Engagement In Healthy Behaviors Research Articles

Defining Self-Management for Solid Organ Transplantation Recipients: A Mixed Method Study.

Patients with Solid Organ Transplantations (SOTx) face long-term lifestyle adaptations, psychological and social adjustments, and complex self-care regimes to maintain health post-transplant. Self-management (SM) skills represent important aspects of nursing communication with SOTx patients; however, there is potential for SM to be defined narrowly in terms of medication adherence. The study presented here collated the existing definitions in a mixed method review in order to identify SM attributes for this group (including those unique to this population). Secondary analysis of a dataset and bibliographic analysis and an expert panel were used to develop a comprehensive working definition of SOTx patients. The analysis comprised critical interpretation of the evolving definition content, concepts, and contexts of application in current usages and over time. We identified eight definitions and 63 cited definition sources from bibliographic analysis. Findings identified limitations of the existing definitions. Population-specific attributes included optimisation of transplant outcomes, active engagement in healthy behaviours, control, structure, and discipline characteristics, and moderating factors of patient motivation, self-efficacy, and cognitive function. A critical appraisal of definitions indicated inadequately defined aspects such as setting, temporal dimension, concept interaction, interventions, and measurable outcomes. The bibliographic analysis highlighted the influence of broader chronic illness constructions of SM, underpinning the generalisable SM attributes in current definitions. Further research may advance the development of a definition in exploring the relevance of SOTx-specific attributes of the definition.

Examining the Building Blocks of Health Behavior Change in Rheumatology Rehabilitation: A Theory-Driven Qualitative Study.

To identify and describe behavior change techniques (BCTs) used in rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs), according to their own perceptions. Further, to examine patients' descriptions of their capability, opportunity, motivation, and readiness for health behavior change. Patients were adults in need of specialized, multidisciplinary rehabilitation services due to inflammatory rheumatic disease, systemic connective tissue disease, or fibromyalgia / chronic widespread pain. Semi-structured interviews of 21 patients were analyzed with deductive qualitative content analysis applying three theoretical frameworks: the Behavior Change Technique Taxonomy, the transtheoretical model and stages of change, and the capability, opportunity, and motivation model of behavior. Forty-six BCTs aggregated within 14 BCT groups were identified used by either patients, healthcare professionals (HPs), or both. Goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution were most frequently used to facilitate behavior change. Twenty patients had reached the action stage and made specific lifestyle changes concerning more than half of their goals. Concerning other goals, 6 of these patients reported to be contemplating behavior change and 15 to be preparing for it. The rehabilitation process appeared to strengthen capability, opportunity, motivation, and the desired behaviors. Patient-reported barriers to behavior change were connected with restrictions in physical capability resulting from an unpredictable and fluctuating disease course, weakened motivation, and contextual factors, such as lack of access to healthcare support and training facilities, and high domestic care burden. The rehabilitation process seemed to strengthen individual and contextual prerequisites for behavior change and facilitate the use of required techniques and engagement in the desired behaviors. However, patients with RMDs may need prolonged support from HPs to integrate healthy lifestyle changes into everyday life. The findings can be used to optimize rehabilitation interventions and patients' persistent engagement in healthy behaviors.

Healthy prison cultures: factors influencing male prisoners' engagement in exercise and subsequent healthy behaviours.

The purpose of this paper is to identify the factors which influence male prisoners' motivation for, and engagement in, exercise and subsequent healthy behaviours. The first authors conducted 20 semi-structured interviews with male prisoners inside an English medium-security male prison. Interviews were recorded and transcribed, themes were identified using thematic analysis and a critical realist perspective applied to understand objective processes behind prisoners' experiences and shared meanings of exercise and engaging in healthy behaviours in prison. Emerging themes indicate that in the context of healthy behaviours male prisoners aspired to a masculine ideal that was characterised by a culture of either adaptive behaviours, or maladaptive behaviours. The former fostered an adaptive exercise culture which promoted psychological well-being through an autonomy-supportive environment, consequently internalising motivation and minimising perceived barriers to engaging in healthy behaviours. Conversely, a culture of maladaptive behaviours fostered a maladaptive exercise culture which led to negative psychological well-being, underpinned by external forms of motivation which emphasised barriers to engaging in healthy behaviours. Findings emphasise the need for prisons to promote an internal perceived locus of control for male prisoners when engaging in healthy behaviours. The authors adopt a rare interdisciplinary approach combining a psychological theory of motivation and criminological perspectives of prison culture to understand how best to minimise the impact of prisons as an institution on the psychological well-being of male prisoners.

