Religiousness and Marginality in Women Globally: Psychometric Testing of Two Instruments Translated into Five Languages for use in Cardiovascular Recovery
Lucia Gonzales, PhD, MSN, MBA, NP-C, RN, Associate Professor, University of San Diego
Among women, cardiovascular (CV) disease is the leading cause of mortality in every major developed country and in most emerging economies. After experiencing an acute cardiovascular event, a woman’s physical health, the prevalence of morbidities, likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favorable than men. This study focused on instruments that could assess the psychosocial stressor of social isolation (e.g. religiousness and marginality). Instrument selection was guided by a schema that conceptually depicts psychosocial stressors and the influence of behavioral risk factors on the pathogenesis of atherosclerosis and the occurrence of CV events.
The purpose of this study was to examine the reliability and validity of the translated versions of the Koci Marginality Index and Duke University Religion Index into Japanese, Ukrainian, Tagalog, Spanish and Arabic among 282 women (aged 35-92 years) representing seven cultures. The ultimate goal was to prepare assessments that could be used by global colleagues to determine a woman’s available resources in achieving positive health outcomes following a CV event.
The study was performed in a multi-center, multicultural context. Concurrent pilot studies of no fewer than 20 participants were conducted. Translated instruments were administered to native-born women of Japanese, Ukrainian, Philippine, Hispanic, American, Omani and Haitian cultures. A cross-sectional study design was used. Participants were approached through snowball technique, the Internet email announcement with access to electronic survey
website, colleagues at the workplace, relatives, or while investigators were conducting medical missions in other countries.
Data analysis was accomplished using descriptive, Pearson r correlations, internal consistency, discriminant and convergent validity and confirmatory factor analyses
Women’s races were white (45%) followed by Asian (33%), and black (19.5%). Results showed that reliability and validity were strong. Coefficient alphas were 0.79 and 0.84. Confirmatory factor analyses for the KMI was RMSEA was 0.000, TLI = 1.004, CFI = 1.000 and the Standardized Root Mean Residual (SRMR) = 0.024; for the DUREL the RMSEA was 0.005, TLI = 0.977,CFI = 0.989 and the SRMR = 0.019. KMI and DUREL demonstrate convergent and discriminant validity. Nationalized annual household income was associated with higher education. Religion was significantly negatively associated with income and
education. No associations were found between marginality and religiousness.
For researchers and clinicians alike, these reliable and valid instruments may be useful to assess a woman’s personal resources and social support or lack thereof during an acute CV event. Understanding a woman’s social isolation and whether she has a connection to religious groups assists health-care professionals to identify a woman’s social support resources during recovery following acute cardiovascular episodes. For clinicians, if marginality is scored low, this may be considered a strength for CV recovery. A high score on marginality may indicate a clinical concern related to social isolation, depression or abuse. Such clinical concerns are associated with negative CV outcomes. High religiousness would typically offer an opportunity to work within local religious organizations who advocate for health.
Among women, cardiovascular (CV) disease is the leading cause of mortality in every major developed country and in most emerging economies. After experiencing an acute cardiovascular event, a woman’s physical health, the prevalence of morbidities, likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favorable than men. This study focused on instruments that could assess the psychosocial stressor of social isolation (e.g. religiousness and marginality). Instrument selection was guided by a schema that conceptually depicts psychosocial stressors and the influence of behavioral risk factors on the pathogenesis of atherosclerosis and the occurrence of CV events.
The purpose of this study was to examine the reliability and validity of the translated versions of the Koci Marginality Index and Duke University Religion Index into Japanese, Ukrainian, Tagalog, Spanish and Arabic among 282 women (aged 35-92 years) representing seven cultures. The ultimate goal was to prepare assessments that could be used by global colleagues to determine a woman’s available resources in achieving positive health outcomes following a CV event.
The study was performed in a multi-center, multicultural context. Concurrent pilot studies of no fewer than 20 participants were conducted. Translated instruments were administered to native-born women of Japanese, Ukrainian, Philippine, Hispanic, American, Omani and Haitian cultures. A cross-sectional study design was used. Participants were approached through snowball technique, the Internet email announcement with access to electronic survey
website, colleagues at the workplace, relatives, or while investigators were conducting medical missions in other countries.
Data analysis was accomplished using descriptive, Pearson r correlations, internal consistency, discriminant and convergent validity and confirmatory factor analyses
Women’s races were white (45%) followed by Asian (33%), and black (19.5%). Results showed that reliability and validity were strong. Coefficient alphas were 0.79 and 0.84. Confirmatory factor analyses for the KMI was RMSEA was 0.000, TLI = 1.004, CFI = 1.000 and the Standardized Root Mean Residual (SRMR) = 0.024; for the DUREL the RMSEA was 0.005, TLI = 0.977,CFI = 0.989 and the SRMR = 0.019. KMI and DUREL demonstrate convergent and discriminant validity. Nationalized annual household income was associated with higher education. Religion was significantly negatively associated with income and
education. No associations were found between marginality and religiousness.
For researchers and clinicians alike, these reliable and valid instruments may be useful to assess a woman’s personal resources and social support or lack thereof during an acute CV event. Understanding a woman’s social isolation and whether she has a connection to religious groups assists health-care professionals to identify a woman’s social support resources during recovery following acute cardiovascular episodes. For clinicians, if marginality is scored low, this may be considered a strength for CV recovery. A high score on marginality may indicate a clinical concern related to social isolation, depression or abuse. Such clinical concerns are associated with negative CV outcomes. High religiousness would typically offer an opportunity to work within local religious organizations who advocate for health.
