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Try out PMC Labs and tell us what you think. Learn More. This article provides data obtained through telephone interviews with 1, white, black, Mexican American, or Puerto Rican respondents. The study was deed to measure differences among ethnic groups in knowledge and attitudes toward White girl or hisp care services and the extent to which knowledge and attitudes affect service use. Across all groups, there is less knowledge about long-term, community-based care than institutional services. The extent of knowledge about services is limited among all groups, but especially among Puerto Ricans.
There are marked differences among groups in attitudes toward services. Minority groups are far more likely to perceive care of the elderly as a family responsibility and to stress the importance of ethnic factors in service delivery. Despite differences among groups, knowledge and attitudes are less directly related to use of services than is activity limitation.
This may be because only a very small proportion of the respondents had any experience with service use. Patterns of health-related use of services vary between white people and minority group members and among different minority groups. Lack of knowledge about services has been cited as a barrier to service use among minorities by a of authors Bell, ; Carp, ; Kent, In a study of minority participation rates of service providers in three counties Holmes et al. Culturally determined attitudes which have been cited in the literature as influencing patterns of service use include emphasis White girl or hisp family-oriented caregiving and lack of physical and psychological accessibility of services for example, staff who shares the same language, traditions, and values; service location in minority neighborhoods.
A of authors have stressed the importance of these issues Bell, ; Carp, ; Cueller, ; Quesada and Heller, ; Torres-Gil, Confirming the importance of minority staff, in our study of service providers Holmes, et al. The aim of this study was to explore differences in knowledge and attitudes between white and minority persons and the relation of any such differences to use of services.
The study was based on 1, telephone interviews with white people, black people, Mexican-Americans, and Puerto Ricans living in eight counties of the United States in which Community Research Applications, Inc. CRA had collected data for an earlier study Holmes, et al. The counties were selected for their relatively high proportion of the target ethnic groups 1 and for the availability of the three service modalities of interest in the current study: in-home nursing, homemaker services, and nursing homes.
Three counties were selected for their Mexican-American populations, one for its Puerto Rican population, and four for their black populations. The data were collected by the National Center for Telephone Research, a subsidiary of the Louis Harris organization, which developed a probability sample with quotas within each county.
Contact was made via random digit dialing. Preliminary screening questions estalished the ethnicity of the person answering the telephone and the availability of an adult for the interview. Once the quota for either minority group members or nonminority group members had been reached in each county, additional random contacts were screened out. Table 1 illustrates the breakdown of respondents in each county.
The structured interview schedules were translated into Spanish, and interviews were conducted in Spanish when desired by the respondent. There were virtually no differences in refusal rates among the different groups. The only consistent difference was in length of interview; Southern respondents took far longer to interview than did their northern counterparts. The extent of knowledge about service availability, service provider functions, sources of information about services, and sources of reimbursement including Medicare and Medicaid.
As ly discussed, the sample comprised respondents residing in eight counties across the country. Most counties are similar in in the household, age, and income. The resondents from counties 5 and 8 tended to be older with less income. However, as discussed later, the major differences are between Puerto Ricans and other groups, particularly white people; thus it is unlikely that this regional anomaly has an appreciable impact on study findings.
There were ificant differences among the groups on three of the four descriptive variables.
These differences reflect differences found in the general population; for example, Hispanics were ificantly younger than other groups. This is consistent with the national census figures which show a median age for Hispanics of Bureau of the Census, As Table 7 shows, ificantly more Puerto Ricans 26 percent than members of other groups had been in their community for 2 years or less. Such a goal would require developing matched samples among the various groups, or otherwise controlling for covariates of the major study dimensions. For example, the Puerto Ricans surveyed had resided in their present neighborhood for less time than had White girl or hisp white study counterparts.
This undoubtedly ed for group variance in service information scores. However, the fact remained that more needed to be done to inform Puerto Ricans—the recent arrivals—about community-based services. From a sampling standpoint, it is important to note that sample size was adequate, and every person accessible by telephone in each of the target counties had an equal choice for selection into the study, once the sampling ratio white versus minority was taken into. A key prerequisite to appropriate use of services is knowledge that the services exist.
Respondents were asked whether each of the three service modalities of the study were available in their community. Differences among population subgroups were highly ificant for all three service modalities. Overall, only 40 percent of respondents knew that such a service was available in their communities.
See Table 9. The level of knowledge about the availability of homemaker services was even lower; only 31 percent of respondents knew that this service was available. More than twice as many respondents in each of the other three groups knew about the availability of nursing homes than did the Puerto Rican respondents.
Aside from the marked differences among ethnic groups, it is important to note the differences in awareness of community-based versus institutional long-term care services. Overall, only 40 percent of all respondents were aware of in-home nursing services, and only 31 percent were aware of homemakers, but 66 percent were aware of the availability of nursing homes. Achieving an appropriate solution to a problem demands that the individual have available information regarding possible options.
Coping requires skill in both problem and resource identification. Respondents were asked what an in-home nurse and a homemaker do; they were scored by whether they could name at least one correct function. See White girl or hisp Overall, 39 percent of respondents could not name a single activity or function of an in-home nurse and almost half 47 percent did not know what a homemaker does.
As Table 11 shows, health facilities and physicians or other professionals were most frequently cited as information sources about in-home nursing by all groups. The Department of Social Services was cited as the most common information source about homemaker services by respondents in all four groups.
Overall, although there was some variability across groups in sources of information, there were no consistent patterns. Departments of Social Services, health facilities, and professionals were perceived as the most important gatekeepers to long-term care services when it came to disseminating information.
