Date of Award


Document type


Access Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program


First Advisor

Cynthia S. Jacelon

Second Advisor

Genevieve E. Chandler

Third Advisor

Daniel S. Gerber

Subject Categories



Background: Women have experienced increased mortality from coronary heart disease over the last two decades, while men‘s rate has declined. This suggests that current treatment and prevention strategies are less effective for women. Furthermore, since most women don‘t participate in cardiac rehabilitation, alternatives to these programs must be explored. Purpose: This study sought to refine an intervention for rural women with coronary heart disease designed to promote self-management and provide pilot data evaluating the efficacy of the intervention. Design and Methods: The study design was mixed methods. Focused qualitative interviews provided data regarding the self-management program. In-depth interviews determined the efficacy of the intervention including adoption of health promoting behaviors, self-awareness, and self-efficacy. The Self-efficacy for Managing Chronic Disease 6-Item Scale provided additional efficacy data and was administered over the course of the study. Ten women from rural New England, diagnosed with coronary heart disease within the last year, comprised the purposeful sample. Findings: The self-learning program met the women‘s needs; however they provided suggestions for improvement. While the women reported varying degrees of self-awareness, many believed the self-learning program influenced their adoption of health-promoting behaviors. In the interviews, the women expressed confidence in their ability to manage their disease; a finding that was congruent with the findings of the self-efficacy scale. Improvement was seen in five of six items on the self-efficacy scale from pre- to post intervention. The women‘s confidence in managing other symptoms or health problems and management of problems related to heart disease saw a statistically (p > .05) significant increase post intervention, and that increase persisted. One item, emotional distress, was flat over the series of administrations. Conclusions: Since women differ from men in the development, expression, and treatment outcomes for coronary heart disease, educational programs that address those differences and meet their needs must be developed. This study demonstrated that a paper-based, holistic, self-management program is a viable alternative or supplement to traditional cardiac rehabilitation programs. Using the self-and family management framework, this intervention enabled women to learn how to care for themselves.


Included in

Nursing Commons