Informal Caregivers and Racial/ethnic Variation in Health Service Use of Stroke Survivors

By Hinojosa, Melanie Sberna; Rittman, Maude et al. | Journal of Rehabilitation Research & Development, March-April 2009 | Go to article overview

Informal Caregivers and Racial/ethnic Variation in Health Service Use of Stroke Survivors


Hinojosa, Melanie Sberna, Rittman, Maude, Hinojosa, Ramon, Journal of Rehabilitation Research & Development


INTRODUCTION

Stroke is the leading cause of serious long-term disability affecting more than four million people in the United States [1-3]. An estimated 500,000 strokes occur each year in the United States and between 11,000 and 15,000 of those strokes are seen among veterans receiving services through the Department of Veterans Affairs (VA) health system. Approximately 80,000 veterans in the VA system are stroke survivors [4-6]. Research indicates that racial/ethnic variations exist in the incidence and mortality of stroke. African Americans and Latinos have a higher incidence of stroke and greater stroke mortality, especially at younger ages and in the lower socioeconomic tiers [1,7-10]. Latino and African-American stroke patients are twice as likely as Caucasian patients to experience a recurrent stroke within 2 years of their first stroke and have greater residual physical impairment after stroke [11-12]. Within Latino subgroups variations also exist, with higher levels of stroke mortality among Puerto Ricans than Cuban or Mexican Americans [13]. Most stroke survivors are released home, often to informal caregivers, for a period of recovery.

African Americans, Latinos, and other minority groups in the United States often face barriers that restrict their use of health services [14]. After stroke, a variety of health services may be used by survivors, including hospital admissions; speech, occupational, and physical therapy; outpatient clinic visits, and various formal care services in the home. Given that African-American and Latino groups face greater stroke burden and greater poststroke disability, examining patterns of health services use of these groups is important. Using Andersen's Behavioral Model of Health Services Use to guide our research questions, we first investigate the racial and ethnic variation in health service use among stroke survivors in our sample. Second, we examine the degree to which caregiver context is an enabling factor in the use of health services for the veterans in our sample of veterans.

According to Andersen's Behavioral Model of Health Services Use, barriers and facilitators to health service use can be used to explain patterns of utilization [15]. Under this model, three types of factors affect the use of health services: predisposing, enabling, and need. Predisposing factors such as race, age, sex, and education affect whether a particular individual will use health services. Enabling factors can be those that enable or impede health service use, including living arrangements, access to healthcare, income, and social and family support. Need factors are specific to health status and physical/ mental functioning. Individuals with greater impairment need more care and thus may have greater use based on this alone. To our knowledge, no work has explored the role of caregivers as it relates to patterns of health service use. Postacute stroke recovery in the home is often a long-term process, and an important aspect of recovery is the presence of an informal caregiver. A majority of stroke survivors return home for rehabilitation, usually to an informal caregiver who is a spouse, child, or friend. Little is known about the specific role caregivers play in the recovery process for stroke survivors, but some evidence suggests that some of the racial and ethnic variation in poststroke recovery may be mediated, at least in part, by the presence of a caregiver [16].

Racial/ethnic differences among caregivers for a number of conditions such as Alzheimer disease, dementia, and cancer have been researched in the literature. African-American and Latino caregivers have different attributes when compared with Caucasian caregivers. Latino caregivers are less likely to institutionalize those in their care, or delay institutionalization the longest compared with other racial/ethnic groups [17]. Latino caregivers are also more likely to be family members, and culturally they report a greater sense of duty toward the elderly in their care compared to other racial/ethnic groups [18-19]. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Informal Caregivers and Racial/ethnic Variation in Health Service Use of Stroke Survivors
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.