Hypertension Clinical Trial
To develop an integrative predictive model of long-term quality of life in cardiovascular disease that emphasized adaptive processes and outcomes.
BACKGROUND:
Modern treatments for cardiovascular disease that enhance survival have increased the need
to understand and improve corresponding aspects of quality of life. The increasing interest
in prevention and health promotion in contemporary cardiovascular care emphasizes reducing
risk factors that have major behavioral components, such as smoking, diet, and exercise.
Personal and social resources and psychological coping strategies are associated with
quality of life both directly and indirectly, through such positive health behaviors.
Findings from this research provided an essential foundation for continued investigation
focusing on longer-term changes in health status and quality of life in a planned ten-year
follow-up with the present sample.
DESIGN NARRATIVE:
The study developed and tested an integrative prospective structural equation model of the
interrelationships among social resources, coping strategies, positive health behaviors, and
quality of life in cardiovascular disease over a four-year time-period. It also contrasted
predictive findings relating to cardiac illness, stroke, and hypertension with predictive
findings from matched-control groups of healthy individuals and individuals with very
serious (cancer) and moderately serious (arthritis) noncardiovascular disease.
The research involved secondary data analysis with a large sample of individuals surveyed
through the Center for Health Care Evaluation at the Stanford University Medical School. The
sample included individuals between the ages of 55 and 65 who had used medical services in
two large medical centers. Extensive psychosocial and physical health data were available
from mail-out inventories at three points in time over a four- year period. Of eligible
respondents contacts, 92 percent agreed to participate in the initial survey, and 89 percent
(1884) of them provided complete data. Participation in one-year and four-year follow-ups
approached 90 percent of surviving respondents from the previous survey. At the initial
testing, 411 respondents (22 percent) reported diagnosed cardiac illness (excluding stroke
and hypertension), 83 respondents (5 percent) reported diagnosed strokes, and 593
respondents (31 percent) reported diagnosed hypertension.
The data base at all three measurement times included extensive information on the quality
of life, positive health behaviors, personal and social resources, and coping strategies.
Computerized hospital medical records were available for one-third of the sample, and were
used to evaluate the reliability of subjects' self-reports of medical conditions and health
status. Group comparisons were made on two dimensions: illness type and post-illness time
interval. Longitudinal analyses were used to examine causal influences on positive health
behaviors and quality of life, and to develop and test an integrative predictive model.
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