Feasibility Study of the Health Empowerment Intervention in Older Adults With Heart Failure.

BACKGROUND: Of almost 5.7 million Americans with heart failure, 80% are 65 years and older. Empowerment approaches facilitating recognition of personal and social contextual resources may improve well-being in this vulnerable population. OBJECTIVE: This research evaluated the feasibility of the Health Empowerment Intervention (HEI) in older adults with heart failure, including effects on health empowerment, purposeful participation, self-management, functional health, and well-being. METHODS: Twenty older adults with heart failure were randomly assigned to HEI or Attention Control conditions. The HEI consisted of 6 weekly sessions based on the Health Empowerment Theory. Outcomes were measured at baseline and at 6 weeks. RESULTS: Feasibility of the HEI was supported; participants realized significant improvement in health empowerment and purposeful participation in goal attainment.ConclusionsThis research supports the feasibility of the HEI and provides a basis for continued evaluation.

Combining Motivational and Physical Intervention Components to Promote Fall-Reducing Physical Activity Among Community-Dwelling Older Adults: A Feasibility Study.

PURPOSE: To assess the feasibility of a new intervention, Ready~Steady, in terms of demand, acceptability, implementation, and limited efficacy. DESIGN: Randomized controlled trial; repeated measures. SETTING: Two rural communities in Itasca County, Minnesota. SUBJECTS: Thirty participants were randomized to an intervention (n = 16) or attention-control (n = 14) group. INTERVENTION: Ready~Steady combined two components: (1) motivational (motivational support, social network support, empowering education), and (2) fall-reducing physical activities (PAs; guidance to practice leg-strengthening, balance, and flexibility activities and walking). MEASURES: Acceptability questionnaire and Indices of Procedural Consistency (investigator developed), Community Health Activity Model Program for Seniors Questionnaire (confirmed with accelerometry), Short Physical Performance Battery, Perceived Environmental Support Scale, Social Support for Exercise Questionnaire, Goal Attainment Scale, Index of Readiness, and Index of Self-Regulation. ANALYSIS: Descriptive statistics and a marginal approach to repeated-measures analysis of variance, using mixed-model procedures. RESULTS: Attrition was 7% and mean attendance was 7.2 of 8 sessions, participants evaluated Ready~Steady as acceptable, and implementation fidelity was good. The intervention group improved significantly more than the attention-control group in PA behavior, F1,27 = 11.92, p = .002; fall risk (functional balance and strength), F1,27 = 14.89, p = .001; support for exercise from friends, F1,27 = 11.44, p = .002; and self-regulation, F1,26 = 38.82, p < .005. CONCLUSION: The Ready~Steady intervention was feasible as evidenced by low attrition and good attendance and implementation, as well as positive effects on targeted outcomes and theoretical mechanisms of change.

A prescription for sustaining community engagement in malaria elimination on Aneityum Island, Vanuatu: an application of Health Empowerment Theory.

BACKGROUND: Community engagement has contributed to disease control and elimination in many countries. Community engagement in malaria elimination (ME) on Aneityum Island has been sustained since its introduction in the early 1990s. Capacity developed within this population has led to a health empowered community response. Health Empowerment Theory (HET) can account for the innovative community actions and capacity development efforts taken to realize and sustain meaningful changes in well-being. This study used the HET framework to investigate participant perceptions of ME efforts on the island focusing on two HET elements, personal and social-contextual resources. The purpose of this study was to explore the role of empowerment as a critical element of community engagement. METHODS: Six focus group discussions, ten key informant interviews and 17 in-depth interviews were conducted in July 2012 on Aneityum. Both deductive and inductive approaches to qualitative content analysis were used to identify themes, which were condensed, coded and classified based on the HET elements above. RESULTS: Awareness and use of personal and social-contextual resources played an important role in ME efforts. Most participants shared their knowledge to prevent malaria reintroduction. Many participants reported their skills needed for behavioral maintenance, problem-solving or leadership. Participants who perceived a threat took preventive actions even in the dry season. Community leaders focused on second generation capacity development. A local health coalition provided ME services. Members of networks were sources of information and assistance. Face-to-face was the preferred method of communication. Barriers to engagement (e.g., financial difficulties, health literacy issues and underdeveloped infrastructure) were minimized through active collaboration and mutual assistance. CONCLUSIONS: In the community engagement continuum, health empowerment develops incrementally overtime as people gain their knowledge and skills, form coalitions and develop collaborative networks (social capital) to make decisions and take action for change. Community engagement, which facilitates local personal and social-contextual resource development, has potential for ME and multilevel empowerment through community-based capacity development processes. These self-empowered communities have written and will continue to write a 'prescription' for sustaining high levels of engagement.

Salud de Corazon: Cultural Resources for Cardiovascular Health among Older Hispanic Women.

