Alexa Stuifbergen

University of Texas at Austin, Austin, Texas, United States

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Publications (92)94.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Multiple sclerosis (MS) is a debilitating, progressive disease with no known cure. Symptoms vary widely for persons with MS and measuring levels of fine motor, gross motor and cognitive function is a large part of assessing disease progression in both clinical and research settings. While self-report measures of function have advantages in cost and ease of administration, questions remain about the accuracy of such measures and the relationship of self-reports of functioning to performance measures of function. Objective The purpose of this study was to compare scores on a self-report measure of functional limitations with MS with a performance-based measure at five different time points. Methods Sixty participants in an ongoing longitudinal study completed two measures of function annually over a five-year period - the self-report Incapacity Status Scale and the MS Functional Composite (MSFC), a performance test. Pearson correlations were used to explore the association of self-report and performance scores. Results There were moderate to strong correlations among the ISS total (r= -.53 to -.63, p<.01) and subscale scores of gross (r=.79 to .87; p<.01)) and fine (r= .47 to .69; p<.01) motor function and the corresponding MSFC performance measure. The pattern of change over time in most scores on self-report and performance measures was similar. Conclusion Findings suggest that the self-report measure examined here, which has advantages in terms of feasibility of administration and patient burden, does relate to performance measurement, particularly in the area of gross motor function, but it may not adequately reflect cognitive function.
    Disability and Health Journal 10/2014; 7(4). DOI:10.1016/j.dhjo.2014.03.003
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    ABSTRACT: Background: Cognitive impairment is among the most debilitating outcomes of multiple sclerosis (MS). Although several neuropsychological tests and self-report cognitive measures have been used to assess cognitive impairment, they may not be sensitive to change over time, or may not be feasible to administer in a clinical setting. The purpose of this study was to assess the reliability and validity of the 8-item PROMIS Cognitive Abilities and Cognitive Concerns Scales in a large community-based sample of people with MS. The PROMIS Cognitive Abilities and Cognitive Concerns Scales derive from the National Institutes of Health-funded Patient Reported Outcomes Measurement Information System (PROMIS), an item repository that capitalizes on recent psychometric advances to produce short, psychometrically sound health measures. Methods: Mailed survey data were collected from 322 individuals recruited from two National Multiple Sclerosis Society chapters in a southwestern state. Results: Both cognitive scales demonstrated high internal consistency reliability and were moderately correlated with self-reported depressive symptoms, self-efficacy, barriers to health promotion, health, and functional status (all correlation coefficients >0.35). In hierarchical regression analysis, the PROMIS Cognitive Concerns score added significant unique variance to the prediction of MS Incapacity Status after controlling for self-reported depressive symptoms, exercise, spiritual growth, and global health. Those who were unemployed owing to their disabilities had significantly lower PROMIS Cognitive Abilities scores and higher Cognitive Concerns scores than those who were working or those who were retired or not working for other reasons. Conclusions: The PROMIS Cognitive Abilities and Cognitive Concerns Scales are short, psychometrically sound measures that assess an important dimension of functioning and health for people with MS.
    04/2014; 16(1):1-8. DOI:10.7224/1537-2073.2012-047
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    Janet D Morrison, Alexa K Stuifbergen
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    ABSTRACT: Research suggests that persons with multiple sclerosis (MS) are much less physically active than the general population and that increased physical activity in persons with MS is associated with numerous benefits such as improvements in fatigue, mobility, and quality of life (Motl & Pilutti, 2012). Potentially modifiable theory-based determinants of physical activity behavior need to be identified so that researchers may study their effectiveness in randomized clinical trials and clinicians may integrate them into practice to promote physical activity in this population. The purpose of this study was to explore the multidimensional (physical, social, and self-evaluative) outcome expectations for physical activity among persons with longstanding MS. A sample of 369 participants diagnosed with MS for more than 15 years completed surveys to measure multidimensional outcome expectations for exercise, MS functional limitations, and physical activity using two different instruments: one measuring physical activity engagement and the other measuring physical activity capability. Results indicated that MS functional limitation was the strongest predictor of both physical activity engagement and physical activity capability. Physical and social outcome expectations contributed to the model explaining 12% of the variation in physical activity engagement, whereas none of the outcome expectancy dimensions (physical, social, or self-evaluative) contributed to the model explaining variation in physical activity capability. Although analyses of cross-sectional data do not infer causation, these findings suggest that positive physical and social outcome expectations for physical activity are associated with engagement in physical activity as well as being potential sources of motivation for increasing physical activity behavior in individuals living with longstanding MS.
