Date of Award

2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Mathew Gregoski

Second Advisor

Bonnie Dumas

Third Advisor

Teresa Kelechi

Fourth Advisor

David Isenhower

Abstract

Physical activity (PA) is a major indicator of health and a strong predictor of risk for coronary heart disease (CHD). The high mortality and morbidity from CHD is associated with high prevalence of risk factors including sedentary lifestyle. As one of the most sedentary among ethnic groups, African American (AA) women are at high risk for CHD and interventions to improve health outcomes need to be identified. A crucial gap exists in understanding the impact of PA as it pertains to the experience of AA women in identifying the most effective interventions to address specific needs of this high-risk population. This dissertation focuses on PA as it pertains to AA women in the context of CHD. The dissertation encompasses the role of worksite wellness programs (WWP) in facilitating PA health promotion for this “hard to reach” group. Specifically, the following research questions are addressed in this dissertation: 1) what do AA employees at high risk for CHD perceive as barriers and motivators to PA, 2) in the context of CHD, what valid instruments are available to measure PA among AA women, and 3) is it feasible to examine telephone support approaches, delivered by a nurse versus a trained peer coach, to improve PA and evaluate health outcomes of two groups of AA female employees at high risk for CHD? The conclusions from this dissertation are that: 1) interventions to alleviate physical limitations as the number one reported barrier to PA and discussion about importance of family relationships as a motivating factor should be incorporated in health promotion programs to improve PA behaviors, 2) the integrative review found 14 self-report instruments with modest but inconsistent psychometric validity, none of the instruments were exclusively used to measure PA in AA women, thus, future research should focus on identification of valid and culturally competent instruments specifically for AA women, and lastly, 3) examination of two telephone support approaches - delivered by a nurse versus a trained peer coach - is feasible among AA female employees at high risk for CHD enrolled in a WWP, and differences in secondary health outcomes offer preliminary estimates of outcome measures to inform future large scale randomized controlled trials. This body of work provides deeper understanding about the PA experience of AA women at high-risk for CHD and highlights the need to identify valid and culturally competent instruments to measure PA to guide interventions specifically for AA women. Lastly, examination of telephone support delivered by a nurse versus a peer coach demonstrates limited feasibility. However, preliminary data shows significant differences in PA represented by pedometer step count and MET-time between groups and across time points irrespective of delivery personnel. Establishing feasibility and acquiring estimates of outcome variability provide preliminary evidence for large scale randomized controlled trials to examine the most effective intervention to promote PA to support health outcomes of AA women in the context of CHD. This dissertation is useful for administrators, researchers, and clinicians because it provides guidance in designing PA programs for high-risk minority populations, specifically, AA women and opportunities to highlight the value of PA in health promotion programs especially in worksite settings.

Rights

All rights reserved. Copyright is held by the author.

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