59 An Examination of the Moderating Effect of Self-Efficacy on the Association Between Health Literacy and Healthy Activity Engagement in Older Adults

Objective:Engagement in activities that promote overall brain health and well-being is often a key step in reducing risks to cognitive health in older adults. Given that higher health literacy has been found to be associated with healthier lifestyles, it is unsurprising that it has been the focus of many studies and programs aimed at improving the health outcomes of older adults. An equally important factor to consider when it comes to such efforts is the role of moderating variables in the relationship between health literacy and engagement in healthy behaviors. The present study examined the moderating effect of self-efficacy, a variable that has been shown to be positively associated with both health literacy and health behaviors. We hypothesized that increased self-efficacy will strengthen the relationship between health literacy and healthy activity engagement in a sample of community-living older adults.Participants and Methods:Forty-nine older adults (age: M = 64.35, SD = 8.00; education: M = 16.39, SD = 2.37; 87.76% female) completed a health literacy measure (Newest Vital Sign; NVS), a self-efficacy questionnaire (General Self-Efficacy Scale; GSE), and a lifestyle behaviors questionnaire (Healthy Aging Activity Engagement Scale; HAAE). The NVS is a performance-based measure in which participants are asked to interpret the verbal and numerical information of a nutrition label to make health-related decisions. The GSE is a self-report measure that evaluates one’s belief in their ability to handle challenges, solve problems, and accomplish goals. The HAAE is a self-report measure that assesses one’s engagement in healthy activities across multiple health domains.Results:To examine whether self-efficacy moderates the relationship between health literacy and healthy activity engagement, a moderation analysis was conducted using Hayes’ PROCESS macro for SPSS with age and education included in the model as covariates. The results revealed no significant interaction between health literacy and self-efficacy, b = 0.23, p = .59, 95% CI [-0.60 to 1.05].Conclusions:Contrary to expectations, in the present sample, the degree of self-efficacy was not a condition under which level of health literacy exerted its influence on healthy activity engagement in older adults. Future studies with larger and more nationally representative samples are needed to explore self-efficacy and other potential moderating factors in order to identify individual characteristics that support older adults’ adoption and engagement in health-promoting behaviors.

P090 How do Australian Shiftworkers and Non-Shiftworkers Prioritise Sleep, Diet, and Physical activity?

Abstract Background Increasing engagement with sleep, diet, and physical activity (PA) is critical for populations who are at higher risk of poor health, such as shiftworkers. To increase engagement in sleep, diet and PA, it is critical to first understand which of these behaviours Australians currently prioritise and whether this prioritisation relates to actual behaviour. Therefore, this study aimed to investigate how Australians prioritise sleep, diet and PA. Methods A cohort of 1151 Australian adults (54% female, aged 18-65 years) completed a phone interview, and a cohort of 588 Australian shiftwork-only adults (76% female, 18-72 years) completed an online survey. All participants were asked which health behaviour (sleep, diet or PA) they prioritised. Behavioural correlates of sleep, diet, and PA, and questions on shiftwork experience were also collected. Results Diet was prioritised by the adults (49%), whereas sleep was prioritised by the shiftwork-only sample (68%). Multinomial logistic regressions revealed that adults who prioritised diet were significantly more likely to report less fast-food consumption (p<0.002) and more fruit consumption (p<0.002) compared to those that prioritised sleep. For the shiftwork-only sample, those with 16-30 years of shiftwork experience were significantly more likely to prioritise sleep compared to diet (p<0.05). Conclusions While prioritising diet was associated with healthier diet behaviour in Australian adults, overall, across both cohorts, behaviour prioritisation did not relate to actual behaviour. This suggests that there are factors other than behaviour prioritisation that influence engagement in healthy behaviours. These factors, such as workplace barriers, should be the focus of future research.

