The health practices of homeless women: a causal model

Social Support, Self-Efficacy, and Helplessness Following Myocardial Infarctions

Numerous factors impact patient recovery following an acute myocardial infarction (AMI). Negative emotional outcomes, such as learned helplessness, are predictors of mortality following AMI, though little is known about these relationships. The purpose of this study was to examine the relationships between social support and self-efficacy with learned helplessness in individuals post-AMI. Using a descriptive cross-sectional design, subjects with a diagnosed AMI within 12 months were recruited. Standardized instruments were used to evaluate social support and self-efficacy and their impact on learned helplessness. A statistically significant, direct relationship was found between social support and self-efficacy, and learned helplessness, suggesting that individuals with better social support and self-efficacy experience less learned helplessness within the first year following an AMI. In developing post-AMI treatment plans, health care staff need to consider encouraging a patient's supportive social network and self-efficacy as meaningful interventions against negative emotional outcomes.

Learned Helplessness and Depressive Symptoms Following Myocardial Infarction

Psychosocial factors are known to impact depressive symptoms across clinical populations. Learned helplessness has the potential of affecting depressive symptoms following acute myocardial infarction (AMI), though little is known about this relationship. The purpose of this study was to examine the relationship between learned helplessness and depressive symptoms in patients following an AMI. Using a descriptive cross-sectional design, participants with a diagnosed AMI within the past 12 months were recruited. Standardized instruments and measures were used to evaluate learned helplessness and depressive symptoms. A statistically significant direct relationship was found between learned helplessness and depressive symptoms, suggesting that individuals with higher self-reported levels of learned helplessness also reported more depressive symptoms. These results indicate learned helplessness is associated with depressive symptoms in individuals following an AMI. In developing post-AMI treatment plans, health care staff should focus on psychologic points of intervention to the same extent as physiologic interventions.

An Integrative Review of Positive Health Practices

This study presents an integrative review of published research articles on positive health practices (PHP) as defined by Muhlenkamp and Brown. Using Cooper's guidelines for accomplishing an integrative review, 29 relevant studies concerning PHP were located, reviewed, and critiqued; theoretical and methodological issues emerging from the studies were identified. Directions for future research on PHP are specified. Implications for nursing practice derived from the research findings are addressed.

A model of occupational empowerment for marginalized populations in community environments

Globally there are individuals who are marginalized from mainstream society due to problems such as physical or psychological impairment, poor socio-economic circumstances, and occupational deprivation. Many develop learned helplessness syndrome, rendering them unable to control their lives and their destinies. This paper proposes a Model of Occupational Empowerment for providing services to these community populations. The model, a grounded theory, emerged from our work at a homeless shelter for women and children. Disempowering environments in the past had caused learned helplessness in the women at the shelter. Occupational engagement was used to empower them. We contend that the model may be used to guide occupational therapy practice with marginalized individuals and families in a number of community environments.

Depression, optimism, and positive health practices in young adolescents

Correlations among depression, optimism, and positive health practices were studied in young adolescents. A sample of 131 boys and girls, aged 12 to 14 (M=13.2, SD=.8) completed the Revised Personal Lifestyle Questionnaire, the Center for Epidemiological Studies-Depression Scale, and the Life Orientation Test. A negative correlation (-.47) was found between scores on Depression and Positive Health Practices, and the correlation for scores on Optimism and Positive Health Practices was .52.

A meta-analysis of predictors of positive health practices

PURPOSE

To identify predictors of positive health practices from empirical studies in which the Personal Lifestyle Questionnaire was used.

METHODS

Meta-analysis to determine the magnitude of the relationships between each of the predictors identified and positive health practices. Fourteen predictors of positive health practices were identified in 37 studies published since 1983; a meta-analysis was conducted on 14 predictors.

RESULTS

Eight predictors (loneliness, social support, perceived health status, self-efficacy, future time perspective, self-esteem, hope, and depression) had moderate effect sizes, and six (stress, education, marital status, age, income, and sex) had small effect sizes.

CONCLUSIONS

Findings enable health care professionals and researchers designing intervention studies to use the strongest predictors identified in this meta-analysis to promote positive health practices.

Barriers to Prenatal Care for Homeless Pregnant Women

OBJECTIVE

The purpose of this study was to explore and describe the barriers to prenatal care for homeless pregnant women.

DESIGN

A descriptive survey with written questionnaires.

PARTICIPANTS

About 183 pregnant homeless women live in Northeast Florida in any given month. More than 250 surveys were distributed to homeless pregnant women via agencies that provide shelter and/or services to homeless people in Northeast Florida. Forty-seven surveys were returned, representing 25.7% of the estimated population.

MAIN OUTCOME MEASURE

Barriers to prenatal care were measured using Melnyk's Barriers Scale, a 27-item Likert-type scale.

RESULTS

Of the respondents, 75.61% perceived barriers to prenatal care. Site-related factors were the most significant, followed by provider/client relationship, inconvenience, fear, and cost.

CONCLUSIONS

Although prenatal care is available to all pregnant women in Northeast Florida, barriers to accessing this care for homeless pregnant women are significant and need to be addressed by health care providers and administrators. Additional qualitative study of these issues is warranted.

