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Council for the Advancement of Nursing Science. 2012 National State of the Science Congress on Nursing Research. September 13-15, 2012 Washington Hilton Hotel Washington, DC. Effects of Acculturation and Literacy on Cardiovascular Health of Mexican-American Women.

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Council for the Advancement of Nursing Science

2012 National State of the Science

Congress on Nursing Research

  • September 13-15, 2012

  • Washington Hilton Hotel

  • Washington, DC


Effects of Acculturation and Literacy on Cardiovascular Health of Mexican-American Women

Viola G. Benavente, PhD, RN, CNS

Assistant Professor

Boston College Connell School of Nursing, Chestnut Hill, MA


Funding Disclosures

  • Postdoctoral Fellowship

    • Biobehavioral Nursing Research Training Grant T32 NR007106 NINR/NIH, University of Washington, Seattle

  • Ruth L. Kirschstein National Research Service Award

    • Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research, Grant F31 NR010847 NINR/NIH, University of Pennsylvania, Philadelphia

  • Xi Chapter Research Grant Award

    • University of Pennsylvania, Philadelphia, PA, Sigma Theta Tau International

  • Southeastern Pennsylvania Chapter Research Grant Award

    • American Association of Critical Care Nurses, Philadelphia, PA


Purpose

  • To identify predictors associated with self-reported health-promoting lifestyle behaviors of Mexican-American women in the US for better cardiovascular health:

    • Coronary heart disease (CHD) Knowledge, Perceived health status, Acculturation level, & Literacy

  • To test a multivariate model of the effects of acculturation and literacy levels on cardiovascular health promotion


Disease Prevention

Risk Reduction

CARDIOVASCULAR HEALTH PROMOTION

Physical Activity

Hypertension

Heart-Healthy Nutrition

Dyslipidemia

Less Alcohol

Obesity

Weight Management

Diabetes Mellitus Type 2

Smoking Cessation or Abstinence

Lifestyle Modifications

Therapeutic Management


Significance of the Study

  • Higher CHD health risk

    • Linked to being “Mexican-American,” “female” and “obesity”

  • Burden of living with chronic CHD

    • Equal or greater among US Hispanics

  • Treatment disparities

    • Unevenness and injustice for women and underrepresented ethnic minorities

Source: IOM, 2009; Christian, et al. 2007; AHRQ, 2005; OMH, 2006; Mosca, 2004


Methods

  • Descriptive cross-sectional study design

    • Mexican-American women free of CHD diagnosis, but at-risk

  • Data collection protocol

    • 4 Spanish-translated measures & demographics

    • Enrollment from April 2009 to June 2010

    • 6 Roman Catholic Churches in Northeastern US

  • Data analysis plan

    • Correlation analysis

    • Simple linear regression


Summary of Findings

  • Greater tendency for cardiovascular health promotion behaviors in Mexican-American women was associated with:

    • More CHD knowledge

    • Better self-perceived health status

    • Higher acculturation levels

    • Increased literacy


  • Correlation Matrixa

a Pearson product moment correlation; * Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).


Demographic Effects

  • Age, income, and education had significant effects on predictor variables:

    • Knowledge differences between older and younger women were evident.

    • Older women were more knowledgeable about CHD.

    • Acculturated women earned higher incomes, were better educated, and had increased literacy.


Pearson’s Correlations

CHD Knowledge

Predictor Variables

Perceived Health Status

Outcome Variable

Key Demographic Variables

.311**

.298**

Acculturation Level

Health Promotion Lifestyle Behaviors

Literacy

.355**

.202*

.179*

Age

Income

Education

.416**

.361**

.246**

-.398**

* Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).


CV-Health Promotion Model

CHD Knowledge

Predictor Variables

Perceived Health Status

Outcome Variable

Key Demographic Variables

.298**

.311**

.305**

.495**

Acculturation Level

Health Promotion Lifestyle Behaviors

Literacy

.202*

.179*

Income

Age

.416**

.361**

Education

.246**

.188*

-.398**

* Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).


Clinical Implications

  • In non-English-speaking populations, it is important to assess:

    • Language preference and literacy

    • Health knowledge and perceptions

    • Acculturation and related stress

      • Cultural orientation

      • Generational status

      • Length of US Residency


Study Limitations

  • Causal inferences

    • Study not designed to identify cause and effect

  • Survey instruments

    • Paucity and quality of Spanish-language tools

  • Self-report

    • Accuracy of reading comprehension and memory recall

  • Group homogeneity

    • Can be a study strength


Future Research Directions

  • Further explore causal pathway modeling analysis

  • Instrument refinement/development

    • Non-English-speaking populations

  • Intervention studies

    • Decrease CHD risk and cardiovascular health disparities among Hispanics

    • Culturally-tailored and sex-specific intervention testing


Questions?

Thank You!

¡Gracias!

  • Email: viola.benavente@bc.edu


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