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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

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

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

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

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


Council for the advancement of nursing science

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

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

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

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


Council for the advancement of nursing science

  • Correlation Matrixa

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


Demographic effects

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

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

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

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

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

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

Questions?

Thank You!

¡Gracias!

  • Email: [email protected]


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