“Modeling Women’s Quality of Life After Cardiac Events”: Article Critique

Article for critique

Beckie, Theresa M., Beckstead, Jason W. and Webb, Mary S.; “Modeling Women’s Quality of Life after Cardiac Events”, Western Journal of Nursing Research, 2001, 23(2), 179-194, Sage Publications DOI: 10.1177/019394590102300206.

Purpose of study

Beckie’s group of researchers intended to investigate the quality of life in women who had undergone the experience of a cardiac event and to examine the factors of perceived health status, dispositional optimism, and hopefulness that influenced this subjective QOL.

Quality of Life has become a significant matter when treatment of patients is being planned. The concept of hope has been frequently explored (Herth, 1993). How hope affects the QOL in women in the context of perceived health, hope, and dispositional optimism has not been investigated yet, hence this study. Subjective QOL has been described as the “satisfaction of needs that are determined by the perceived discrepancy between one’s aspirations and achievements” (Andrews and Withey, 1976). The Multiple Discrepancies Theory has evolved after the study by Andrews and Withey.

An improved QOL is the outcome of interventions. Improvement in treatment interventions may be achieved only by fully understanding the factors which contribute to Subjective QOL. However, the literature on the subject is ambiguous at times. Even the definition is unclear and many names and assumptions have been attributed to the subject: QOL, health-related QOL (HRQOL), health status, functional assessment, and needs assessment (Haas, 1999).

Literature on the subject of perception of health revealed that women had a poorer perception when compared to men. Men carried the concept that cardiac surgery afforded them a chance to make a positive change so that their personal goals were achieved. Women thought differently. They found it more difficult to adjust. Their thoughts were mostly concerned about home activities that were disturbed because of their illness and postoperative period. Others believed that health was related to mortality and worried about coping with illness in old age.

Several definitions and aspects of hope have emerged from the literary review.

The one by Dufault and Martochio (1985, p 380)appears to be the best: “a multidimensional dynamic life force characterized by a confident yet uncertain expectation of achieving good, which to the hoping person, is realistically possible and personally significant”. It is still unclear as to how hope influences QOL, perceptions of health, and clinical outcomes.

Dispositional opposition is the central concept in the theory of behavioral self-regulation. There is an expectancy that good things would happen. This theory says that people would go on believing that good outcomes would occur if they strive for it when it is attainable. This dispositional optimism was a significant predictor of coping efforts when hospitalized and affected the recovery phase. Optimists were concerned about returning to normal activities as early as possible. They believed in keeping close to their treatment regimes. In a survey after coronary bypass surgery women were found it difficult to manage their homes after discharge. Optimism is believed to be a quality that is not seen in everybody.

Research Question

This has not been framed here. It could probably go like this: How do perceived health status, dispositional optimism, and hope affect subjective QOL in women following a cardiac event?

Design and Instruments

A correlational design was used. The instruments used were the SF-36, HHI, and LOT.

SF-36 measures perceived health and had 36 questions that measured the eight concepts of physical functioning (PF), role functioning–physical problems (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role functioning–emotional problems (RE), and mental health (MH). The higher the score, the better the perceived health. 2 methods were used to validate this instrument. The content validity of the Sf-36 was assessed against other commonly used health surveys. 8 questions were found in 7 other instruments. Content validity was also checked for factors, correlational studies, and criterion-related validity studies. Mental health and physical health were found to be factors of health.

The Herth Hope Scale is a 12-item Likert type of scale marked 1 to 4. It assessed the level of hope. The higher score denoted a higher level of hope. Criterion validity was established by correlating this to the parent HHS, Existential well-being scale and Nowotny Hope scale. Divergent validity was established using the Hopelessness scale.

Temporality and future, positive readiness and expectancy, and interconnectedness supported construct validity.

Dispositional optimism was measured using the LOT. It has 10 items and is for the self measure. A 5 point scale from 0 (strongly disagree) to 5 (strongly disagree) is used.

3 items are worded positively and 3 negatively. The negative scoring is reversed and then the scores are totaled to check for optimism. Scores range from 0-24. Cronbach’s alpha is 0.78 (King et al, 1998).

Study Sample and Setting

93 women who had suffered an acute cardiac event from two hospitals in West Central Florida participated. The criteria for inclusion were: “suffering a myocardial infarction (MI), unstable angina, or undergoing surgery for coronary revascularization (CABG)”, had a valve replacement or percutaneous coronary intervention, oriented to time, place, and person, able to read, write and speak English and willingness to participate.

The ethical requirements were fulfilled by informed consent for participation and giving due consideration for the comfort of the participants while administering the instruments, the SF-36 Health Survey, the HHI, and the LOT.

Research Findings

91.4% of the women were white. 62.4 % were retired. 77.4 % were women of ages between 50and 79. The mean age was 66. Equal numbers of married and widowed women were present in the sample (38.7% each). 40.9% lived alone and 36.6 % lived with a spouse. The illness most of them suffered from was hypertension (67.7%). Then came the others: dyslipidemia (65.6%), physical inactivity (58.1%), a history of smoking (50.5%), a previous MI (47.3%), and diabetes (38.7%). 47.3% had undergone CABG surgery. 28% had undergone PCI. Surprisingly nearly all of them had never attended a cardiac rehabilitation program (91.4%). Though 91.4 % of them had attained menopause, 67.7% had no hormone therapy.

Reliability estimates for the instruments were acceptable as per norms. However low mean scores were obtained for physical functioning, role functioning, bodily pain, and vitality as compared to the American norm sample (Ware et al, 1993). There was primarily no statistical difference on the SF-36. A clustering was observed towards the positive end of the scales and tailing off at the negative end.

The Kayser-Meyer-Olkin measure showed that the sampling was adequate at 0.848. This and the Bartlett test indicated that the data were appropriate for analysis.

QOL was considered a unidimensional concept dependent on other concepts. The assumption is that hope, optimism and the perception of health are separate and are unique predictors of QOL and that they are not dimensions of QOL. Error variances of the subscales of SF36 and HHI and LOT ranged from 8-30%. Only the general health perceptions seemed to influence the global QOL assessment of the patients. General health and outlook together explained 2/3 of the variations in the subjective QOL assessments. When compared to the general population norms, the health perceptions of the women in the sample were poor. However, their self-assessments of the global QOL were comparable to general norms.

Theresa M.Beckie, an Assistant Professor in the College of Nursing, and her colleagues have performed a valuable study done with the good intention of adding reliable material with the purpose of improvement of the quality of life of patients by acquiring knowledge on their assumptions of health. Since there is associated literature for men, they have taken the subject of QOL for women. The study has future implications in that further research can be done to improve on the limitations found in this study. Treatment interventions and how they are best implemented conforming to the individual perceptions of quality of life is significant for the nursing practice. The paper is well-written, grammatically correct. The referencing is broad and informative.


Andrews, F. M., & Withey, S. B. (1976). Social indicators of well-being: Americans’ perceptions of life quality. New York: Plenum.

Dufault, K., & Martocchio, B. (1985). Hope: Its spheres and dimensions. Nursing Clinics of North America, 20(2), 379-391.

Haas, B. (1999). Clarification and integration of similar quality of life concepts. Image: Journal of Nursing Scholarship, 31(3), 215-220.

Herth, K. (1993). Hope in older adults in community and institutional settings. Issues in Mental Health Nursing, 14, 139-156.

King, K. B., Rowe, M. A., Kimble, L. P., &Zerwic, J. J. (1998). Optimism, coping and long-term recovery from coronary artery surgery in women. Research in Nursing and Health, 21, 15-26.