to explore the “activity spaces” (i.e. day-to-day activities) of aging minorities and the potential issues or barriers regarding the integration of health care services into their daily lives.

Methods: This study utilized a “geoethnographic” mixed methods approach, combining geographic information systems (GIS), quantitative surveys, and qualitative interviews. A purposive sample of 40 African Americans and Hispanics/Latinos aged 60 and over was recruited from a geriatric clinic in northeast Houston, Texas. Quantitative data included sociodemographic characteristics, health/mental health measures, and mobility measures. In addition, detailed locational information regarding their day-to-day activities (e.g. grocery shopping, church, social activities, etc.) were collected and used to map their activity spaces.  With these data, standard deviational ellipses were calculated to represent each participant’s activity space and then compared to their healthcare destinations spatially. Semi-structured interviews were conducted with 20 participants, focusing on three general domains: community life, health care services, and transportation issues. Content analysis was used to code the transcripts and derive key themes.

Results: The average activity space for the total sample was 14.7 sq. miles (or 38.1 sq. km), with females and African Americans having larger activity spaces than their counterparts. Participants aged 70 to 79 years had significantly larger activity spaces, compared to both the young-old (60-69) and old-old (80+) cohorts. Participants went to an average of 2.22 local health facilities (sd=1.03), but less than a third (29.7%) went to a health facility located within their activity space. Half of the sample relied on a relative or friend for transportation for medical reasons. The content analysis revealed several key themes, including: 1) a growing sense of detachment from one’s community; 2) the proximity of services is important, but is often trumped by other accessibility issues (e.g. insurance coverage); 3) limited availability of geriatric health services in the region, particularly specialty care; and 4) most participants rely on driving oneself or friends/family due to limited transportation options.

Conclusions and Implications: This study highlighted some of the health access challenges minorities face as they age and the spatial incongruence between their activity spaces and the health system. The potential implications for policy and program planning are discussed.