Susan Noble Walker

The Health-promoting Lifestyle Profile: Development and Psychometric Characteristics

This article describes the development and initial psychometric evaluation of an instrument to measure health-promoting life-style. Based on responses from 952 adults in midwestern communities, the Health-Promoting Lifestyle Profile was evaluated using item analysis, factor analysis, and reliability measures. Factor analysis isolated six dimensions: Self-Actualization, Health Responsibility, Exercise, Nutrition, Interpersonal Support, and Stress Management. These six factors accounted for 47.1% of the variance in the 48-item measure. Second-order factor analysis yielded a single factor, interpreted as Health-Promoting Lifestyle. The alpha reliability coefficient for the total scale is.922; alpha coefficients for the subscales range from .702 to .904. Further evaluation of the measure with different populations appears warranted. This instrument will enable researchers to investigate patterns and determinants of health-promoting life-style, as well as the effects of interventions to alter lifestyle.

Predicting health-promoting lifestyles in the workplace.

A multivariate model proposed as explanatory and predictive of health-promoting lifestyles was evaluated in a sample of 589 employees enrolled in six employer-sponsored health-promotion programs. Perceived personal competence, definition of health, perceived health status, and perceived control of health accounted for 31% of the variance in health-promoting lifestyle patterns. Employees who reported more health-promoting lifestyles perceived themselves as competent in handling life situations, defined health as high-level wellness rather than merely the absence of illness, evaluated their health positively, and perceived their health as affected by significant others but not by chance or luck. Those who were female, older, and in the maintenance phase of the company fitness program also had healthier lifestyle patterns. These variables and the perception of health as internally controlled were predictive of health-promoting lifestyles three months later.

Health-promoting life styles of older adults: comparisons with young and middle-aged adults, correlates and patterns.

The purposes of the study presented were to compare the health-promoting behaviors of older adults with those of young and middle-aged adults, to examine the relationship of age and other sociodemographic characteristics to life style throughout adulthood, and to identify differing life-style patterns among older adults. Six dimensions of life style were measured by the Health-Promoting Lifestyle Profile in 452 adults aged 18 to 88. Older adults had higher scores in overall health-promoting life style and in the dimensions of health responsibility, nutrition, and stress management than both young and middle-aged adults. Sociodemographic variables accounted for only 13.4% of the variance in life style and for 5.2% to 18.6% in its six dimensions. Five major health-promoting life-style patterns were identified among older adults, depicting a heterogeneous group with varying needs for health promotion programming.

Theoretical and methodological differentiation of moderation and mediation

Efficient research design and well-chosen methods of analysis help immensely in clearing the way for coherent interpretation of study results. The articles published in the “Methodology Corner” are particularly useful for accomplishing this objective. In this issue of Nursing Research, we have again been able to expand this valuable feature into an entire section.

Determinants of health-promoting lifestyle behaviors in rural older women.

The purpose of this study was to: (a) describe the health-promoting lifestyle behaviors and attempts at change among 102 community-dwelling rural women aged 65 and older, and (b) determine the extent to which personal influences (demographics, definition of health, and perceived health status) and contextual influences (sources of health information and provider counseling) explain health-promoting lifestyle behaviors and attempts at change among those women. They scored highest on frequency of nutrition behaviors and lowest on frequency of physical activity behaviors. They had attempted change in from zero to five areas of health-promoting lifestyle within the past year. Multiple regression analyses revealed that younger age, living with other(s), defining health as wellness, better perceived mental health, more sources of health information and provider counseling were significantly associated with health-promoting lifestyle behaviors. Only younger age and more sources of health information were significantly associated with attempts at change. These findings provide information that is relevant in designing interventions to enhance health-promoting lifestyle behaviors among rural older women.

Confirming the theoretical structure of the McGill pain questionnaire in acute clinical pain

&NA; Based upon a tripartite theoretical model of pain, the Pain Rating Index (PRI) of the McGill Pain Questionnaire (MPQ) continues to be one of the most frequently used instruments to measure clinical pain. Although a number of exploratory factor analytic studies have failed to consistently support the theoretical structure of the instrument, one previous confirmatory factor analytic study of chronic pain did statistically support the a priori model. Because it has been suggested that acute pain may not involve the same dimensions as chronic pain, this study provided a direct test of the theoretical structure of the MPQ through multi‐sample confirmatory factor analysis (CFA) using data provided by women experiencing pain during labor (n = 185) and women experiencing acute postoperative pain (n = 192). Results of the LISREL CFA analysis indicated that the a priori, 3‐factor, oblique model originally proposed by Melzack provided the most parsimonious representation of the data across the 2 samples of acute pain.

Tailored versus standard internet-delivered interventions to promote physical activity in older women.

