Time Perspectives and Health Behaviors of Adults With Hypertension: A Feasibility Study

Saturday, 29 July 2017

Stephanie E. Kitch, PhD, RN
College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Purpose:  Hypertension is a considerable population health problem. Nearly a third of American adults have hypertension; the prevalence of hypertension is also growing among young adults (Mozaffarian et al., 2015). Furthermore, almost half of adults with hypertension do not have the condition well-controlled (Nwankwo, Yoon, Burt, & Gu, 2013). Uncontrolled hypertension can lead to serious future health events, such as heart attack, stroke, organ damage, and even death (American Heart Association, 2016). Yet, hypertension is often preventable or manageable with the adoption of healthy behaviors (Centers for Disease Control and Prevention, 2015; James et al., 2014). Despite the importance of a healthy lifestyle, people often resist making necessary lifestyle changes, especially young adults (Carter & Kelly, 2013). One potentially important factor in health behavior is time perspective, or how people incorporate the past, present, and future into daily life (Zimbardo & Boyd, 1999). Past, present, and future time perspectives may influence health behaviors in varying ways, and time perspectives may be different for individuals of different ages (Guthrie, Lessl, & Ward, 2013; Sansbury, Dasgupta, Guthrie, & Ward, 2014). However, additional research is needed to examine time perspectives and health behaviors within the context of hypertension. Therefore, the purpose of this study was to examine time perspectives and health behaviors in adults with hypertension, and explore feasibility of selected recruitment methods for a larger study.

Methods: This study implemented a cross-sectional, descriptive correlational design. Time perspectives were measured using the Zimbardo Time Perspective Inventory (ZTPI), which captures past (negative and positive), present (fatalistic and hedonistic) and future perspective subscales (Zimbardo & Boyd, 1999). Hypertension-specific time perspectives were measured using the Hypertension Temporal Orientation (HTO) scale (Brown & Segal, 1997). Health-promoting behaviors (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management subscales) were measured with the Health-Promoting Lifestyle Profile II (HPLP-II; Walker, Sechrist, & Pender, 1995). Each of these measurements uses a Likert scale format, and each subscale is reported as a mean. Recruitment efforts incorporated the use of flyers at local high traffic public spaces, businesses, and clinics, a display table at a local community event, and the use of a referral system. Participants who completed the survey were given the option to refer a young hypertensive adult (18-35 years old) using a referral card with a unique ID. If the referral card was returned, the original participant was entered in a gift card raffle. Participants completed a paper survey. To address missing data, mean substitution was used if a participant was missing only one item from any subscale. Data were analyzed using descriptive statistics. Additionally, correlations were used to examine the association among age, each mean time perspective subscale scores, and mean health-promoting behavior subscale scores.

Results:  Fifty surveys were administered. Only four participants opted to take a referral card; two were returned. The local community event yielded the largest number of participants (n = 29). Three surveys were missing multiple data points in one or more subscales; thus, the final sample consisted of 47. Of these, 34 (72.3%) were women, 26 (55.3%) were Caucasian, 15 (31.9%) African American, and 6 (12.7%) Hispanic, Asian or other races. Ages ranged between 22 and 72 years. Categorized by generation, twelve (25.5%) were between 18 and 35; 16 (34%) between 36 and 51, 17 (36.2%) between 52-70, and the remainder were 71+ (n = 2, 4.3%) A total of 25 (0.4%) data points were calculated using mean substitution. Ranging from 1-5, mean (SD) ZTPI scores were 2.652 (0.712) for past negative, 3.865 (0.573) for past positive, 2.214 (0.623) present fatalistic, 3.227 (0.587) present hedonistic, and 3.834 (0.497) for future. Preliminary data analyses revealed several significant correlations. Negative correlations were found between a past negative perspective and nutrition (r = -.357, p = .014), interpersonal relations (r = -.314, p = .031), and total health-promoting lifestyle (r = -.309, p = .034). Past positive perspective significantly positively correlated with spiritual growth (r = .343, p = .018). Present hedonistic was positively correlated to spiritual growth (r = .319, p = .029), stress management (r = .321, p = .028), and total health-promoting lifestyle (r = .288, p = .05). Higher present fatalistic perspectives negatively correlated with health responsibility (r = -.332, p = .022), spiritual growth (r = -.401, p = .005), interpersonal relations (r = -.391, p = .007), and total health-promoting lifestyle (r = -.356, p = .014). Higher future perspectives correlated with spiritual growth and interpersonal relations (r = .403, p = .005; r = .353, p = .015, respectively). However, neither present nor future time perspective correlated with physical activity or nutrition, which was an unexpected finding. The HTO measure did not significantly correlate to any health-promoting behaviors. Age did not significantly correlate to any time perspective. Additional data analysis is ongoing.

Conclusion:  Recruitment at events within the local community appeared to the most successful approach, although the referral process yielded very few prospective participants. Recruitment strategies yielded adults of all ages. However, there was no significant correlation between age and mean time perspective scores with preliminary data analysis. In this sample, mean past positive and future time perspective scores were the highest. A number of significant relationships between various time perspectives and health-promoting behaviors emerged. However, unexpected nonsignificant relationships were also identified. A future study may require a larger sample size to detect additional significant relationships among age, time perspectives, and/or health-promoting behaviors while controlling for other variables. As indicated in preliminary analyses, individual time perspectives influence different health-promoting behaviors, and in differing directions. Thus, incorporating an individual’s past, present, and future perspective may provide a well-rounded approach to identifying underlying behavioral influences. Gaining a better understanding of the relationship between time perspectives and health-promoting behaviors will guide nurse researchers in the design of tailored, individualized interventional strategies to encourage health-promoting behaviors. Individual interventional strategies can be implemented to better prevent or manage hypertension, and to reduce the long-term negative health outcomes associated with uncontrolled hypertension.