Additive and interactive associations among body appreciation, self-compassion, and gender in understanding college students’ health behaviors

Body appreciation and self-compassion are associated with each other and individually associated with important health behaviors. Less is known about their combined associations with health behaviors, although previous work has examined self-compassion as a moderator of negative body image experiences. Self-compassion may likewise amplify the positive association between body appreciation and engagement in healthy behaviors. In this study, we examined the additive and interactive associations of body appreciation and self-compassion with three health behaviors (physical activity, sleep, stress management activities) among 302 college students from a northeastern university in the United States. We further examined gender differences in key variables and in associations among body appreciation, self-compassion, and health behaviors. We found that body appreciation was independently associated with physical activity and stress management activities, with the association stronger for men than women. We also found that self-compassion was independently associated with sleep and stress management activities. Body appreciation and self-compassion did not interact in predicting any health behaviors. Findings from this study highlight the unique associations of body appreciation and self-compassion with different health behaviors and underscore the need to increase body appreciation and self-compassion among college students to promote overall health and well-being.

Digital applications as a means for promotion of healthy behaviours among Albanian children.

Digital applications can be effective tools for strengthening school-based health education programs as they can provide valuable health information to children through interactive videos, quizzes and games. We aimed at assessing the change in the prevalence of healthy behaviours among children exposed to digital applications (intervention) employed for promoting healthy behaviours. We conducted a cross-sectional study before the intervention in March 2022 including a representative sample of 1500 Albanian schoolchildren (≈54% girls) aged 12-15 years. In June 2022, after 4-month exposure to digital applications aimed at promoting healthy behaviours (intervention), we carried out a second cross-sectional study in the same sample of schoolchildren. In both survey rounds, an anonymous and structured self-administered questionnaire inquired children about a range of behavioural practices including nutrition, oral health, physical activity and hygiene practices. After the intervention, overall, there was evidence of a significant increase in the prevalence of all healthy behavioural practices measured: ~9% for breakfast consumption and/or environmental protection, 12% for toothbrushing, 14% for handwashing, 15% for leisure time physical exercise and 24% for adequate fruit and vegetable intake (all p < 0.001). Engagement in healthy behaviours only after the intervention was higher among rural children (from 18% for breakfast consumption to 37% for handwashing and/or adequate fruit and vegetable intake) and especially those pertinent to Roma/Egyptian communities (from 18% for breakfast consumption to 46% for adequate fruit and vegetable intake), except for engagement in safe environmental protection which was more prevalent among urban residents (28% vs. 15% among rural children) and ethnic Albanian children (24% vs. 13% among Roma/Egyptian children). Our findings from Albania indicate that digital applications can be useful for strengthening school-based health promotion programs.

Body dissatisfaction, negative affect, and engagement in healthy behaviors: The conditional effect of future-self continuity.

The relationship between body dissatisfaction and negative affect is complex, with some research suggesting that this combination motivates individuals to engage in more health-related behaviors; while other studies find it increases unhealthy behavior. To bridge this gap, it may be the case that to the extent these individuals have continuity between their present and future selves, the more likely they are able to make positive health-related choices with this future self in mind. We examined individuals (n = 344; 51.74% men) aged between 18 and 72 years (M = 39.66, SD = 11.49) who endorsed high negative affect along with body dissatisfaction but either had high or low levels of future self-continuity. We found individuals experiencing body dissatisfaction and negative affect reported higher engagement in healthy behaviors only if they had a strong connection to their future self, index of moderated mediation = 0.07 (95% CI = 0.02, 0.13). These findings support targeting future-self continuity in therapeutic regimens to bolster engagement in healthy behaviors among individuals with body dissatisfaction and high negative affect.

The interplay of ADHD symptoms and exercise in youth

The interplay of ADHD symptoms and exercise in youth

Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework.

Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior GDM and identify relevant intervention components. Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive-deductive model, themes were mapped to the TDF and COM-B model. After screening 5148 citations and 139 full texts, we included 35 studies (N= 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence-based recommendations for communications to support behaviour change. We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from diverse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.

Characterizing fatigue phenotypes with other symptoms and clinically relevant outcomes among people with multiple sclerosis.

