Perceived stress among patients with heart failure who have low socioeconomic status: A mixed-methods study

Carolyn Dickens, Victoria Vaughan Dickson, Mariann R. Piano

Research output: Contribution to journalArticle

Abstract

Background: Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care - especially among patients with heart failure (HF). Objective: We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. Methods: In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. Results: Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. Conclusions: Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.

Original languageEnglish (US)
Pages (from-to)E1-E8
JournalJournal of Cardiovascular Nursing
Volume34
Issue number3
DOIs
StatePublished - May 1 2019

Fingerprint

Self Care
Social Class
Social Determinants of Health
Heart Failure
Psychological Stress
Aptitude
Family Health
Family Relations
Urban Hospitals
Crime
Violence
Health Personnel
Cohort Studies
Referral and Consultation
Interviews

Keywords

  • heart failure
  • readmission
  • social determinants of health
  • socioeconomic status

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Perceived stress among patients with heart failure who have low socioeconomic status : A mixed-methods study. / Dickens, Carolyn; Vaughan Dickson, Victoria; Piano, Mariann R.

In: Journal of Cardiovascular Nursing, Vol. 34, No. 3, 01.05.2019, p. E1-E8.

Research output: Contribution to journalArticle

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abstract = "Background: Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care - especially among patients with heart failure (HF). Objective: We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. Methods: In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. Results: Self-care was poor: 91.5{\%} of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34{\%} of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. Conclusions: Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.",
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