Access Type

Open Access Dissertation

Date of Award

January 2019

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Debra Schutte

Abstract

ABSTRACT

PERSONAL SATISFACTION, CARDIOVASCULAR DISEASE RISK, AND HEALTH PROMOTING BEHAVIOR AMONG ARAB AMERICAN MIDDLE-AGED WOMEN

by

RNDA I. ASHGAR

MAY 2019

Advisor: Dr. Debra Schutte Major: Nursing

Degree: Doctor of Philosophy

Purpose and Background/Significance: Cardiovascular disease (CVD) is the number one leading cause of death among middle-aged women. It was estimated that CVD causes 1 in 3 deaths each year, or one woman each minute. The purpose of this study was to examine the impact of personal satisfaction on CVD risk and health promoting behavior (HPB) among Arab American middle-aged women. The specific aims of this study were:

1) Specific Aim 1. To describe the prevalence of personal satisfaction (self-satisfaction, life satisfaction, and health satisfaction), HPB, and CVD risk among Arab American middle-aged women.

2) Specific Aim 2. To investigate the relationship among personal satisfaction, HPB, and CVD risk among Arab American middle-aged women.

Theoretical Framework: King’s Conceptual System was used to examine the association among personal satisfaction, HPB, and CVD risk. Personal system dimensions from King’s conceptual system that were meaningful to this phenomenon are perception and growth and development. The middle-aged woman was viewed as personal system who is multidimensional and in constant interaction with their environment -internal and external- to achieve a state of health and to be able to function in their socially respective roles. Therefore, environmental and health were also two main concepts from King’s Conceptual System that were utilized in this theoretical framework. Personal satisfaction was consistent with the concept of perception from King’s Personal System, growth and developmental factors were consistent with growth and development dimension, HPB was consistent with the external environmental factors, and CVD risk was consistent with health from King’s Conceptual System.

Method: The design was a non-experimental correlational design. A convenience sample of 114 Arab American middle-aged women was recruited from two clinical sites: a private primary care clinic and the Arab Community Center for Economic and Social Services (ACCESS) in Dearborn, MI to detect a medium effect size (ES = .15) at a power of 0.80 and for Alpha of 0.05. Inclusion criteria were: (a) female between 40 and 65 years old; (b) self-identify as Arab American; (c) having the following information in their medical records within the last six months: SBP, DBP, fasting blood glucose level, total cholesterol level, and HDL, (d) not diagnosed with CVD; (e) and not diagnosed with or taking medications for mental illness or disorder. Participants completed a demographic questionnaire, the Health-Promoting Lifestyle Profile-II, the Multidimensional Scale of Perceived Social Support, the Satisfactory with Life Scale, the Rosenberg Self-Esteem Scale, and the single item for health-satisfaction. Biomarker data for ACC/AHA 10-year ASCVD were taken from participants’ medical records. Data were analyzed using correlational and multiple linear regression analyses.

Results: Women in this study had a mean age of 49.90 (SD= 6.99). Most of them had their last menstrual period this month, last month or within three months ago (53.3%), and had a regular menstrual cycle before the age of forty (73.7%). The majority of women were married (74.6%), had less than $20,000 annual income (67.5%), had less than high school education (56.1%), had children (94.7%), were not smoker (80%), were not employed (78.1%), and preferred the Arabic language for the survey (87.7%). For roles within the family, most women reported having three or more roles in their families and/or provide care for two different generations (54.4%).

Specific Aim 1. On average, women in this study reported a moderate level of health satisfaction (M= 6.39, range 0-10), moderate level of life satisfaction (M= 25.26, range= 5-35), and a moderate level of self-satisfaction (M=21.79, range 0-30). Moreover, women in this study reported engaging in HPB sometimes (M= 2.66, range 1-4), and had low CVD risk score (M= 3.1, range= ≥0). All the estimated population means were significant at the alpha level.05 (p< .0001). Spiritual growth (3.08 ± .59) and interpersonal relationships (3.04 ± .61) were the most practiced dimensions of HPB among this sample. Women had high level of fasting blood glucose (M= 102.86, SD= 27.13), and normal level of total cholesterol (M=186.61, SD= 31.75), HDL (M= 53.65, SD= 14.63), and systolic blood pressure (M=119.70, SD 13.43). All the estimated means were significant (P< .0001).

Specific Aim 2. The increase in personal satisfaction was associated with an increase in HPB. HPB was significantly correlated with self-satisfaction (r= .54, p< .0001), health satisfaction (r= .45, p< .0001), and life satisfaction (r= .41, p< .0001). Similarly, the increase in personal satisfaction was associated with a decrease in CVD risk. Life satisfaction had the highest correlation with CVD risk score (r= - .27, p= .002) and was significant at the 0.01 level. Health satisfaction correlation with CVD risk score (r= - .18, p= .029), and self-satisfaction correlation with CVD risk score (r= - .17, p= .039) were significant at the 0.05 level.

Growth and development factors (age, menstruation status, roles within the family, job status, and social support) predicted 13% of health satisfaction. A step-type regression model was used to estimate the optimal model. Social support and being employed significantly predicted 14% of the variance in health satisfaction (F = 10.11, p< .0001). Growth and development factors predicted 26% of the variance in life satisfaction. Using a step-type regression model, social support alone significantly predicted 26% of the variance in life satisfaction (R²= 0.26, F = 41.45, p< .0001). In regard to self-satisfaction, growth and development factors predicted 5% of the variance in self-satisfaction. Utilizing a step-type regression model, social support significantly predicted 8% of the variance in self-satisfaction (F = 11.06, p= .001).

Multiple regression analysis was conducted with including growth and development factors and personal satisfaction as independent variables and HPB as a dependent variable. The model explained 32% of the variance in HPB (F= 7.568, p< .0001). Using a step-type regression model, 32% of the variance in HPB was explained by self-satisfaction and health satisfaction (F= 27.99, p< .0001). Lastly, multiple regression analysis was conducted with including growth and development factors, personal satisfaction, and HPB as independent variables and CVD risk score as a dependent variable. The model explained 49% of the variance in CVD risk (F= 12.84, p< .0001). Using a step-type regression model, 50% of the variance in the CVD risk score was explained by age and life satisfaction (F= 58.28, p< .0001).

Conclusions: Personal satisfaction was associated with HPB and CVD risk. Only social support and being employed predicted personal satisfaction level. Personal satisfaction predicted HPB while age and personal satisfaction predicted CVD risk. These findings can inform nursing researchers and health care professionals to further explore this phenomenon among middle-aged Arab American women. Future research should consider longitudinal design studies and comparative groups. Incorporating personal satisfaction, HPB and CVD risk assessment in middle-aged women’s routine care in primary care settings is recommended to promote HPB and prevent CVD among middle-aged Arab American women.

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