Fatigue is a common symptom of multiple sclerosis (MS) and can adversely affect all aspect of quality of life. The etiology of fatigue remains unclear, and its treatments are suboptimal. Characterizing the phenotypes of fatigued persons with MS may help advance research on fatigue's etiology and identify ways to personalize fatigue interventions to improve quality of life. The purpose of this study was to identify fatigue phenotypes; examine phenotype stability overtime; and characterize phenotypes by health and function, social and environmental determinants, psychosocial factors, and engagement in healthy behaviors. We conducted a longitudinal study over a 3-month period with 289 fatigued participants with MS. To identify fatigue phenotypes and determine transition probabilities, we used latent profile and transition analyses with valid self-report measures of mental and physical fatigue severity, the mental and physical impact of fatigue, depression, anxiety, and sleep quality. We used ANOVAs and effect sizes to characterize differences among phenotypes. The best fitting model included six subgroups of participants: Mild Phenotype, Mild-to-Moderate Phenotype, Moderate-to-Severe Phenotype, Severe Phenotype, Fatigue-dominant Phenotype, and Mental Health-dominant Phenotype. The transition analysis indicated that phenotypic membership was highly stable. Variables with a large eta squared effect size included environmental barriers, self-efficacy, and fatigue catastrophizing. These results indicate that the magnitude of fatigue experienced may be more important to consider than the type of fatigue when characterizing fatigue phenotypes. Future research should explore whether tailoring interventions to environmental barriers, self-efficacy, and fatigue catastrophizing reduce the likelihood of transitioning to a more severe phenotype.

Incorporating motivation and execution into healthy building rating systems based on the theory of planned behaviour (TPB)

Although healthy building rating systems include health strategies in the building design and management, they insufficiently consider occupants' motivations to engage in and the execution of health strategies. This study aims 1) to classify the design and management strategies of healthy building rating systems according to occupants’ subjective motivations and objective execution and 2) to optimize healthy building rating systems by applying the theory of planned behaviour (TPB). Based on a survey of occupants in WELL certified buildings and the related analysis using structural equation models (SEMs), it was found that attitudes, subjective norms, and perceived behavioural control all had significant positive effects on the health-related behaviours of office workers. Management tools were more effective than design tools in implementing healthy building strategies. Spatial planning design strategies had the most evident intervention effect on personnel engaging in healthy behaviours, while the intelligent automation category had a negative effect on behaviour intentions. This research provides suggestions for optimizing the relevant rating systems of building assessment standards by discussing the typical characteristics of occupants and strategies to promote their engagement in healthy behaviours.

Perceptions of aging and wellness engagement among life plan community residents

ABSTRACT Despite the availability, some residents choose not to participate in wellness offerings at their residential communities. Perceptions of aging can influence engagement in healthy behaviors. The purpose of this research was to examine the relationship between perceptions of aging and wellness engagement among Life Plan Community residents. A total of 447 residents (ages 59 to 97; M = 81.82, SD = 6.55) of 10 Life Plan Communities completed surveys that measured their perceptions of aging, self-reported wellness, interest in improving wellness, participation in wellness programs, and barriers to wellness participation. Multiple regression analyses revealed that more positive perceptions of aging were associated with better wellness, higher interest, more frequent participation, and fewer barriers. Follow-up analyses revealed that these effects could be accounted for by specific types of aging attitudes (i.e. psychological growth, psychosocial loss, and physical change). These findings have implications for the development, implementation, and promotion of wellness programs for older adults.

Positive affect predicts engagement in healthy behaviors within a day, but not across days

Positive affect predicts engagement in healthy behaviors within a day, but not across days

The Intersection of Social Determinants and Health Behaviors: Effect on Preterm Birth

