Although many studies have been published over the past ten years on informal support of dependent elderly, few, if any, have examined the reticence of their caregivers to use formal support services. Further understanding of this phenomenon is required, for it questions the feasability of preventive measures for this population as well as the relationship between formal and informal support systems, considered optimal by government in their efforts to rationalize today's health care services. This article presents a conceptual framework enabling us to better understand the reasons why caregivers of the elderly seldom use formal support services, and discusses health, social and research implications.

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In Canada, the care provided by families occurs in an increasingly multiethnic context. Against this backdrop, the present qualitative study aims to explore the needs/expectations and solutions not only of (female) natural caregivers of an elderly relative hailing from Haiti (presented in terms of tracking cases) but also of remunerated home care providers - all with a view to developing a culturally sensitive service offering. As such, this study works from a conceptual framework centring on the negotiation of a common area of agreement between the stakeholders involved (i.e., natural caregivers and home care providers). To this end, focus groups and individual interviews were conducted among 15 caregivers and 37 home care providers. The three recurrent themes emerging from the data analysis concern, in context, the needs/expectations and solutions surrounding the experience of service use, barriers to use, and the relationships between natural caregivers and home care providers. The statements of both groups evidenced a consistency of views and have thus provided a basis for developing some recommendations acceptable to all stakeholders from the perspective of making culturally-based adjustments to the service offering.