Abstract
Inadequately insured Americans experience a disproportionately low health-related quality of life (HRQoL)–a multidimensional and subjective indicator of health associated with premature mortality. Although the inadequately insured are a growing and at-risk group of individuals, little research has examined factors associated with HRQoL within this population. Health Self-Empowerment Theory (HSET) and precision prevention influenced the conceptualization of this study. HSET is a health empowerment theory that recognizes the effects of certain cognitive-behavioral variables on health promotion within at-risk groups. Precision prevention advocates for individual or precise group-specific tailored and optimized health promotion approaches based on key sociodemographic variables. We investigated the impact of HSET variables on mental and physical HRQoL among 279 inadequately insured women and men who completed a questionnaire assessing HRQoL, health self-efficacy, health motivation, and active coping. Among the women in our sample, results indicate that exercise and psychological well-being self-efficacy were significantly and positively associated with mental and physical HRQoL. Among men, psychological well-being and responsible health practices self-efficacy, in addition to active coping, were significantly and positively associated with mental HRQoL. Psychological well-being self-efficacy and active coping were significantly and positively associated with physical HRQoL among men. The findings of our study suggest that HSET variables play an important role in the development of tailored HRQoL-promotion interventions for inadequately insured Americans, and that the roles of those variables may differ based on gender.
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27 January 2022
The journal title in the running head was published as ‘The Journal of Primary Prevention’. This has been corrected as ‘Journal of Prevention’.
References
AHRQ. (2017). 2016 National Healthcare Quality and Disparities Report | Agency for Healthcare Research & Quality. Rockville, MD: Agency for Healthcare Research and Quality.
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122–147. https://doi.org/10.1037/0003-066X.37.2.122
Barile, J. P., Reeve, B. B., Smith, A. W., Zack, M. M., Mitchell, S. A., Kobau, R., Cella, D. F., Luncheon, C., & Thompson, W. W. (2013). Monitoring population health for Healthy People 2020: Evaluation of the NIH PROMIS® Global Health, CDC Healthy Days, and satisfaction with life instruments. Quality of Life Research, 22(6), 1201–1211. https://doi.org/10.1007/s11136-012-0246-z
Becker, H. (1993). Self-rated abilities for health practices: A health self-efficacy measure. Health Values: THe Journal of Health Behavior, Education & Promotion, 17(5), 42–50.
Bharmal, M., & Thomas, J. (2005). Health insurance coverage and health-related quality of life: Analysis of 2000 Medical Expenditure Panel survey data. Journal of Health Care for the Poor and Underserved, 16(4), 643–654.
Brown, D. S., Jia, H., Zack, M. M., Thompson, W. W., Haddix, A. C., & Kaplan, R. M. (2013a). Using health-related quality of life and quality-adjusted life expectancy for effective public health surveillance and prevention. Expert Review of Pharmacoeconomics & Outcomes Research, 13(4), 425–427. https://doi.org/10.1586/14737167.2013.818816
Brown, D. S., Thompson, W. W., Zack, M. M., Arnold, S. E., & Barile, J. P. (2013b). Associations between health-related quality of life and mortality in older adults. Prevention Science, 16(1), 21–30. https://doi.org/10.1007/s11121-013-0437-z
Collins, S., Gunja, M., & Aboulafia, G. (2020). U.S. Health Insurance Coverage in 2020: A Looming Crisis in Affordability. Retrieved on September 7th, 2021, from https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-coverage-2020-biennial.
DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question: A meta-analysis. Journal of General Internal Medicine, 21(3), 267–275. https://doi.org/10.1111/j.1525-1497.2005.00291.x
Dominick, K. L., Ahern, F. M., Gold, C. H., & Heller, D. A. (2002). Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clinical and Experimental Research, 14(6), 499–508. https://doi.org/10.1007/BF03327351
Forrest, C. B., Blackwell, C. K., & Camargo, C. A. (2018). Advancing the science of children’s positive health in the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) research program. Journal of Pediatrics, 196, 298–300. https://doi.org/10.1016/j.jpeds.2018.02.004
Gakidou, E., Afshin, A., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Aboyans, V., Abu-Raddad, L. J., Abu-Rmeileh, N. M. E., Abyu, G. Y., Adedeji, I. A., Adetokunboh, O., Afarideh, M., Agrawal, A., Agrawal, S., Ahmad Kiadaliri, A., & Murray, C. J. L. (2017). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1345–1422. https://doi.org/10.1016/S0140-6736(17)32366-8
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., Suzuki, N., & Watson, D. (2014). The brief experiential avoidance questionnaire: Development and initial validation. Psychological Assessment, 26(1), 35–45. https://doi.org/10.1037/a0034473
Hayes, S. C., & Wilson, K. G. (1994). Acceptance and Commitment Therapy: Altering the verbal support for experiential avoidance. The Behavior Analyst, 17(2), 289–303. https://doi.org/10.1007/bf03392677
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006X.64.6.1152
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
Hays, R. D., & Morales, L. S. (2001). The RAND-36 measure of health-related quality of life. Annals of Medicine, 33(5), 350–357. https://doi.org/10.3109/07853890109002089
Hays, Ron D., Sherbourne, C. D., & Mazel, R. M. (1993). The RAND 36-item health survey 10. Health Economics, 2(3), 217–227. https://doi.org/10.1002/hec.4730020305
Hekler, E., Tiro, J. A., Hunter, C. M., & Nebeker, C. (2020). Precision health: The role of the social and behavioral sciences in advancing the vision. Annals of Behavioral Medicine, 54(11), 805–826. https://doi.org/10.1093/abm/kaaa018
Herbert, A., Gerry, N. P., McQueen, M. B., Heid, I. M., Pfeufer, A., Illig, T., Wichmann, H. E., Meitinger, T., Hunter, D., Hu, F. B., Colditz, G., Hinney, A., Hebebrand, J., Koberwitz, K., Zhu, X., Cooper, R., Ardlie, K., Lyon, H., Hirschhorn, J. N., & Christman, M. F. (2006). A common genetic variant is associated with adult and childhood obesity. Science, 312(5771), 279–283. https://doi.org/10.1126/science.1124779
Khoury, M. J., Iademarco, M. F., & Riley, W. T. (2016). Precision public health for the era of precision medicine. American Journal of Preventive Medicine, 50(3), 398–401. https://doi.org/10.1016/j.amepre.2015.08.031
Laucis, N. C., Hays, R. D., & Bhattacharyya, T. (2014). Scoring the SF-36 in orthopaedics: A brief guide. Journal of Bone and Joint Surgery, 97(19), 1628–1634. https://doi.org/10.2106/JBJS.O.00030
Manchón, J., Quiles, M. J., León, E. M., & López-Roig, S. (2020). Acceptance and Commitment Therapy on physical activity: A systematic review. Journal of Contextual Behavioral Science, 17, 135–143. https://doi.org/10.1016/j.jcbs.2020.07.008
McGinnis, J. M., Williams-Russo, P., & Knickman, J. R. (2002). The case for more active policy attention to health promotion. Health Affairs. https://doi.org/10.1377/hlthaff.21.2.78
Minivielle, E. (2018). Toward customized care. International Journal of Health Policy and Management, 7, 272–274. https://doi.org/10.15171/ijhpm.2017.84
Moorman, C., & Matulich, E. (1993). A model of consumers’ preventive health behaviors: The role of health motivation and health ability. Journal of Consumer Research, 20(2), 208–228. https://doi.org/10.1086/209344
National Research Council. (2012). Toward precision medicine: Building a knowledge network for biomedical research and a new taxonomy of disease. In Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. https://doi.org/10.17226/13284
Paolacci, G., & Chandler, J. (2014). Inside the Turk: Understanding Mechanical Turk as a participant pool. Current Directions in Psychological Science, 23(3), 184–188. https://doi.org/10.1177/0963721414531598
Pristed, S. G., Fromholt, J., & Kroustrup, J. P. (2012). Relationship between morbidly obese subjects’ attributions of low general well-being, expectations and health-related quality of life: Five-year follow-up after gastric banding. Applied Research in Quality of Life, 7(3), 281–294. https://doi.org/10.1007/s11482-011-9163-5
