Self-Advocacy in Health Care Decision-Making among Elderly African Americans

Article excerpt

Abstract: The purpose of this study was to identify factors that influence the self-advocacy expressions of elderly African Americans. The sample consisted of 100 elderly African Americans who responded to a series of questions about the characters in seven vignettes. Each vignette told a story about an elderly African American in a health care dilemma. The health care dilemma became more complex as the age of the main character increased. In addition, each participant completed the Multi-dimensional Health Locus of Control Scale and the Philadelphia Geriatric Morale Scale. Statistically significant differences were found between males and females and educational levels on the Powerful Others Subscale. A statistically significant relationship was found between high self advocacy expressions and marital status. Twenty-four percent (24.1%) of the participants rated as having high self-advocacy expressed dissatisfaction with their health status. The findings demonstrate some of the complexities involved in the study of elderly African Americans particularly related to the major impact of life experiences on their lives today.

Key Words: African Americans, Elderly African Americans, Health Care Decision-Making, Self-Advocacy

Cultural values and beliefs play a significant role in shaping the health attitudes and practices of elderly African Americans. Beliefs about health and illness combined with age, exposure to racial prejudices, income, marital status, education, and life experience have greatly influenced the elderly African Americans' ability to become actively involved in decision-making about their health care (Spence, 1997; Richardson, 1992). These factors also play a significant role in how well elderly African Americans recognize and meet their health care needs.

Fears of reprisal and discomfort, when in the presence of healthcare providers, have often resulted in the African American elderly person's failure to express his/her health care needs and concerns (Weaver & Gary, 1996). This behavior continues today, for example, often elderly African Americans find themselves in a situation where they must interact with a member (s) of the majority culture whom they believe has little or no genuine interest in them and their well being (Cherry & Giger, 1996; Small, 1991). In many instances, these elderly individuals withhold critical information from the health care professional in fear of "not being heard." These beliefs and behaviors of elderly African Americans differ from those of the European American culture, span the life course, and have become problematic for the patient and the health care practitioner (Gary & DeBoeanegra,T996; Gibson, 1992; Congress & Lyons, 1992). It has been found that African Americans make fewer annual physician visits than do Whites (Davis et al., 1994; Ruiz, 1994). In addition, elderly African Americans tend to use informal networks consisting of family and friends to more frequently fulfill their needs, including the needs for health care and health care decision-making.

Economic hardships, frustrated aspirations, chronic insecurity about jobs and life, and uncertainty about how one is perceived because of skin color and / or race are sources of prolonged stress causing physical, social and emotional harm. For elderly African Americans these risk factors are perceived as urnitations and serve as barriers to self-expression throughout the life span. Often it is what one does throughout life that emerges as the factors most determinant of health and survival. It is not merely a matter of planning for and researching ways to insure greater access to the health care system for elderly African Americans throughout their lives. The subtle relations of minority status with other variables impact on the ways older Blacks interact with health care professionals and on their ability to practice self-advocacy in their health care decision-making behaviors. …