Alexa Stuifbergen

An explanatory model of health promotion and quality of life in chronic disabling conditions.

BACKGROUND Although previous studies have examined selected factors influencing health-promoting behaviors or quality of life, the complex interplay of these variables in persons with chronic disabling conditions has not been investigated. OBJECTIVE To test an explanatory model of variables influencing health promotion and quality of life (Stuifbergen & Rogers, 1997) in persons living with the chronic disabling condition of multiple sclerosis (MS). METHODS A sample of 786 persons with MS (630 women and 156 men) completed a battery of instruments measuring severity of illness-related impairment, barriers to health-promoting behaviors, resources, self-efficacy, acceptance, health-promoting behaviors, and perceived quality of life. The proposed model was assessed and modified using the weighted least squares procedure (WLS), which is implemented by LISREL8 (Joreskog & Sorbom, 1993). RESULTS The initial model was modified to obtain a recursive model with adequate fit, chi2 (8, N = 786) = 77, p < 0.05; GFI = 0.96; IFI = 0.98; CFI = 0.98. The antecedent variables accounted for 58% of the variance in the frequency of health-promoting behaviors and 66% of the variance in perceived quality of life. The effects of severity of illness on quality of life were mediated partially by health-promoting behaviors, resources, barriers, self-efficacy and acceptance. CONCLUSIONS The final model supports the hypothesis that quality of life is the outcome of a complex interplay among contextual factors (severity of illness), antecedent variables (Stuifbergen & Rogers, 1997), and health-promoting behaviors. The strength of direct and indirect paths suggests that interventions to enhance social support, decrease barriers, and increase specific self-efficacy for health behaviors would result in improved health-promoting behaviors and quality of life. Further research using a longitudinal design is needed to clarify the effects of the interaction between health-promoting behaviors and trajectory of illness on quality of life for persons with chronic disabling conditions.

Weight and Behavioral and Psychosocial Factors Among Ethnically Diverse, Low-Income Women After Childbirth: II. Trends and Correlates

ABSTRACT Objective: This paper presents a longitudinal analysis of behavioral and psychosocial correlates of weight trends during the first postpartum year. Data are derived from the Austin New Mothers Study (ANMS), a longitudinal study of a low-income, tri-ethnic sample of postpartum women that incorporated serial assessment of weight and behavioral and psychosocial variables. Method: Postpartum body mass index (BMI) was measured prospectively (post-delivery, 6 weeks, and 3, 6, and 12 months postpartum). The analytic sample consisted of 382 White, African American, and Hispanic women receiving maternity care funded by Medicaid who had at least three measured postpartum weights. Behavioral and psychosocial variables included energy intakes, fat intakes, physical activity, health-related lifestyle, smoking, breastfeeding, contraception, depressive symptoms, emotional eating, body image, and weight-related distress. Results: Using hierarchical linear modeling to incorporate baseline only and time-varying effects, significant associations with postpartum BMI were found for the following variables: ethnicity (p = .001), time of weight measurement (p < .001), the interaction of ethnicity and time (p = .005), prepregnant BMI (p < .001), gestational weight gain (p < .001), weight-related distress (p < .001), and energy intakes (p = .005). After adjusting for covariates, ethnic groups displayed differing trends in postpartum BMI resulting in White women having significantly lower BMIs at 12 months postpartum compared to ethnic minority women (ps < .01). Conclusion: Behavioral and psychosocial variables contribute to a fuller understanding of BMI status of low-income women during the first postpartum year.

PHYSICAL ACTIVITY AND PERCEIVED HEALTH STATUS IN PERSONS WITH MULTIPLE SCLEROSIS

&NA; Regular exercise and physical activity can minimize deconditioning and assist individuals with multiple sclerosis (MS) to maintain function at optimal levels. The purpose of this study was to explore the relationship of physical activity to social, mental and physical health and well‐being in persons with MS. A convenience sample of 37 persons with MS completed the Human Activity Profile and the Medical Outcomes Study Short‐Form Health Survey (SF36). Activity levels in persons with MS were much lower than norms reported for other groups of healthy adults and adults with a variety of chronic conditions. Higher activity scores were associated with higher scores on the measures of physical functioning and general health. The subgroup of persons who reported engaging in regular exercise had significantly higher scores on the measure of physical functioning than those who did not exercise. Additional research is needed to investigate barriers and facilitators of physical activity for persons with MS and whether increasing activity may have synergistic effects with other therapies.

Health Promotion: An Essential Component of Rehabilitation for Persons with Chronic Disabling Conditions

This qualitative study was undertaken to clarify an emerging explanatory model of health-promoting behaviors, and quality of life in individuals with chronic disabling conditions. Twenty individuals with multiple sclerosis shared their stories regarding health promotion, domains of quality of life, and factors that affected these domains. Health-promoting behaviors were viewed as essential to the process of rehabilitation and maintaining an acceptable quality of life. Important quality-of-life issues were related to domains other than function. Implications are that health promotion efforts need to be encouraged and supported in individuals with chronic disabling conditions.

Development of a scale to measure barriers to health promotion activities among persons with disabilities.

