Fibromyalgia is a chronic illness characterized by pain and fatigue. Persons with fibromyalgia experience increased the risk for poor mental and physical health-related quality of life, which may be dependent on multiple factors, including health beliefs, such as confidence in physicians and the health-care system, and health behaviors, such as treatment adherence. Respondents with fibromyalgia (n = 409) were recruited nationally, via support organizations, and completed self-report measures: Multidimensional Health Profile – Health Functioning Index (MHP-H), Short-Form-36 Health Survey (SF-36v2), and Medical Outcomes Study (MOS) Measure of Patient Adherence – General Adherence Items. In mediation models, belief in the healthcare system and health-care personnel, and health efficacy exerted an indirect effect through treatment adherence on mental and physical quality of life. Adaptive health beliefs and attitudes were related to greater treatment adherence and, in turn, to a better quality of life. Maladaptive health beliefs and mistrusting attitudes about physician-level and systemic-level healthcare provision are negatively related to both treatment adherence and consequent physical and mental health-related quality of life in persons with fibromyalgia. Future randomized controlled trials are needed to determine if therapeutic strategies to alter health values might improve adherence and self-rated health.

Increasing physical activity levels of older adults is a public health priority given the associated risks with sedentary lifestyles. Exercise such as walking may positively affect older adults as they age decreasing the risk of heart disease, stroke, or death. The purpose of this study was to examine physical activities of older adults in senior housing and to determine if age correlates with the amount of physical activity. Physical activity studies on older adults are limited due to time and resources. The health belief model and transtheoretical model frames this study theorizing that older adults will take positive steps towards achieving recommended physical activities based on their perceived threats and benefits. A correlational research design provided systematic information about physical activities of older adults in senior housing and aided in determining if age relates to the amount of physical activity. The study used a convenience sampling of 62 older adults in senior housing and data collected from the Community Health Activities Model Program for Seniors questionnaire. The make-up of the sample included 36 females and 26 males aged 65 to 84 years old. The age of older adults in a senior housing community is not related to the amount of physical activity completed per week. The results of the descriptive analyses show that 53% of older adults in senior housing are not meeting physical activity guidelines of at least 150 minutes of physical activity per week. However, this is not statistically significant since all p-values for physical activity are greater than .05% level of significance at .776. Additional services such as providing leisure activity support to older adults through peer monitoring or adequate recreational facilities in the community can aid in helping older adults achieve physical activity recommendations.

In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical record (EMR) alert system with an additional bone health education in the patient instruction menu can improve participation by 11 health care providers (HCPs). Prior to the participants receiving the fact sheet, the knowledge, health beliefs, and perceived risks for developing osteoporosis were measured using the Revised Osteoporosis Knowledge Test (ROKT) and the Osteoporosis Health Belief Scale (OHBS). Although 87% of participants identified menopause as a major osteoporosis risk factor, fewer women (33%) knew that surgical removal of the ovaries was also a risk factor and half agreed or strongly agreed that calcium and exercise can prevent osteoporosis. After receiving the fact sheet, the participants had an average confidence score of 62% on the Osteoporosis Self-Efficacy Scale (OSES) for engaging in exercise and an average confidence score of 65% for adhering to calcium intake guidelines. Furthermore, the EMR alert system facilitated 100% documentation by HCPs. These results indicated the fact sheet can motivate premenopausal women to engage in osteoporosis preventive behaviors. Importantly, the EMR reminder with education fact sheet can facilitate the active involvement of HCPs in patient education.

