![Qualitative Results Similarities
Learning Aids & Label Reading
Samples & Recipes Well, well I've
always observed that what you can see
with your eyes and what you hear goes
together and if you can observe
something, it sticks with you a lot better
than what you hear sometimes. Yes
and the nice treats that you had for us
and showing us how things could go.
(SCT-71Su)
Test-tube & Label reading I didn't
know so, when, when that lady showed
us in the little containers that the salt
that was in different items I had no idea
there was that much salt. Have mercy,
tried to cut back on salt, and some of the
sugar. I like sweets. (AE-65F)
Other Behavior Changes
Blood Pressure Control I think the fact
that my blood pressure has finally
gotten down to normal and it's still
normal. (…being an RN you already knew
about your blood pressure [laughter] so that
was just kind of a reminder again) Yeah,
oh yeah. Because until I retired my
blood pressure was nowhere near
normal so then when I retired, it was
still sort of borderline and then when I
took this class, then it came down to
normal and … it's still normal. (Do you
take any medications?) It was high, even
with the medications. And we couldn't
get it down and my doctor was so
exasperated, so she's very pleased now.
(AE-42F)](https://image.slidesharecdn.com/33efcc73-5335-4b5d-b833-d063f674b374-160608230916/85/DissertationDefenseBenya-19-320.jpg)
DissertationDefenseBenya
- 1. Hypertension and Health Behavior Change in Older Adults: The Effect of an Appreciative Education Approach Dissertation Defense University of South Carolina Department of Physical Education and Athletic Training June 17, 2015 Mary Katherine Benya, MA, Gerontologist, Phd(c)
- 2. 10,000 baby boomers turn 65 daily between 2011-13 Cohn & Taylor, 2010; Passel & Cohn, 2008; Vincent & Velkoff, 2010 adults over 55 90% lifetime risk of hypertension Chobanian et al., 2003 life expectancy over 78 years Murphy, Xu, & Kochanek, 2012 coronary heart disease leading cause of death in US & 81%US deaths over age 65 Murphy et al., 2012; Statistics, 2011 hypertension gateway chronic disease preventable & controllable with lifestyle changes Dagogo-Jack, Egbuonu, & Edeoga, 2010; I. Hajjar, Appel et al., 2006, Kotchen, & Kotchen, 2006 Older Adults Hypertension Control
- 4. Community-based Interventions 1st generation CHAD Program, West Jerusalem Abramson et al., 1981; Parker & Assaf 2005 2nd generation Stanford Five Cities Project Farquhar et al., 1977 3rd generation South Carolina Cardiovascular Disease Prevention Project Health, Fuchs, Croft, Temple & Wheeler, 1995 4th generation WISEWOMAN Program CDC, 2011b; Khavjou, Finkelstein, & Will, 2007
- 5. Lifestyle University Intervention ≈ Community program focused on adults with risk factors for or conditions of hypertension, obesity, and diabetes ≈ 6 sessions (2.5 hours each) ≈ Content Areas 1) Nutrition 4) Stress Management 2) Physical Activity 5) Medical Knowledge 3) Social Support 6) Pharmacy ≈ Classes offered at no cost to participant ≈ Individuals must be motivated to make lifestyle behavior changes Hajjar et al., 2005
- 6. Social Cognitive Theory Personal Factors BehaviorEnvironment Self-efficacy ≈ Vicarious experiences (modeling) ≈ Mastery experiences ≈ Social persuasion ≈ Modeling of coping strategies to reduce or eliminate the stressful reaction Reciprocal Determinism Bandura, 1986, 1989
- 7. Appreciative Cycle disarm discover dream design deliver or destiny don't settle Bloom et al., 2011; Bloom et al., 2008
- 9. Research Questions 1) Is the Appreciative Education approach more effective than the Social Cognitive Theory approach in promoting health behavior change when applied to an educational intervention in older adults to control hypertension? 2) How do participant perspectives and health behaviors after the intervention differ between the Appreciative Education approach and Social Cognitive Theory approach?
