Hispanics with Serious Mental Illness and At Risk for Cardiovascular Disease

Persons with serious mental illness (SMI) are in worse physical health compared to persons in the general population and are more likely to develop medical conditions, such as obesity and diabetes, which place them at risk for cardiovascular disease (CVD). There is some evidence that Hispanics with serious mental illness are at greater risk for developing CVD risk factors compared to non-Hispanic Whites with SMI mainly due to health disparities. This study asks the questions: 1) What self-management behaviors do Hispanics with SMI and at risk of CVD engage in or attempt to engage in?, 2) How do measures of self-efficacy and patient activation correspond to self-management behaviors and barriers?, and 3) How do patients’ and stakeholders’ reports of barriers converge or diverge? Self-efficacy theory and social ecology theory were used as theoretical frameworks. Twenty four consumers were recruited from an outpatient mental health clinic. Seventeen stakeholders were recruited through various sites. A convergent mixed methods approach was used. Quantitative measures of self-efficacy and patient activation were compared to qualitative data on self-management behaviors and barriers to healthy living. Additionally, two sets of qualitative data on consumers’ and stakeholders’ perceptions of barriers to healthy living were compared to determine if they converged. Self-management behaviors identified included: healthy eating, seeking medical care, engaging in physical activity, involving others, self-motivation, use of faith, and engaging in structured and unstructured activities. Consumers with high levels of self-efficacy and patient activation tended to engage in more self-management behaviors regularly and perceived fewer barriers. Consumers with the lowest levels of self- efficacy and patient activation engaged in fewer self-management behaviors regularly and encountered more barriers. Consumer and stakeholder perceptions of barriers to healthy living experienced by consumers did converge, with the exception of the following additional barriers which were only identified by stakeholders: lack of health education, lack of formal education, consumer beliefs and fears, and body image. Using an ecological approach, barriers were identified at different environmental levels, often interacting. Overall, self-efficacy and patient activation may have an important influence on self-management behaviors among Hispanics with SMI and at risk for CVD. There is the possibility that barriers may moderate this relationship. Additionally, an ecological approach to understanding barriers to healthy living can be used to locate barriers and develop interventions which address them.