Ramsey, S. R., Thompson, K. L., McKenzie, M., & Rosenbaum, A. (2016). Psychological research in the internet age: The quality of web-based data. Computers in Human Behavior, 58, 354–360. https://doi.org/10.1016/j.chb.2015.12.049
Roche, A. I., Kroska, E. B., & Denburg, N. L. (2019). Acceptance- and mindfulness-based interventions for health behavior change: Systematic reviews and meta-analyses. Journal of Contextual Behavioral Science, 13, 74–93. https://doi.org/10.1016/j.jcbs.2019.06.002
Rouse, S. V. (2015). A reliability analysis of Mechanical Turk data. Computers in Human Behavior, 43, 304–307. https://doi.org/10.1016/j.chb.2014.11.004
Slabaugh, S. L., Shah, M., Zack, M., Happe, L., Cordier, T., Havens, E., Davidson, E., Miao, M., Prewitt, T., & Jia, H. (2017). Leveraging Health-Related Quality of Life in population health management: The case for Healthy Days. Population Health Management, 20(1), 13–22. https://doi.org/10.1089/pop.2015.0162
Tucker, C. M., Butler, A. M., Loyuk, I. S., Desmond, F. F., & Surrency, S. L. (2009). Predictors of a health-promoting lifestyle and behaviors among low-income African American mothers and White mothers of chronically ill children. Journal of the National Medical Association, 101(2), 103–110. https://doi.org/10.1016/S0027-9684(15)30821-X
Tucker, C. M., Smith, T. M., Wippold, G. M., et al. (2016a). Impact of a university-community partnership approach to improving health behaviors and outcomes among overweight/obese Hispanic adults. American Journal of Lifestyle Medicine, 11(6), 479–488. https://doi.org/10.1177/1559827615623773
Tucker, C. M., Wippold, G. M., Williams, J. L., Arthur, T. M., Desmond, F. F., & Robinson, K. C. (2016b). A CBPR study to test the impact of a church-based health empowerment program on health behaviors and health outcomes of Black adult churchgoers. Journal of Racial and Ethnic Health Disparities, 4(1), 70–78. https://doi.org/10.1007/s40615-015-0203-y
United States Department of Labor (2021). Minimum Wage. Retrieved on September 7, 2021, from https://www.dol.gov/general/topic/wages/minimumwage.
Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental summary scales: A user’s manual. In A User’s Manual. Boston, MA: The Health Institute.
Wippold, G., & Roncoroni, J. (2020). Hope and health-related quality of life among chronically ill uninsured/underinsured adults. Journal of Community Psychology, 48(2), 576–589. https://doi.org/10.1002/jcop.22270
Wippold, G., Nmezi, N., Williams, J., Butler, J., & Hodge, T. (2020a). An exploratory study to understand factors associated with Health-related Quality of Life among uninsured/underinsured patients as identified by clinic providers and staff. Journal of Primary Care & Community Health. https://doi.org/10.1177/2150132720949412
Wippold, G. M., Tucker, C. M., Roncoroni, J., & Henry, M. A. (2020b). Impact of stress and loneliness on Health-Related Quality of Life among low income senior African Americans. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-020-00865-w
Wippold, G. M., Tucker, C. M., Kroska, E. B., & Hanvey, G. A. (2020c). Perceived socioeconomic status and health-related quality of life (HQoL) among urban adults: Evaluating the protective value of resilience. American Journal of Orthopsychiatry. https://doi.org/10.1037/ort0000514
Woolhandler, S., & Himmelstein, D. U. (2017). The relationship of health insurance and mortality: Is lack of insurance deadly? Annals of Internal Medicine, 167(6), 424–431. https://doi.org/10.7326/M17-1403
Funding
Funding for the present study was provided by the University of South Carolina. Dr. Wippold was also funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number K23MD016123. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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The present study received institutional review board approval from the University of South Carolina (Pro00084677).The procedures used in this study adhere to the tenets of the 1964 Declaration of Helsinki.
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Wippold, G.M., Frary, S.G. The Role of Modifiable, Self-Empowerment-Oriented Variables to Promote Health-Related Quality of Life Among Inadequately Insured Americans. J Primary Prevent 43, 95–110 (2022). https://doi.org/10.1007/s10935-021-00652-1
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DOI: https://doi.org/10.1007/s10935-021-00652-1