HPRHealth Psychology ResearchTBA2420-8124Health Psychology Research10.4081/hpr.2013.e13GeneralSelf-care self-efficacy, religious  participation and depression  as predictors of poststroke  self-care among underserved  ethnic minoritieshttps://healthpr.org/journal/HPR/1/1/10.4081/hpr.2013.e13M. RobertsonSuzanne,HuddlestonCashuna,PorterBen,B. AmspokerAmber,L. Evans-HudnallGina2013112013-01-02Underserved ethnic minorities have multi ple chronic disease risk factors, including tobacco, alcohol and substance use, which con tribute to increased incidence of stroke. Self efficacy (self-care self-efficacy), religious par ticipation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and sub stance use in a sample of largely ethnic minor ity, underserved stroke survivors (n=52). Participants previously recruited for a cultural ly tailored secondary stroke prevention self care intervention were included. The treat ment group received three stroke self-care ses sions. The usual care group completed assess ments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, reli gious practice and depression as the referents, were used to predict binary outcomes of tobac co, alcohol and substance use at 4-weeks post stroke. Higher depression and self-care self efficacy were associated with reduced odds of smoking and substance use. Greater participa tion in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy,and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the con text of stroke self-management. stroke, self-care, underserved, low socioeconomic status, self-efficacy, alcohol, tobacco, substance, religious participation

1. Manjila S, Masri T, Shams T, et al. Evidence-based review of primary and secondary ischemic stroke prevention in adults: a neurosurgical perspective. Neurosurg Focus 2011;30:E1.2. CDC.gov. Atlanta(GA): U.S. Centers for Disease Control and Prevention. National Center for Health Statistics: Mortality Data. C2009. Available from: http://www.cdc.gov/nchs/deaths.htm 2009.3. Hinojosa MS, Rittman M, Hinojosa R, Rodriquez W. Racial/ethnic variation in recovery of motor function in stroke survivors: role of informal caregivers. J Rehabil Res Dev 2009;46:223-32.4. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics 2009 update: a report from the American Heart Association. Statistics committee and stroke statistics subcommittee. Circulation 2009;119:e182.5. National Institute of Neurological Disorders and Stroke. National Institute of Health, 2011. (DHHS Pub.no. [PHS] 2011-8935) Bethesda, MD: U.S. Public Health Service; 2011. 6. Appelros P, Nyderik I, Viitanen M. Poor outcomes after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year. Stroke 2009;34:122-26. 7. Hankey G, Jamrozik K, Broadhurst R, et al. Long-term disability after first ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990. Stroke 2002;33:1034-40.8. Jorgensen, HS, Nakayama, H, Raaschouch, O, Olsen TS. Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants. The Copenhagen Stroke Study. Stroke 1997;28:1138-41. 9. Glymour MM, Avendano M, Haas S, Berkman LF. Life course social conditions and racial disparities in incidence of first stroke. Ann Epidemiol 2008;18:904-12.10. Morgenstern LB, Lisabeth LB, Mecozzi AC, et al. A population-based study of acute stroke and TIA diagnosis. Neurology 2004;62:895-900.11. Sacco RL, Boden-Albala B, Gan R, et al. stroke incidence among white, black, and hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol 1998;147:259-68.12. Sacco RL, Foulkes MA, Mohr JP, et al. Determinants of early recurrence of cerebral infraction. The stroke data bank. Stroke 1989;20:983-89.13. Sheinart KF, Tuhrim S, Horowitz DR, et al. Stroke recurrence is more frequent in blacks and hispanics. Neuroepidemiology 1998;17:188-98. 14. Boardman JD, Finch BK, Ellison CG, et al. Neighborhood disadvantage, stress, and drug use among adults. J Health Soc Behav 2001;42:151-65.15. Mulia N, Ye Y, Zemore SE, Greenfield TK. Social disadvantage, stress, and alcohol use among black, hispanic, and white americans: findings from the 2005 U. S. national alcohol survey. J Stud Alcohol Drugs 2008;69:824-33. 