African Americans with heart failure (HF) are at increased risk for unanticipated hospitalizations and utilization of emergency department services. [Mental health issues, such as depression and anxiety, are also more prevalent in African American women with HF than African American women without HF. African American women are recognized to have compounded stressors that augment the strain of self-management of this intensive disease]. Recognizing the relationships of physical and psychosocial issues in self-management is important;and, in particular, the role of emotion regulation. Emotion regulation is defined as the experiencing, processing, and modulating of emotional responses in response to stressors or situations, and is required to facilitate behavioral adherence to HF self-management. Research has identified relationships between emotional and physical health in the African American women, but less is known about how perceptions of illness and emotion regulatory capacity alter behavioral adherence and health service usage outcomes of this patient population. [Thus, this prospective observational study proposes to examine emotion regulation, illness perceptions, and adherence to medications, exercise, and diet in African American women with HF.
The specific aims of this study are to:
Aim 1. Determine the associations between psychological factors (anxiety, stress, and depression) and emotion regulation in African American women with HF (time 1).
Aim 2. Determine the relationship of the contributing factors (clinical, demographic, and psychological) and illness perceptions with emotion regulation at intake (time 1) for African American women with HF.
Aim 3. Determine the effects of illness perceptions and emotion regulation on [the outcomes of] adherence and the use of healthcare services (hospitalization, emergency department, urgent care and unanticipated primary care visits) in African American women with HF at 30-days (time 2). The proposed project utilizes a repeated measures design with two data collection points: 1) discharge from the hospital, and 2) 30-days after discharge. Measurements will include surveys eliciting socio-demographic, emotion regulation, illness perception, and adherence information and medical record data to obtain clinical indicators and determine additional use of healthcare services. Patients included will be African American women who are being discharged from a hospitalization for exacerbation of HF with discharge instructions that include diet, medication, and exercise. The project will be completed with support from the students'interdisciplinary mentorship team. Nurse researchers Dr.'s Lehto, Given and [D. Moser] have advanced knowledge and experience in cognitive behavioral, adherence, and health disparities research in chronic illness populations respectively. Dr. J. Moser has extensive research background in emotion regulation, including measurement and analysis.
African American women with HF have complex medical needs, documented higher levels of depression and anxiety and treatment adherence challenges. Illness perceptions and the patients'ability to regulate emotions are integral to understanding self-management and adaptation to chronic illness. The study will investigate illness perceptions, emotion regulation and adherence in African American women with HF.