RESEARCH ARTICLE

Source: Kim, C., Junes, K., & Song, R. (2003). Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in institutionalized elderly women. International Journal of Nursing Studies, 40(4), 375–81.

Introduction

Kim, Junes, and Song (2003) conducted a quasi-experimental study with a one group pretest-posttest design. “A convenient sample of 21 elderly women was recruited from a home for elderly people.” (Kim et al., 2000, p. 376). The purpose of the study was to determine the health benefits of a 3-month health-promotion program for institutionalized elderly women on cardiovascular risk factors,health behaviors, and life satisfaction. These researchers found the following positive effects from the program: reductions in total risk score, improved health behaviors, and improved life satisfaction. However, Kim et al. (2003) noted a decrease in these positive effects 3 months after the completion of the health-promotion program.

Relevant Study Results

A total of 25 women were enrolled in the health-promotion program and 21 subjects completed the program with three sets of outcome assessments at pretest, 3 months, and 6 months. The mean age of the subjects was 77 years, and 90% of them had been diagnosed with one or more chronic diseases. The significance level of the study was set at α = 0.05. The results from the study are presented in the two tables that follow. Table 2 describes the health-promotion program’s effects on cardiovascular risk factors, and Table 3 describes the effects on health behaviors. The third dependent variable of this study was life satisfaction, which was significantly improved from pretest to the end of the health-promotion program at 3 months and at 6 months follow-up.

TABLE 2 ■ Program Effects on Cardiovascular Risk Factors

	*PRETEST*	3 MONTHS		6 MONTHS
Variable	M (SD)	M (SD)	Paired t ᵅ	M (SD)	Paired t ᵇ
Total risk score	*20.1 (4.5)*	*16.8 (3.2)*	4.14*	*18.1 (4.0)*	2.56*
Cholesterol	*200.2 (29.1)*	*189.6 (25.3)*	2.03*	*192.7 (22.1)*	*1.73*
Triglyceride	*164.2 (42.0)*	*150.4 (44.1)*	2.58*	*142.9 (53.5)*	2.20*
BMI	*22.7 (3.0)*	*22.1 (3.0)*	3.44*	*22.9 (3.0)*	−*0.80*
Systolic BP	*121.7 (14.6)*	*117.2 (12.3)*	*1.57*	*115.6 (13.4)*	*1.66*

BMI (body mass index), BP (blood pressure)

*p < 0.05.

aPaired t-test results between the pretest and 3-month measures.

bPaired t-test results between the pretest and 6-month measures.

Kim, C., Junes, K., & Song, R. (2003). Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in institutionalized elderly women. International Journal of Nursing Studies, 40(4), p. 378

TABLE 3 ■Program Effects on Health Behaviour

	*PRETEST*	3 MONTHS		6 MONTHS
Variable	M (SD)	M (SD)	Paired t ᵅ	M (SD)	Paired t ᵇ
Total health behavior	66.3 (8.1)	69.7 (5.0)	−3.02*	68.1 (5.1)	−1.34
Health responsibility	2.19 (0.5)	2.13 (0.3)	1.03	2.29 (0.3)	−1.39
Exercise	1.88 (0.3)	2.58 (0.3)	−7.75*	2.29 (0.4)	−3.93*
Diet behavior	3.41 (0.3)	3.47 (0.2)	−0.93	3.26 (0.3)	2.00
Stress management	2.39 (0.4)	2.44 (0.3)	−0.65	2.45 (0.3)	−0.70
Smoking behavior	2.85 (0.8)	2.92 (0.8)	−1.45	3.01 (0.7)	−0.96

*p < 0.05.

aPaired t-test results between the pretest and 3-month measures.

bPaired t-test results between the pretest and 6-month measures.

EXERCISE 31 QUESTIONS (1-10)

What are the two groups whose results are reflected by the t ratios in Tables 2 and 3?

The two groups whose results are compared is a sample of 21 elderly women immediately after 3-month health promotion programme and 3-months after completion of the health programme where the considered variables are cardiovascular risk factors and health behaviour.

Which t ratio in Table 2 represents the greatest relative or standardized difference between the pretest and 3 months outcomes? Is this t ratio statistically significant? Provide a rationale for your answer.

BMI represents the greatest relative or standardized difference between pretest and 3 months outcomes.

This is shown by; 3.44 – (-0.80) = 3.44+0.80 = 4.24

This t ratio is statistically significant because compared by the one obtained in pretest there is a significant difference.

Which t ratio listed in Table 3 represents the smallest relative difference between the pretest and 3 months? Is this t ratio statistically significant? What does this result mean?

Stress management represents the smallest relative or standardized difference between pretest and 3 months outcomes.

This is shown by; -0.65 – (-0.70) = -0.65+0.70 = 0.05

This t ratio is statistically significant because compared by the one obtained in pretest there is a significant difference, especially considering one is positive while the other one is negative.

What are the assumptions for conducting a t-test for dependent groups in a study? Which of these assumptions do you think were met by this study?

The assumptions are:

The samples are evenly distributed
Same treatment is given to all samples
All samples participate fully in the experiment

The assumption one and two were met in this study since all the participants were elderly women living within the same setting and they were subjected to similar conditions.

Compare the 3 months and 6 months t ratios for the variable Exercise from Table 3. What is your conclusion about the long-term effect of the health-promotion intervention on Exercise in this study?

It shows that it was statically significant, but negatively. This may imply that the long-term effect of the health-promotion intervention may have negative influence on exercise.

What is the smallest, significant t ratio listed in Table 2? Provide a rationale for your answer

The smallest significant t ratio listed in Table 2 is -0.80 for BMI after 3 months. This shows a negative influence on BMI after the completion of the health-promotion programme.

Why are the larger t ratios more likely to be statistically significant?

This is mainly because they show significant response from the treatment or conditions to which the study participants are exposed to in course of the study.

Did the health-promotion program have a statistically significant effect on Systolic blood pressure (BP) in this study? Provide a rationale for your answer.

The t ratio is statistically significant for systolic BP because a comparison of pretest and 3 month outcome show a significant difference.

Examine the means and standard deviations for Systolic BP at pretest, 3 months (completion of the treatment), and 6 months. What do these results indicate? Are these results clinically important? Provide a rationale for your answer.

They show a slight change which may be clinically important since clinical results are supposed to be within a specific range because deviations from that range indicate an abnormality.

Is this study design strong or weak? Provide a rationale for your answer.

This study design is strong because it ensures that the participants were subjected to the most appropriate conditions.

BONUS QUESTION

Would you, as a health care provider, implement this intervention at your facility based on the

Total Risk Score results? Provide a rationale for your answer.

As a health care provider I would highly recommend this programme because it seems to have significant positive influence on health of elderly people which would be essential to improve their health.

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