African American Elders' Psycho-Social-Spiritual Healing across Serious Illness

Abstract

Background: Disparities in care for seriously ill African American (AA) elders exist because of gaps in knowledge regarding culturally sensitive physiological, psychological, social, and spiritual needs and preferences. Conceptual Framework: The foundation of culturally sensitive patient-centered PC is formed from social, spiritual, psychological and physical experiences of serious illness. Purpose: Aim 1 was to describe categories and patterns of psych-social-spiritual healing from the perspective of AA elders with serious illness. Aim 2 was to examine the NIH Clinical Center's psych-social-spiritual healing measure as a valid, culturally appropriate measure for this population. Methods: A purposive sample of 28 AA elders with serious illnesses and from the Jackson MS area participated in this study. Aim One used the qualitative method of narrative analysis. Aim Two used cognitive interviewing methodology, including verbal probing and think aloud techniques. Findings: Aim One: Prior experiences, I changed, and Across past, present experiences and future expectations were the three main of the thematic analysis. The thematic categories in prior experiences were: been through it...made me strong, I thought about…others, and went down little hills...got me down. The thematic categories in I changed were: I grew stronger, changed priorities, do things I never would have done, and quit doing. The thematic categories in Across past, present experiences and future expectations were: God did and will take care of me, close-knit relationships, and life is better. The most prevalent theme of God did and will take care of me was divided into subthemes of: God did, God will and developing faith. Aim Two: Of the fifty-three items on the Psychological-Social-Spiritual Healing instrument, thirty-seven items were retained, eight items revised, and eight items deleted. Conclusions: Aim one: The narratives were stories of remarkable strength. This strength was grounded in the participants' "faith" in God that helped the aging seriously ill AA elder "overcome things." Aim Two: Linguistic validity was enhanced with expert input from the seriously ill AA elders. Pragmatic validity, using both the research team and participants' input, improved the content validity. These findings provide evidence towards a more valid and culturally sensitive tool.