    03/2014; 46(3). DOI:10.1097/JNN.0000000000000050
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    ABSTRACT: Women's racial/ethnic-specific attitudes toward physical activity have been pointed out as a plausible reason for their low participation rates in physical activity. However, very little is actually known about racial/ethnic commonalities and differences in midlife women's attitudes toward physical activity. The purpose of this study was to explore commonalities and differences in midlife women's attitudes toward physical activity among 4 major racial/ethnic groups in the United States (whites, Hispanics, African Americans, and Asians). This was a secondary analysis of the qualitative data from a larger study that explored midlife women's attitudes toward physical activity. Qualitative data from 4 racial/ethnic-specific online forums among 90 midlife women were used for this study. The data were analyzed using thematic analysis, and themes reflecting commonalties and differences in the women's attitudes toward physical activity across the racial/ethnic groups were extracted. The themes reflecting the commonalities were: 1) physical activity is good for health, 2) not as active as I could be, 3) physical activity was not encouraged, 4) inherited diseases motivated participation in physical activity, and 5) lack of accessibility to physical activity. The themes reflecting the differences were: 1) physical activity as necessity or luxury, 2) organized versus natural physical activity, 3) individual versus family-oriented physical activity, and 4) beauty ideal or culturally accepted physical appearance. Developing an intervention that could change the social influences and environmental factors and address the women's racial/ethnic-specific attitudes would be a priority in increasing physical activity of racial/ethnic minority midlife women.
    Journal of midwifery & women's health 07/2013; 58(4):440-50. DOI:10.1111/j.1542-2011.2012.00259.x
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    ABSTRACT: Randomized control trial of a health promotion intervention was implemented for low-income cancer survivors. The majority of participants were female, older, divorced, educated, and unemployed or on disability leave. Findings indicate the health promotion intervention improved cancer survivors' self-efficacy and increased their use of health-promoting behaviors.
    Holistic nursing practice 05/2013; 27(3):140-7. DOI:10.1097/HNP.0b013e31828a0988
  • Gayle M Timmerman, Nicolina A Calfa, Alexa K Stuifbergen
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    ABSTRACT: : Excess weight in women with fibromyalgia syndrome (FMS) may further contribute to joint pain and fatigue. However, there is little research addressing weight issues in this population. : This study examined the relationship of body mass index (BMI) to quality of life. : Quality of life was measured by the 36-Item Short Form Health Survey, severity of FMS, nutritional intake, Barriers to Health Promoting Behaviors for Disabled Persons Scale (BS), and self-efficacy for health-promoting behaviors (Self-Rated Abilities for Health Practices Scale) in women with FMS. Baseline data were collected on 179 women diagnosed with FMS. : Controlling for age, BMI was significantly (p < .05) correlated with 36-Item Short Form Health Survey subscales of physical functioning, bodily pain and vitality, severity of FMS using the Tender Point Index, calories, protein, fat, saturated fat, BS, and Self-Rated Abilities for Health Practices Scale subscale for exercise. The findings support a growing body of evidence that excess weight is negatively related to quality of life and pain in women with FMS.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2013; 32(2):113-9. DOI:10.1097/NOR.0b013e3182879c08
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    ABSTRACT: The accumulation of limitations over the life course requires that women readapt to environmental barriers they encounter over time. The purpose of this qualitative case study was to detail the life experiences associated with living with mobility, cognitive, and sensory loss experienced by a woman and her sister who participated in an ongoing ethnographic study of mobility impairment in women. In-depth interviews were subjected to thematic, life course analysis. A family case study was interpreted as an exemplar for aging with early-onset disability into multiple morbidity, which was described as a series of loss, recovery, and reengagement. Within the case study, the participant suggested that because her functional limitations were not accommodated earlier in life due to societal and family-level disadvantage, these limitations were more difficult to adjust to in later years.