Cancer is the second leading cause of death in the United States. Prostate cancer is the leading cause of cancer deaths among African American men, and African American men have the highest incidence of prostate cancer in the world. Limited studies have been conducted that address this critical issue. Existing literature reveals that the primary cause of increased mortality rates of prostate cancer in African American men is lack of participation in prostate cancer screening activities. The purpose of this three-phase study was to develop a valid and reliable instrument to measure prostate cancer screening intention among African American men. Three gender-specific focus groups were conducted in the first phase of the study. Twenty men from two north Florida churches participated in the focus groups. Eight dominant themes emerged from the focus groups and were utilized to develop the items for the intention instrument: fear, healthy lifestyle, hopelessness/helplessness, machismo, mistrust of healthcare providers, social/familial support, job requirements and transportation barriers. The second and third phases of the study consisted of development of the instrument and assessment of the instrument for validity and reliability. The Cancer Screening Intention Scale-Prostate (CSIS-P) consists of 43 items and was developed utilizing the results of the focus groups. The reading level of the CSIS-P was 5.6 utilizing the Flesch-Kincaid index and 7.0 utilizing the SMOG Readability Formula. The CSIS-P was assessed for content validity by a panel of oncology experts. The content validity index for the scale was .90 and internal consistency was found to be .92. The CSIS-P was evaluated for construct validity utilizing factor analysis techniques. Test-retest procedures were also conducted to assess stability of the CSIS-P and the reliability coefficient was .93. Factor analysis techniques demonstrated a three-structure model. The factors that emerged were benefits to prostate cancer screening, barriers to prostate cancer screening, and health promotion. The internal consistency of the three factors were found to be .88, .81, and .86 respectively. Factor analysis procedures reduced the CSIS-P to a 17-item scale. The CSIS-P is a parsimonious, culturally sensitive instrument that is valid and reliable in assessing prostate cancer screening intention. Recommendations for future study of the instrument include replication of the study with a more heterogeneous sample and utilization of the scale with other cancers.

Doctorate of Health Sciences / Abstract The aim of this study was to understand the meaning of caring as experienced by Arab Muslim nurses within the context of Arab culture. A qualitative approach using ethnographic methodology based on the approaches of Geertz (1973), Fitzgerald (1997) and Davies (1999) was used to develop a description that embeds the phenomena of the nurses’ meaning of caring within the cultural context. Good and Good’s (1981) meaning–centred approach was used to interpret the nurse’s explanatory models of health, illness and healing that inform the caring experience. This study conveys the cultural worlds of Arab Muslim nurses from Saudi Arabia, Lebanon, Jordan and Egypt while caring for Arab Muslim patients in Saudi Arabia. Data were collected over a four year period (2004-2007). Arab Muslim nurses have a religiously informed explanatory model where health is spiritual, physical and psycho-social well-being. Spirituality is central to the belief system where spiritual needs take priority over physical needs as a distinctive care pattern. The professional health belief system blends into the nurses’ cultural and religious belief system, forming a culturally distinct explanatory health beliefs system. This finding suggests that in non-Western health contexts, professional models are not dominant but incorporated into nurses’ indigenous worldviews in a way that makes sense within the culture. Caring is based on shared meanings between nurse and patient. Caring is an act of spiritualty and an action by the nurse to facilitate his or her own spirituality and that of the patient. In turn, the nurse receives reward from Allah for caring actions. A distinct ethical framework based on principles of Islamic bio-ethics guides the nurses in their caring. This research provides the missing link between Western professional nursing systems and Arab Muslim nurses’ caring models and contributes to the development of a caring model that is relevant to, and reflective of, Arab cultural and Islamic religious values. This caring model can provide direction for nurse education and the provision of care to Muslim patients, whether in Arab cultures, Islamic societies or with immigrant Muslim populations. In addition, it provides the basis for an Islamic nursing identity and a beginning point for improving the moral status and image of nursing in the Middle East.

Thesis (M.A.)--Indiana University, 2009. / Title from screen (viewed on February 1, 2010). Department of English, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Ulla M. Connor, Frank M. Smith, Honnor Orlando. Includes vitae. Includes bibliographical references (leaves 138-139).