16. Siahpush M, Spittal M, Singh G. Association of smoking cessation with financial stress and material well-being: results from a prospective study of a population-based national survey. Am J Public Health 2007;97:2281-7.17. Blumenthal R. Tobacco control: a state perspective. Yale J Health Policy Law Ethics 2002;3:151-6.18. Underner M, Peiffer G. Light and intermittent tobacco smokers. Rev Mal Respir 2010;27:1150-63.19. Houston TK, Scarinci IC, Person SD, Greene PG. Patient smoking cessation advice by health care providers: the role of ethnicity, socioeconomic status, and health. Am J Public Health 2005;95:1056-61.20. Lopez-Quintero C, Crum RM, Neumark YD. Racial/ethnic disparities in report of physician-provided smoking cessation advice: analysis of the 2000 National Health Interview Survey. Am J Public Health 2006;96:2235-9.21. Mostofsky E, Burger MR, Schlaug G, et al. Alcohol and acute stroke ischemic stroke onset: the stroke onset study. Stroke 2010;41:1845-9.22. Levine SR, Brust JC, Futrell N, et al. Cerebrovascular complications of the use of the crack form of alkaloidal cocaine. New Engl J Med 1990;323:699-704.23. Levine SR, Brust JC, Futrell N, et al. A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride--a review. Neurology 1991;41:1173-7.24. Chartier K, Caetano R. Ethnicity and health disparities in alcohol research. Alcohol Res Health 2010;33:152-60.25. Ma GX, Shive S. A comparative analysis of perceived risks and substance abuse among ethnic groups. Addict Behav 2000;25:361-71.26. Yang JC, Huang D, Hser YI. Long-term morbidity and mortality among a sample of cocaine-dependent black and white veterans. J Urban Health 2006;83:926-40.27. Levine DA, Neidecker MV, Kiefe CI, et al. Racial/ethnic disparities in access to physician care and medications among US stroke survivors. Neurology 2011;76:53-61.28. Campbell MK, Hudson MA, Resnicow K, et al. Church-based health promotion interventions: evidence and lessons learned. Ann Rev Public Health 2007;28:213-34.29. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis 2005;2:A14. 30. Lorig KR, Ritter P, Stewart AL, et al. Chronic disease self-management program: 2- year health status and health care utilization outcomes. Med Care 2001;39:1217-23.31. Korpershoek T, van der Bijl, J, Hafsteinsdottir, TB. Self-efficacy and its influence on recovery of patients with stroke: a systematic review. J Adv Nursing 2011;18:1876-94.32. Ambs AH, Miller MF, Smith AW, et al. Religious and spiritual practices and identification among individuals living with cancer and other chronic disease. J Soc Integr Oncol 2007;5:53-60.33. George LK, Larson DB, Koenig HG, McCullough ME. Spirituality and health: what we know, what we need to know. J Soc Clin Psychol 2000;19:102-16.34. Giaquinto S, Spiridigliozzi C, Carracciolo B. Can faith protect from emotional distress after stroke? Stroke 2007;38:993-7.35. Fritzsche A, Clamor A, von Leupoldt A. Effects of medical and psychological treatment of depression in patients with COPD - a review. Respir Med 2011;105:1422-33.36. Ghose SS, Williams LS, Swindle RW. Depression and other mental health diagnoses after stroke increase inpatient and outpatient medical utilization three years post-stroke. Med Care 2005;43:1259-64.37. Lenzi GL, Altieri M, Maestrini I. Post-stroke depression. Rev Neurol (Paris) 2008;164:837-40.38. Aström M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3- year longitudinal study. Stroke 1993;24:976-82.39. Austin M, Mitchell P, Goodwin G. Cognitive deficits in depression: possible implications for functional neuropathy. Br J Psychiatry 2001;178:200-6. 40. Gillen RTH, McKee TE, Gernert-Dott P, Affleck G. Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch Phys Med Rehabil 2001;82:1645-49. 