    Research in Gerontological Nursing 01/2013; 6(1):57-69. DOI:10.3928/19404921-20121107-01
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    ABSTRACT: Background: Little is known about how midlife women's attitudes toward physical activity influence their physical activity despite an increasing number of studies on women's physical activity. Objectives: The purpose of the study was to examine differences in midlife women's attitudes toward physical activity and their actual physical activity by ethnicity, and determine the relationships between the two major variables. As the theoretical framework, the Midlife Women's Attitudes toward Physical Activity model was used. Method: This was a cross-sectional study among 542 midlife women using the Internet as the medium for data collection. The data were collected using questions on background characteristics and health and menopausal status, the Physical Activity Assessment Inventory, the modified Barriers to Health Activities Scale, the Questions on Attitudes toward Physical Activity, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention, and the Kaiser Physical Activity Survey. Then, the data were analyzed using ANOVA, correlation, hierarchical multiple regression, and path analyses. Results: There were significant differences in the attitudes scores (F=2.58, p<.05) by ethnicity, but no differences in the physical activity scores by ethnicity. Yet, there were significant differences in the occupational physical activity scores (F=5.68, p<.01) by ethnicity. The attitude scores significantly explained the total variances of the physical activity scores (R2=.05, Fch=43.52, p<.01). The direct paths from the attitudes scores, the self-efficacy scores, and the barrier scores to the physical activity scores (.01
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: OBJECTIVES: To explore Asian American midlife women's attitudes toward physical activity using a feminist perspective. DESIGN: A qualitative online forum study. SETTINGS: Internet communities/groups for midlife women and ethnic minorities. PARTICIPANTS: A total of 17 Asian American women recruited through the Internet using a convenience sampling method. METHODS: A 6-month qualitative online forum was conducted using 17 online forum topics. The data were analyzed using thematic analysis. RESULTS: Three major themes related to Asian American midlife women's attitudes toward physical activity were extracted from the data: keeping traditions, not a priority, and not for Asian girls. Because Asian American midlife women were busy in keeping their cultural traditions, they rarely found time for physical activity. The women gave the highest priority to their children, and physical activity was the lowest priority in their busy lives. Also, the women were rarely encouraged to participate in physical activity during their childhoods, and they perceived that their weak and small bodies were not appropriate for physical activity. CONCLUSIONS: Several implications for future development of physical activity promotion programs for this specific population have been suggested based on the findings.
    Journal of Obstetric Gynecologic & Neonatal Nursing 07/2012; 41(5). DOI:10.1111/j.1552-6909.2012.01392.x
  • Heather Becker, Alexa Stuifbergen, Janet Morrison
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    ABSTRACT: Cognitive impairment has a major impact on the lives of people with Multiple Sclerosis (MS). Yet, it is often under-diagnosed, and more effective assessment methods are needed. In particular, brief measures that focus on cognitive functioning in daily life situations, are sensitive to modest change over time, and do not require a highly skilled assessor merit exploration. The purpose of this exploratory study was to investigate the performance of individuals with MS on three relatively new measures: the PROMIS Cognitive Concerns and Abilities Scales and the Everyday Problems Test (EPT), and to compare scores on these measures with scores on neurocognitive performance measures typically used to assess cognitive functioning in people with MS. Twenty-nine individuals with MS who reported cognitive concerns participated in the study. Most were non-Hispanic White women, with relapsing-remitting MS, diagnosed approximately 18 years ago. All three measures yielded reliability coefficients of .80 or above and also demonstrated sensitivity to change following an educational intervention. Scores on the revised EPT were moderately correlated with scores on five standard neuropsychological measures. Compared with the PROMIS Cognitive Concerns scale, scores on the self-reported PROMIS Cognitive Abilities scale tended to correlate more highly with the neurocognitive performance measures, although the correlations were generally small. While results of this exploratory study are promising, future research should be conducted with larger and more diverse samples of people with MS to determine the broader utility of these measures.
