Jean McSweeney

University of Arkansas for Medical Sciences, Nursing, Faculty Member

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There’s more to food store choice than proximity: a questionnaire development study

BMC Public Health, Jun 17, 2013

Background: Proximity of food stores is associated with dietary intake and obesity; however, indi... more Background: Proximity of food stores is associated with dietary intake and obesity; however, individuals frequently shop at stores that are not the most proximal. Little is known about other factors that influence food store choice. The current research describes the development of the Food Store Selection Questionnaire (FSSQ) and describes preliminary results of field testing the questionnaire. Methods: Development of the FSSQ involved a multidisciplinary literature review, qualitative analysis of focus group transcripts, and expert and community reviews. Field testing consisted of 100 primary household food shoppers (93% female, 64% African American), in rural and urban Arkansas communities, rating FSSQ items as to their importance in store choice and indicating their top two reasons. After eliminating 14 items due to low mean importance scores and high correlations with other items, the final FSSQ questionnaire consists of 49 items. Results: Items rated highest in importance were: meat freshness; store maintenance; store cleanliness; meat varieties; and store safety. Items most commonly rated as top reasons were: low prices; proximity to home; fruit/vegetable freshness; fruit/vegetable variety; and store cleanliness. Conclusions: The FSSQ is a comprehensive questionnaire for detailing key reasons in food store choice. Although proximity to home was a consideration for participants, there were clearly other key factors in their choice of a food store. Understanding the relative importance of these different dimensions driving food store choice in specific communities may be beneficial in informing policies and programs designed to support healthy dietary intake and obesity prevention.

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Informed Consent: A Process to Facilitate Older Adults' Participation in Research

Journal of Gerontological Nursing, Apr 1, 2004

Trust is the foundation of the informed consent process. According to Kass et al., Yet only throu... more Trust is the foundation of the informed consent process. According to Kass et al., Yet only through vigilance and humility will we, as investigators, be able to live up to the trust that is placed in us; and only if that trust is deserved can the research enterprise survive (1996, p. 28). Therefore, further research should examine the effect of the informed consent process in limiting older adults&amp;amp;amp;amp;amp;amp;#39; participation. Only by re-evaluating the first point of contact, implementing creative strategies to overcome barriers to the informed consent process, and validating these strategies through research will nurses facilitate the inclusion of older adults in research.

Exploring older women's lifestyle changes after myocardial infarction

PubMed, Jun 1, 2003

The researchers explored the failure of older women to attend cardiac rehabilitation after myocar... more The researchers explored the failure of older women to attend cardiac rehabilitation after myocardial infarction, and examined facilitating and inhibiting factors in making lifestyle changes. Three global categories emerged: physiological changes, health decisions and actions, and life outcomes of the change process.

Qualitative study of influences on food store choice

Appetite, Oct 1, 2012

Previous research indicates food store choice influences dietary intake and may contribute to hea... more Previous research indicates food store choice influences dietary intake and may contribute to health disparities. However, there is limited knowledge about the reasons which prompt the choice of a primary food store, particularly among populations vulnerable to obesity and chronic diseases (e.g., individuals living in rural locations and African-Americans). Purposive sampling was used to select rural and urban communities (3 African-American and 2 Caucasian focus groups; n=48) in Arkansas from June to November 2010, allowing examination of potential racial or rurality differences. Primary household food shoppers (n=48) (96% female, 63% African-American, mean age=48.1±13.9 years old, mean BMI=30.5±7.8) discussed reasons for choosing their primary store. Qualitative analysis techniques-content analysis and constant comparison-were used to identify themes. Four themes emerged: proximity to home or work, financial considerations and strategies, availability/quality of fruits, vegetables, and meat, and store characteristics (e.g., safety, cleanliness/smell, customer service, nonfood merchandise availability, and brand availability). While there were persistent rurality differences, the relevant factors were similar between African-American and Caucasian participants. These findings have important implications for future policies and programs promoting environmental changes related to dietary intake and obesity, particularly in rural areas that appear to have significant challenges in food store choice.