- 10. Mixed-methods ≈ Pretesting during required orientation one week prior to the start of each course ~ 6 Lifestyle University courses 3 control Social Cognitive Theory 3 courses Appreciative Education modified during last 50 minutes of four classes 2-5 ~ 6 bi-weekly classes per course on either Tuesday or Thursday ~ Older adults, aged 50 and older ≈ Post-test 1 part of class 6 ≈ Post-test 2 at least 6 weeks after class 6 ≈ Post-intervention interviews 34
- 11. Quantitative Measures ≈ descriptive statistics ≈ repeated measures group x time ANOVA 7 dependent variables 1) systolic blood pressure 2) diastolic blood pressure 3) body mass index 4) fruits & vegetables, avg daily – EATS 5) physical activity, avg METS/wk– IPAQ 6) self- selected gait – 10-meter gait 7) fast gait – 10-meter gait
- 12. Demographics
- 13. Control (SCT†) Intervention (AE≈) Pre Post1 Post2 Pre Post1 Post2 Variable n Mean SD Mean SD Mean SD n Mean SD Mean SD Mean SD F p-value Systolic blood pressure (mm Hg) 29 142.89 (26.56) 132.15 (21.73) 133.62 (22.53) 13 148.02 (29.23) 130.61 (24.61) 128.40 (20.86) (2, 80) 2.02 0.140 Diastolic blood pressure (mm Hg) 29 75.68 (11.02) 69.54 (9.54) 69.69 (9.05) 13 78.87 (9.95) 73.40 (8.86) 71.63 (7.20) (2, 80) 0.26 0.773 BMI (lb/m2) 29 31.34 (6.86) 31.07 (7.05) 30.87 (6.95) 13 28.17 (6.43) 28.05 (6.57) 27.74 (6.63) (2, 80) 0.86 0.150 Self-selected gait speed (meters/sec) 29 1.20 (0.28) 1.07 (0.19) 1.07 (0.20) 13 1.02 (0.12) 1.12 (0.13) 1.06 (0.14) (2, 80) 9.80 0.0002* Fast gait speed (meters/sec) 29 1.54 (0.39) 1.36 (0.32) 1.42 (0.29) 13 1.39 (0.22) 1.42 (0.26) 1.44 (0.30) (2, 80) 6.67 0.002* †Social Cognitive Theory (SCT) ≈Appreciative Education (AE) * significant Note: all individuals with missing data were dropped from the analysis Quantitative Results
- 14. Mean Self-selected & Fast Gait Speed Pre Post1 Post2 SCT 1.2 1.07 1.07 AE 1.02 1.12 1.06 0.9 0.95 1 1.05 1.1 1.15 1.2 1.25 Self-selectedGaitSpeed(m/sec) Mean Self-selected Gait Speed Pre Post1 Post2 SCT 1.54 1.36 1.42 AE 1.39 1.42 1.44 1.25 1.3 1.35 1.4 1.45 1.5 1.55 1.6 FastGaitSpeed(m/sec) Mean Fast Gait Speed
- 15. Pre-test to Post-test 2 Changes Pre Post1 Post2 SCT 142.89 132.15 133.62 AE 148.02 130.61 128.4 115 120 125 130 135 140 145 150 SystolicBP(mmhG) Systolic Blood Pressure Pre Post1 Post2 SCT 75.68 69.54 69.69 AE 78.87 73.4 71.63 64 66 68 70 72 74 76 78 80 DiastolicBP(mmhG) Diastolic Blood Pressure
- 16. Qualitative Results 3 Perspective themes & sub-themes 1) Peer Influence (SCT) ~ advice & ideas ~ challenges & support ~ successes 2) Health Relationships (AE) ~ bucket list ~ reflection ~ taking action ~ noticing the connections 3) Enjoyment 4 Health Behavior themes & sub-themes 1) Accountability ~ food ~ physical activity ~ blood pressure 2) Consumption Changes ~ fruits & vegetables ~ water ~ salt and/or sugar 3) Learning Aids & Activities ~ samples & recipes ~ test tubes & label reading ~ grocery store tour 4) Other Behavior Changes ~ physical activity ~ stress management ~ blood pressure control ~ unintended benefits Strauss & Corbin, 2015; Glaser & Strauss, 1967; Lincoln & Guba, 1985 Grounded Theory, open & axil coding, constant comparison analysis
- 17. Qualitative Results Differences Peer Influences Advice & Ideas Well, the different opinions of different people gave me more ideas of a, you know, what you should do and how you should go about doing it. (So that was helpful for you.) Um huh. (SCT- 31Sp) Successes Well it was pretty enlightening to see how others were operating, which was already shittier than mine. I think we've all improved… when you realize that even though someone else had bad habits that you have, then you're more conscious of it and you're curtailing it. And so now when I'm offered that third glass of wine, I'm not going to say that I say no to the second…But if I'm offered the third, except maybe twice a year, I have said no. (would you say it was the peer influence?) Yes (SCT-05Su) Health Relationships Bucket List …made you sit down & think about things... expanden your thirst for getting more information & identify those things within yourself that you need to reevaluate…that’s a major issue, that was really emphasized in the class. Looking at things that you do every day. (AE-57F) Noticing the Connections …if I’m not healthy, I wouldn’t enjoy doing, on going those places. Wouldn’t be able to walk around if I don’t keep my walk up…when you, go on a trip and do the touring, especially when you’re walkin around, you get in a lot of walking miles…we took the girls, I’m a Girl Scout leader… Disney World…we walked around all day long, it seemed like… I had over 10,000 miles on those days we were down there. So I thought, you know, if I had been keep doin this before, I wouldn’t be able to keep this up today! (AE- 20Sp+)
