Dolores Sands

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.

A comparative study among college students of sexual abuse in childhood

A disproportionate random sample (200 women, 400 men) of students attending a major university was invited to participate in a mailed survey to study differences in self-efficacy, coping, and well-being between men and women who were sexually abused in childhood and those who were not. A total of 271 students (111 women, 160 men) responded by returning the completed survey. Fifty percent of the women and 22% of the men in the sample reported one or more unwanted sexual experiences in childhood. Multivariate analysis of variance (MANOVA) techniques to analyze differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between women and men who reported childhood sexual abuse and those who did not showed significant interaction effects by sex for abuse (F = 2.609, P = .025, df 5,263) and significant effects by sex (F = 3.356, P = .006), but no significant differences for abuse alone. Univariate F tests were significant (F = 5.386, P = .021) for palliative coping with abused men reporting the highest scores, abused and nonabused women having the highest scores on emotive coping (F = 9.049, P = .003), and nonabused men and women having highest scores on well-being (F = 7.276, P = .007). A second MANOVA was performed on data from 245 students (nonabused and those who reported contact sexual abuse). Significant interaction effects by sex for abuse (F = 2.259, P = 0.49, df 5,237) and main effects for abuse (F = 3.225, P = .008) were found. Although abused men scored lowest on well-being, both abused men and abused women scored higher on emotive coping and lower on well-being than nonabused subjects. These are new findings with implications for developing and testing nursing interventions for this vulnerable group of young adults.

Designing and testing self-help interventions

A LTHOUGH procedures for developing and refining assessment tools for clinical research have received much attention (Waltz, Strickland, & Lenz, 1984), standard nursing research texts are virtually silent about comparable procedures for nursing interventions. For this reason, this article focuses on a three-phase process for developing and testing nursing interventions. Specifically, the focus is on self-help interventions that use a paper-and-pencil medium, such as a workbook. Self-help paper-and-pencil interventions may be suitable for improving coping strategies, lifestyle, and health-related problem-solving.

Competence-Building in Adolescents, Part I: A Self-Help Nursing Intervention

The purpose of this study was to test the effects of a self-help nursing intervention on adolescent psychosocial competence. A community sample of 139 adolescents was assigned to three conditions (intervention, delayed intervention, and control) within a pretest-posttest design. The self-help nursing intervention was a 9-page, 14-step self-help workbook for use by adolescents in dealing with upsetting situations in day-to-day living. After a self-assessment of coping, subsequent workbook steps aided adolescents in developing alternate coping responses and generating other ways to deal with the upsetting situation. Adolescents in the three conditions did not differ on pretest measures of psychosocial competence: problem-solving appraisal, adolescent self-perception, and general self-efficacy. After statistically controlling for pretest scores, gender, and age, the intervention group showed more favorable self-perceptions in scholastic competence, social acceptance, and conduct/morality compared with the control group. However, expected differences in the delayed intervention group failed to appear. Thus, anticipated benefits in psychosocial competence were found inconsistently. Although not predicted, significant reductions in the prevalence of negative affect occurred among adolescents in both intervention groups. Overall, the self-help format for delivering psychosocial competence training lacked the power needed to bring about consistent benefits for adolescents. Testing the self-help workbook in a group context is recommended in future nursing intervention research.

Competence-Building in Adolescents, Part II: Community Intervention for Survivors of Peer Suicide

Nurses often encounter situations in which they are called upon to assist in post-suicide community interventions with teachers, church youth group leaders, and mental health professionals. Controlled studies of interventions to aid adolescents coping with the loss of a peer are lacking. The purpose of this study, conditioned by an unanticipated suicide in an ongoing research study, was to document changes in psychosocial competence of adolescent peer suicide survivors. Following a supportive community intervention, the peer survivor group was compared with a similar group of adolescents who did not experience peer suicide. Both groups were in the control condition of a larger nursing study of social competence-building. The survivor group had significantly greater self-efficacy immediately after the community intervention and 2 months later when contrasted with the comparison group. In addition, the survivor group reported greater social acceptance and job competence immediately after the community intervention. Correlated t-tests showed the survivor group had significant gains in problem-solving appraisal and global self-worth after the community intervention, but significant declines in global self-worth and scholastic competence 2 months after the intervention. The findings support the belief that community interventions are initially worthwhile in helping adolescents to cope with peer suicide, but continued supportive intervention may be needed to offset declines noted over time in areas such as self-worth and academics.