Predictors of African American Women's Perceived Health Status in the Context of Caring for a Relative With End Stage Renal Disease

Abstract

The purposes of this study of African American women who were family caregivers of persons with end stage renal disease (ESRD) were to: (1) identify their perceived health status and changes in perceived health status since assuming the caregiver role, (2) document the association between objective health status and caregiver age, (3) document the relationship between age and perceived health status, (4) identify demographic and subjective and objective health factors that predict perceived health status, and (5) identify their health promotion behaviors. The design for this study was a cross-sectional, descriptive correlational secondary analysis of data obtained from 75 African American women caring for a relative diagnosed with ESRD. These women participated in a larger study designed to investigate the predictors of health and burden in 120 family caregivers of patients with ESRD. The current study included data collected using the following instruments: The Caregiver Demographic Data Form, Caregiver’s Perceived Health Form, Severity of Caregiver’s Disease Scale, and the Center for Epidemiological Studies Depression Scale (CES-D). Data were analyzed using descriptive statistics, Spearman’s correlation analysis, and stepwise multiple regression analysis. Overall, 28% of the caregivers rated their health as either fair or poor although most reported good health. Caregivers also reported several negative changes in health associated with the caregiving experience including decreases in exercise, energy, time for self, time for family and friends, and the amount/quality of sleep and increases in weight, and worry stress/tension. Forty-nine caregivers had scores of 0-15 indicating no signs of clinical depression; however, three caregivers (4.0%) had scores of greater than 31 which indicated severe distress. The mean body mass index for caregivers was 31.2 % indicating that on average this sample was obese. Reported health problems included hypertension (48%) and diabetes (24%). A significant weak positive correlation was found between perceived health status and caregiver age. Predictors of caregiver perceived health status indicated that five variablesnumber of prescription medications, number of physician office visits in the past 6 months, number of health problems, caregiver age, and total score of CES-D explained 31% (p=.000) of the total variance. Older caregivers on more prescription medications and with more provider visits, health problems and depressive symptoms reported the lowest perceived health status. The relatively small amount of perceived health status variance explained suggests that there are other factors that influenced the perceived health status of participating caregivers. The most common health behaviors reported by African American family caregivers were nutrition, exercise, modifying stress, spirituality/faith, following physician orders, and taking medication as ordered. Though participants reported multiple physical health problems most reported participating in health promotion activities and on average they perceived their health as good. There may be cultural and economic factors that explain this apparent dissonance between objective indictors of health and perceived health status of study participants. The health status of patients and families are the focus of nursing care and nursing research. End stage renal disease potentially affects the health of both patients and their caregivers. In this study caregivers reported multiple changes in health that could jeopardize their ability to continue to provide care. Findings from this study provide support for developing health promotion interventions that address the needs of understudied African American caregivers assisting persons with ESRD.