41. Robinson-Smith G. Prayer after stroke. Its relationship to quality of life. J Holist Nurs 2002;20:352-66.42. Evans-Hudnall G, Stanley MA, Foreyt JP, Sander AM. Self-management in acute care: Are we starting risk reduction efforts too late? J Behav Med Forthcoming 2012.43. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.44. Ramsey F, Ussery-Hall A, Garcia D, et al. Prevalence of selected risk behaviors and chronic diseases: behavioral risk factor surveillance system (BRFSS), 39 Steps Communities, United States, 2005. MMWR. 2008;57:1-20.45. Brownson RR, Eyler AA, King AC, et al. Reliability of information on physical activity and other chronic disease risk factors among US women aged 40 years or older. Am J Epidemiol 1999;149:379-91.46. Lutfiyya MN, Asner N, Lipsky MS. Disparities in stroke symptomology knowledge among US midlife women: an analysis of population survey data. J Stroke Cerebrovasc Dis 2009;18:150-7.47. Serdula MK, Collins ME, Williamson DF, et al. Weight control practices of U. S. adolescents and adults. Ann Intern Med 1993;119:667-71.48. Shea S, Stein AD, Lantigua R, Basch CE. Reliability of the behavioral risk factor survey in a triethnic population. Am J Epidemiol 1991;133:489-500.49. Lorig K, Stewart A, Ritter PF, et al. Outcome measures for health education & other health care interventions. Thousand Oaks, CA: Sage Publications; 1996.50. Fetzer Institute/National Institute on Aging Working Group. Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research: A Report of the Fetzer Institute/National Institute on Aging Working Group. 1 ed. Kalamazoo, MI: Fetzer Institute; 1999.51. Bush AL, Jameson JP, Barrera T, et al. An evaluation of the brief multidimensional measure of religiousness/spirituality in older patients with prior depression or anxiety. Ment Health Relig Cult 2012;2:191-203.52. Derogatis LR. BSI: administration, scoring, and procedures manual- II. Townson, MD: Clinical Psychometric Research; 1992.53. Zabora J, BrintzenhofeSzoc K, Jacobsen P. A new psychosocial screening instrument for use with cancer patients. Psychosomatics 2001;42:241-6.54. Jackson-Triche ME, Greer-Sullivan J, Wells KB, et al. Depression and health-related quality of life in ethnic minorities seeking care in general medical settings. J Affect Disord 2000;58:89-97.55. Bernal H, Woolley S, Schensul J, Dickinson JK . Correlates of self-efficacy in diabetes self-care among Hispanic adults with diabetes. Diabetes Educ 2000;26:673-80.56. Gardner JK, McConnell TR, Klinger TA, et al. Quality of life and self-efficacy: gender and diagnoses considerations for management during cardiac rehabilitation. J Cardiopulm Rehabil 2003;23:299-306. 57. Sarker U, Sadia A, Whooley MA. Self-efficacy and health status in patients with coronary heart disease: findings from the heart and soul study. Psychosom Med 2007;69:306-12. 58. Lorig K, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003;26:1-7. 59. DiClemente CC, Hughes SO. Stages of change profiles in outpatient alcoholism treatment. J Subst Abuse 1990;2:217-35.60. Carey KB, Carey MP. Changes in self-efficacy resulting from unaided attempts to quit smoking. Psychol Addict Behav 1993;7:219-24.61. Gwaltney CJ, Metrik J, Kahler CW, Shiffman S. Self-efficacy and smoking cessation: a meta-analysis. Psychol Addict Behav 2009;23:56-66.62. De Wit L, Putman K, Baert I, et al. Anxiety and depression in the first six months after stroke. A longitudinal and multicentre study. Disabil Rehabil 2008;30:1858-66.63. Caetano R, Clark CL. Trends in alcohol-related problems among whites, blacks, and Hispanics: 1984-1995. Alcohol Clin Exper Res 1998;22:534-8.64. Brown DR, Gary LE. Religious involvement and health status among African American males. J Nat Med Assoc 1994;86:825-31.65. Bazargan S, Sherkat DE, Bazargan M. Religion and alcohol use among African American and Hispanic innercity emergency care patients. J Sci Study Relig 2004;43:419-28.66. Katon W, Lin EH, Korff MV, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363:2611-20.