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Idiopathic infertility: a trial of bromocriptine versus placebo

PubMed, Nov 30, 1979

Stress, Prolactin, and Infertility

The Lancet, 1979

Development of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey

Journal of Cardiovascular Nursing, 2004

Background/Objectives: Coronary heart disease (CHD) is the number one cause of death in women, ye... more Background/Objectives: Coronary heart disease (CHD) is the number one cause of death in women, yet, little is known about women's symptoms. Early symptom recognition of CHD in women is essential but most instruments do not assess both prodromal and acute CHD symptoms. Our aims were to develop an instrument validly describing women's prodromal and acute symptoms of myocardial infarction and to establish reliability of the instrument, the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Methods: Four studies contributed to the content validity and reliability of this instrument. Two qualitative studies provided the list of symptoms that were confirmed in study 3. The resulting instrument assesses 37 acute and 33 prodromal symptoms. In study 4, 90 women were retested 7 to 14 days after their initial survey. We used the kappa statistic to assess agreement across administrations. Results: The women added no new symptoms to the MAPMISS. The average kappa of acute symptoms was 0.52 and 0.49 for prodromal. Next we calculated a weighted score. The mean acute score for time 1 was 19.4 (SD = 14.43); time 2 was 12.4 (SD = 8.79) with Pearson correlation indicating stability (r = .84; P < .01). The mean prodromal score at time 1 was 23.80 (SD = 24.24); time 2 was 26.79 (SD = 30.52) with a Pearson correlation of r = .72; P < .01. Conclusions: The tool is comprehensive, has high content validity, and acceptable test-retest reliability. Low kappas were related to few women having those symptoms. The symptom scores remained stable across administrations. myocardial infarction | cardiovascular nursing | nursing | acute heart disease Keywords: symptoms | coronary heart disease Article: Although researchers have focused on cardiovascular disease for the previous 50 years, it remains the number one cause of death in men and women. 1 Cardiovascular disease has retained this ranking in part because health care professionals do not recognize and subsequently treat early warning or prodromal symptoms of coronary heart disease (CHD). 2-4 Prodromal symptoms, those symptoms that come and go prior to and change after a myocardial infarction (MI), are especially important to identify in women since they experience both higher morbidity and disability than men do after a MI. 1 However, only 7% of women identify CHD as women's greatest health threat. 5,6 Because most women are unaware of their risk for CHD or do not believe their symptoms indicate heart problems, they often ignore prodromal symptoms. Likewise, since health care providers learn the symptoms indicative of CHD from studies predominately of men whose symptoms often differ from women's symptoms, they have difficulty recognizing and treating women's symptoms appropriately. 5-8 Limited studies, primarily with men, have addressed variability of acute MI symptomatology, but consensus is growing that women's symptoms of MI vary from men's. 8-14 Although larger MI studies included women, they often did not differentiate women's symptoms from men's, 15-18 or used tools that excluded some important symptoms frequently reported by women, according to our preliminary work. 11,12,19-21 Further, no large-scale study has investigated both prodromal and acute symptoms in women. Therefore, development of a symptom instrument was warranted for earlier diagnosis of CHD in women. This article discusses 4 studies that contributed to the development and establishment of validity and reliability for the symptom portion of an instrument to describe the full range of prodromal and acute symptoms: the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). This article will describe the content development of the symptom portion of the instrument by summarizing 2 qualitative studies (1 and 2). Then, it will describe tool development, validity, and reliability by summarizing 2 quantitative studies (3 and 4). The University Human Research Advisory Committee approved all studies.

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What's Wrong With Me? Women's Coronary Heart Disease Diagnostic Experiences

Progress in Cardiovascular Nursing, Mar 1, 2005

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Abstract 17315: Comparing Knowledge and Attitudes about CHD Prevention Among Older Women Prior to and After a Cardiac Event

Circulation, Nov 22, 2011

Purpose: Risk factors for coronary heart disease (CHD) are at epidemic proportions among older wo... more Purpose: Risk factors for coronary heart disease (CHD) are at epidemic proportions among older women but few recognize their actual risk. Our purpose was to compare and contrast knowledge and attitudes concerning CHD prevention among older women without a CHD diagnosis with those who had experienced a cardiac event. Method: Using a mixed-methods design, we measured standard cardiac risk factors to determine actual risk and obtained measures of self-perceived risk among 20 older women, 6-12 months post cardiac event, and 24 community-dwelling women (≥60 years) without a CHD diagnosis. Semi-structured individual qualitative interviews were conducted to query about knowledge and attitudes regarding CHD prevention and risk. Narratives were transcribed verbatim and analyzed using content analysis. Next, constant comparison was used to compare and contrast findings between the two groups with the quantitative risk measures for convergence/divergence of data. Results: Of the 44 women, 30% were African-American a...

