Understanding the Relationship Between Self-care Agency, Self-care Practices and Obesity among Rural Midlife Women

Purpose of the research The purpose of this non experimental, predictive correlation study was to examine the relationship between self-care agency, self-care practices, and obesity among rural midlife women. Although self-care practices have been linked to the reduction of obesity, no prior studies of the relationship between self-care and obesity among rural midlife women have been identified (Burdette, 2012). Type of research study Qualitative data identified the meaning of health, self-care and impact of distance on access to healthcare in rural midlife women.

Utilizing a non-experimental, predictive correlation design, the relationship between self-care agency, self-care and obesity in rural midlife women was studied. Three instruments were completed by the women including Demographic Instrument, Denyes Self-Care Agency Instrument, and Denyes Self-Care Practices Instrument. The study included ten counties in South Dakota sampling women, ages 40-64 years, ambulatory and able to read and write English. 224 women were evaluated, 98. 7% being white, 0. 4% American Indian, and 0. 4% Asian.

Participants’ marital status was excluded from the study, as well at women living in assisted living, nursing home, or receiving home health care services. Participants were recruited by way of newspapers, flyers in the community, and a county fair booth (Burdette, 2012). Key terms Self-care is defined by Dorothea Orem as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health and well-being. Rural nursing theory defines self-care as “activities self-initiated and performed for self or family members in response to symptoms”.

Also defined is self-care agency as defined by Orem is “the complex acquired capability to meet one’s continuing requirements for self…. ” Health, as defined by Orem, is a state of being whole and sound. Rural nursing theory’s definition of health as being able to do what the person wants to do; it is a way of life and a state of mind (Burdette, 2012). Denyes Self-Care Agency Instrument is a measure of self-care agency with six scale scores including ego strength, valuing health, health knowledge and decision making capability, energy, feelings and attention to health.

Denyes Self-Care Practice Instrument is used to measure self-care or self-care activities appropriate for use with healthy populations as well as with diseases/conditions (Burdette, 2012). Literature review A literature review provided insight into women’s views of self-care and the process of self-care actions. Studies identified white non-Hispanic middle aged women and Latinas in the United States and women in Pakistan, Taiwan and Thailand to explore the concept of self-care, self-care agency and self-care practices. The studies evaluated were dated 1993, 1999, 2000-2008.

Education and age were found to be correlated to self-care agency and self-care. Distance was identified as a potential for compromised health care (Burdette, 2012). No studies were identified related to the relationship of self-care to rural mid-life women and obesity. There were no studies identified that utilized both Orem’s theory and the rural nursing theory as theoretical framework. The literature review shows that the impact of the rural environment on self-care and obesity in rural midlife women is an area lacking research (Burdette, 2012).

Concepts, models, theories Dorothea Orem’s self-care theory and rural nursing theory provided the theoretical framework for the study. Orem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated theories; the theory of self-care, the self-care deficit theory, and the theory of nursing systems (Gonzalo, 2011). The key concepts of the rural nursing theory include work beliefs, health beliefs, isolation, distance, self-reliance, lack of anonymity, outside/insider, old timer/newcomer, informal networks,

lay care networks, familiarity and professional isolation (Burdette, 2012). Demographic Instrument, Denyes Self-Care Agency Instrument, Denyes Self-Care Practice Instrument were completed by participants. The Denyes Self-care Agency Instrument was based on Orem’s definition and theory of self-care. A predictive model of self-care in rural midlife women was constructed base on Orem’s theory and rural nursing theory. Basic conditioning factors were organized by sets as recommended by Orem literature. Set one: age, marital status, ethnicity, number of children living at home, and education.

Set two: pattern of living, tobacco use, and place of residence. Set three: health state and health system, date of last physical exam, number of chronic conditions, insurance, and distance from health resources (Burdette, 2012). The final model of the study was constructed including the independent variables, education level, body mass index, and number of chronic diseases. Solutions Qualitative themes found to facilitate self-care agency include knowledge, importance of health, use of the internet, group support and positive reinforcement by family and friends.

Barriers to self-care agency were identified as balancing personal, family and work needs; lack of energy; and lack of motivation, money and self-discipline. Smoking and chronic illness were found to be barriers to self-care practices. The final model constructed suggests that as body mass index increases, the level of self-care agency decreases which leads to a decrease in self-care. An increased level of education increases the level of self-care agency leading to increased self-care. Also, with the increase of personal chronic disease, there is a decrease in self-care.

No impact of distance on access to healthcare was supported or identified by participants. The model suggests that, since it was found that the strongest effect on self-care agency was the negative of body mass index, interventions to increase self-care agency must address body mass index. Body mass index was found to negatively influence self-care agency and self-care practices. Self-care was defined in this study as taking care of and reasonability for self by making good choices and remaining independent.

Health, as derived from the data, was defined as well being of mind, body and soul supporting the ability to work and play. Understanding the meaning of health and self-care for the rural midlife woman can assist nursing in promoting health and self-care. The obesity epidemic needs to be addressed to improve self-care agency and self-care practices. It is suggested that nursing education should focus on developing and adjusting interventions to promote health, self-care and self-care practices for rural residents by implementing the rural nursing theory.

Nursing needs to be active in identifying solutions for the obesity and overweight crisis by increasing personal and patient knowledge. Strengths and weaknesses This study, being grounded in nursing theoretical framework and being the first to link self-care agency, self-care and obesity with rural midlife women is itself a strength. Definitions for health and self-care from a rural woman’s perspective were provided as a result of this study. Self-care behaviors may vary with seasons, this particular study was conducted in the summer.

The focus of this study being primarily on white women, the study lacked ethnic diversity. Also, this study is not representative of the entire population as it was conducted only in a portion of one US state. Overall, additional research will need to be conducted to understand the relationship of the rural environment and the health of midlife women. Contributions The model suggests new knowledge of the relationships of self-care agency, self-care practices and body mass index in rural midlife women. Health and self-care were defined from the perspective of rural midlife women as a result of the data.

References Burdette, L. (2012). Relationship Between Self-care Agency, Self-care Practices and Obesity among Rural Midlife Women. Self-Care, Dependent-Care & Nursing, 19(1), 5-14. Gonzalo, A. (2011). Dorothea E. Orem – Theoretical Foundations of Nursing. Theoretical Foundations of Nursing – Home. Retrieved October 5, 2013, from http://nursingtheories. weebly. com/dorothea-e-orem. html Publication manual of the American Psychological Association (6th ed. ). (2010). Washington, DC: American Psychological Association.