THE RELATIONSHIPS AMONG BODY AWARENESS, SELF-REGULATION, SELF-MANAGEMENT ...

260 Pages·2015·2.34 MB·English

by  Ana Solano Lopez

THE RELATIONSHIPS AMONG BODY AWARENESS, SELF-REGULATION,
SELF-MANAGEMENT, AND BLOOD PRESSURE
IN ADULTS WITH HYPERTENSION

by

ANA LAURA SOLANO LÓPEZ

Submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy

Frances Payne Bolton School of Nursing

CASE WESTERN RESERVE UNIVERSITY

May, 2016
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CASE WESTERN RESERVE UNIVERSITY
SCHOOL OF GRADUATE STUDIES

We hereby approve the thesis/dissertation of
Ana Laura Solano López
candidate for the degree of Doctor in Philosophy*.

Committee Chair
Dr. Shirley Moore

Committee Members
Dr. Mary Dolansky
Dr. Ronald Hickman
Dr. Richard Josephson
Dr. David Fresco

Date of Defense
November 30th 2015

*We also certify that written approval has been obtained
for any proprietary material contained therein.
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Table of Contents
Table of Contents ................................................................................................................ 3
List of Tables ...................................................................................................................... 6
List of Figures ................................................................................................................... 11
Acknowledgements ........................................................................................................... 12
Abstract ............................................................................................................................. 13
CHAPTER I: Introduction ............................................................................................ 15
Research Questions ....................................................................................................... 23
Theoretical Framework ................................................................................................. 24
Definition of Terms....................................................................................................... 28
Study Assumptions ....................................................................................................... 32
Significance of the Study .............................................................................................. 32
CHAPTER II: Literature Review ................................................................................. 34
Uncontrolled Hypertension ........................................................................................... 34
Hypertension Self-Management ................................................................................... 37
Self-Regulation ............................................................................................................. 45
Interoceptive Awareness ............................................................................................... 53
Summary ....................................................................................................................... 68
CHAPTER III: Methods ................................................................................................ 70
Design ........................................................................................................................... 70
Sample........................................................................................................................... 70
Setting ........................................................................................................................... 74
Procedures ..................................................................................................................... 74
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Description of the Sample ............................................................................................. 75
Data Collection ............................................................................................................. 78
Measures ....................................................................................................................... 80
Data Management ......................................................................................................... 98
Preliminary Data Analysis ............................................................................................ 98
Data Analysis .............................................................................................................. 102
Human Subjects’ Protection ....................................................................................... 104
Chapter IV: Results ...................................................................................................... 107
Description of Main Variables .................................................................................... 107
Description of Covariates ........................................................................................... 110
Research Question 1 ................................................................................................... 112
Exploratory Analysis .................................................................................................. 128
Research Question 2 ................................................................................................... 134
Summary of Results .................................................................................................... 148
Chapter V: Discussion .................................................................................................. 149
Associations among Independent Variables ............................................................... 149
Independent Variables as Predictors of Blood Pressure ............................................. 158
Moderating Effects of Covariates ............................................................................... 162
Other Findings ............................................................................................................ 162
Significance of the Findings ....................................................................................... 164
Limitations .................................................................................................................. 166
Recommendations for Further Research ..................................................................... 169
Conclusion .................................................................................................................. 170
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Appendix A: Instructions for the Heartbeat Perception Task ......................................... 171
Appendix B: Multidimensional Assessment of Interoceptive Awareness ...................... 173
Appendix C: Iowa Gambling Task App ......................................................................... 178
Appendix D: Index of Self-Regulation ........................................................................... 182
Appendix E: Morisky’s Medication Adherence Scale .................................................... 184
Appendix F: DASH Diet Index....................................................................................... 186
Appendix G: Wrist Heart Rate Monitor Instructions ...................................................... 190
Appendix H: Exercise Diary ........................................................................................... 193