Relatively small proportions percent of people cited Medicare and Medicaid as potential sources of reimbursement for in-home nursing services Table A high proportion 44 percent reported lack of knowledge regarding sources of reimbursement for in-home nursing. An even higher proportion of respondents 49 percent did not know of any sources of reimbursement for homemaker services. The proportion of people who did not know of sources of reimbursement for nursing homes was smaller than the proportion of people who did not know about sources of reimbursement for community-based services.
Respondents were asked to illustrate their knowledge of Medicare and Medicaid by listing the requirements for eligibility. As Table 13 shows, the majority of the total sample was ignorant in this regard. Overall, 68 percent of the respondents reported lack of familiarity with Medicare eligibility requirements.
There was an even lower level of knowledge about Medicaid; 79 percent of the sample reported lack of knowledge about Medicaid eligibility requirements. Internal consistency, as measured by White girl or hisp alpha, for the item scale is. Table 14 presents item statistics for each group. Although Puerto Ricans and black people were at a particular disadvantage when it came to knowledge of community-based services, the mean score was very low for all groups. The alpha for this six-item scale is. Knowledge of institutional services was also very low among all groups, given a possible score of 6.
Whites were ificantly more knowledgeable than were members of minority groups. Lack of knowledge was one major barrier to service use. Culturally-determined attitudes were hypothesized to be the other major barrier. One oft-cited reason for lower minority use of services was the value placed on family care of the ill elderly and the belief that caregiving is basically a family responsibility.
Minority respondents, especially Puerto Ricans, were over-represented among those who agree with the ethos that services, whether community-based or institutional, are basically for people without families Table Respondents, especially white people, were more likely to feel that homemaker services, rather than in-home nursing, are for people without families, perhaps reflecting an awareness that in-home nursing requires particular skills that might not be available to family members. Whereas only 44 percent of the white people agreed that nursing homes are for those without families, 59 percent of Mexican Americans, 66 percent of the black people, and 71 percent of Puerto Ricans expressed this view.
Overall, approximately half of all respondents agreed that they would feel guilty if a family member were placed in a nursing home. For example, almost two-thirds of the Puerto Ricans and only 40 percent of the white people agreed with this sentiment.
Black people and Mexican-Americans were also more inclined than white people to express reservation regarding placing family members in nursing homes. However, the major differences in orientation occured between white people and Puerto Ricans. A of attitudinal items were developed to explore the importance of ethnic identity and language issues as possible barriers to use of services.
Based on research, ethnicity and language of staff—and, in the case of nursing homes, location—appeared to be key issues. The percentages of people who agreed that nursing homes are not sensitive to the needs of the minority elderly were substantially greater.
In fact, more than half 53 percent of Puerto Ricans agreed with this statement. While ethnicity of staff was of considerable importance, the key issue was language. A large majority of people in all groups agreed that it was important for service providers to speak the same language as their clients.
Ninety-one percent of white people, 88 percent of black people and Mexican Americans, and 87 percent of Puerto Ricans believed that better service is provided if an in-home nurse speaks the same language as the elderly person. There were no ificant differences among groups. White girl or hisp was agreement among 86 percent of each minority group and 89 percent of white people about the importance of the homemaker speaking the same language.
Overall, 82 percent of those interviewed agreed that it is important for staffs of nursing homes to speak the same language as the residents. Given the importance attached to language, it is likely that inability to speak with a staff person in one's own language is a major barrier to service use. There were three additional issues pertinent to nursing homes which were not pertinent to the other two services; ethnicity of other residents, language of other residents, and location of the facility in the elderly person's neighborhood.
Respondents felt that ethnic status of other residents was important. In fact, the response pattern suggested that ethnic status of residents was more important than ethnic White girl or hisp of staff. While only 28 percent of white people said it was important for staff to be of the same ethnic status, 60 percent saw this as important for residents.
Parallel figures among black people were 40 percent staff and 53 percent residentsand among Mexican-Americans, 46 percent staff and 66 percent residents. In the Puerto Rican group, which had the strongest preference for ethnically-similar staff 59 percent76 percent agreed that a nursing home should have persons of the same ethnic status. Ethnicity of residents of staff was less important than language. Overall, 58 percent of the respondents agreed that it is important that a nursing home be located in the elderly person's neighborhood. Several items were developed to measure concerns about service costs.
Most people did not believe that services, whether community-based or institutional, are only for people on welfare. There were differences, however, across ethnic groups in the proportion of people who believed that each service is primarily for those on welfare. Similarly, most people did not think that services are only for the wealthy. More minority members than white people believed that community-based services cost too much for their families.
There was considerable agreement across groups about nursing home costs; approximately half of the respondents in each group believed nursing homes are too costly for them. A scale was constructed to measure attitudes toward use of community resources Table It contained 10 items related to homemaker and in-home nursing services and had a Cronbach's alpha of. A high score indicated positive attitude. White people had the most positive attitude toward community services and black people had the most negative attitude.
A scale was constructed using attitudinal items related to nursing facilities Table Respondents agreed or disagreed with 15 statements related to characteristics of, and sentiments toward, nursing homes. White people had a ificantly more positive attitude and Puerto Ricans a ificantly less positive attitude toward nursing homes.
An activity limitation scale was constructed for entry into the multivariate analyses. Items related to reports of difficulty experienced by an elderly relative in preparing meals, dressing, bathing, controlling bowel and bladder, and the like. The scale alpha is.White girl or hisp
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