“We as Drug Addicts Need that Program”: Insight from Rural African American Cocaine Users on Designing a Sexual Risk Reduction Intervention for Their Community

Substance Use & Misuse, 2012

This focused ethnographic study examines data collected in 2007 from four gender-and agespecific ... more This focused ethnographic study examines data collected in 2007 from four gender-and agespecific focus groups (FGs) (N = 31) to inform the development of a sexual risk reduction intervention for African American cocaine users in rural Arkansas. A semi-structured protocol was used to guide audio-recorded FGs. Data were entered into Ethnograph and analyzed using constant comparison and content analysis. Four codes with accompanying factors emerged from the data and revealed recommendations for sexual risk reduction interventions with similar populations. Intervention design implications and challenges, study limitations, and future research are discussed.

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The Associations of Diagnoses of Fatigue and Depression With Use of Medical Services in Patients With Heart Failure

Journal of Cardiovascular Nursing, May 16, 2019

Background: Fatigue and depression based on self-report and diagnosis are prevalent in patients w... more Background: Fatigue and depression based on self-report and diagnosis are prevalent in patients with heart failure and adversely affect high rates of hospitalization and emergency department visits, which can impact use of medical services. The relationships of fatigue and depression to use of medical services in patients with preserved and reduced left ventricular ejection fraction (LVEF) may differ. Purpose: We examined the associations of diagnoses of fatigue and depression with use of medical services in patients with preserved and reduced LVEF, controlling for covariates. Methods: Data were collected on fatigue, depression, covariates, and use of medical services. Patients (N = 582) were divided into 2 groups based on LVEF (<40%, reduced LVEF; ≥40%, preserved LVEF). Multiple linear regression analyses were used to analyze the data. Results: A diagnosis of fatigue was a significant factor associated with more use of medical services in the total sample (β = .18, P < .001, R 2 = 54%) and patients with reduced LVEF (β = .13, P = .008, R 2 = 54%) and also preserved LVEF (β = .21, P < .001, R 2 = 54%), controlling for all covariates, but a diagnosis of depression was not. Conclusions: This study demonstrates the important roles of a diagnosis of fatigue in use of medical services. Thus, fatigue needs to be assessed, diagnosed, and managed effectively.

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Sleep disturbance in women before myocardial infarction

Heart & Lung, Sep 1, 2012

OBJECTIVE-To describe the prevalence and correlates of sleep disturbances among women who retrosp... more OBJECTIVE-To describe the prevalence and correlates of sleep disturbances among women who retrospectively reported sleep disturbance prior to their myocardial infarction (MI). BACKGROUND-MI is frequently unrecognized in women because they may have only vague symptoms, such as sleep disturbance. Describing correlates of sleep disturbance prior to MI may assist in recognizing women at risk for coronary heart disease. METHODS-Secondary analysis of dataset derived from 15 sites. RESULTS-Of 1270 women experiencing initial MI, 632 reported new onset of or worsening sleep disturbance before MI. Prevalence was similar across racial groups. Women reporting prodromal sleep disturbance were more likely to be older, heavier, and report cognitive changes (aOR= 1.47), new or increasing anxiety (aOR= 2.21), and unusual fatigue (aOR= 2.16). CONCLUSIONS-Subjective report of sleep disturbance preceding MI appear to be prevalent in women of all races and may be an important warning sign for MI in women.

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Disparities in Heart Failure and other Cardiovascular Diseases among Women

Women's Health, Jul 1, 2012

This article reviews literature pertinent to cardiovascular disparities in women, focusing primar... more This article reviews literature pertinent to cardiovascular disparities in women, focusing primarily on heart failure (HF). It provides an in-depth look at causes, biological influences, self-management and lack of adherence to HF-treatment guidelines in women. Disparities in treatment of causative factors of HF, such as myocardial infarction and hypertension, contribute to women having poorer HF outcomes than men. This article discusses major contributing reasons for nonadherence to medication regimes for HF in women, including advanced age at time of diagnosis, likelihood of multiple comorbidities, lack of social support and low socioeconomic status. Limited inclusion of women in clinical trials and the scarcity of gender analyses for HF and other cardiovascular diseases continues to limit the applicability of research findings to women.

