Health-Promoting Behaviors, Hope, and Health-Related Quality of Life in Persons Impacted by

165 Pages·2017·1.31 MB·English

South Dakota State University
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Teses and Dissertations
2017
Health-Promoting Behaviors, Hope, and Health-
Related Quality of Life in Persons Impacted by
Parkinson’s Disease
Amy K. Forbes
South Dakota State University
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Forbes, Amy K., "Health-Promoting Behaviors, Hope, and Health-Related Quality of Life in Persons Impacted by Parkinson’s Disease"
(2017).Teses and Dissertations. 1219.
htp://openprairie.sdstate.edu/etd/1219
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HEALTH-PROMOTING BEHAVIORS, HOPE, AND HEALTH-RELATED QUALITY
OF LIFE IN PERSONS IMPACTED BY PARKINSON’S DISEASE
BY
AMY K. FORBES
A dissertation submitted in partial fulfillment of the requirements for the degree
Doctor of Philosophy
Major in Nursing
South Dakota State University
2017
ii
iii
This dissertation is dedicated to my mom. And for others with chronic illness who
struggle to maintain quality of life.
“Hope” is the thing with feathers –
That perches in the soul –
And sings the tune without the words –
And never stops – at all –
And sweetest – in the Gale – is heard –
And sore must be the storm –
That could abash the little Bird
That kept so many warm
I’ve heard it in the chilliest land –
And on the strangest Sea –
Yet, never in Extremity,
It asked a crumb – of Me.
Emily Dickinson (C.1891/1960)
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ACKNOWLEDGMENTS
Thank you to my committee: Dr. Kay Foland, Dr. Cynthia Elverson, Dr. Linda
Burdette, and Dr. Renee Oscarson. I also wish to thank Dr. Kay Herthe, Dr. Nola Pender,
and Dr. Jenkinson for the use of their instruments, and Dr. Stuifbergen for the use of her
Explanatory Model of Health Promotion and Quality of Life in Chronic Disabling
Conditions.
A special thank you to my colleagues and PhD sistas in the doctoral program. The
joy, laughter, and tears together has made this journey more meaningful than I could have
imagined.
Thank you to my husband and children who were patient every time I said I
needed to write just five more minutes. Thank you to my dad for encouraging me and for
saying, “Education is something no one can take away from you.” Thank you for the life
lessons that you teach me every day. I love you to the moon and back.
Finally, I want to thank the persons with Parkinson’s disease that shared their time
and experiences with me, and my mother who had such tough days with Parkinson’s
disease, yet always put on a smile. Thank you for being my inspiration, Mom, for being
the wind beneath my wings. Your love is always with me and eternally supports me.
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CONTENTS
ABBREVIATIONS ....................................................................................................viii
LIST OF FIGURES .....................................................................................................ix
LIST OF TABLES .......................................................................................................x
ABSTRACT ................................................................................................................xii
CHAPTER 1: INTRODUCTION AND BACKGROUND ........................................1
PURPOSE OF THE STUDY ..........................................................................9
RESEARCH QUESTIONS ...........................................................................9
RESEARCH HYPOTHESES ........................................................................10
DEFINITIONS ...............................................................................................13
CHAPTER 2: REVIEW OF LITERATURE .............................................................16
PREVALENCE OF PARKINSON’S DISEASE...........................................16
HOPE .............................................................................................................18
HEALTH-RELATED QUALITY OF LIFE ..................................................22
HEALTH-PROMOTING BEHAVIORS ......................................................28
THEORETICAL FRAMEWORK .................................................................33
CHAPTER 3: RESEARCH METHODOLOGY .......................................................42
RESEARCH DESIGN ...................................................................................42
SAMPLE ........................................................................................................42
SETTING .......................................................................................................44
INSTRUMENTS............................................................................................45
DATA COLLECTION ..................................................................................49
vi
ANALYSIS ....................................................................................................50
THREATS TO RELIABILITY AND VALIDITY ........................................52
CHAPTER 4: RESULTS AND ANALSYIS ............................................................54
RESULTS AND ANALYSIS ........................................................................55
ANALYSIS OF MULTIVARIATE METHODS ..........................................61
FACTOR ANALYSIS ...................................................................................62
SUMMARY OF PATH ANALYSIS ...........................................................88
ANALYSIS OF QUESTION 1 ......................................................................89
ANALYSIS OF QUESTION 2 ......................................................................92
ANALYSIS OF QUESTION 3 ......................................................................96
CHAPTER 5: SUMMARY OF FINDINGS ...............................................................102
SUMMARY OF FINDINGS .........................................................................102
IMPLICATIONS FOR NURSING PRACTICE ...........................................104
IMPLICATIONS FOR THEORETICAL FRAMEWORK ...........................108
STRENGTHS OF THE STUDY ...................................................................111
LIMITATIONS OF THE STUDY.................................................................112
RECOMMENDATIONS FOR FUTURE STUDY .......................................113
CONCLUSION ..............................................................................................115
REFERENCES ...........................................................................................................116
APPENDICES ..........................................................................................................137
A. DEMOGRAPHHIC INSTRUMENT FOR BACKGROUND …….……….137
B. HOEHN AND YAHR DISEASE SEVERITY SCALE ................................138
vii
C. HEALTH PROMOTING LIFESTYLE PROFILE (HPLP II).......................139
D. HERTH HOPE INDEX .................................................................................144
E. PARKINSON’S DISEASE QUALITY OF LIFE QUESTIONNAIRE ........146
F. PRE-NOTICE STUDY LETTER CONTACT .............................................147
G. FIRST LETTER CONTACT .........................................................................148
H. THANK YOU LETTER CONTACT ............................................................149
I. PERMISSION EMAIL DR. NOLA PENDER ..............................................150
J. PERMISSION EMAIL DR. KAYE HERTH ................................................151
viii
ABBREVIATIONS
B Beta Coefficien
df Degrees of Freedom
M Mean
N Total Sample
P Significance level
r Pearson Product-moment Correlation Coefficient
SD Standard Deviation
SEM Standard Error of the Mean
t Statistical test to compare difference om group means
PDF Parkinson’s Disease Foundation
HRQOL Health-Related Quality of Life
PDQ Parkinson’s Disease Questionnaire (measures quality of life)
HHI Herth Hope Index- measures hope
HPLP Health-Promoting Lifestyle Profile (measures health-promoting behaviors)
H&Y Hoehn and Yahr (stage of Parkinson’s disease score)
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LIST OF FIGURES
Figure 1. Study Framework .......................................................................................10
Figure 2. Explanatory Model of Health Promotion and Quality of Life in Chronic
Disabling Conditions .................................................................................................37
Figure 3. Scree Plot ....................................................................................................63
Figure 4. Confirmatory Factor Model Diagram .........................................................72
Figure 5. Histograms with Fitted Curves ...................................................................78
Figure 6. Boxplots ......................................................................................................79
Figure 7. Scatterplot Matrix .......................................................................................82
Figure 8. Visual Inspection of the Residual Terms (Errors) ......................................86
Figure 9. Conceptual Diagram of the Hypothesized Path Model ..............................92
Figure 10. Final Path Analysis Model for Hypothesis 2 ............................................96
Figure 11. Final Path Analysis Model for Hypothesis 3 ............................................101
Figure 12. New Model for Variables- Hope, Health-Promoting Behaviors
and HRQOL ...............................................................................................................108