Appendix I: International Physical Activity Questionnaire ............................................ 195
Appendix J: Blood Pressure Protocol ............................................................................. 198
Appendix K: Demographics ........................................................................................... 200
Appendix L: Montreal Cognitive Assessment ................................................................ 203
Appendix M: Charlson Comorbidity Index .................................................................... 205
Appendix N: PROMIS Depression and Anxiety ............................................................ 207
Appendix O: Medication Regimen Complexity Index ................................................... 209
Appendix P: Blood Pressure Knowledge Scale .............................................................. 212
Appendix Q: Description of Missing Data ..................................................................... 214
Appendix R: Hierarchical Regressions for each Self-Management Behavior ................ 217
Bibliography ................................................................................................................... 228
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List of Tables
Table 1: Comparison of Effect Sizes from other Studies.………………………………73
Table 2: Characteristics of the Sample……………………………………………….…78
Table 3: Descriptive Statistics of Main Variables………………………..…………….109
Table 4: Descriptive Statistics of Covariates…….…………………………….…….…111
Table 5: Correlations among Main Variables………………………...……………...…114
Table 6: Correlations between Main Variables and Covariates……..………………….116
Table 7: Correlations among Covariates………………………………………….…….118
Table 8: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by MAIA on systolic blood pressure.……………………121
Table 9: Hierarchical regression for self-management behaviors, self-regulation
skills, decision-making ability, and interoceptive awareness measured
by the heartbeat perception task on systolic blood pressure…………………... 123
Table 10: Hierarchical regression for self-management behaviors, self-regulation
skills, decision-making ability, and interoceptive awareness measured
by MAIA on diastolic blood pressure ………..………………………………..125
Table 11: Hierarchical regression for self-management behaviors, self-regulation
skills, decision-making ability, and interoceptive awareness measured
by the heartbeat perception task on diastolic blood pressure…………………...127
Table 12: Hierarchical regression for medication adherence, self-regulation skills,
decision-making ability, and interoceptive awareness measured by MAIA
on systolic blood pressure………………………………………………………130
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Table 13: Hierarchical regression for medication adherence, self-regulation
skills, decision-making ability, and interoceptive awareness measured by
heartbeat perception task on systolic blood pressure…………………………...133
Table 14: Hierarchical regression for self-management behaviors, self-regulation
skills, decision-making ability, and interoceptive awareness measured
by MAIA, age, and age*medication adherence on diastolic blood pressure…...136
Table 15: Hierarchical regression for self-management behaviors, self-regulation
skills, decision-making ability, and interoceptive awareness measured
by the heartbeat perception task, age and age*medication adherence
on diastolic blood pressure…………………………………………………..… 137
Table 16: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by MAIA, age, and age*diet adherence
on diastolic blood pressure……………………………………………………. 138
Table 17: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by the heartbeat perception task, age and
age*diet adherence on diastolic blood pressure…………………………..…… 139
Table 18: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by MAIA, age and age*physical activity
on diastolic blood pressure……………………………………...…………..…..140
Table 19: Hierarchical regression for self-management behaviors,
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self-regulation skills, decision-making ability, and interoceptive
awareness measured by the heartbeat perception task, age and
age*physical activity on diastolic blood pressure………………...…………….141
Table 20: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by MAIA, age, and age*self-regulation
on diastolic blood pressure……………………………………………….....…..142
Table 21: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by the heartbeat perception task, age and
age*self-regulation on diastolic blood pressure………………….……………..143
Table 22: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by the MAIA, age and age*decision-making
on diastolic blood pressure…………………………………………………..….144
Table 23: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by the heartbeat perception task, age
and age*decision-making on diastolic blood pressure………………………….145
Table 24: Hierarchical regression for self-management behaviors,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by the MAIA, age and
age*MAIA on diastolic blood pressure……………………………………..….146
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Table 25: Hierarchical regression for self-management behaviors,
self-self-regulation skills, decision-making ability, and
interoceptive awareness measured by the heartbeat perception task,
age and age*heartbeat perception task on diastolic blood pressure………….…147
Table 26: Description of missing data …………………..……………………………..215
Table 27: Hierarchical regression for diet adherence, self-regulation skills,
decision-making ability, and interoceptive awareness measured
by MAIA on systolic blood pressure…………………………………….……. 218
Table 28: Hierarchical regression for diet adherence, self-regulation skills,
decision-making ability, and interoceptive awareness measured
by heartbeat perception task on systolic blood pressure………………..……....219
Table 29: Hierarchical regression for physical activity, self-regulation skills,
decision-making ability, and interoceptive awareness measured by
MAIA on systolic blood pressure……………………………………………. 220
Table 30: Hierarchical regression for physical activity, self-regulation skills,
decision-making ability, and interoceptive awareness measured
by heartbeat perception task on systolic blood pressure……………………….221
Table 31: Hierarchical regression for medication adherence,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by MAIA on diastolic blood pressure………………… 222
Table 32: Hierarchical regression for medication adherence,
self-regulation skills, decision-making ability, and interoceptive
awareness measured by the heartbeat perception task
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on diastolic blood pressure………………………………………………...……223
Table 33: Hierarchical regression for diet adherence, self-regulation skills,
decision-making ability, and interoceptive awareness measured by
MAIA on diastolic blood pressure…………………………………………...…224
Table 34: Hierarchical regression for diet adherence, self-regulation skills,
decision-making ability, and interoceptive awareness measured by the
heartbeat perception task on diastolic blood pressure……………………….….225
Table 35: Hierarchical regression for physical activity, self-regulation skills,
decision-making ability, and interoceptive awareness measured by
MAIA on diastolic blood pressure………………………………….…………..226
Table 36: Hierarchical regression for physical activity, self-regulation skills,
decision-making ability, and interoceptive awareness measured by
the heartbeat perception task on diastolic blood pressure………………………227