- 18. Qualitative Results Similarities Enjoyment I loved takin that class, I mean I, you know, had so much fun and I always get something out of it. (AE-39F) I think the most interesting thing to me was taking time to read on the different things in the grocery store before I purchase. (So reading the labels)… Yeah. That was just too interesting I really enjoyed that. I had no idea things, so many fascinating things were (laughter) right there before me and I was just buying, taking home, having a great time, and hum, a, but after coming here it bothered me, the difference, you know...Oh yea. And I been trying to keep it up. (SCT- 84Su) Consumption Changes Fruits, Vegetables & Water Well to at least think about your servings of food everyday. Are you getting 4 servings of fruits & vegetables … daily which I had never given a lot of thought to before…less of the complex carbs…sugary drinks, more water. (SCT- 03Sp) I've been drinkin water as much as I can...every once in a while, if I go out to eat, I will, sometimes I will get a soda, a diet soda, I'm tryin to, I'm tryin to wean myself away...probably the most important thing felt like was about drinkin the water (AE-02F+) Accountability Food & Physical Activity First of all a, my eating habits…eliminating fat & some salt, including fruits & vegetables, cut down on meat and a also a lot of starches. The other thing was not just the eating was exercising & relaxation a lectures that we had I found very beneficial, also…particularly the little thing that you gave us that …we put on when you walk. (AE-51Sp)
- 19. Qualitative Results Similarities Learning Aids & Label Reading Samples & Recipes Well, well I've always observed that what you can see with your eyes and what you hear goes together and if you can observe something, it sticks with you a lot better than what you hear sometimes. Yes and the nice treats that you had for us and showing us how things could go. (SCT-71Su) Test-tube & Label reading I didn't know so, when, when that lady showed us in the little containers that the salt that was in different items I had no idea there was that much salt. Have mercy, tried to cut back on salt, and some of the sugar. I like sweets. (AE-65F) Other Behavior Changes Blood Pressure Control I think the fact that my blood pressure has finally gotten down to normal and it's still normal. (…being an RN you already knew about your blood pressure [laughter] so that was just kind of a reminder again) Yeah, oh yeah. Because until I retired my blood pressure was nowhere near normal so then when I retired, it was still sort of borderline and then when I took this class, then it came down to normal and … it's still normal. (Do you take any medications?) It was high, even with the medications. And we couldn't get it down and my doctor was so exasperated, so she's very pleased now. (AE-42F)
- 20. Discussion Quantitative ≈ Self-selected and Fast gait only significant differences between groups ≈ Intervention is effective in reducing BMI, systolic & diastolic BP ≈ EATS & IPAQ results affected by missing data & outliers Qualitative ≈ Perspective differences theme 1 peer influences & 2 health relationships reflect the respective theoretical approaches ≈ Food samples effective in encouraging increase in healthy food choices ≈ Qualitative results were overwhelmingly positive; a larger sample size or modification to the delivery protocol might yield more significant qualitative results
- 21. Results in Relation to Previous Research and Supporting Theories ≈ Hypertension gait decline Rosano et al., 2011 ≈ Gait speed can increase Hardy et al., 2007; Plummer-D'Amato et al., 2012; Wang et al., 2015 ≈ Positive aging stereotypes and gait speed increase a AE Hausdorff, Levy, & Wei, 1999; Wolff, Warner, Ziegelmann, & Wurm, 2014 ≈ Effective lifestyle interventions; LU, PREMIER, AA Senior Center I. M. Hajjar, Dickson, Blackledge, Herman, & Watkins, 2007 Appel et al., 2003 Fernandez, Scales, Pineiro, Schoenthaler, & Ogedegbe, 2008 ≈ Social Cognitive Theory a Peer Influence perception theme ≈ Appreciative Education a Health Relationship perception theme
- 22. Recommendations for Future Study ≈ Design AE intervention from bottom up linking personal goals & functional ability ≈ Measure long-term intervention effects ≈ Include food prep in intervention ≈ Long-term case studies of older adults Limitations ≈ Internal validity ≈ External validity ≈ Instruments ≈ Use of Community Health Advisors ≈ Attendance at multiple courses ≈ Medications