Subjectively-defined barriers to engaging in health promoting activities are one of the most important, yet least well operationalized, components in our models of health promotion. This article describes the development of a tool to measure barriers to health promotion among persons with disabilities. The Barriers to Health Activities among Disabled Persons scale (BHADP) is comprised of 16 items reflecting barriers to taking care of ones health identified from previous barriers literature and interviews with disabled persons. In a study of 135 disabled adults living in two southwestern cities, the BHADP yielded a Cronbach Alpha of .82 as a measure of internal consistency reliability. In addition, t-test analyses demonstrated a significant difference in scores between the disabled sample and a comparison group of 144 nondisabled adults, suggesting the BHADP discriminate between these groups. The BHADP may be useful in sensitizing health care providers to the wide range of barriers experienced by persons with disabilities, thereby enabling them to work more effectively with this special population.

The experience of fatigue and strategies of self-care among persons with multiple sclerosis

Fatigue is one of the most common and least understood symptoms of many chronic and disabling conditions. This qualitative study used a convenience sample (N = 13) of individuals with multiple sclerosis (MS). A semistructured interview guide was used to elicit a description of the experience of fatigue. Its perceived antecedents, and the self-care strategies used to manage it. Data were gathered during two 90 minute interviews. Five themes were identified that describe the experience of fatigue for persons with MS. Categories of self-care strategies included energy conservation, recharge efforts, enhancing resistance to fatigue, and temperature control. Further research is needed to explore the effects of specific interventions in the management of fatigue.

A randomized controlled trial of a cognitive rehabilitation intervention for persons with multiple sclerosis

Objective: To explore the feasibility and effects of a computer-assisted cognitive rehabilitation intervention – Memory, Attention, and Problem Solving Skills for Persons with Multiple Sclerosis (MAPSS-MS) – for persons with multiple sclerosis on cognitive performance, memory strategy use, self-efficacy for control of symptoms and neuropsychological competence in activities of daily living (ADL). Design: A randomized controlled single-blinded trial with treatment and wait list control groups. Setting: Southwestern United States. Subjects: Convenience sample of 61 persons (34 treatment, 27 wait list control) with multiple sclerosis (mean age 47.9 years, SD 8.8). Intervention: The eight-week MAPSS-MS intervention program included two components: (a) eight weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and (b) a computer-assisted cognitive rehabilitation program with home-based training. Outcome measures: A neuropsychological battery of performance tests comprising the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) and self-report instruments (use of memory strategies, self-efficacy for control of multiple sclerosis and neuropsychological competence in ADL) were completed at baseline, two months (after classes), and at five months. Results: Both groups improved significantly (P < 0.05) over time on most measures in the MACFIMS battery as well as the measures of strategy use and neuropsychological competence in ADL. There was a significant group-by-time interaction for scores on the measures of verbal memory and the use of compensatory strategies. Conclusions: The MAPSS-MS intervention was feasible and well-accepted by participants. Given the large relative increase in use of compensatory strategies by the intervention group, it holds promise for enhancing cognitive function in persons with multiple sclerosis.

Promoting wellness for women with multiple sclerosis.

There is increasing interest in wellness programs among health care providers and consumers. A unique intervention program was developed to promote wellness for women with multiple sclerosis (MS). Key processes include: provision of accurate knowledge that is specific to health promotion within the context of MS; enhancement of self-efficacy for health behaviors and individualized goal setting and monitoring. Participants have reported positive changes as a result of this two-phase (knowledge/skill building classes and telephone follow-up) intervention.

The use of individualized goal setting to facilitate behavior change in women with multiple sclerosis.

&NA; Setting goals is a useful strategy for changing behavior. The purpose of this study was to examine the effectiveness of a wellness intervention for women with multiple sclerosis (MS) on achieving health‐related goals set individually by each participant in the experimental group (N = 57) using goal attainment scaling. The two‐phase intervention included lifestyle‐change classes over 8 weeks, then telephone follow‐up over 3 months. Participants were followed over an 8‐month period. Goal achievement was assessed at baseline, 2 months (following class), 3 1/2 months (6 weeks after class). 5 months (following 3 months of telephone follow‐up), and at 8 months. The majority of the women met or exceeded all their individualized goals for changing behavior at the 6‐week postclass assessment. Achievement and maintenance of individual goals remained high (59%‐84%) over the 5 months after class follow‐ups. These data support the positive effects of wellness interventions for helping women with MS to meet their own individualized health goals. Setting goals with incremental steps helped participants to articulate their individual goals and monitor achievement over time.

Family experiences related to the decision to institutionalize an elderly member in Taiwan: an exploratory study

Industrialization and urbanization have changed the structure of Taiwanese families. Placing elder family members with impairments in nursing homes has become a new caregiving alternative. However, Taiwanese commonly consider this placement to be a violation of traditional filial obligation. Therefore, institutionalization is a highly sensitive cultural issue. Data were gathered through semi-structured interviews with nine family members, revealing three major processes in the decision of institutionalization -- breaking harmony, rebuilding harmony and evolution, as well as four important factors that influence the decision -- the quality of the relationship between the elder and his/her family, characteristics of the elder, financial condition of the family and perceived public opinion toward institutionalization. The findings suggest that the decision process in institutionalization is a gradual, fluid, cyclical movement without definite steps.