exploring healthy lifestyle behaviors, deployment factors, and adjustment among military spouses a

109 Pages·2011·0.85 MB·English

by  Norma J. Suarez

EXPLORING HEALTHY LIFESTYLE BEHAVIORS, DEPLOYMENT FACTORS,
AND ADJUSTMENT AMONG MILITARY SPOUSES

A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE
UNIVERSITY OF HAWAI`I AT MĀNOA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

IN

NURSING

AUGUST 2011

By

Norma Jean Suarez

Dissertation Committee:

Victoria Niederhauser, Chairperson
Joseph Mobley
Debra Mark
Mijung Park
Sharon Reese
Charles Mueller

Keywords: Military Spouse, Adjustment, Health Promoting Behaviors
UMI Number: 3485490
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ii

DEDICATION

This work is dedicated to my husband, Carlos M. Suarez,
and to my children, Carlos III, David, and Nicolas.
iii

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my advisor, Dr. Victoria
Niederhauser, for taking me under her wings, and providing excellent supervision,
encouragement, and support, which enabled me to understand and complete this
dissertation. I would like to thank Dr. Joe Mobley, Dr. Debra Mark, Dr. Mijung Park, Dr.
Sharon Reese, and Dr. Charles Mueller for guiding my research, for their thoughtful
criticisms, and for their time and attention given to this study with special thanks to Dr.
Sharon Reese, who genially accepted working with me as the study site principal
investigator at Fort Hood, Texas.
I would like to thank my friends and colleagues for sharing their enthusiasm for
my work. I would like to thank the Fort Hood community and especially the military
spouses at Fort Hood who so graciously participated in this study.
I would like to thank my husband, Carlos Suarez, for believing in me and for
always being there to push me to finish my study, despite all the obstacles placed before
me during the past several years.
Finally, I would like to thank God for granting me the perseverance and
determination to complete this dissertation and for carrying me through it all.
iv

ABSTRACT
Background
Military family separations have increased significantly in the past decade and
military readiness has never been so critical. This can have an impact on the adjustment
of military spouses. There have been many interventions to promote the well-being of
military spouses, but little, if any, has been documented on the engagement of healthy
lifestyle behaviors as a tool for adjustment.
Objectives
The overall aim of this study is twofold: the first aim is to explore the healthy
lifestyle behaviors of military spouses of service members stationed at Fort Hood, Texas.
The second aim is to investigate whether healthy lifestyle behaviors, deployment factors,
and demographic factors are associated with and predict adjustment in these military
spouses.
Methods
After approval by appropriate channels, study surveys were distributed to military
spouses at Fort Hood, Texas. The following instruments were used for data collection:
demographic questionnaires including deployment questions, the Healthy Lifestyle
Profile II, the Psychological General Well-Being Index, and the Depression, Anxiety, and
Stress Scale. Analysis was conducted using SPSS 18.0 for Mac.
Results
A convenience sample of 158 military spouses who met study criteria completed
the study survey. Results of the study indicate that most health-promoting behaviors
correlate significantly with adjustment while spiritual growth, health responsibility and
v

stress management predict adjustment. Unfortunately, only a small percentage of military
spouses were actively engaged in health-promoting behaviors. Several demographic and
deployment variables also correlate highly with adjustment, but after a multiple
regression analysis and a multiple analysis of variance, none of these variables were
found to predict adjustment.
Conclusion
The employment of healthy lifestyle behaviors as a coping strategy was found to
predict adjustment in military spouses. Therefore, new efforts are needed to promote
opportunities for military spouses to engage more frequently in healthy lifestyle
behaviors.
vi

TABLE OF CONTENTS
ABSTRACT ....................................................................................................................... iv
LIST OF TABLES ............................................................................................................ vii
CHAPTER 1. INTRODUCTION ...................................................................................... 1
Background .................................................................................................................................. 1
Problem Statement ....................................................................................................................... 4
Study Aims .................................................................................................................................. 4
Significance of the Study/Nursing Implications .......................................................................... 4
CHAPTER 2. REVIEW OF THE LITERATURE ............................................................ 6
The Impact of a Military Deployment ......................................................................................... 6
Reservists ................................................................................................................................... 15
Reunion ...................................................................................................................................... 16
Family Support to Assist with the Impact of Deployment ........................................................ 17
Adjustment ................................................................................................................................. 18
Deployment Factors ................................................................................................................... 24
Healthy Lifestyle Behaviors to Cope and Adjust ...................................................................... 26
Theoretical Framework .............................................................................................................. 31
Gaps in Knowledge ................................................................................................................... 36
CHAPTER 3. RESEARCH METHOD ........................................................................... 38
Purpose of the Study and Research Questions .......................................................................... 38
Study Design .............................................................................................................................. 39
Procedures ................................................................................................................................. 40
Measures .................................................................................................................................... 41
Data Analysis ............................................................................................................................. 45
CHAPTER 4. RESULTS ................................................................................................. 46
Study Participants ...................................................................................................................... 46
Statistical Results ....................................................................................................................... 47
Association between HPLP II scales and adjustment scales ................................................. 51
Association between deployment factors and adjustment scales .......................................... 56
Association between demographic variables and adjustment ............................................... 59
Multiple regression ................................................................................................................ 61
Multiple analysis of variance (MANOVA) ........................................................................... 62
CHAPTER 5. DISCUSSION ........................................................................................... 64
Demographic Variables ............................................................................................................. 69
Deployment Factors ................................................................................................................... 70
Limitations and Recommendations ........................................................................................... 72
Other Recommendations for Future Research ........................................................................... 74
Implications for Nursing ............................................................................................................ 75
Conclusion ................................................................................................................................. 76
Appendix ........................................................................................................................... 77
vii