The prevalence of cardiovascular disease risk factors in Hispanic women has been substantiated across studies. While many studies have focused on the impact of these risk factors, few qualitative studies have addressed cultural and contextual meanings of cardiovascular health promotion in this population. This research explored cultural resources for cardiovascular health promotion among older Hispanic women. A qualitative descriptive methodological design using focus groups with 7 Hispanic women was used. Culture provided an overarching perspective, guiding identification and choice of resources and supports in order to promote cardiovascular health. Themes included Living Tradition, Caring for Family, Connecting with Friends, Having Faith, and Moving as Life. Data provide an initial step toward generating a more complete understanding of perceived cultural resources for cardiovascular health in older Hispanic women. Researchers and clinicians are increasingly recognizing that individuals, families and communities uniquely define cultural and contextual meaning of cardiovascular health promotion.

Empowerment interventions for older adults.

There has been much discussion regarding the need to empower older adults to make informed health decisions and to test interventions targeting empowerment to promote health among older adults. It has been suggested that an empowerment approach may nurture an older adult's participation in health care decisions and promote positive health outcomes. The purpose of this article is to report the findings of a critical review of published empowerment intervention studies with community-dwelling older adults. A descriptive literature review was conducted to examine how empowerment is conceptualized across interventions, the guiding theoretical frameworks, the outcomes measured, as well as the health outcomes of these interventions. Based on the findings from this review, recommendations for future empowerment intervention research with older adults as well as implications for practice are proposed.

Randomized control trial of the Health Empowerment Intervention: feasibility and impact.

BACKGROUND: Older adults prefer to stay in their homes for as long as possible but are often unaware of the resources in their community to help them to remain in their home. Access to resources may be important among older adults, representing a critical area for intervention. OBJECTIVES: The study aim was to evaluate the feasibility of the Health Empowerment Intervention (HEI) and to explore the impact of the HEI on the theoretical mediating variables of health empowerment and purposeful participation in goal attainment and the outcome variable of well-being with homebound older adults. METHOD: Fifty-nine eligible homebound older adults were randomly assigned to the intervention group or the comparison group. The HEI consisted of 6 weekly visits, whereas the comparison group received a weekly newsletter for 6 weeks. Participants were measured at baseline, after the 6-week protocol, and at 12 weeks. Data were analyzed using descriptive statistics, t test, chi, and analysis of covariance. RESULTS: There was a significant difference between groups in education. The participants in the intervention found the sessions to be helpful in recognizing resources. In addition, participants in the intervention group had significantly higher scores in the mediator purposeful participation in goal attainment, F(2, 83) = 3.71, p = .03. There was no significant main effect for the mediator health empowerment; however, the intervention group increased in the subscale personal growth from baseline to 12 weeks, F(1, 83) = 3.88, p = .05. DISCUSSION: This randomized control trial provided initial support for the hypothesis that homebound older adults receiving the HEI would find the intervention acceptable and have significantly improved health empowerment, purposeful participation in goal attainment, and well-being than an attentional comparison group receiving a weekly newsletter.

An innovative approach to recruiting homebound older adults.

Recruiting older adults to participate in intervention research is essential for advancing the science in this field. Developing a relevant recruitment plan responsive to the unique needs of the population before beginning a project is critical to the success of a research study. This article describes our experiences in the process of recruiting homebound older adults to test a community-based health empowerment intervention. In our study, the trust and partnership that existed between the research team and Community Action Agency facilitated the role of the home-delivered meal drivers as a trusted and untapped resource for study recruitment. Researchers can benefit from thinking creatively and developing meaningful partnerships when conducting research with older adults.

The rhythm of health in older women with chronic illness.

Trends in population growth indicate that nurses increasingly will be caring for older adults, especially older women, who are at risk for less than optimal health due to chronic illnesses. The purpose of this qualitative study was to obtain a better understanding of the meaning of health from the perspective of older women. Focus group interviews with 51 women, aged 55 to 93, were held. Data were analyzed using directed qualitative content analysis. A Rogerian perspective of human health provided the broad conceptual lens for the study. Three themes explicating the meanings of health emerged from the data: realizing the potential for purpose, listening to energy flow, and purposefully participating in health-related changes. The three themes represented ways in which the women dealt with the paradoxes posed by their chronic illness. Findings captured the hopeful, although sometimes conflicting, meanings of health among the women as brought forth by experiences with chronic illness and the challenges of aging.

A telephone-delivered empowerment intervention with patients diagnosed with heart failure.

