Title: Relationship Between Self-care Ability & Self-reported Health among Older Women

Abstract

Background: Orem’s (2001) theory of self-care suggests that one major component of health is the ability to perform self-care. Self-care deficits are often measured as part of routine health care assessments (e.g., OASIS, MDS). Understanding whether or not a relationship exists between self-care and health would help nurses identify those in poor health and in need of nursing care.

Objective: The objective of this study was to assess the relationship, if any, between older women’s self-care and their self-perception of health. We hypothesized that older women who were able to perform self-care would have higher self-reported health compared with women who have self-care deficits.

Methods: This study is a secondary analysis of data collected as part of a behavior change study. Approval from the institutional review board was obtained prior to the study’s onset. Self-care was measured using Lawton’s instrumental activities of daily living (ADLs) (Graf, 2013). Self-assessments of health were measured using a four-point Likert scale (poor = 1, fair = 2, good = 3, excellent = 4). Descriptive statistics and a correlation analysis were performed. A strong relationship was defined as r_s < 0.7; a moderate relationship was defined as r_{s =} 0.4-0.69. A weak relationship was defined as r_s < 0.39. Significance was set at p < 0.05.

Results: A convenience sample of 43 older women completed the IADL and Likert scales. Based on the small sample size and lack of a standard distribution, Spearman’s rho (r_s) was used to assess the relationship, if any, between IADL scores & self-reported health. The sample’s (N=43) ages ranged from 50 to 99 years (mean 66.7, SD 11.33). The majority of the sample were single (e.g., never married, divorced, or widowed) (n=36, 83.7%), unemployed (n=34, 79%), and Caucasian (n=37, 86%) which was representative of the community from which the subjects were recruited. Subjects reported their socioeconomic statuses as less than enough (n=6, 14%), enough (n=31, 72%), and more than enough (n=6, 14%). Self-rated health status was reported as poor-fair (n=1, 2.3%), fair (n=10, 23.3%), good (n=28, 65.1%), and excellent (n=4, 9.3%). IADL scale scores, used as measures of self-care ability, were 6 (n=3, 7%), 7 (n=4, 9.3%), and 8 (n=36, 83.7%). The correlation analysis showed only a weak relationship between self-reported health and self-care (r_s = .119, p = .448). Thus, the underlying assumption that self-reported self-care based on IADL scores could be used as a measure of health status in older women was not supported.

Conclusions: Findings suggest that, for women in this sample, self-care was not strongly correlated with self-reported health. Study limitations include the use of a small sample and the use of only one measure of self-care.

Implications: It is possible that other self-care measures (e.g., activities of daily living) contribute to older women's perception of health. Nurses should continue to identify ways to identify individuals in poor health and in need of nursing care.

References:

Graf, C. (2013). The Lawton instrumental activities of daily living (IADL) scale. https://consultgeri.org/try-this/general-assessment/issue-23.pdf

Orem, D. E. (2001). Nursing: Concept of practice (6th ed.). Mosby.