Development of the Health Hope Scale for Measuring Health Equity Process Among African American Home Healthcare Workers

Background/Purpose: According to the Centers for Disease Control and Prevention (CDC), health equity has to do with everyone having the opportunity to be as healthy as possible. Health disparities on the other hand refer to the differences in health outcomes and their causes among groups of people. Psychosocial and economic determinants of health disparities include poverty, chronic homelessness, economic instability, stigma and discrimination. While much has been stated on the importance of integrating social needs care into the delivery of healthcare by the National Academies of Sciences, Engineering and Medicine, evidence is slim on what process measures can be incorporated in providing a good direction for future research and innovative strategies to reduce health disparities. In order to fill this gap in the literature, psychological self-sufficiency (PSS)—a theoretical framework that explains an empowerment-based process of switching structural and individual barriers to hope vis-à-vis goal pursuit in the context of maintaining good health—will be utilized as the foundation for this study, particularly as it relates to Black or African American healthcare workers . The purpose of this study is to examine the factor structure of the health hope scale (HHS) that can provide a process-based metric that can be used for health equity.

Methods: Surveys were collected from employees of a home healthcare company which provides comprehensive care to home-based patients. Using a convenience sample of 211 participants, this paper deductively constructed the items for HHS. The definition of health hope was adopted from the psychological self-sufficiency (PSS) theory (Hong, 2013). Employment hope scale (EHS) (Hong, Polanin, & Pigott, 2012), which is one of the components of PSS, was modified to create the health hope scale. The questionnaires consist of empowerment, self-motivation, utilization of skills and health knowledge, goal orientation, and health behavior using a Likert scale. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy test and Bartlett’s test of sphericity was conducted using Stata 15. Next, exploratory factor analysis (EFA) was conducted to reveal any latent variables in HHS.

Results: A total of 211 surveys were analyzed. The descriptive statistics revealed that 90% of respondents were female and were mostly Black or African American. The age range were between 22 to 72 years of age. The KMO sampling adequacy was .927 and Bartlett’s test of sphericity was statistically significant at a=.001 (p=.000). As a result of EFA, HHS was determined to comprise two factors—health goal-orientation (item 11-23) and psychological empowerment (factor 2, items 1-12).

Implications: Applying the PSS theory in health—maintaining a positive balance between health barriers and health hope on the path to health literacy, access, and health outcomes—it is posited that one has to recognize the barriers as such and be able to transform this to a motivational outlook and effort toward realistic health goals as one becomes empowered as a self-care agent. Future research will need to empirically validate the extent to which PSS as a non-cognitive empowerment process affects health literacy, healthcare access, and health outcomes by which reducing health disparities.