Abstract
The average older adult reaches age 65 with at least two chronic, co-occurring illnesses, or multiple morbidities (MM). We currently lack critical information about the specific strategies older adults use to attempt to control these MM. To increase our understanding of how older adults attempt to manage these MM and retain control of their health, in-depth interviews were conducted with 41 Black and White middle aged and older men and women with MM. We were particularly interested in representing the experience of those groups more vulnerable to adverse health outcomes due to greater disease prevalence and low income. During in-depth interviews, we asked open-ended questions on life and health history and open-ended and semi-structured questions about self-care for multiple morbidities. Participants expressed a strong desire to remain in control of their health; to do so they employed a wide range of strategies including cognitive structuring techniques (being health vigilant, normalizing, resignation/relinquishing control, and social comparison), self-care activities (emphasizing diet, exercise, medication taking, modifying existing activities, going to the doctor), and faith orientations (prayer as a constructive support strategy, gaining strength from God, church as a central part of life). With the exception of faith orientations, there were no race/ethnicity differences in the strategies participants use. Future studies should expand on this knowledge by exploring the contextual, cultural, and psychological backdrop and characteristics that shape the use of these coping strategies.
Similar content being viewed by others
Notes
We use the term “multiple morbidity” (MM) to describe the co-occurrence of two or more chronic illnesses, as opposed to “comorbidity” in which conditions are linked with an index disease under study. We use this term since we are not referring to any specific coexisting illness
References
Affleck, G., Tennen, H., Pfeiffer, C., & Fifield, J. (1987). Appraisals of control and predictability in adapting to a chronic disease. Journal of Personality and Social Psychology, 53(2), 273–279. doi:10.1037/0022-3514.53.2.273.
Ai, A. L., Peterson, C., Rodgers, W., & Tice, T. N. (2005). Effects of faith and secular factors on locus of control in middle-aged and older cardiace patients. Aging & Mental Health, 9(5), 470–481. doi:10.1080/13607860500142804.
Bandura, A. (1982). Self-efficacy mechanism in human agency. The American Psychologist, 37(2), 122–147. doi:10.1037/0003-066X.37.2.122.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (1989). Social cognitive theory. In R. Vasta (Ed.), Annals of child development. Six theories of child development (vol. Vol. 6, (pp. 1–60)). Greenwich, CT: JAI.
Bandura, A. (2003). On the psychological impact and mechanisms of spiritual modeling. The International Journal for the Psychology of Religion, 13(3), 167–173. doi:10.1207/S15327582IJPR1303_02.
Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143–164. doi:10.1177/1090198104263660.
Barry, L. C., Kerns, R. D., Guo, Z., Duong, B. D., Iannone, L. P., & Reid, M. C. (2004). Identification of strategies used to cope with chronic pain in older persons receiving primary care from a veterans affairs medical center. Journal of the American Geriatrics Society, 52, 950–956. doi:10.1111/j.1532-5415.2004.52263.x.
Bayliss, E. A., Steiner, J. F., Fernald, D. H., Crane, L. A., & Main, D. S. (2003). Descriptions of barriers to self-care by persons with comorbid chronic diseases. Annals of Family Medicine, 1(1), 15–21. doi:10.1370/afm.4.
Becker, G., & Newsom, E. (2005). Resilience in the face of serious illness among chronically ill African Americans in later life. Journal of Gerontology: Social Sciences, 60B(4), S214–S223.
Bell, R. A., Passaro, K., Lengerich, E., & Norman, M. (1997). Preventive care knowledge and practices among persons with diabetes mellitus—North Carolina, behavioral risk factor surveillance system, 1994–1995. Morbidity and Mortality Weekly, 46, 1023–1026.
Blaxter, M. (1990). Health and Lifestyles. NY: Routledge.
Broom, D., & Whittaker, A. (2004). Controlling diabetes, controlling diabetics: moral language in the management of diabetes Type 2. Social Science & Medicine, 58(11), 2371–2382. doi:10.1016/j.socscimed.2003.09.002.
