Hopelessness and Physical Activity in Racial Minority Patients with Heart Disease

Susan Dunn, PhD, RN    

Principal Investigator: Susan Dunn, PhD, RN, College of Nursing, Michigan State University

Co-Investigators: James Schafer, MD, Heart and Vascular Services, Sparrow Hospital Timothy Foy, BS, PT, Cardiac Rehabilitation, Sparrow Hospital Lorraine Robbins, PhD, RN, FAAN, FNP-BC, College of Nursing, MSU Sandi Smith, PhD, College of Communication Arts and Sciences, MSU Rajiv Ranganathan, PhD, College of Engineering and Department of Kinesiology, MSU

Consultants: Holli DeVon, PhD, RN, FAHA, FAAN, College of Nursing, University of Illinois at Chicago Barbara Given, PhD, RN, FAAN, College of Nursing, MSU Nathan Tintle, PhD, Department of Statistics, Dordt College

Hopelessness is associated with increased morbidity and mortality in patients with coronary heart disease (CHD). Physical inactivity is additionally responsible for increased cardiovascular events and death. Most individuals with CHD do not meet current exercise guidelines, and hopeless individuals are at particularly high risk for inactivity. Yet, little research exists describing hopelessness and its relationship to exercise in CHD patients and no research exists specific to racial minority patients. The purpose of this project is: 1) to describe hopelessness in racial minority CHD patients and 2) to evaluate in these patients the feasibility, acceptability, satisfaction, and preliminary efficacy of two 6-week motivational text-messaging (MTM) interventions, one with and one without social support (SS), both designed to decrease hopelessness through the promotion of physical activity (PA). This project is innovative in that no intervention has been tested to encourage hopeless CHD patients to exercise and no research has been done examining hopelessness and exercise in racial minority CHD patients. Specific aims include to:

1) Describe hopelessness in racial minority patients. 2) Evaluate the feasibility and acceptability of MTM, with and without SS. 3) Examine patient satisfaction with MTM, with and without SS. 4) Evaluate preliminary efficacy of MTM, with and without SS, in improving PA. 5) Determine preliminary efficacy, with and without SS, in decreasing hopelessness.

Significance: MTM, with or without a SS component, has not been tested in hopeless CHD patients and the relationship between hopelessness and exercise in racial minority CHD patients has not been examined. Based on prior work, we expect hopelessness to be more prevalent in racial minority patients and for racial minority hopeless patients to have unique motivational needs.

Methods: Sixty racial minority adults diagnosed with myocardial infarction, angina, or angioplasty/stent will participate in the cross-sectional descriptive study while hospitalized at Sparrow Hospital. Patients with moderate to severe hopelessness, who have a cell phone, and an interest in text messaging will additionally be invited to participate in an ongoing randomized intervention study, using a block design to ensure that 1/5 of total patients enrolled (n=30) will be of racial minority status (n=6). Patients will be randomized to: 1) MTM, 2) MTM with SS, or 3) standard care. Data collection for the intervention study will occur 1 and 8 weeks after hospital discharge in the patient’s home. Patients in each MTM group will meet with a motivational interviewer and receive MTMs. The MTM with SS group will receive supportive text messages from their significant other. Descriptive variables include hopelessness, depression, demographic and clinical characteristics and comorbidities. Additional variables in the intervention pilot include feasibility, acceptability, satisfaction, exercise self-regulation, exercise steps and minutes (accelerometer), and social support.

Future Funding: This project builds on a program of research that has identified hopelessness in CHD patients, developed and tested a state-trait hopelessness scale, and identified a negative relationship between exercise and hopelessness in CHD patients. Findings will be foundational to an application for external funding (R01) to be submitted to NIH/NINR by February 2017.