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Health Care Choices

Project Overview

This Health Care Choices Project is applied research which seeks to discover the use of, cost of, and satisfaction with complementary therapy by older adults in rural communities. Interest in the use of complementary therapies, those neither taught widely in medical schools or generally available in hospitals, has increased greatly over the past decade. In 1990, out-of-pocket spending by the U. S. population for complementary therapy exceeded that for hospitalizations. Since that time, complementary therapy has achieved greater acceptance within the health care community and is included in some health care plans. This trend has far-reaching implications for health care professionals because complementary therapy can be effective alone in combination with traditional care, or even contraindicated. Also, use of complementary therapy is not reported to traditional health care professionals by the individual 72% of the time.

Research had not explored the use of complementary therapy in specific populations; therefore, this three-year study targeted the use of complementary therapy by older (60+) rural dwellers. Because complementary therapy is often self-care in nature and is generally provided by non-traditional providers, it is important to explore the question, " What impact does complementary therapy have on the health of older people living in rural areas?" The Aday & Andersen model of health care utilization was used as an organizing framework for this cross-sectional survey of older people living in the rural areas.

A descriptive survey design was employed to address the aims of the study. Twenty rural towns in Montana and North Dakota were randomly selected and potential participants were randomly selected from these towns. Inclusion criteria: 60 years or older with a mailing address and phone listing in one of the selected towns. A total of 325 older adults participated in telephone interviews, 165 from North Dakota and 160 from Montana. Of the 469 households contacted by telephone, 325 participated and 144 declined, for a participation rate of 69.3%. . Logistic regression analysis was used to develop three models explaining the relationship between use of complementary care and a variety other variables. Dependent variables were "use of complementary providers," "use of self-directed complementary care," and "use of any complementary care (providers and/or self-directed care)." Main effects included age, gender, education, marital status, spirituality, and rurality. Interaction terms were added to identify significant interaction among the main effects. In each model, several main effects and interaction terms were found to be significantly associated with use. Odds ratios for significant main effects and interaction terms and clinical implications were presented.

Additional analysis using a portion of the data set was conducted to answer the following research question: What factors predict use of complementary therapy among older rural women? A direct logistic regression analysis was performed on the use of complementary or alternative medicine (CAM) as outcome and eight potential predictors. Data from 156 women were included in this analysis. A total of 25.6% (n = 40) of the women reported using CAM in the recent past. Rural women most likely to use CAM were those who were fairly well-educated, not currently married, andin their early older years. They had one or more significant chronic illnesses and lower health-related quality of life due to emotional concerns.

This study found that many older rural adults use complementary care although the relationship between use and various demographic, sociographic, and health status factors is complicated and nonlinear. Clarifying the use of complementary therapy by older rural adults is particularly relevant since older rural residents have been shown to be more independent, engage in more self-care, have less access to allopathic care, and have a higher prevalence of chronic health conditions than their urban age-mates. By improving the understanding of who is or is not likely to use complementary health care, the results of this study can be used by rural providers in giving comprehensive care for their older clients - including client education about safe and proven methods for meeting health care needs.




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