Chatters, L. (2000). Religion and health: public health research and practice. Annual Review of Public Health, 21, 335–367. doi:10.1146/annurev.publhealth.21.1.335.
Cherry, D., & Woodwell, D. (2002). National Ambulatory Medical Care Survey: 2000 Summary. Advance Data, 328, 1–32.
Conner, T. S., Tennen, H., Zutra, A. J., Affleck, G., Armeli, S., & Fifield, J. (2006). Coping with rhrumatoid arthritis pain in daily life: Within-person analyses reveal hidden vulnerability for the formerly depressed. Pain, 126(1–3), 198–209. doi:10.1016/j.pain.2006.06.033.
Creswell, J. (1998). Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Thousand Oaks, CA: Sage.
DeCoster, V. A., & Cummings, S. (2004). Coping with Type 2 Diabetes: Do race and gender matter? Social Work in Health Care, 40(2), 27–53.
Duncan, C. (1999). World's Apart: Why poverty persists in rural America. New Haven, CT: Yale University Press.
Ellison, C. G., & Sherkat, D. E. (1995). The "semi-involuntary institution" revisited: regional variations in church participation among black Americans. Social Forces, 73, 1415–1437. doi:10.2307/2580453.
Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Medical Care, 40(1), 52–59. doi:10.1097/00005650-200201000-00007.
Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. Journals of Gerontology: Biological and Medical Sciences, 59(3), 255–263.
Gantt, L. (2002). As normal a life as possible: Mothers and their daughters with congenital heart disease. Health Care for Women International, 23, 481–491.
Guralnick, J. M. (1996). Assessing the impact of comorbidity in the older population. Annals of Epidemiology, 6, 376–380. doi:10.1016/S1047-2797(96)00060-9.
Harvey, I. S. (2006). Self-management of a chronic illness: An exploratory study on the role of spirituality among older African American women. Journal of Women & Aging, 18(3), 75–88. doi:10.1300/J074v18n03_06.
Harvey, I. S., & Silverman, M. (2007). The role of spirituality in the self-management of chronic illness among older African and Whites. Journal of Cross-Cultural Gerontology, 22, 205–220. doi:10.1007/s10823-007-9038-2.
Haynes, R. B., McDonald, H., & Garg, A. X. (2002). Helping patients follow prescribed treatment. Journal of the American Medical Association, 288, 2880–2883. doi:10.1001/jama.288.22.2880.
Helgeson, V. S., & Franzen, P. L. (1998). The role of perceived control in adjustment to diabetes. Anxiety, Stress, and Coping. International Journal (Toronto, Ont.), 11(2), 113–136.
Jette, K. (2002). Making the connection: seeking and receiving help by elderly African–Americans. Qualitative Health Research, 12, 373–387. doi:10.1177/104973202129119955.
Joachim, G., & Acorn, S. (2000). Living with chronic illness: The interface of stigma and normalization. Canadian Journal of Nursing Research, 32(3), 37–48.
Kane, R. L., Preister, R., & Totten, A. (2005). Meeting the challenge of chronic illness. Baltimore: Johns Hopkins University Press.
Konrad, T. R. (1998). The patterns of self-care among older adults in western industrialized societies. In M. G. Ory, & G. H. DeFries (Eds.), Self-care in later life: Research, programs and policy issues (pp. 1–23). New York: Springer.
Krause, N. (2006). Religion and health in later life. In J. E. Birren, & K. W. Shaie (Eds.), Handbook of the Psychology of Aging (pp. 499–518). San Diego: Academic.
Levin, J. S., Taylor, R. J., & Chatters, L. M. (1994). Race and gender differences in religiosity among older adults: findings from four national surveys. Journal of Gerontology: Social Sciences, 49, S137–S145.
Li, W. W., Stewart, A. L., Stotts, N., & Froelicher, E. S. (2006). Cultural factors associated with antihypertensive medication adherence in Chinese immigrants. The Journal of Cardiovascular Nursing, 21(5), 254–362.