The objective of this work to provide evidence that the engagement in healthy behaviors has a protective relationship between preterm birth (PTB). We also want to examine participation in healthy behaviors from a social context by examining the effects of social determinants. This study is a retrospective cohort study that used data from US counties. The data was sourced from the county health rankings website (https://www.countyhealthrankings.org) and March of Dimes Peristats. Healthy behaviors were defined as percent of county population abstinence from smoking, alcohol and drug use. We also included the percent sufficient consumption of fruits and vegetables, engagement in physical activities and sufficient sleep. Social determinants observed were race, immigration status, neighborhood deprivation, income, education, access to healthcare. We also included physical and mental health variables as well. Data were analyzed using principle components analysis (PCA) and ordinary least squares (OLS) regression. The results of the PTB model showed that behavior had a significant and inverse relationship with PTB (β = -0.276, p < 0.001). Other components that had significant relationships with PTB were household demographics (β=0.270, p < 0.001), community deprivation (β=0.166, p < 0.001), healthcare access (β=-0.108, p < 0.001), and chronic disease (β=0.110, p < 0.001). We also found that household economics (β=0.311, p < 0.001), healthcare access (β=0.290, p < 0.001), household demographics (β=-0.273, p < 0.001) and neighborhood deprivation (β=- 0.145, p < 0.001) are social determinants that have a significant relationship with engagement with healthy behaviors. This study reaffirmed the importance of healthy behaviors in the prevention of PTB and how engagement may offset the effect of social disadvantage. This work adds to the literature in that it does not look at behaviors in a vacuum, but sought to look at the behavior within social context by examining the social determinants which may promote or present barriers to the engagement of health promoting behaviors.

The Role of Aging Anxiety, Ageism, and Health Locus of Control on Middle-Aged Adults Health Outcomes and Behaviors

Older adults with more ageist attitudes and aging anxiety and who endorse an external health locus of control (HLOC) have poorer mental and physical health and less engagement in healthy behaviors than those who report less ageist attitudes, aging anxiety, and endorse an internal HLOC. However, middle-aged adults have not been examined in this literature. Using Terror Management Theory as a framework, this study examined the relationship of middle-aged adults’ aging anxiety, ageist attitudes, and HLOC with health behaviors and mental and physical health outcomes. 391 middle-aged participants (40-55 years) completed measures of ageist attitudes, aging anxiety, HLOC (Internal, External, and Powerful Other), engagement in health behaviors, mental health, and physical health. The path analysis model demonstrated acceptable fit, χ2(2)=7.794, p=.02, CFI=.99, TLI=.92, RMSEA=.09). For health behaviors, eight of the 10 paths were significant; higher aging anxiety, higher ageist attitudes, and less endorsement of internal HLOC were related to less engagement in healthy behaviors. For mental health and physical health, five of the 10 paths were significant; in general, higher aging anxiety, higher ageist attitudes, and less endorsement of internal HLOC were related to poorer mental and physical health. This study demonstrated that middle-aged adults’ aging anxiety, ageist attitudes, and health locus of control are related to their health behaviors and mental and physical health. Furthermore, higher endorsement of specific forms of ageist attitudes and aging anxiety were related to worse reported mental and physical health and to less engagement in health behaviors. Implications of these findings will be discussed.

Psychological Distress Among the U.S. General Population During the COVID-19 Pandemic.

The COVID-19 pandemic is taking a significant global toll on emotional well-being, but evidence of mental health impacts in the United States remains limited. In April 2020, we conducted an exploratory survey of U.S. residents to understand prevalence of and factors associated with psychological distress during the pandemic. Data collection was conducted using Qualtrics, an online survey platform, and U.S. adult respondents were recruited via Amazon's Mechanical Turk platform. Among 1,366 respondents, 42% (n = 571) reported clinically significant anxiety and 38% (n = 519) reported clinically significant depression. Factors associated with anxiety and depressive symptoms included Hispanic/Latino ethnicity; younger age; lower income; employment as or living with a health care worker-first responder; caregiver status; SARS-CoV-2 infection status; decreased frequency of engagement in healthy behaviors; and changed frequency of engagement in unhealthy behaviors. That some of these factors are associated with elevated distress during the pandemic is not yet widely appreciated and might be useful in informing management of mental health care resources.

