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Council for the Advancement of Nursing Science

2012 National State of the Science Congress on Nursing Research September 13-15, 2012

Washington Hilton HotelWashington, DC

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Effects of Acculturation and Literacy on Cardiovascular Health of Mexican-American Women

Viola G. Benavente, PhD, RN, CNSAssistant ProfessorBoston College Connell School of Nursing, Chestnut Hill, MA

Funding DisclosuresPostdoctoral Fellowship

◦ Biobehavioral Nursing Research Training Grant T32 NR007106 NINR/NIH, University of Washington, Seattle

Ruth L. Kirschstein National Research Service Award ◦ Individual Predoctoral Fellowship to Promote Diversity

in Health-Related Research, Grant F31 NR010847 NINR/NIH, University of Pennsylvania, Philadelphia

Xi Chapter Research Grant Award◦ University of Pennsylvania, Philadelphia, PA, Sigma

Theta Tau InternationalSoutheastern Pennsylvania Chapter Research

Grant Award◦ American Association of Critical Care Nurses,

Philadelphia, PA

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PurposeTo identify predictors associated with

self-reported health-promoting lifestyle behaviors of Mexican-American women in the US for better cardiovascular health:◦Coronary heart disease (CHD)

Knowledge, Perceived health status, Acculturation level, & Literacy

To test a multivariate model of the effects of acculturation and literacy levels on cardiovascular health promotion

Physical Activity

Weight Management

Smoking Cessation or Abstinence

Heart-Healthy Nutrition

Less Alcohol

Lifestyle Modifications

Therapeutic Management

Hypertension

Diabetes Mellitus Type 2

Dyslipidemia

Obesity

CARDIOVASCULAR HEALTH

PROMOTION

DISEASE PREVENTION RISK REDUCTION

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Significance of the StudyHigher CHD health risk

◦Linked to being “Mexican-American,” “female” and “obesity”

Burden of living with chronic CHD◦Equal or greater among US Hispanics

Treatment disparities◦Unevenness and injustice for women

and underrepresented ethnic minorities

Source: IOM, 2009; Christian, et al. 2007; AHRQ, 2005; OMH, 2006; Mosca, 2004

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MethodsDescriptive cross-sectional study design

◦Mexican-American women free of CHD diagnosis, but at-risk

Data collection protocol◦4 Spanish-translated measures &

demographics◦Enrollment from April 2009 to June 2010◦6 Roman Catholic Churches in Northeastern

USData analysis plan

◦Correlation analysis◦Simple linear regression

Sample Description (N = 128)

31 years Median Age, range 20 to 72 years

91.3% Catholic

78.2% Married/partnered

68.0% Education 8 years or less

58.9% Unemployed/homemaker

74.1% Income insufficient to support family

79.4% US residency: 10 years or less

100% Spanish-language preference

77.3% Literacy: No reading/writing assistance

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Spanish Measures M (SD) Range α

Health-Promoting Lifestyle Profile-IICardiovascular Health Promotion 2.31 (.46)

1.32-3.63 (1-4)

.93

Heart Disease Fact Questionnaire

CHD Knowledge

14.70 (4.05) 6-22 (0-25)

.74

Short Acculturation Scale for Hispanics

Acculturation Level

1.46 (.41) 1-5 (1-5)

.44

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Summary of FindingsGreater tendency for

cardiovascular health promotion behaviors in Mexican-American women was associated with:◦More CHD knowledge ◦Better self-perceived health status◦Higher acculturation levels◦Increased literacy

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Cardiovascular Health Promotion

CHD Knowledge

Acculturation Level

Literacy

Cardiovascular Health Promotion

1

CHD Knowledge .298** 1

Acculturation Level .179* .134 1

Literacy .246** .188* -.085 1

Correlation Matrixa

a Pearson product moment correlation; * Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).

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Demographic EffectsAge, income, and education had

significant effects on predictor variables:◦Knowledge differences between

older and younger women were evident.

◦Older women were more knowledgeable about CHD.

◦Acculturated women earned higher incomes, were better educated, and had increased literacy.

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Predictor Variables

Perceived Health Status

CHD Knowledge

Acculturation Level

Literacy

Outcome Variable

Health Promotion Lifestyle

Behaviors

Age

Income

Education

Key Demographic Variables .298**

.355**

.246**

.179*

.311**

.202*

.361**

-.398**

.416**

Pearson’s Correlations

* Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).

CV-Health Promotion Model

* Correlation significant at .05 significance level; ** Correlation significant at 0.01 level (2-tailed).

Predictor Variables

Perceived Health Status

CHD Knowledge

Acculturation Level

Literacy

Outcome Variable

Health Promotion Lifestyle

Behaviors

Age

Income

Education

Key Demographic Variables .298**

.495**

.246**

.179*

.311**

.202*

.361**

-.398**

.416**

.305**

.188*

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Clinical ImplicationsIn non-English-speaking

populations, it is important to assess:◦Language preference and literacy◦Health knowledge and perceptions◦Acculturation and related stress

Cultural orientation Generational status Length of US Residency

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Study LimitationsCausal inferences

◦Study not designed to identify cause and effect

Survey instruments◦Paucity and quality of Spanish-

language toolsSelf-report

◦Accuracy of reading comprehension and memory recall

Group homogeneity◦Can be a study strength

Future Research DirectionsFurther explore causal pathway

modeling analysisInstrument

refinement/development◦Non-English-speaking populations

Intervention studies◦Decrease CHD risk and

cardiovascular health disparities among Hispanics

◦Culturally-tailored and sex-specific intervention testing

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Questions?

Email: viola.benavente@bc.edu

¡Gracias!

Thank You!