Loeb, S. J. (2006). African American older adults coping with chronic health conditions. Journal of Transcultural Nursing, 17(2), 139–147. doi:10.1177/1043659605285415.
Loeb, S. J., Penrod, J., Falkenstern, S., Gueldner, S. H., & Poon, L. W. (2003). Supporting older adults living with multiple chronic conditions. Western Journal of Nursing Research, 25(1), 8–29. doi:10.1177/0193945902238830.
Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Bandura, A., Ritter, P., et al. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care, 37(1), 5–14. doi:10.1097/00005650-199901000-00003.
Lynch, J. W., Kaplan, G. A., & Salonen, J. T. (1997). Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Social Science & Medicine, 44(6), 809–819. doi:10.1016/S0277-9536(96)00191-8.
Ma, J., Urizar, G. G., Alehegn, T., & Stafford, R. S. (2004). Diet and physical activity counseling during ambulatory care visits in the United States. Preventive Medicine, 39(4), 815–822. doi:10.1016/j.ypmed.2004.03.006.
McMullen, C. K., & Luborsky, M. R. (2006). Self-rated health appraisal as cultural and identity processes: African American elders’ health and evaluative rationales. The Gerontologist, 46(4), 431–438.
Morecroft, C., Cantrill, J., & Tully, M. P. (2006). Individual patient’s preferences for hypertension management: a Q-methodological approach. Patient Education and Counseling, 61(3), 354–362. doi:10.1016/j.pec.2005.04.011.
Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal of Advanced Nursing, 54(2), 151–158. doi:10.1111/j.1365-2648.2006.03799.x.
Narayanasamy, A. (2002). Spiritual coping mechanisms in chronically ill patients. British Journal of Nursing (Mark Allen Publishing), 11(22), 1461–1470.
Ory, M., DeFriese, G., & Duncker, A. (1998). Introduction: The nature, extent and modifiability of self-care behaviors in later life. In D. M. Ory, & G. H. DeFriese (Eds.), Self-Care in later life, (pp. xv–xxvi). NY: Springer.
Penrod, J., Gueldner, S. H., & Poon, L. W. (2003). Managing multiple chronic health conditions in everyday life. In B. M Sprouse, L. W. Poon, & S. H. Gueldner (Eds.), Successful Aging and Adaptation with Chronic Disease, (pp. 181–208). NY: Springer.
Rijken, M., van Kerkhof, M., Dekker, J., & Schellevis, F. G. (2005). Comorbidity of chronic disease. Quality of Life Research, 14, 45–55. doi:10.1007/s11136-004-0616-2.
Roberto, K. A., Gigliotti, C. M., & Husser, E. K. (2005). Older women’s experiences with multiple chronic conditions: daily challenges and care practices. Health Care for Women International, 26, 672–692. doi:10.1080/07399330500177147.
Samuel-Hodge, C. D., Headen, S. W., Skelly, A. H., Ingram, A. F., Keyserling, T. C., Jackson, E. J., et al. (2000). Influences on day-to-day self-management of type 2 diabetes among African–American women. Diabetes Care, 23, 928–933. doi:10.2337/diacare.23.7.928.
Schoenberg, N. (1997). A convergence of health beliefs: an ethnography of adherence of African–American rural elders with hypertension. Human Organization, 56(2), 174–181.
Schoenberg, N. E., & Drungle, S. (2001). Barriers to non-insulin dependent diabetes mellitus (NIDDM) self-care practices among older women. Journal of Aging and Health, 13(4), 443–466. doi:10.1177/089826430101300401.
Silverman, M., Musa, D., Kirsch, B., & Siminoff, L. A. (1999). Self-care for chronic illness: older African Americans and white. Journal of Cross-Cultural Gerontology, 14(2), 169–189. doi:10.1023/A:1006676416452.