Purpose: While substantial evidence demonstrates physical activity is effective at reducing risk for cardiovascular and other diseases, the percentage of older women participating in regular activity is low. The Internet offers an alternative method for delivery of a primary prevention intervention. This preliminary study examined the feasibility and effectiveness of using the Internet to deliver behavior change interventions for promoting physical activity in women ages 50‐69 years. Methods: Thirty‐one healthy women (56.1 ± 4.9 years) were randomly assigned to either tailored or standard newsletter groups. Both groups received 3 Internet‐delivered newsletters at baseline, 1 month, and 2 months. Behavioral markers and biomarkers were measured at baseline and postintervention. Post‐testing occurred at 3 months (1 month after delivery of the third newsletter). Results: Repeated measures ANOVAs revealed improvement in measures of flexibility and perceived barriers to exercise for both groups. For the standard group, improvement occurred in % body fat while VO2max declined. Women indicated the newsletters were helpful in influencing behavior change. Conclusion: Internet‐delivered newsletters appeared feasible and promising for favorably influencing perceptions about barriers to physical activity in these women. Selfreported physical activity did not increase although selected biomarkers did improve. Whether tailored or standard messaging was more effective was inconclusive.

An Explanatory Model of Fatigue in Women Receiving Adjuvant Breast Cancer Chemotherapy

BACKGROUND Fatigue is the most common and disturbing complaint reported by women during adjuvant breast cancer chemotherapy, but little is known about the mechanisms influencing it. OBJECTIVES To test an explanatory model of variables influencing fatigue in women during the first three cycles of adjuvant breast cancer chemotherapy and to determine the extent to which model variables explain fatigue at treatments and predict fatigue at cycle midpoints. METHODS A prospective, correlational design with repeated measures was used. The sample included 60 women who received chemotherapy after surgery for Stage I or II breast cancer. Fatigue was measured by the Piper Fatigue Scale. Predictor variables and measures were health and functional status (MOS SF-36), chemotherapy protocol, health-promoting lifestyle behaviors (HPLPII), nutritional status (hematocrit [Hct] and body mass index [BMI]), symptom distress (MSDS), and initial reaction to the diagnosis of cancer (RDCQ). Multiple regression was used for path analyses. RESULTS Trimmed models of influences on fatigue were identified. At treatments, direct influences on fatigue were symptom distress (beta = 0.45-0.76, p = 0.002-0.001), chemotherapy protocol (beta = 0.26, p = 0.02), and interpersonal relations (IPR) behaviors (beta = -0.28, p = 0.02); indirect influences were confronting reaction to the diagnosis through IPR behaviors and through symptom distress. At cycle midpoints, direct influences on fatigue were symptom distress from the previous treatment (beta = 0.36-0.43, p = 0.004-0.001), physical and social function (beta = -0.31-0.50, p = 0.02-0.001), and IPR behaviors (beta = -22, p = 0.05); an indirect influence was confronting reaction to the diagnosis (through IPR behaviors). Variance explained in fatigue ranged from 42% to 62% at treatments and from 40% to 56% at cycle midpoints. CONCLUSIONS Further testing of the model is warranted. Findings suggest that interventions to reduce symptom distress and promote health and functional status need to be developed and evaluated for effectiveness in modifying fatigue during adjuvant breast cancer chemotherapy.

Use and Reliability of the World Wide Web Version of the Block Health Habits and History Questionnaire with Older Rural Women

OBJECTIVE To estimate the parallel forms reliability of the paper and pencil and World Wide Web versions of the 1998 Block Health Habits and History Questionnaire (HHHQ) and to examine the feasibility of older women using the Web version. DESIGN Within a 2-week period, participants completed both the paper and pencil and Web versions of the HHHQ and pre- and postsurveys about their comfort level and experience in using the computer. SUBJECTS A convenience sample of 31 white women, aged 58.2 6.3 years, from a rural location were recruited via direct mail, public service announcements, and public posters. VARIABLES MEASURED The parallel forms reliability of the HHHQ administered in two different ways and the perceptions of the women on their computer use were measured. ANALYSIS Dietary data were analyzed using Pearson correlations and paired t tests. Alpha significance level was set at P <or=.05. RESULTS The Web HHHQ had adequate reliability when compared with the paper and pencil version; paired sample correlations approximated acceptable coefficients (r >.70), with only vitamin C (r =.54) and iron (r =.65) falling below the acceptable standard. Eleven women indicated initial discomfort with the computer, but after the study, only three said they were uncomfortable completing the on-line survey. IMPLICATIONS Internet dietary assessment tools could be a feasible assessment tool for older women to self-administer.

Determinants of Older Rural Women’s Activity and Eating

This research examined the relationship of cognitive-perceptual determinants from the Health Promotion Model to physical activity and healthy eating at baseline of a clinical trial among rural women aged 50 to 69. Two multivariate regression analyses with canonical correlation (N = 179) each yielded one interpretable canonical variate that explained similar amounts of variance (21.7% and 22.5%) in sets of activity and eating variables. In both analyses, the determinants set is a linear combination of all four cognitive-perceptual constructs from the model (perceived self-efficacy, benefits, barriers, interpersonal influences). The activity behavior set included caloric expenditure, VO2max, and stretching and strengthening activity, whereas the eating behavior set included daily percentage of calories from fat and servings of fruits and vegetables, meat, and whole grains. As predicted by theory, greater self-efficacy, benefits and interpersonal support, and fewer barriers are associated with desirable healthy lifestyle behaviors.