council for the advancement of nursing science
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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. - PowerPoint PPT PresentationTRANSCRIPT
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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 HotelWashington, DC
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Effects of Acculturation and Literacy on Cardiovascular Health of Mexican-American Women
Viola G. Benavente, PhD, RN, CNSAssistant ProfessorBoston College Connell School of Nursing, Chestnut Hill, MA
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Funding DisclosuresPostdoctoral 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 InternationalSoutheastern Pennsylvania Chapter Research
Grant Award◦ American Association of Critical Care Nurses,
Philadelphia, PA
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PurposeTo 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
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Physical Activity
Weight Management
Smoking Cessation or Abstinence
Heart-Healthy Nutrition
Less Alcohol
Lifestyle Modifications
Therapeutic Management
Hypertension
Diabetes Mellitus Type 2
Dyslipidemia
Obesity
CARDIOVASCULAR HEALTH
PROMOTION
DISEASE PREVENTION RISK REDUCTION
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Significance of the StudyHigher 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
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MethodsDescriptive 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
USData analysis plan
◦Correlation analysis◦Simple linear regression
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Sample Description (N = 128)
31 years Median Age, range 20 to 72 years
91.3% Catholic
78.2% Married/partnered
68.0% Education 8 years or less
58.9% Unemployed/homemaker
74.1% Income insufficient to support family
79.4% US residency: 10 years or less
100% Spanish-language preference
77.3% Literacy: No reading/writing assistance
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Spanish Measures M (SD) Range α
Health-Promoting Lifestyle Profile-IICardiovascular Health Promotion 2.31 (.46)
1.32-3.63 (1-4)
.93
Heart Disease Fact Questionnaire
CHD Knowledge
14.70 (4.05) 6-22 (0-25)
.74
Short Acculturation Scale for Hispanics
Acculturation Level
1.46 (.41) 1-5 (1-5)
.44
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Summary of FindingsGreater 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
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Cardiovascular Health Promotion
CHD Knowledge
Acculturation Level
Literacy
Cardiovascular Health Promotion
1
CHD Knowledge .298** 1
Acculturation Level .179* .134 1
Literacy .246** .188* -.085 1
Correlation Matrixa
a Pearson product moment correlation; * Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).
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Demographic EffectsAge, 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.
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Predictor Variables
Perceived Health Status
CHD Knowledge
Acculturation Level
Literacy
Outcome Variable
Health Promotion Lifestyle
Behaviors
Age
Income
Education
Key Demographic Variables .298**
.355**
.246**
.179*
.311**
.202*
.361**
-.398**
.416**
Pearson’s Correlations
* Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).
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CV-Health Promotion Model
* Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).
Predictor Variables
Perceived Health Status
CHD Knowledge
Acculturation Level
Literacy
Outcome Variable
Health Promotion Lifestyle
Behaviors
Age
Income
Education
Key Demographic Variables .298**
.495**
.246**
.179*
.311**
.202*
.361**
-.398**
.416**
.305**
.188*
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Clinical ImplicationsIn 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
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Study LimitationsCausal inferences
◦Study not designed to identify cause and effect
Survey instruments◦Paucity and quality of Spanish-
language toolsSelf-report
◦Accuracy of reading comprehension and memory recall
Group homogeneity◦Can be a study strength
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Future Research DirectionsFurther explore causal pathway
modeling analysisInstrument
refinement/development◦Non-English-speaking populations
Intervention studies◦Decrease CHD risk and
cardiovascular health disparities among Hispanics
◦Culturally-tailored and sex-specific intervention testing