Factors Influencing Homelessness in Women

The specific aims of the article were to: (i) compare childhood experiences of intimacy and autonomy as they occurred in the families of origin of women who have and women who have not experienced homelessness; (ii) compare social support, reciprocity, and conflict as they occurred in the childhood support networks and in the current support networks of women who have and women who have not experienced homelessness; (iii) examine the relationships between intimacy and autonomy in families of origin and the social support networks from childhood of women who have and women who have not experienced homelessness. Descriptive correlational design: 255 women were interviewed to determine levels of intimacy, autonomy, social support, reciprocity, and conflict in childhood relationships. The ANCOVA models for each of support, reciprocity, and conflict indicated a significant group effect. The post-hoc analysis for support indicated that the homeless group was significantly lower in support and reciprocity and significantly higher in conflict than the never-homeless groups. The never-homeless, never-abused group scored significantly higher on autonomy and intimacy than the homeless or the never-homeless, abused groups. This study demonstrates the significance of families of origin and learning how to develop and utilize support systems in preventing or reducing homelessness.

The revised Personal Lifestyle Questionnaire for early adolescents

The purposes of this study were to revise the Personal Lifestyle Questionnaire (PLQ), a measure of positive health practices, for use with early adolescents and to provide evidence of reliability and validity for the revised PLQ instrument. The sample consisted of 224 seventh and eighth graders who responded to the revised PLQ and instruments measuring three theoretically relevant variables. Relative to the revised PLQ, content validity was established, construct validity was determined by support of three hypotheses derived from theoretical propositions, and a two-factor solution was accepted in factor analysis procedures using principal components analysis with Varimax rotation. Acceptable reliabilities were obtained on the total revised PLQ and Factor 1; the reliability for Factor 2 fell slightly below the acceptable standard.

Can burdened caregivers be effective facilitators of elder care-recipient health care?

BACKGROUND

Caregiving by informal family caregivers of dependent older people in the community may be affected by burden and by the personal and social resources available to the caregiver. Given the increase in the dependent older population, study of factors affecting informal caregiving is necessary.

AIMS

To examine caregiver resources, burden and competence as predictors of health-care facilitation on behalf of older patients.

DESIGN

Cross-sectional data were collected by an interview schedule from 240 randomly sampled spousal and filial caregivers in Jerusalem. Study variables included caregiver background variables, general self-concept and feelings of caregiver competence, informal and formal social support, burden and levels of health-care facilitation. Path analysis was performed to clarify the direct and indirect predictors of health-care facilitation.

RESULTS

Caregiver facilitation of health-care was positively related both to the presence of personal and social resources and to burden levels. The results suggest that quality caregiving can coexist with burden, provided that ample caregiver resources are present. The most important resources were caregiver sense of competence and support from the professional health-care provider.

DISCUSSION

Caregiving burden is not readily reducible, given the chronic nature of older people's health problems. However, caregiver resources can be bolstered, particularly by health professionals. Nurses, who are orientated to holistic family centred care, are especially well-suited for this important intervention.

Social support, self-esteem, and positive health practices of early adolescents

The purpose of this study was to examine the relations of social support and self-esteem to positive health practices in early adolescents. A sample of 148 early adolescents (70 boys and 78 girls), aged 12 to 14 years, attending an urban middle school, responded to The Revised Personal Lifestyle Questionnaire, the Personal Resource Questionnaire 85-Part II, and the Rosenberg Self-esteem Scale in classrooms. A correlation of .59 (p<.05) was found between scores on social support and scores for positive health practices, and a correlation of .44 (p<.05) between scores on the Rosenberg Self-esteem Scale and scores for positive health practices.

Social support and positive health practices

The purpose of this study was to examine the relationships between positive health practices and social support, self-esteem, and optimism. The relationships between social support and self-esteem and between social support and optimism were also examined. Two alternative mediational models. with self-esteem in Model 1 and optimism in Model 2, were tested to help explain the relationship between social support and positive health practices in middle-age adults. The sample of 202 middle-age adults completed a demographic data sheet, the Personal Lifestyle Questionnaire, Personal Resource Questionnaire 85-Part 2, Rosenberg Self-Esteem Scale, and Revised Life Orientation Test. The five correlational hypotheses were supported. Social support, self-esteem, and optimism were all positively related to positive health practices, and social support was positively related to self-esteem and optimism. The two mediational models tested with regression analyses were not supported.

Health disparities among vulnerable populations: evolution of knowledge over five decades in Nursing Research publications

BACKGROUND

Considerable attention has been focused recently on conducting research on the health disparities experienced by some Americans as the result of poverty, ethnicity, and/or marginalized social status. Nursing research has a major role to play in developing this body of knowledge.

PURPOSE

The purpose of this paper is to review the contributions that Nursing Research made through its publications over the last five decades in developing the body of tested knowledge about health disparities in vulnerable groups and to analyze the progress made.

METHODS

Criteria for reviewing the literature were established. All Nursing Research publications between 1952 and 2000 were searched manually, indexes of each year's bound volumes were reviewed, and computer searches were conducted. Included in the review were research reports, research briefs, and methodology articles.

