Affiliations: [a] Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston/Harris County Hospital District, TX, USA | [b] Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA | [c] Center for Trauma Rehabilitation Research, Harris County Hospital District, Houston, TX, USA | [d] Graduate College of Social Work, University of Houston, Houston, TX, USA | [e] Chronic Disease Prevention and Control Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA | Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
Correspondence:
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Address for correspondence: Allison N. Clark, Ph.D., Brain Injury Research Center, 2323 S. Shepherd, Ste. 907, Houston, TX 77019, USA. Tel.: +1 713 630 0519; Fax: +1 713 630 0529; E-mail: [email protected]
Abstract: The purpose of the current study was to investigate the contribution of caregivers' characteristics to health service utilization by minority persons with first episode stroke. Participants were 61 primary caregivers of minority persons (41% African American; 59% Hispanic) with first episode symptomatic stroke consecutively admitted to an inpatient rehabilitation unit at a county hospital. Caregiver characteristics included resources for daily living, general health, social support, and health beliefs. Health service utilization was defined as the percentage of medical and therapy appointments attended for the first 6 months following discharge from inpatient rehabilitation. There was no difference in percentage of appointments attended between African American and Hispanic caregivers. There was a significant difference between caregivers on the External Control by Powerful Others subscale of the Multidimensional Health Locus of Control Scale (MHLC), with Hispanic caregivers reporting a greater belief that powerful others exerted control over their health. There was a trend for Hispanics to score higher on the External Control by Chance subscale of the MHLC. Results of logistic regression analyses indicated that persons with stroke were less likely to attend appointments if their caregiver believed that health was related to chance factors. These results suggest that caregiver health beliefs play an important role in patient adherence to medical recommendations. Education of caregivers may result in improved follow-through with medical recommendations.
Keywords: Stroke, caregivers, health service utilization, race/ethnicity
