History of major depression as a barrier to health behavior changes after a chronic disease diagnosis

Predictors of an Active Lifestyle in Middle-Aged and Older Adults with HIV in the United States Deep South

Background and Purpose

An active lifestyle is important for health maintenance and disease prevention. This study was to examine what factors predict an active lifestyle in HIV+ and HIV- adults from the United States Deep South.

Methods

The sample included 279 participants (174 HIV+ and 105 HIV-) who completed a comprehensive assessment. An active lifestyle composite was created using variables of employment status, level of social support, level of physical activity, and diet. Correlations and regression analyses were conducted between the active lifestyle composite and possible predictors for all (HIV+ and HIV-), HIV+, and HIV- participants, respectively.

Results

Lower levels of depression, higher socioeconomic status (SES), and younger age were significant predictors of a more active lifestyle for the full sample, HIV+, and HIV- participants, respectively.

Conclusion

SES and depression represent important factors influencing engagement in an active lifestyle in PLWH. Such factors should be considered when developing and implementing lifestyle interventions.

Experiences of midlife and older African American men living with type 2 diabetes

OBJECTIVE

Type 2 Diabetes Mellitus (T2DM) is a complicated disease that disproportionately affects African American men. Understanding the experiences of African American men living with T2DM is important for developing effective, culturally sensitive interventions. The purpose of this study was to describe how African American men view their T2DM and describe their perspectives on living with and self-managing T2DM.

DESIGN

In-depth semi-structured qualitative interviews were conducted with 22 African American men aged 40-85 years diagnosed with T2DM. Interviews were transcribed and analyzed using NVivo 10 with thematic analysis.

RESULTS

Disbelief, shock, and denial were commonly experienced reactions at initial diagnosis. Many participants defined diabetes using words such as 'sugar' or 'glucose' and reported an awareness of health complications caused by diabetes, such as amputations and diabetic comas. Participants expressed various perspectives and attitudes towards having diabetes, including avoidance/apathy, fatalism, guilt and shame, fear and concern, and self-mastery. The majority of men described efforts to self-manage diabetes via glucose monitoring, changing dietary habits, and exercise. Many participants expressed concern over the financial burden associated with managing diabetes and reported that high costs can hinder a patient's ability to maintain active self-monitoring and deter patients from attending needed doctor's visits. Many participants expressed confidence in their healthcare providers, although a few expressed feelings of distrust and being uninformed. Participants tended to most appreciate physicians who spent time discussing their condition and who made an effort to engage in open patient-provider communication.

CONCLUSION

Living with diabetes can be emotionally, physically, and mentally challenging. Efforts to improve adoption and maintenance of self-management behaviors may benefit from sensitivity to the patient's attitude and perspectives towards diabetes self-management, assistance overcoming the financial burden of managing diabetes, and open patient-provider communication.

The associations among illness perceptions, resilient coping, and medication adherence in young adult hypertensive black women

Hypertension, a modifiable risk factor of cardiovascular disease, is largely responsible for the disproportionate morbidity and mortality in black women. Black women 20 years of age and older have a higher prevalence of HTN compared to white women (44% vs 28%). Poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in cardiovascular disease morbidity and mortality experienced by black people. The purpose of this study was to examine medication adherence in black women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive, and behavioral factors. This was a prospective, descriptive cross-sectional study of N = 85, hypertensive black women, with mean age of 39 ± 5.4 years, 18-45 years of age. Variables and measures included: sociodemographic characteristics, clinical, adverse social stressors, psychosocial, cognitive-behavioral factors, and medication adherence. Descriptive statistics, correlations, multivariate logistic regressions, and moderation analysis were tested. 81.2% (n = 69) of the sample was categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. HTN illness perceptions, composite score, resilient coping, depressive symptoms, exposure to lifetime gender, and racial stressors, were not associated with HTN medication adherence. Using multivariate logistic regression, decreased SBP and lower scores on the "Consequence" dimension of the HTN illness perception scale were associated with medication adherence (χ2  = 10.53, P = .001). Adherence was associated with both the "Consequence" and "Identity" dimensions of the HTN illness perception scale indicating the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.

Associations between psychological distress and health-related behaviors among adults with chronic kidney disease

Chronic kidney disease (CKD) affects 15% of the US general population, and this rate is projected to increase. A healthy lifestyle is important for individuals with CKD to reduce risk for CKD progression and adverse heath events. Adults with CKD also have high rates of psychological distress, which may be associated with unhealthy behaviors. Using the 2013-2017 public use data files of the US National Health Interview Survey, we compared health behaviors (smoking, alcohol use, and physical activity [PA]) and psychological distress (assessed with the Kessler-6 scale) between adults with a CKD diagnosis in the preceding year and a matched sample of adults without a CKD diagnosis. We then examined the association between psychological distress and health behaviors among adults with CKD (n = 3923) using multinomial logistic regression models. Compared to those without CKD, those with CKD had lower rates of smoking, heavy alcohol use, and engagement in any type of PA 3+ times a week and higher rates of psychological distress. In addition to the health concerns posed by the high smoking rate (17%) and low physical activity rate (34%) among those with CKD, smoking and lack of PA were associated with greater risk of mild-moderate and/or serious psychological distress. Compared to no unhealthy behaviors, 2-3 unhealthy behaviors were associated with 4.72 (95% CI = 2.97-7.48) times greater risk of serious psychological distress. Adults with CKD and unhealthy behaviors need help with lifestyle modifications and assessment and treatment of psychological distress to reduce CKD progression and prevent other health complications.

The relationship between self-esteem, sense of self-efficacy and level of illness acceptance, and healthful behaviours in patients with long-term illnesses (type II diabetes, Hashimoto’s disease)

Background

Hashimoto thyroiditis and type II diabetes are chronic diseases which have adverse consequences impacting emotional and cognitive functioning. Healthful behaviours focused on improvement of one’s health or on combating the illness play a key role in psychosocial functioning of a person, particularly one suffering from a long-term illness. The aim of the research was the measurement and analysis of healthful behaviours and the distinction of variables determining healthful behaviours. We attempted to examine the connection between adhering to healthful behaviours, and the level of illness acceptance, self-efficacy and self-esteem, in terms of exhibiting healthful behaviours in the above-mentioned groups of patients.

Participants and procedure

The study group consisted of 140 persons (70 persons with type II diabetes, 70 persons with Hashimoto’s disease). The following measurement techniques were used: the Health Behaviour Inventory by Z. Juczyński, the General Self-Efficacy Scale by R. Schwarzer and M. Jerusalem adapted for Polish by Z. Juczyński, the Acceptance of Illness Scale by B. J. Felton, T. A. Revenson and G. A. Hinrichsen, and the Self-Esteem Scale by M. Rosenberg.

Results

The results show that for the group of type II diabetes patients self-efficacy constitutes a statistically significant moderate positive predictor of psychological attitude and appropriate eating habits, and is a positive weak predictor of general healthful behaviour and prophylaxis at the tendency level. For Hashimoto’s sufferers the sense of self-efficacy is a statistically significant moderate predictor of healthful behaviours.

Conclusions

The study investigated significant relations between the level of illness acceptance, the sense of self-efficacy and self-esteem, and engagement in healthful behaviour. The sense of self-efficacy determines higher healthful practices in both research groups. The study allowed for a comparison of two groups of long-term illnesses sufferers – type II diabetes, and Hashimoto’s disease – in terms of adhering to healthful behaviours, and dependencies between selected psychological variables and patients’ preferred healthful behaviours.