CHRONIC CONDITION SELF-MANAGEMENT FOR OLDER AFRICAN AMERICANS: THE CHALLENGE OF COMPLEXITY

Abstract

Abstract Older African Americans have higher rates of comorbidity and face substantive challenges with chronic condition self-management (CCSM), including less effective and supportive CCSM care than their white counterparts. Such disparities in care stem, in part, from physicians’ lack of understanding about challenges older African Americans face as they engage in CCSM. Yet little is known about the CCSM experiences of older African Americans with comorbidity. In this study, we aimed to determine the central dynamics of those experiences. As part of a larger study on African American CCSM and physician empathy, we conducted in-depth qualitative interviews with 30 older African Americans living in Detroit aged 65 years and older with comorbidity. We used grounded theory analysis to distill findings into a core conceptual category as well as component domains and dimensions. “Complexity” emerged as the core category to describe CCSM in our sample. Complexity resides often at the intersection of race, age, and social position making the older African American CCSM experience inherently difficult for those of different races, ages, and social positions to understand. Data illustrate that domains of complexity include "care time", "care roles", "social context", "logistics", "learning", and "pain management". Each domain is composed of 2 to 4 dimensions, further fleshing out the nature of CCSM complexity for older African Americans with comorbidity. Findings provide a basis to enhance understanding and empathy for older African Americans with comorbidity. We discuss how the model will be used to test understanding of older African American CCSM by medical students.