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Perceptions of family history and genetic testing and feasibility of pedigree development among African Americans with hypertension

European Journal of Cardiovascular Nursing, Oct 16, 2014

Background-Pedigree development, family history, and genetic testing are thought to be useful in ... more Background-Pedigree development, family history, and genetic testing are thought to be useful in improving outcomes of chronic illnesses such as hypertension (HTN). However, the clinical utility of pedigree development is still unknown. Further, little is known about African Americans' (AAs') perceptions of family history and genetic testing. Aims-This study examined the feasibility of developing pedigrees for AAs with HTN and explored perceptions of family history and genetic research among AAs with HTN. Methods-The US Surgeon General's My Family Health Portrait was administered, and 30-60 minute in-person individual interviews were conducted. Descriptive statistics were used to analyze pedigree data. Interview transcripts were analyzed with content analysis and constant comparison. Results-Twenty-nine AAs with HTN were recruited from one free clinic (15 women, 14 men; mean age 49 years, SD 9.6). Twenty-six (90%) reported their family history in sufficient detail to develop a pedigree. Perceptions of family history included knowledge of HTN in the family, culturally influenced family teaching about HTN, and response to family history of HTN. Most participants agreed to future genetic testing and DNA collection because they wanted to help others; some said they needed more information and others expressed a concern for privacy. Conclusion-The majority of AAs in this sample possessed extensive knowledge of HTN within their family and were able to develop a three generation pedigree with assistance. The majority were willing to participate in future genetic research.

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Testing a Holistic Meditation Intervention to Address Psychosocial Distress in Patients With Heart Failure

Journal of Cardiovascular Nursing, Mar 1, 2018

Background: Many patients with heart failure (HF) experience persistent symptoms and poor health-... more Background: Many patients with heart failure (HF) experience persistent symptoms and poor health-related quality of life (HRQOL). Psychosocial distress is common and adversely affects HF symptoms and HRQOL. A holistic meditation (HOME) intervention that combines mindfulness, compassionate meditation, and self-management may reduce psychosocial distress. Purpose: The aims of this study were to examine the feasibility and acceptability of the HOME intervention in patients with HF and to obtain preliminary data about its effects on psychosocial factors (depressive symptoms, perceived control, and social support), HF symptoms, and HRQOL. Methods: Weekly 90-minute intervention sessions were delivered to 11 patients with HF for 12 weeks. Data on feasibility and acceptability were collected for 12 weeks, and data on psychosocial factors, HF symptoms, and HRQOL were collected at baseline and after the intervention. Results: Eleven of 13 enrolled patients completed all intervention sessions; 2 withdrew because of family health issues. Mean acceptability scores for all sessions ranged from 98% to 100%. In paired t test analyses, perceived control (P = .02, Cohen d = 0.82) and social support (P = .008, Cohen d = 1.00) increased, severity of depressive symptoms (P G .001, Cohen d = 1.54) and HF symptoms (P G .001, Cohen d = 1.91) decreased, and HRQOL was improved (P G .001, Cohen d = 1.82). Conclusions: The HOME intervention was feasible and acceptable and had positive effects on psychosocial variables, HF symptoms, and HRQOL for patients with HF. Our results indicate that treatment effects should be tested in a larger, controlled clinical trial.

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A Tailored Dietary Sodium Intervention Using Technology and Psychosocial Support

Journal of Cardiovascular Nursing, Mar 1, 2019

Background: In patients with heart failure (HF), high dietary sodium intake is common and associa... more Background: In patients with heart failure (HF), high dietary sodium intake is common and associated with HF symptoms, poor health-related quality of life (HRQOL), and high hospitalization rates. Purpose: The aims of this study were to examine the feasibility of a tailored dietary intervention with a practical tool (MyFitnessPal) and to obtain preliminary data about the effects on sodium intake, factors affecting sodium intake (knowledge, skills, experiences, confidence, perceived benefits and barriers, and depressive symptoms), HF symptoms, and HRQOL. Methods: A 6-session intervention was delivered to 11 participants. Paired t tests were used to compare the baseline outcomes with those at 3 months. Results: Participants completed 98% of intervention sessions, and 91% used MyFitnessPal. Sodium intake was reduced, and factors affecting sodium intake, symptoms, and HRQOL were improved (all P < .05). Conclusion: The intervention was feasible and warrants further research to test the effects of the intervention on the outcomes using larger, heterogeneous samples.