Low levels of physical activity (PA) are a significant predictor of early death among recipients of implantable cardioverter defibrillators (ICDs). Regular, moderate PA is associated with improved quality of life (QOL), reduced arrhythmia burden, and improved health outcomes in ICD recipients yet many do not engage in PA and the reasons for lack of engagement are unclear. The purpose of this descriptive, cross-sectional study was to examine health beliefs related to PA and QOL in adults living with ICDs. The Health Belief Model provided the theoretical framework for this study. A convenience sample of 107 adult, ICD recipients (26 females and 81 males) were recruited from five cardiology clinic settings within the same private practice. Seventy-seven percent completed the study tasks (N=81). Subjects completed a Demographic Data Questionnaire, Self-Efficacy Expectations after ICD Scale, Exercise Self-Efficacy Scale, Health Belief Questionnaire, Incidental and Planned Exercise Questionnaire and Quality of Life Medical Outcomes Survey-SF36®. Clinical data was collected from the medical record. Mean age of the subjects was 70.23 yrs. ± 11.76 yrs. The majority were male (71.6 percent) and 77.8 percent were White, non-Hispanic. Most were insured by Medicare (79 percent), were retired (50 percent) and reported incomes less than 20,000 dollars/year (39 percent). Over 98 percent were diagnosed with heart failure and almost 40 percent reported their physical activity had decreased since having an ICD implanted. There were no differences in health beliefs and QOL scores between subjects who had an ICD as a primary or secondary prevention of sudden cardiac death. Predictors of PA participation in this population were Self-Efficacy for Exercise (SEE) beliefs, Self-Efficacy ICD (SEICD) beliefs, age and NYHA Class. Almost 33 percent of variance in PA participation can be explained by SEE (b = 2.407, β = .390, t = 3.911, p<.01); SEICD (b =2.304, β = .215, t = 2.149, p<.05); age (b = -.394, β = -.234, t =-2.277, p<.05); and NYHA Class (b = -6.373, β =-.198, t = -1.998, p =<.05). Findings indicate the strength of self-confidence in influencing healthy behavior. Findings support the need for more research in identifying barriers and predictors of PA participation in adult, ICD recipients.

Doctorate of Health Sciences / Abstract The aim of this study was to understand the meaning of caring as experienced by Arab Muslim nurses within the context of Arab culture. A qualitative approach using ethnographic methodology based on the approaches of Geertz (1973), Fitzgerald (1997) and Davies (1999) was used to develop a description that embeds the phenomena of the nurses’ meaning of caring within the cultural context. Good and Good’s (1981) meaning–centred approach was used to interpret the nurse’s explanatory models of health, illness and healing that inform the caring experience. This study conveys the cultural worlds of Arab Muslim nurses from Saudi Arabia, Lebanon, Jordan and Egypt while caring for Arab Muslim patients in Saudi Arabia. Data were collected over a four year period (2004-2007). Arab Muslim nurses have a religiously informed explanatory model where health is spiritual, physical and psycho-social well-being. Spirituality is central to the belief system where spiritual needs take priority over physical needs as a distinctive care pattern. The professional health belief system blends into the nurses’ cultural and religious belief system, forming a culturally distinct explanatory health beliefs system. This finding suggests that in non-Western health contexts, professional models are not dominant but incorporated into nurses’ indigenous worldviews in a way that makes sense within the culture. Caring is based on shared meanings between nurse and patient. Caring is an act of spiritualty and an action by the nurse to facilitate his or her own spirituality and that of the patient. In turn, the nurse receives reward from Allah for caring actions. A distinct ethical framework based on principles of Islamic bio-ethics guides the nurses in their caring. This research provides the missing link between Western professional nursing systems and Arab Muslim nurses’ caring models and contributes to the development of a caring model that is relevant to, and reflective of, Arab cultural and Islamic religious values. This caring model can provide direction for nurse education and the provision of care to Muslim patients, whether in Arab cultures, Islamic societies or with immigrant Muslim populations. In addition, it provides the basis for an Islamic nursing identity and a beginning point for improving the moral status and image of nursing in the Middle East.

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