Smithson, J. (2000). Using and analyzing focus groups: limitations and possibilities. International Journal of Social Research Methodology, 3(2), 103–119. doi:10.1080/136455700405172.
Stoller, E., Forster, L. E., & Portugal, S. (1993). Self-care responses to symptoms by older people: A health diary study of illness behavior. Medical Care, 31(1), 24–42. doi:10.1097/00005650-199301000-00002.
Streubert-Speziale, H. J., & Carpenter, D. R. (2003). Qualitative Research in Nursing: Advancing the Humanistic Imperative (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.
Taylor, R. J., Chatters, L. M., Jayakody, R., & Levin, J. S. (1996). Black and white differences in religious participation: a multisample comparison. Journal for the Scientific Study of Religion, 35(4), 403–410. doi:10.2307/1386415.
Taylor, L. F., Kee, C. C., King, S. V., & Ford, T. A. (2004). Evaluating the effects of an educational symposium on knowledge, impact, and self-management of older African Americans living with osteoarthritis. Journal of Community Health Nursing, 21(4), 229–238. doi:10.1207/s15327655jchn2104_3.
Townsend, A., Wyke, S., & Hunt, K. (2006). Self-managing and managing self: Practical and moral dilemmas in accounts of living with chronic illness. Chronic Illness, 2, 185–194.
Weisz, J. R. (1986). Contingency and control beliefs as predictors of psychotherapy outcomes among children and adolescents. Journal of Consulting and Clinical Psychology, 54(6), 789–795. doi:10.1037/0022-006X.54.6.789.
White, R., Tata, P., & Burns, T. (1996). Mood, learned resourcefulness, and perceptions of control in type 1 diabetes mellitus. Journal of Psychosomatic Research, 40(20), 205–212. doi:10.1016/0022-3999(95)00515-3.
Williams, D. R. (1999). Race, socioeconomic status, and health: the added effects of racism and discrimination. Annals of the New York Academy of Sciences, 896, 173–188. doi:10.1111/j.1749-6632.1999.tb08114.x.
Williams, D. R., & Rucker, T. D. (2000). Understanding and addressing racial disparities in health care. Health Care Financing Review, 21, 75–90.
Williams, D. R., & Wilson, C. M. (2001). Race, Ethnicity, and Aging. In R. H. Binstock, & L. K. George (Eds.), Handbook of Aging and the Social Sciences (pp. 160–178). San Diego: Academic.
Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162(20), 2269–2276. doi:10.1001/archinte.162.20.2269.
World Health Organization (1983). Health education in self-care: Possibilities and limitations. Geneva: World Health Organization.
Wu, S. Y., & Green, H. Y. (2000). Projection of chronic illness prevalence and cost inflation. Washington, DC: RAND Health.
Acknowledgements
This research was supported by the Department of Behavioral Science at the University of Kentucky. We also acknowledge the contributions of Michelle Johnson, William Edwards, Heather Wallace, Joy Jacobs–Lawson and, most especially, the 41 elders who gave generously of their time.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Partial list of questions asked during in-depth interviews:
Please tell me about your health these days.
Probes:
What illnesses do you have?
What do you do to take care of these illnesses?
For each disease, the following questions were asked:
What do you do to take care of it?
Do you do these things on a daily basis?
Do you consider the illness serious?
We hear a lot about people say that it is difficult to deal with more than one illness. Would you say this is true for you? What are the most difficult parts of caring for more than one disease?
I’d like to ask you now to think about all of the things you do to take care of your disease/health condition on a typical day, from when you wake up to when you go to bed. This would include the meals that you eat, any exercise or pills you take, medical care you get, etc.
Rights and permissions
About this article
Cite this article
Leach, C.R., Schoenberg, N.E. Striving for Control: Cognitive, Self-Care, and Faith Strategies Employed by Vulnerable Black and White Older Adults with Multiple Chronic Conditions. J Cross Cult Gerontol 23, 377–399 (2008). https://doi.org/10.1007/s10823-008-9086-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10823-008-9086-2