The role of stress responses on engagement in dietary and physical activity behaviors among Latino adults living with prediabetes

ABSTRACT Objectives Latinos are at a high risk of developing type 2 diabetes (T2D). Prediabetes is a major risk factor for T2D; however, progression to T2D can be slowed with engagement in healthy behaviors. Stress can hinder engagement with health behaviors. Qualitative methods were used to understand how Latinos with prediabetes attempted to modify their diet and physical activity behaviors to slow T2D progression and how stress affected their engagement in these behaviors. Design Semi-structured interviews were conducted with 20 Latinos with prediabetes in North Carolina. Participants were asked questions about types of stress they experienced and how stress affected their health. We generated codes on stress and stress responses and used content analysis to organize codes between and within participants. Results Behaviors changed after prediabetes diagnosis. Few participants reported changing their physical activity, however, all participants attempted to change their eating patterns by changing food types consumed and reducing portion sizes. The stress participants experienced impacted their ability to self-regulate their diet. They reported overeating or appetite suppression during stressful periods. Stress also affected cognitive responses by compromising healthy decision-making and instigating negative emotional reactions. Overall, stress complicated participants’ ability to properly engage in recommended behaviors by negatively impacting participants’ behavioral self-regulation and cognitive processes. Conclusions Stress affects behavioral and cognitive progresses that adversely alters primarily dietary behaviors. Tailored plans acknowledging the impact of stress and providing coping and supportive help for dealing with stress may enhance engagement in healthy behaviors for Latinos with prediabetes.

Conspiracy Theories, Mistrust Take Root During Pandemic

Conspiracy Theories, Mistrust Take Root During Pandemic

Does gender moderate the associations of caregiving distress with engagement in healthy behaviors and self-management in rural caregivers?

Abstract Introduction Caregivers are globally vulnerable populations facing a high risk of cardiovascular disease (CVD) development and mortality. Caregiving distress, defined as caregiver burden, stress, depressive symptoms, and anxiety, may contribute to a lack of engagement in healthy behaviors and self-management. Although gender differences in caregiving distress have been reported, there is limited evidence about whether gender moderates the associations between caregiving distress and engagement in healthy behaviors or self-management in rural caregivers. Purposes To compare gender differences in caregiving distress (i.e., burden, stress, depressive symptoms, and anxiety), and engagement in healthy behaviors and self-management; and to determine whether gender moderates the associations of caregiving distress with engagement in healthy behaviors and self-management. Methods Rural informal caregivers caring for patients with chronic disease and having at least two or more CVD risk factors completed baseline assessment in an ongoing randomized controlled trial of a CVD risk reduction intervention. Caregiving distress was assessed using the Zarit Burden Interview, the Perceived Stress Scale, the Patient Health Questionnaire-9, and the Brief Symptom Inventory-Anxiety. Engagement in healthy behaviors and self-management were assessed using the MOS-Specific Adherence Scale and the Patient Activation Measure, respectively. Independent t-tests and multiple regression modeling with the PROCESS macro was used. Results Of the 262 rural caregivers (mean age= 53.7 years; 78% female; 96% white), 55% of the caregivers reported having at least one or more types of CVD. Female caregivers reported significantly higher levels of burden, perceived stress, depressive symptoms, and anxiety than male caregivers, but they experienced similar levels of engagement in healthy behaviors and self-management. High levels of burden (SB=−0.454, P&amp;lt;0.001), stress (SB=−0.456, P&amp;lt;0.001), depressive symptoms (SB=−0.363, P&amp;lt;0.001) and anxiety (SB=−0.365, P&amp;lt;0.001) were significantly associated with low levels of engagement in healthy behaviors, but there were no gender moderation effects on these associations. High levels of burden (SB=−0.334, P&amp;lt;0.001) were significantly associated with poor engagement in self-care, but this association was strong and significantly only for female caregivers. High levels of stress (SB=−0.384, P&amp;lt;0.001) were also significantly associated with poor engagement in self-care for only female caregivers. Although depressive symptoms (SB=−0.325, P&amp;lt;0.001) and anxiety (SB=−0.349, P&amp;lt;0.001) were associated with low levels of self-management, there were no gender effects on these associations. Conclusions Significant gender effects on associations of caregiving distress with self-management suggest the need for designing interventions targeting caregiving burden and stress to reduce caregiving distress for women rural caregivers. Funding Acknowledgement Type of funding source: Other. Main funding source(s): National Institutes of Health