LIST OF TABLES
Table Page

1. DASS Scales Score – 21-Item Version…..………………………………........ 44

2. Descriptive Statistics for HPLP II Subscales and Overall Scale…….....….…. 48

3. Correlations among HPLP II and PGWBI Subscales and Overall Scale…...... 52

4. Correlations among HPLP II and DASS Subscales and Overall Scale…......... 53

5. Correlations among Number of Deployments and PGWBI/DASS Subscales
and Overall Scale..…...…….……………………………………….……….... 56

6. Appendix B: Descriptive Statistics for PGWBI Subscales and Overall
Scale...….…………………………………………………….……………..... 78

7. Appendix C: Descriptive Statistics for DASS Subscales and Overall Scale.... 79

8. Appendix D. Summary of All Significant Relationships between
Demographics and PGWBI Scales…………………………………….…...… 80

9. Appendix E: Summary of All Significant Relationships between
Demographics and DASS Scales……………………….…………..………… 81

10. Appendix F: Summary of Final Stage of PGWBI Multiple Regression……… 82

11. Appendix G: Summary of Final Stage of DASS Multiple Regression…......... 83
1

CHAPTER 1. INTRODUCTION
Background
The September 11th attacks in Washington D.C. and New York City, the
continued world war against terrorism, and even the disasters brought about by Mother
Nature, such as the 2010 earthquakes in Chili and Haiti have resulted in a summon for the
U.S. military back into the forefront. Consequently, military family separations have
increased significantly in the past decade due to such combat mission assignments,
hazardous training rotations, humanitarian missions and other deployments in various
places worldwide. Additionally, the downsizing of military forces has lead to a call upon
the forces to fulfill such missions with fewer human resources, creating a situation of
increasing readiness for deployment and ultimately separation of military personnel from
their family.
Geographical separations resulting from deployment are part of the military life
and may have an adverse effect on marital relations, children, family unit stabilization,
and mental health of the spouse and children left behind (Wexler & McGrath, 1991; Zeff,
et al., 1997). The service member may be called upon at any time to deploy for an
extended period of time to serve the nation’s defense mission. Deployments are
considered the most stressful event the typical military family will endure (Knox & Price,
1995). The effects of military-induced separation on the spouse and children have been
well documented (Kelley, 1994; Wexler & McGrath, 1991; Zeff et al., 1997). Spouses
were reported to have experienced emotional symptoms of anxiety and loneliness and
2

physiological symptoms of headaches, insomnia, tenseness, and inability to focus
(Wexler & McGrath, 1991). Others have found that spouses experienced symptoms of
depression, lowered self-esteem, and hopelessness prior to and during a deployment with
symptoms lessening during post-deployment (Kelley, 1994). Researchers have found that
military-induced separation can have an undesirable effect on children as well. Children
exhibited internalized behaviors, such as fear and inhibition and externalized behaviors,
such as aggression and antisocial acts during pre- and post-deployments (Kelley, 1994).
Common diagnoses for many of the children were depression, attention
deficit/hyperactivity disorder, and oppositional defiant disorder (Kelley, 1994). Studies
examining the impact that deployment-induced separation has on the service member, the
spouse, and children while the service member is deployed are found in the literature
review in the following chapter. These brief descriptions of the effect of military
separations give clear indications that the military family experience physiological and
psychological consequences. It is apparent then, that being deployed and being on a
continuum of readiness for deployment can have an impact on the adjustment of military
spouses.
To address the psychological outcomes, traditional means such as the use of
support from families, friends, the military unit and social services, the use of online
resources, and seeking medical care have all been mentioned. Little, if any at all, has
been documented on addressing psychological outcomes by use of non-traditional means,
particularly the adoption of healthy lifestyle behaviors.
The concept of lifestyle is centered around the idea that people typically display a
familiar pattern of behavior in their daily lives as in regular work routines, leisure time,