Margaret McCarthy

Abstract

Objectives: Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF. Design: In this mixed methods study, 30 Black patients (mean age 59.63 SD 615 years; 60% male) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care, depression, and physical functioning. Thematic content analysis was used to explore the meaning of depression and elicit themes about how depressive symptoms affect daily self-care practices. Qualitative and quantitative data were integrated in the final analytic phase. Results: Self-care was very poor in the sample. Forty percent of the sample had evidence of depressive symptoms (PHQ-9≥10; mean 7.59 ± 6 5.29, range 0 to 22). Individuals with depressive symptoms had poorer self-care (P=.029). In the qualitative data, individuals described depressive mood as "feeling blue⋯ like I failed." "Overwhelming" sadness and fatigue influenced self-care and resulted in treatment delays. For many, spirituality was central to coping with sadness. Few discussed depressive feelings with health care providers. Conclusions: Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, since depression influences self-care and minority populations continue to experience poorer outcomes.

Abstract

BACKGROUND:: Heart failure (HF) places a disproportionate burden on ethnic minority populations, including blacks, who have the highest risk of developing HF and experience poorer outcomes. Self-care, which encompasses adherence to diet, medication, and symptom management, can significantly improve outcomes. However, HF self-care is notoriously poor in ethnic minority black populations. OBJECTIVES:: Because culture is central to the development of self-care, we sought to describe the self-care practices and sociocultural influences of self-care in an ethnic minority black population with HF. METHODS:: In this mixed-methods study, 30 black patients with HF (mean [SD] age, 59.63 [15] years; 67% New York Heart Association class III) participated in interviews about self-care, cultural beliefs, and social support and completed standardized instruments measuring self-care and social support. Thematic content analysis revealed themes about sociocultural influences of self-care. Qualitative and quantitative data were integrated in the final analytic phase. RESULTS:: Self-care was very poor (standardized mean [SD] Self-care of Heart Failure Index [SCHFI] maintenance, 60.05 [18.12]; SCHFI management, 51.19 [18.98]; SCHFI confidence, 62.64 [8.16]). The overarching qualitative theme was that self-care is influenced by cultural beliefs, including the meaning ascribed to HF, and by social norms. The common belief that HF was inevitable ("all my people have bad hearts") or attributed to "stress" influenced daily self-care. Spirituality was also linked to self-care ("the doctor may order it but I pray on it"). Cultural beliefs supported some self-care behaviors like medication adherence. Difficulty reconciling cultural preferences (favorite foods) with the salt-restricted diet was evident. The significant relationship of social support and self-care (r = 0.451, P = .01) was explicated by the qualitative data. Social norms interfered with willingness to access social support, and "selectivity" in whom individuals confided led to social isolation and confounded self-care practices. CONCLUSIONS:: Research to develop and test culturally sensitive interventions is needed. Community-based interventions that provide culturally acceptable resources to facilitate self-care should be explored.

Abstract

Objective: The study objective was to describe the self-care behaviors of adherence to medication, diet, exercise, and symptom monitoring of older workers with cardiovascular disease (CVD) and explore the relationship among job characteristics (job demands, job control, and workplace support), self-care, and quality of life. More than 3.5 million workers have CVD with significant work limitations and increased disability. Workers must meet the challenges of today's work processes that include increased stress and intense production demands while managing the complexities of their CVD. Methods: A total of 129 workers (aged ≥ 45 years) with CVD completed standardized instruments about self-care (Specific Adherence Scale α = .74), job characteristics (Job Content Questionnaire α = .71), and quality of life (MacNew health-related quality of life α = .84). Regression analyses were used to examine relationships between variables. Results: The sample had a mean age of 59.16 ± 8.83 years, 56.3% were female, and 36.5% were African-American. Self-care behaviors varied. Most workers (71.4%) reported medication adherence, and few adhered to diet (27%), exercise (18%), or symptom monitoring (31.3%). Psychologic job demands were negatively correlated to self-care (r = -217, P = .02). Better adherence was reported by those with workplace support (r = .313, P = .001). Job characteristics explained 22% of variance in self-care adherence behaviors. Adherence was a significant determinant of general quality of life. Conclusion: Because job characteristics may interfere with self-care, clinicians should assess job demands and discuss stress management with employed patients. Interventions that foster worksite programs and facilitate self-care among workers with CVD are needed.

Abstract

Although death rates from cardiovascular disease (CVD) have declined in recent years, it continues to be the leading cause of death for women in the United States. The risk factors for CVD are well established and include physical inactivity. According to the Centers for Disease Control, in 2008, 38% of women reported no physical activity. For many women who experience a cardiac event, their first opportunity to become physically active is through a formal cardiac rehabilitation (CR) program. Unfortunately, women often underutilize CR programs. The purpose of this integrative review was to examine the barriers to participation in a CR program among women with CVD.