Determinants of Health-Promoting Behavior among Women Ages 65 and above Living in the Community
Lucas, Judith A. EdD, Rn, Cs, Orshan, Susan A. PhD, Rnc, Cook, Frances Rnc, Scholarly Inquiry for Nursing Practice
This study utilized Fender's Health Promotion Model to investigate through canonical correlation analysis the role that select cognitiveperceptual factors (health self-determinism, learned helplessness, selfesteem, and perceived health) and modifying factors (age, race, marital status, education, and income) play in understanding participation of community-living older adult women (age ≥ 65) in the health-promoting behaviors of health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. These were measured by the Health-Promoting Lifestyle Profile II in a convenience sample of 107 community-living older adult women (mean age 76.7 years). Gender-specific benefits and barriers to participating in healthpromoting behaviors were also explored using open-ended questions.
Two significant canonical variates were demonstrated. These indicated that age, marital status, race, education, and self-esteem and the two health-related factors of perceived health and health self-determinism made statistically significant contributions to the health-promoting behaviors of physical activity, nutrition, spiritual growth, and interpersonal relations. Benefits identified included better psychological well-being, coping with the general issues of aging, social interaction, improved function, and management of existing health problems. Internal barriers focused on perceived physical difficulties with all types of health-promoting behaviors; external barriers included aspects of the activity itself, lack of support from others and structural barriers. Study results suggest that older adult women (age ≥ 65) participate in health-promoting behaviors for both health enhancement and health management reasons and that barriers may be a more important determinant of older women's healthpromoting lifestyle behaviors than previously described in the model.
The increased incidence of health problems such as cancer and cardiovascular disease among women has thrust the importance of women's health issues into the national spotlight (Public Health Service [PHS], 1991). While younger women have been the focus of health promotion activities, older women (age ≥ 65) have not received the same considerations (PHS, 1998; U.S. Census Bureau, 1999). With the issues of quality of active life expectancy (U.S. Census Bureau, 1999) assuming increasing importance, both the Public Health Service (1991) and the Institute of Medicine (Berg & Cassells, 1990) have called for health promotion strategies for older adults ages 65 and above to improve functional abilities, prevent declines from chronic problems, and to benefit physical health and psychological well-being. In this study older adult was defined by current convention in gerontological research as 65 years or older; except where indicated, studies cited used samples with mean age of ≥ 65 years.
The few studies on health promotion among older adults (age ≥ 65) have not explained the continued low rate of participation in health-promoting activities among older adults despite the identified potential benefits (Caspersen & Merritt, 1995; Conn, 1998; Jones & Nies, 1996). Among the small group of studies focusing on women aged 65 years or older, sample sizes have been small, predominately White, and with subjects recruited from congregate housing, who may not represent older adults living independently in the community. In addition, many of the studies have been descriptive, often disease related, and few have described age- and gender-specific benefits and barriers to health behaviors (Duffy, 1993; Heidrich, 1998; Lough & Schank, 1996; Martin & Panicucci, 1996; Pascucci, 1992; Walker, Volkan, Sechrist, & Pender, 1988). In her recent review of health promotion literature, Heidrich (1998) identified one of the most pressing research issues related to health promotion in old age as the lack of investigations of quality of life outcomes/ benefits of health-promoting behaviors. …