Older Mothers and Adult Daughters: High Blood Pressure Self Management Behaviors

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DESCRIPTION (provided by applicant): Heart disease is the leading cause of death in American women. Kentucky ranks as the 6 highest state in the nation for heart disease among women. This program of research will advance the initiatives of Healthy People 2010 by assisting women to develop self management behaviors to reduce and moderate hypertension, a major risk factor for heart disease. The long-term aim of this program of research is to determine the causal relationships of inner strength, perceived control, and quality of the relationship of older mothers and their adult daughters so that nursing interventions can be developed to improve cardiovascular self management behaviors and health related quality of life. The specific aim of this longitudinal predictive study is to determine the impact of inner strength, perceived control, and the quality of the relationship of older mothers and their adult daughters on blood pressure self management behaviors and health related quality of life. To achieve these goals, the candidate has designed a comprehensive training program with experienced nurse researchers who will facilitate the development of the candidate's expertise in the theoretical perspectives of chronic illness management, specifically blood pressure self management, and health related quality of life. The candidate will complete formal coursework and planned interactions and meetings with mentors and consultants. In addition, the candidate will participate in on-going research seminars, prepare and submit scientific publications, and present at scientific sessions. Mentors will be Dr. Debra Moser, Professor, U. of Kentucky and Dr. Neville Strumpf, Professor, U. of Pennsylvania. The proposed training and research environments are: the College of Nursing and Sanders Brown Center on Aging at the U. of Kentucky, Lexington, Kentucky; Hartford Center for Geriatric Nursing Excellence: U. of Pennsylvania, Philadelphia, Pennsylvania; and U. of Louisville School of Nursing, Louisville, Kentucky. The candidate will apply the knowledge gained from the training program to develop a program of research designed to enhance blood pressure self management behaviors of older women with hypertension. The aims of the proposed study are to: (1) Use dyadic analysis to examine the direct (i.e., 'actor') and indirect (i.e., 'partner') effects of mothers' and daughters' inner strength on the outcomes of self management strategies for blood pressure and health related quality of life in both mothers and daughters measured at baseline and 6 months later, and to determine whether there are significant changes over time in the outcomes; (2) To determine, using dyadic analysis, whether perceived control mediates the relationship between inner strength and outcomes in mothers and daughters; (3) To determine, using dyadic analysis, whether the mother-daughter relationship mediates the relationship between inner strength and outcomes in mothers and daughters; (4) To determine, using dyadic analysis, if there is a significant relationship between perceived control and quality of the mother-daughter relationship. The findings from this study will be used to support a program of theory-based nursing intervention studies designed to increase blood pressure self management behaviors of mother-daughter dyads when the older woman is diagnosed with hypertension. The adult daughter may or may not be diagnosed with hypertension and the study is designed to compare relationships whether or not daughters are diagnosed with hypertension. Previous work by the candidate demonstrated that inner strength was a key concept for older women and their adult daughters in managing health crisis. The candidate plans to further examine the significance of inner strength and modifiable health behaviors of older women with hypertension.