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African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

SAGE Open, 2016

More than 80 million Americans have hypertension (HTN), and African Americans (AAs) are dispropor... more More than 80 million Americans have hypertension (HTN), and African Americans (AAs) are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs' perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs' perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, inperson interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years). Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments "passed down," increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

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Losing All the Pieces: A Qualitative Study of HIV Risk Perception and Risk Reduction among Rural African American Women Who Use Cocaine

Journal of Drug Issues, Jul 1, 2009

The purpose of this study was to examine HIV-related beliefs of rural African American women who ... more The purpose of this study was to examine HIV-related beliefs of rural African American women who use stimulant drugs and their perceived risk for acquiring HIV. Qualitative interviews were conducted with 15 African American women living in the Mississippi Delta region of rural Arkansas. All women in the study were active users of crack and/or powder cocaine. We used the qualitative methods of content analysis and constant comparison to analyze the transcribed interviews. Four major themes emerged from the analysis: 1) Knowledge and Beliefs, 2) Don't Ask, Don't Tell, 3) Staying Safe, and 4) Surviving in the Community. Based on participants' responses, we discuss implications for framing new risk-reduction interventions tailored to the specific needs of this high-risk population at both the individual and community levels.

A Review of the Literature on Cardiac Symptoms in Older and Younger Women

Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG, Jan 8, 2016

To describe acute and prodromal cardiac symptoms in older and younger women. PubMed, CINAHL, MEDL... more To describe acute and prodromal cardiac symptoms in older and younger women. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched for articles published between January 2000 and January 2015. A combination of the MESH terms acute coronary syndrome, myocardial infarction, symptoms, prodromal symptoms, sex, gender, and age was used. The search was limited to studies on humans published in English and original articles related to symptoms of acute coronary syndrome (ACS) in women with symptoms stratified by age or analyses adjusted for age and/or sex. A total of 432 articles were identified, and 20 met the inclusion criteria. Key findings for differences in acute ACS symptoms for women based on age included the following: (a) typical chest pain and pain of any kind were less likely in older women (≥65 years); (b) women were more likely to have nonpain symptoms of nausea, dyspnea, and fatigue after adjustment for age; (c) most researchers did not adjust for menopausal sta...

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Impact of Attitudes and Rurality on Veterans’ Use of Veterans Health Administration Mental Health Services

Psychiatric Services, 2021

OBJECTIVE Veterans, especially those residing in rural areas, continue to underutilize mental hea... more OBJECTIVE Veterans, especially those residing in rural areas, continue to underutilize mental health care. This longitudinal study assessed attitudes relevant to seeking mental health care services from the Veterans Health Administration (VHA) over 12 months, adjusting for residence. METHODS A questionnaire addressing attitudes, sociodemographic factors, residence, place identity, perceived health status and needs, and structural barriers was administered by telephone to 752 veterans with previous VHA service use. Service use data were obtained from a VHA database. RESULTS In adjusted models, four attitudes were significantly associated with underuse of VHA mental health care (no use vs. any use; no use vs. nonsustained use vs. sustained use). Higher levels of mistrust of others (adjusted odds ratio [AOR]=1.06, p=0.046), emotional stoicism (AOR=1.08, p=0.003), belief in the self-resolving nature of mental health problems (AOR=1.91, p=0.015), and belief in the efficacy of religious counseling for such problems (AOR=1.09, p=0.022) were associated with no subsequent service use versus any use. Place identity (suburban), older age, and greater need were associated with greater odds of VHA use. For the comparison of no use versus sustained use, women had lower odds of no use (AOR=0.49, p<0.001); similarly, women had lower odds of nonsustained use versus sustained use (AOR=0.45, p<0.001). CONCLUSIONS The association of potentially modifiable attitudes with underuse of VHA mental health services suggests that attitudes offer useful targets for efforts to increase mental health care use. That these attitudes were influential regardless of residence suggests that programs addressing attitudinal barriers can be broadly targeted.

Jean McSweeney

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