    07/2012; 14(2):71-76. DOI:10.7224/1537-2073-14.2.71
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    ABSTRACT: Despite an increasing number of studies of midlife women's physical activity, little is known about how attitudes toward physical activity of midlife women from diverse ethnic groups influence the women's physical activity. To explore ethnic differences in midlife women's attitudes toward physical activity and determine the relationships between the attitudes and their actual participation in physical activity while considering other influencing factors. The Midlife Women's Attitudes Toward Physical Activity model was used to guide the study. This was a cross-sectional Internet survey study of 542 midlife women. The instruments included questions on background characteristics and health and menopausal status; the Physical Activity Assessment Inventory; a modified Barriers to Health Activities Scale; the Questions on Attitudes Toward Physical Activity, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Kaiser Physical Activity Survey. The data were analyzed using ANOVA, correlation, hierarchical multiple regression, and path analyses. There were significant ethnic differences in the attitude scores (F = 2.58, p < .05), but no ethnic differences in the physical activity scores. Interestingly, there were significant ethnic differences in the occupational physical activity scores (F = 5.68, p < .01). Attitude scores accounted for 5% of total variances of the physical activity scores (F(ch) = 43.52, p < .01). The direct paths from the attitude scores (p < .01), the self-efficacy scores (p < .01), and the barrier scores (p < .05) to the physical activity scores were statistically significant. Ethnic differences in the women's attitudes toward physical activity need to be considered in promoting physical activity of midlife women.
    Nursing research 06/2012; 61(5):342-52. DOI:10.1097/NNR.0b013e31825da85a
  • Heather Becker, Sook Jung Kang, Alexa Stuifbergen
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    ABSTRACT: To explore whether measures of resources, barriers, and health-promoting behaviors would add significantly to the prediction of health-related quality of life among survivors with disabilities that occurred prior to their cancer diagnosis once contextual factors were controlled for. A descriptive correlational study. Adult cancer survivors with preexisting disabling conditions who had completed active treatment were recruited from throughout the United States. Most of the 145 respondents were breast cancer survivors with preexisting neuromuscular conditions such as polio and multiple sclerosis. The average time since cancer diagnosis was nine years. Respondents completed a mailed survey. Health-promoting behaviors, self-efficacy, barriers to health promotion, social support, functional limitations, cancer-related variables, depression, and quality of life. The sample reported poorer physical well-being than other cancer survivors without preexisting disabling conditions. Health-promoting behaviors and psychosocial factors, such as depressive symptoms and self-efficacy, added significantly to the prediction of physical, social, emotional, and functional components of health-related quality of life after contextual factors entered the equations. The findings underscore the importance of providing this population with the means to promote their health to the greatest extent possible, given the multiple threats to their health status. Nurses may be able to help survivors with preexisting disabling conditions reduce the negative influence of poorer health status and functional limitations on quality of life by providing interventions that reduce depression and build perceived ability to engage in health-promoting behaviors.
    Oncology Nursing Forum 03/2012; 39(2):E122-31. DOI:10.1188/12.ONF.E122-E131
  • Ana Todd, Alexa Stuifbergen
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    ABSTRACT: There is evidence that early detection from breast cancer screening is an effective means to reduce overall mortality from breast cancer. Findings from multiple research studies suggest that women with chronic disabling conditions are less likely to participate in breast cancer screening due to the multiple barriers they face. Barriers include those related to finances, environment, physical limitations, health carers' attitudes and lack of knowledge, and psychosocial issues. The purpose of this article is to provide an overview of the existing evidence of the barriers to breast cancer screening experienced by women with physical disabilities. Rehabilitation nurses that work with women who have chronic disabling conditions can be instrumental in eliminating these barriers to breast cancer screening through their efforts to promote health which is consistent with the philosophy of maximizing the health potential and quality of life of these women whose needs are often overlooked.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 03/2012; 37(2):74-9. DOI:10.1002/RNJ.00013
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    ABSTRACT: Objective: To explore the feasibility and effects of a computer-assisted cognitive rehabilitation intervention - Memory, Attention, and Problem Solving Skills for Persons with Multiple Sclerosis (MAPSS-MS) - for persons with multiple sclerosis on cognitive performance, memory strategy use, self-efficacy for control of symptoms and neuropsychological competence in activities of daily living (ADL). Design: A randomized controlled single-blinded trial with treatment and wait list control groups. Setting: Southwestern United States. Subjects: Convenience sample of 61 persons (34 treatment, 27 wait list control) with multiple sclerosis (mean age 47.9 years, SD 8.8). Intervention: The eight-week MAPSS-MS intervention program included two components: (a) eight weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and (b) a computer-assisted cognitive rehabilitation program with home-based training. Outcome measures: A neuropsychological battery of performance tests comprising the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) and self-report instruments (use of memory strategies, self-efficacy for control of multiple sclerosis and neuropsychological competence in ADL) were completed at baseline, two months (after classes), and at five months. Results: Both groups improved significantly (P < 0.05) over time on most measures in the MACFIMS battery as well as the measures of strategy use and neuropsychological competence in ADL. There was a significant group-by-time interaction for scores on the measures of verbal memory and the use of compensatory strategies. Conclusions: The MAPSS-MS intervention was feasible and well-accepted by participants. Given the large relative increase in use of compensatory strategies by the intervention group, it holds promise for enhancing cognitive function in persons with multiple sclerosis.