BACKGROUND: Heart failure (HF) is a major public health problem. Case management by nurses using telephone follow-up has been suggested as a convenient and effective mechanism to promote the self-management of HF. Similarly, a patient empowerment approach to the management of chronic disease has been suggested as one that may nurture self-management in individuals with chronic illness. OBJECTIVE: The purpose of this study was to examine the effects of a telephone-delivered empowerment intervention (EI) on clinically and theoretically relevant outcomes in patients with HF, including purposeful participation in goal attainment, self-management of HF, and perception of functional health. The EI was guided by Rogers' Science of Unitary Human Beings person-environment process. METHODS: A convenience sample of men and women aged 21 years and older with a clinical diagnosis of HF was obtained from a metropolitan hospital located in the southwestern United States. The participants were randomly assigned to the control group (n = 45) or EI group (n = 45). All participants received standardized HF patient education; the intervention group also received an EI delivered through telephone follow-up calls from a registered nurse. Repeated-measures analysis of variance was used to evaluate intervention effects. RESULTS: The telephone-delivered EI facilitated self-management of HF through self-care activities in EI group members. CONCLUSION: The knowledge gained from this study provides a beginning understanding of strategies to enhance health care providers' ability to facilitate self-management of HF among patients diagnosed with HF.

Toward a nursing theory of health empowerment in homebound older women.

The purpose of this phenomenological study was to identify the essential structure of health empowerment from an experience in which homebound older women felt able to change, improve, or participate in their health. The long-term goal of this study was to further refine the theory of health empowerment to guide development of clinical practice strategies for nurses working with homebound older women. Fourteen homebound older women, ages 69 to 94, were interviewed. The findings support the idea of health empowerment as a participatory process in which women engage their personal and social contextual resources in ways that facilitate well-being.

Social support promoting health in older women.

Given the aging of women and their increased risk for health problems, it is important to explicate factors that may foster health promotion. While social support has been a concept of interest in predicting health promotion in women, the concept has been inconsistently defined and poorly explicated. A qualitative study was conducted to describe the types and processes of social support for health promotion in older women. Focus group interviews with 51 women, aged 55-93, were held. Data were analyzed using open coding to categorize data with attention to consistency and variance. Data explicated aspects of social support unique to health promotion in community-dwelling older women. Broad categories identified included connectedness and collectivism. Findings validate existing conceptualizations and provide an expanded perspective of social support by demonstrating aspects of support unique to the social context of older, community-dwelling women. Findings also provide a basis for development of socially relevant interventions designed to promote health and optimize health outcomes in older women.

Heart disease awareness among college students.

The purpose of this research was to explore college students' attitudes about heart disease risks and preventive strategies. The survey population consisted of students enrolled in selected lecture courses at Arizona State University. A total of 1481 surveys were used in data analysis. Respondents indicated a lower perception of heart disease risk for women than for men, and a majority of students incorrectly believed that breast cancer is a more significant health concern for women than heart disease. Respondents in most ethnic groups believed that whites are most at risk for developing heart disease. Students overall had relatively low levels of knowledge about heart disease and its risk factors compared to other health issues, such as sexually transmitted diseases (STDs) and psychological disorders. The results suggest that educational intervention is necessary to increase college students' knowledge about heart disease; and, in particular, efforts need to be made to raise awareness about heart disease among women and minorities. Guidelines for future educational intervention must address common misconceptions about which demographic groups are at risk for developing heart disease and address gaps in knowledge that young people have regarding heart disease prevention.

Empowerment: reformulation of a non-Rogerian concept.

The authors present a reformulation of empowerment based upon historical and current perspectives of empowerment and a synthesis of existing literature and Rogerian thought. Reformulation of non-Rogerian concepts familiar to nurses is proposed as a strategy to accelerate the mainstreaming of Rogerian thought into nursing practice and research. The reformulation of empowerment as a participatory process of well-being inherent among human beings may provide nurses with new insights for practice. This paper may also serve as a model for reformulating other non-Rogerian concepts and theories for wider dissemination across the discipline.

Relationships of contextual and relational factors to health empowerment in women.

The purpose of this study was to determine the relationships of contextual and relational factors to health empowerment in women with children. This study used a descriptive, correlational design to answer the basic research question: "What contextual and relational factors explain health empowerment in women?" The theoretical framework of health empowerment was based upon a synthesis of social and developmental perspectives and guided by a Rogerian view of the person-environment process. The analytic approach included bivariate correlations and a series of multiple regressions to identify factors explaining health empowerment. The contextual (demographic) and relational (social and professional support) factors explained 38% of the variance in health empowerment measured as knowing participation in change. For health empowerment, measured as lifestyle behaviors, the contextual and relational factors explained 43% of the variance. The results of this study offer partial empirical support for theoretical relationships. Findings provide a basis to generate additional nursing research focusing on the continuous mutual process of human beings and the environment, leading to theory-based interventions.

Exploring telehealth opportunities in domestic violence shelters.

PURPOSE: To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention. DATA SOURCES: Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews. CONCLUSIONS: Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs. IMPLICATIONS FOR PRACTICE: Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.