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

描述(申请人提供)：心脏病是美国女性的主要死因。肯塔基州是全国女性心脏病发病率最高的6个州。这项研究计划将通过帮助妇女发展自我管理行为来减少和缓和高血压，从而推动2010年健康人的倡议，高血压是心脏病的一个主要风险因素。这项研究的长期目标是确定老年母亲和她们成年女儿的内在力量、知觉控制和关系质量之间的因果关系，以便开发护理干预措施，以改善心血管自我管理行为和与健康相关的生活质量。这项纵向预测性研究的具体目的是确定老年母亲及其成年女儿的内心力量、控制感和关系质量对血压自我管理行为和健康相关生活质量的影响。为了实现这些目标，应聘者与经验丰富的护士研究人员一起设计了一个全面的培训计划，他们将促进应聘者在慢性病管理理论方面的专业知识的发展，特别是血压自我管理和与健康相关的生活质量。应聘者将完成正式的课程作业，并计划与导师和顾问进行互动和会面。此外，候选人将参加正在进行的研究研讨会，准备和提交科学出版物，并在科学会议上发言。导师将是肯塔基大学教授黛布拉·莫泽博士和宾夕法尼亚大学教授内维尔·斯特伦夫博士。拟议的培训和研究环境是：肯塔基州列克星敦大学的护理学院和桑德斯·布朗老龄中心；哈特福德老年护理卓越中心：宾夕法尼亚州费城大学的哈特福德老年护理中心；以及肯塔基州路易斯维尔大学路易斯维尔护理学院。候选人将应用从培训计划中获得的知识来开发一项研究计划，旨在加强患有高血压的老年妇女的血压自我管理行为。这项研究的目的是：(1)使用二元分析来检验母女的内在力量对自我管理策略的结果的直接(即‘行动者’)和间接(即‘伙伴’)效应，并在基线和6个月后测量母亲和女儿的血压和与健康相关的生活质量，并确定这些结果是否随着时间的推移发生显著变化；(2)使用二元分析来确定知觉控制感是否在母女的内在力量和结果之间的关系中起中介作用；(3)用二元分析来确定母女关系是否在母女之间的内在力量和结果之间起中介作用；(4)用并元分析来确定母女关系质量与控制感之间是否存在显著的关系。这项研究的结果将被用于支持一项基于理论的护理干预研究项目，该项目旨在提高老年女性被诊断为高血压时母女二人组的血压自我管理行为。成年的女儿可能被诊断为高血压，也可能没有被诊断为高血压，这项研究旨在比较女儿是否被诊断为高血压的关系。这位候选人之前的工作表明，内在力量是老年女性及其成年女儿管理健康危机的关键概念。候选人计划进一步研究患有高血压的老年女性的内在力量和可改变的健康行为的重要性。

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.