RESULTS

Seventy-nine papers were found that met basic criteria for inclusion. The number of relevant publications increased each decade, with a sizable increase in numbers since 1990, and may be related to the social, political, and economic climate of each decade. The research questions asked and the methods used became more complex over time.

CONCLUSIONS

Nursing Research has made a significant contribution in disseminating the body of tested knowledge related to the health disparities experienced by vulnerable populations and the methodologies associated with vulnerable populations research. Areas for future research are community-based studies, intervention studies that provide tangible resources, and methodologic approaches that involve participants in the research process.

Psychometric evaluation of the personal lifestyle questionnaire for adolescents

The purpose of this study was to provide evidence of validity for the Personal Lifestyle Questionnaire (PLQ), a measure of positive health practices, in a sample of 222 adolescents ages 15-21. Using a priori criteria, it was found that a two-factor solution, resulting from a principal components analysis with an orthogonal rotation, best represented the factor structure of the PLQ for adolescents. Of the two factors, only Factor I demonstrated an acceptable coefficient alpha reliability; this factor was labeled General Health Practices. Evidence of construct validity for the total PLQ was provided by two statistically significant correlations found between the scale and the theoretically relevant variables of perceived health status and symptom patterns. Contrary to expectation, dependency was not related to positive health practices. A post hoc analysis indicated that Factor I correlated significantly with perceived health status and symptom patterns. The results support the use of Factor I, consisting of 13 items, as a measure of general health practices with adolescents.

Research with homeless people uncovers a model of health

This grounded theory research study, explored health experiences of 11 homeless persons in shelters in three New Brunswick cities and the strategies that they used to attain, maintain, or regain health. Audiotaped interviews were conducted, transcribed verbatim, and analyzed. The model that emerged from analysis consists of three pathways to health. This model of health has two central components, person and health. Person is influenced directly by family values and beliefs, and directly and indirectly by societal values and beliefs. Health is the outcome and is reached through two mediating factors of lifestyle behaviors and sector services. The first pathway to health contains the mediating factor of lifestyle behaviors, the second contains the mediating factor of sector services, and the third contains both mediating factors. Pathway strategies of choosing, accessing, and appraising appropriateness of methods influence the active participation of the person that directs the action within the model. Implications of the study include that a fragmented system of help hinders access to services intended to promote health in this population.

Resourcefulness and health practices of diabetic women

More than one fourth of the millions of Americans with Type 2 diabetes experience depression, of which two thirds are women. Unless the individual is resourceful, coexisting diabetes and depression adversely affect one' health practices. The effects of diabetic and depressive symptoms on health practices and the mediating and moderating role of learned resourcefulness in this relationship were examined in 90 women with Type 2 diabetes. Regression analyses showed direct negative effects of diabetic and depressive symptoms on health practices. The effects of depressive, but not diabetic, symptoms were partially mediated by resourcefulness; no moderating effects were found. The results suggest the need to test interventions to minimize symptoms associated with diabetes, particularly depression. Teaching resourcefulness to Type 2 diabetic women may promote their positive health practices by minimizing their depression.

Codependency and related health variables

Codependency is a controversial concept especially for feminist scholars who are concerned about pathologizing traditional female roles. This study's purpose was to determine: (1) the prevalence of codependency in a sample of older women who because of age may ascribe to traditional roles; (2) how the Hughes-Hammer/Martsolf theoretical model of codependency relates to other health variables; and (3) whether previous findings about the relationship between codependency and depression replicate. Survey design was used with a sample of 238 women (ages 65 to 91) attending a flu shot clinic. Subjects completed the Codependency Assessment Tool, Beck Depression Inventory, Quality of Life Scale, Perceived Health Report, Measurement of Patient Functional Abilities, and Illness Prevention Screening Behaviors Checklist. Of these women, 99% had low codependency scores. Statistically significant correlations existed between codependency and perceived health (p < .01), and functional ability (p < .01). Codependency was not significantly correlated with illness prevention behaviors and quality of life. Codependency and depression, as in previous studies, were significantly correlated (r = .446, p = .0001). Using analysis of variance, 3 codependency subscales had significant positive effect on depression: Low Self-Worth, Medical Problems, and Hiding Self. Further studies should examine the degree of ascribing to traditional female roles in women dealing with codependency issues.

Psychosocial predictors of current drug use, drug problems, and physical drug dependence in homeless women

We examined risk and protective factors associated with three qualitatively different drug use constructs describing a continuum of drug use among a sample of 1,179 homeless women. Relationships among positive and negative sources of social support, positive and negative coping strategies, depression, and the drug constructs of current drug use, drug problems, and physical drug dependence were assessed using structural equation models with latent variables. Current drug use was predicted by more negative social support (from drug-using family/friends), depression, and less positive coping. Drug Problems were predicted by more negative coping, depression, and less positive coping. Physical Drug Dependence was predicted by more negative social support and depression, and less positive social support. Results highlighted the importance of investigating both the positive and negative dimensions of psychosocial functioning, while suggesting that empowering homeless women and offering tangible resources for coping with the stress of being homeless may be beneficial to them.