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Concordance of race/ethnicity of interventionists and caregivers of dementia patients: relationship to study outcomes

McGinnis, Kathleen (2014) Concordance of race/ethnicity of interventionists and caregivers of dementia patients: relationship to study outcomes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Purpose: To assess the effects of racial/ethnic concordance between caregivers and interventionists on several study outcomes in a multisite randomized clinical trial with racially/ethnically diverse caregivers and interventionists.
Design and Methods: Family caregivers of patients with Alzheimer’s disease were randomized to intervention or control groups at 5 sites from 2002 to 2004. Interventionists provided tailored multicomponent interventions aimed at improving quality of life in 3 racial/ethnic caregiver groups. This analysis included the 323 caregivers assigned to the intervention group and a subgroup of those who received at least one face-to-face intervention. To examine the relationship of concordance with outcomes, the following outcomes were modeled using random effects logistic and linear mixed models, as appropriate: loss to follow-up, mean changes in burden, problems, depression, and social support, number of sessions attended, and satisfaction with the study. The main models included the covariates concordance, caregiver gender/ race/ethnicity, and interventionist race/ethnicity and interventionist was specified as the random effect.
Results: White caregivers were more likely to have at least one face-to-face intervention than African-American or Hispanic caregivers. Of those who received a face-to-face intervention, concordance was not statistically significantly associated with any of the outcomes examined. There were some differences in outcomes by caregiver gender/race/ethnicity. Based on the main multivariate model, mean change in problems was statistically significantly greater (worse) for African-American men than for white women (p=.010), African-American women (p=.03), white men (p=.004), Latina women (p=.002), and Latino men (p=.004). African-American men and Latino/a men and women were more likely to report higher satisfaction with the study compared to white men and women and African-American women.
Conclusions: No overall differences were found in outcomes by racial/ethnic concordance between caregivers and interventionists. Out of the seven outcomes, we found a difference by race/ethnicity for only two outcomes. Problems became worse for African-American males compared to African-American females and white males and females and satisfaction was higher for African-American males compared to African-American women and white men and women. Research studies need to continue to address the disparity in outcomes by participant race/ethnicity.
Public Health Significance: To eliminate racial/ethnic disparities in health, these disparities also need to be evaluated and eliminated in health research settings.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSharma, Ravi K.rks1946@pitt.eduRKS1946
Committee MemberRicci, Edmund Memricci@pitt.eduEMRICCI
Committee MemberSchulz, Richardschulz@pitt.eduSCHULZ
Committee MemberStone, Roslyn Aroslyn@pitt.eduROSLYN
Date: 27 June 2014
Date Type: Publication
Defense Date: 20 March 2014
Approval Date: 27 June 2014
Submission Date: 6 April 2014
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 101
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: DrPH - Doctor of Public Health
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: racial disparities
Date Deposited: 27 Jun 2014 20:37
Last Modified: 15 Nov 2016 14:17


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