Increased Psychological Demands of Work are Associated with Poor Self-Care and Poor Health-Related Quality of Life Among Workers with Cardiovascular Disease

Dickson, Victoria Vaughan

Thursday, July 14, 2011: 10:35 AM

Victoria Vaughan Dickson, PhD, RN, CRNP
College of Nursing, New York University, New York, NY

Learning Objective 1: Describe the relationship of job characteristics and self-care practices among workers with cardiovascular disease.

Learning Objective 2: Discuss the implications for future research and clinical care of adults with CVD who return to work.

Purpose: Over 3.5 million workers have cardiovascular disease (CVD) with significant work limitations and increased disability. Workers must meet the challenges of today’s work processes including increased stress and intense production demands while managing the complexities of CVD. Little is known about self-care practices (medication, diet, exercise and symptom monitoring) in this population. This study explored the relationship of job characteristics (job demands, job control, and workplace support), self-care and health-related quality of life (HRQL) among workers with CVD.

Methods: In this cross-sectional, descriptive study 129 workers over age 45 with CVD were recruited from clinical and community settings and completed standardized instruments about self-care (General Adherence Scale a=.74, Self-Care of Heart Disease Index a=.70, Self-Care of Hypertension Index a=.79), job characteristics (Job Content Questionnaire a =.71) and HRQL (Macnew HRQL a=.835). Correlational and regression analyses examined relationships between variables.

Results: The sample was 56.3% female, 36.5% African American, mean age 59.16 years ± 8.83; 80.5% were employed (60.2% full or part time; 20.3% self-employed). Hypertension was common (45.5%) and 27.8% had coronary heart disease (angina, prior-MI or CHF). Self-care behaviors varied. Medication adherence was reported by most (71.4%); few adhered to diet (27%), exercise (18%) or symptom monitoring (31.3%). Psychological job demands were negatively correlated to self-care (r=-0.217, p=.02). Better self-care was reported by those with workplace support (r=.313, p=.001); and correlated to HRQL (r=0.274¸ p = .004). Overall, job characteristics explained 22% of variance in self-care behaviors and were significant determinants of HRQL (p=.004).

Conclusion: Generally, self-care is poor among workers with CVD. Since job characteristics may interfere with self-care and influence HRQL, clinicians should assess job demands and include stress management as part of patient counseling for workers with CVD. Research to develop and test interventions that foster worksite programs that facilitate self-care behaviors among workers with CVD is needed.

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