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Mexican American elders have higher levels of functional impairment and chronic illness, yet they use formal home care services less than do non-Hispanic White elders. This article describes the processes by which Mexican American elders and their caregivers decide to use home care services. Interviews were conducted with Mexican American elders (n = 11) and family caregivers (n = 12) for a sample of 23 individuals. The emerging substantive grounded theory included three stages that described the process of deciding to use home care services: Taking Care of our Own, Acknowledging Options, and Becoming Empowered. The processes describe how Mexican American families eventually accept home care services while maintaining their cultural norm of taking care of elders. The theory gives voice to both elders and caregivers in this process, adds to extant knowledge, and shapes interventions to support traditional Mexican American family values such as elders' staying at home as long as possible. The theory meets nursing's goals of reducing health care disparities by improving or sustaining elders' health and functional ability, decreasing the caregiving burden, and reducing health care costs.

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Teaching online can be particularly challenging when there is a need to immerse students located anywhere in the world in specific environmental contexts. We used the Ecological Psychology Approach to Instructional Design (EPAID) to design four courses in two concentration areas (Border Health, and Workforce and Healthcare Delivery Environments). In each case, we sought to provide students with a virtual first-hand understanding of contexts that they would not experience themselves. In this paper, we describe the major tenets of EPAID, the strategies we used to apply EPAID in the courses, and the results of our initial, formative evaluation.

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