Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

Abstract

Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

Social determinants of willingness to discuss end‐of‐life care with family and doctors among Korean American immigrants: Findings from a cross‐sectional survey in Alabama

“…Cronbach's α = 0.65; Taber, 2018) in this sample. The final anlaysis, however, included the variable since social isolation has not been fully studied, despite its important theroretical role, regarding its effect on end‐of‐life‐related outcomes (Noh et al, 2022). Literature on a measure of internal consistency (Hinton, 2004; Taber, 2018; van Griethuijsen et al, 2015) suggests that a convetional adequate value for Cronbach's alpha (i.e.…”

Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE)

“…Financial stressors are associated with decreased awareness of hospice among minority populations and lower utilization of hospice. [20][21][22] The geographic disparity should be studied in more detail to better describe regional differences in end-of-life care in minority populations and ways to mitigate the effects of financial hardship on end-of-life choices.…”

Willingness to Discuss End-of-Life Care Wishes Among Rural Black/African American Residents of the Alabama Black Belt

“…Health literacy score was obtained by adding these four items (range=0–4), and higher scores represented higher levels of health literacy. To assess the literacy specific to end-of-life care, a single yes-or-no question was used to measure hospice awareness: “have you heard of hospice care?” (Noh et al, 2021a).…”

“…To assess the literacy specific to end-of-life care, a single yes-or-no question was used to measure hospice awareness: "have you heard of hospice care?" (Noh et al, 2021a).…”