Date of Award

2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Abstract

Methods/Measurements: A cross-sectional correlational design explored the relationships between symptoms, functional status, health perceptions and QoL in women with CVD. The aims of the study were: 1) to determine the relationship of symptoms (depression/anxiety) to functional status (health-promoting behaviors), health perceptions (illness perception), and QoL; and 2) to determine whether age is a factor contributing to negative mood symptoms, functional status, health perceptions, and QoL after controlling for social support. Measurements were collected at one time-point to address these aims that included the following: biological function (Framingham Recurrent Risk Model and Functional Comorbidity Index), symptoms (Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7), functional status (Health-Promoting Lifestyle Profile-II), general health perceptions (Illness Perception Questionnaire-Revised-Cardiac version), QoL (Quality of Life Index-Cardiac version) and social support (Medical Outcomes Study-Social Support Survey). A convenience sample of 81 women aged 35-78 years with CVD were recruited from two cardiology clinic sites within a single health care system in the Chicago west suburbs. The study was approved by the institutional review boards from Advocate Health Care and Loyola University Chicago. Data Analysis: The primary study hypothesis was that negative mood symptoms (depression/anxiety) will be associated with fewer health-promoting behaviors, less perception of risk (illness), and poorer QoL. SPSS Statistics version 25 was used to perform all the analyses. To test the primary hypothesis, the analysis included descriptive statistics on all study variables, correlations, and multiple regression. Correlational analyses demonstrated the following: (1) more depressive symptoms were associated with greater anxiety symptoms (r = .689, p < .01), less health promoting behaviors (r = -.366, p < .01), poorer QoL (r = -.673, p < .01), less social support (r = -.380, p < .01), and greater functional comorbidities (r = .431, p < .01), (2) symptoms of higher anxiety were associated with less health promoting behaviors (r = -.328, p < .01), poorer QoL (r = -.687, p < .01), less social support (r = -.431, p < .01) and greater functional comorbidities (r = .345, p < .01), (3) better QoL was significantly associated with more health promoting behaviors (r = .535, p < .01). When examining illness perception, correlations indicated that greater depressive and anxiety symptoms were associated with: (1) greater number of CVD symptoms (r = .274, p < .05; r = .246, p < .05), (2) less understanding of CVD (r = -.340, p < .01; r = -.322, p < .01), and that (3) CVD caused distress (r = .431, p < .01; r = .522, p < .01). Stepwise multiple regression method was used to determine the variables that predict QoL. Anxiety symptoms ( = -.324 (SE = .120, t = -3.69, p < .001), health promoting behaviors ( = .292 (SE = .014, t = 4.08, p < .001), functional comorbidities ( = -.257 (SE = .119, t = - 3.68, p < .001), illness perception CVD caused distress ( = -.215 (SE = .067, t = -2.80, p < .01), and social support ( = .152 (SE = .026, t = 2.03, p < .05), were significant predictors of QoL. Greater anxiety symptoms, greater functional comorbidities, and the belief that CVD caused distress predicted poorer QoL. Greater health promoting behaviors and greater social support predicted greater QoL. Although depressive symptoms were not a predictor of QoL, there was a trend ( = -.178 (t = -1.85, p = .069) toward poorer QoL. An important finding is that anxiety symptoms ( = -.324) were a greater predictor of poorer QoL than depressive symptoms ( = -.178) in this sample of women. The secondary hypothesis was that women who are younger will have more negative symptoms, fewer health-promoting behaviors, less perception of illness, and lower QoL than women who are older. In order to test this hypothesis, Analysis of covariance (ANCOVA) for social support was used to examine differences between age groups (less than 65 or 65 and older) among the key study variables. The analysis results found that younger women had lower QoL compared to the older women (F(1,78) = 5.81, p < .05). In addition, there was a trend for younger women to have more anxiety symptoms (F(1,78) = 3.41, p = .068) and perceive more emotional distress related to CVD (F(1,78) = 3.86, p = .053). In summary, younger women with CVD reported worse outcomes than older women. These findings support the importance to target the younger women to treatments, such as antidepressant/anti-anxiety medications, education on CVD illness, and health promoting behaviors to increase their overall QoL. Nursing and Healthcare Implications: Overall, findings from this study support the need to identify early detection of negative mood symptoms and implement interventions to promote healthy behaviors, address illness perceptions to improve QoL. Collaborative care models, managed by advanced practice nurses, have been shown to be more effective in improving negative mood, healthy behaviors, and QoL in patients with CVD. Ultimately, advanced practice nurses have the opportunity to develop evidence-based practice guidelines to develop and implement a collaborative care approach to improve women's CVD health and QoL. The overall benefit could potentially reduce CVD secondary events that translate to cost savings to the health care system.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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