    Clinical Rehabilitation 02/2012; 26(10):882-93. DOI:10.1177/0269215511434997
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    ABSTRACT: Background: Women's negative attitudes toward physical activity have been pointed out as a plausible reason for their low participation rates in physical activity. However, the current literature is meager regarding midlife women's ethnic-specific attitudes toward physical activity. Purpose: The purpose of this study was to explore midlife women's attitudes toward physical activity among four major racial/ethnic groups in the U.S. (Whites, Hispanics, African Americans, and Asians). Methods: This was a secondary analysis of qualitative data among 90 midlife women from a larger study that included both an Internet survey and four ethnic-specific online forums on midlife women's attitudes toward physical activity. The data were analyzed using thematic analysis. Findings: The themes reflecting the commonalities were: (a) good for health; (b) not as active as I could be; (c) not encouraged; (d) inherited; and (e) not accessible. The themes reflecting the differences by race/ethnicity were: (a) necessity or luxury; (b) organized or natural; (c) individualistic or family-oriented; and (d) beauty ideal or culturally accepted appearance. The five themes reflecting the commonalities could be interpreted as more positive than reported in the literature, whereas the four themes reflecting the differences could be interpreted as more negative than reported in the literature. Conclusions: Developing an intervention that could change the social influences and environmental factors and that incorporate the women's ethnic-specific attitudes might be valuable in increasing physical activity of racial/ethnic minority midlife women.
    139st APHA Annual Meeting and Exposition 2011; 10/2011
  • Claudia C Beal, Alexa Stuifbergen, Deborah Volker
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    ABSTRACT: Delayed arrival at the emergency department after the onset of ischemic stroke symptoms is an important reason for low tissue plasminogen activator administration rates. There is evidence that women arrive at the hospital later than do men, but little is known about women's experiences in the period between symptom onset and hospital arrival. The purpose of this naturalistic investigation using narrative methodology was to gain understanding of women's early symptom experience of ischemic stroke. The sample consisted of 9 women aged 24 to 86 years with an ischemic stroke within 1 year of diagnosis. Data were collected using in-depth interviews in which participants were asked to tell the story of their stroke from the moment they noticed the symptoms until they arrived at the hospital. Data were analyzed using sequential methods of narrative analysis. The participants experienced stroke onset as the inability to carry out their accustomed activities in usual ways and as a process occurring over time rather than a discrete event. There was a tendency to objectify the body. Two participants considered stroke as a possible cause for their symptoms, and the other women attributed symptoms to everyday bodily experiences and/or other health conditions. Most participants did not perceive themselves at risk for stroke, although all but 1 woman had risk factors. For some women, stroke onset was different from their previous ideas about this event, and this was especially the case if a woman had prodromal symptoms. Decision making during early stroke flowed from women's evaluation of symptoms and the meaning of symptoms, and meaning was informed by a woman's life situation. The findings from this study may yield variables for future studies of cognitive, emotional, and behavioral predictors of hospital arrival time. There is a need for research on women's prodromal symptoms.
    The Journal of cardiovascular nursing 07/2011; 27(3):240-52. DOI:10.1097/JCN.0b013e31821bf83c
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    ABSTRACT: In 2007, the Neuroscience Nursing Foundation (NNF) convened a research panel to update NNF's research priorities used to guide funding. The research panel identified leaders in neuroscience nursing and conducted a review of neuroscience nursing research literature and an American Association of Neuroscience Nurses membership survey on research priorities. A workgroup of leaders in neuroscience nursing was then convened to draft and set priorities on the basis of the review of the literature and the membership survey. The updated priorities were submitted to the NNF Board of Trustees for approval. The revised document reviews the mission of NNF and outlines six strategies and five program areas (including specific subareas) that represent priorities for NNF research funding. The purpose of the updated priority document is to provide guidelines for the systematic development of knowledge in neuroscience nursing through the encouragement of selected neuroscience nursing research activities.
    06/2011; 43(3):149-55. DOI:10.1097/JNN.0b013e3182135b40
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    Eun-Ok Im, Bokim Lee, Wonshik Chee, Alexa Stuifbergen
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    ABSTRACT: To explore attitudes toward physical activity of White midlife women in the United States using a feminist perspective. A cross-sectional qualitative study using a thematic analysis. Internet communities for midlife women. Twenty-nine White midlife women in the United States recruited using a convenience sampling method. We used 17 topics on attitudes toward physical activity and ethnic-specific contexts to administer an online forum. We analyzed the data using thematic analysis. We found three themes: thinking without action, gendered and sedentary culture, and motivating myself. The women knew and understood the necessity of physical activity for their physical and mental health but in most cases had not been able to take action to increase their physical activities. Although the culture that circumscribed the women's physical activity was sedentary in nature, the women tried to motivate themselves to increase their physical activities through several creative strategies. The findings strongly suggest that although women were doing their best, American culture itself needs to be changed to help women increase physical activity in their daily lives.
    Journal of Obstetric Gynecologic & Neonatal Nursing 05/2011; 40(3):312-21. DOI:10.1111/j.1552-6909.2011.01249.x
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    ABSTRACT: The purpose of this study was to explore African American midlife women's attitudes toward physical activity. Using a feminist perspective, a 6-month online forum was conducted with 21 African American midlife women recruited on the Internet. The data were analyzed using thematic analysis. Four themes emerged: (a) culturally acceptable body, (b) missed opportunity to learn, (c) physical activity as a luxury, and (d) want to do by myself. The women had positive body images regardless of their actual weight. The women considered physical activity "a luxury" in their busy lives and thought that they had already missed opportunities to learn. The women wanted to participate in physical activities alone because of their bad childhood experiences and hesitance to go out in public with sweaty, messy hair. The findings suggested that unique programs that promote physical activity should be developed that consider the women's ethnic-specific attitudes.
    Western Journal of Nursing Research 03/2011; 34(3):317-39. DOI:10.1177/0193945911400637
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    ABSTRACT: The purpose of this article is to report the influence of gender on aging with childhood onset paralytic polio. The hermeneutic phenomenological exploration of gender was done using multiple qualitative interviews with 25 women, age 55 to 75 years of age, who had polio since before 14 years of age. We noted three themes: (a) the movement of her body, (b) integrating body and gender, and (c) gender discrepancies. Findings are discussed in the context of gendered expectations and the women's bodies.
    Journal of Gerontological Social Work 02/2011; 54(2):138-58. DOI:10.1080/01634372.2010.529864

Publication Stats

1k Citations
94.03 Total Impact Points

Institutions

  • 1990–2014
    • University of Texas at Austin
      • School of Nursing
      Austin, Texas, United States
  • 2003–2009
    • University of California, Davis
      • Department of Psychology
      Davis, California, United States
  • 2008
    • University of Missouri
      Columbia, Missouri, United States
  • 2005
    • Western Michigan University
      Kalamazoo, Michigan, United States
  • 2004
    • University of North Carolina at Charlotte
      • School of Nursing
      Charlotte, NC, United States