John Henryism and Perceived Health among Hemodialysis Patients in a Multiracial Brazilian Population: the PROHEMO

Abstract

Purpose: John Henryism (JH) is a strong behavioral predisposition to engage in high-effort coping with difficult socioenvironmental stressors. We investigated associations between JH and perceived general health (GH) among maintenance hemodialysis (MHD) patients in a multiracial Brazilian population.

Design: The 12-item John Henryism Acting Coping (JHAC) Scale was completed by 525 patients enrolled in The Prospective Study of the Prognosis of Hemodialysis Patients (PROHEMO) in Salvador (Bahia) Brazil. JH scores could range from 12 to 60. The low and high JH groups were determined by a median split (<52 vs ≥52). The 36-Item Short Form Health Survey was used to determine GH score (range 0-100; higher means better health). Linear regression with extensive adjustments was used to test associations.

Results: Mean age was 48.3±13.7 years; 38.7% were female; 11.4% were White, 29.1% were Black and 59.4% were mixed race. JH was positively associated with higher GH in the whole sample (adjusted difference [AdjDif]=7.14, 95% CI= 2.98, 11.3) and similarly in men and women. A strong positive association between JH and GH was observed in non-Whites but not in Whites; (AdjDif in Blacks =16.4, 95% CI=8.37, 24.4). Also, a strong positive association between JH and GH was observed for patients aged <60 years (AdjDif =9.04, 95% CI = 4.46, 13.6) but not for older patients.

Conclusions: The results indicate that MHD patients engaged in high-effort coping with socioenvironmental stressors as demonstrated by high JH tend to feel more positively about their overall health. This seems to be especially the case for non-White and younger patients.

Keywords: Coping; General Health; Hemodialysis; John Henryism; Quality of Life; Race.

Figure 1.. Means and linear regression unadjusted and adjusted differences in general health score by John Henryism category in the total group and by sociodemographic subgroups

P were <.05 for the linear regression coefficients of John Henryism * Black race (White as reference) and John Henryism * age, using age as dichotomous variable (aged <60 years and ≥ 60 years). JH, John Henryism. a. Differences were adjusted for age, gender, race, marital status, education, economic class, months of dialysis, dialysis dose by Kt/V, serum creatinine, serum albumin, hemoglobin, type of vascular access for hemodialysis, hypertension, heart failure, diabetes, cerebrovascular disease and a group of low-prevalence comorbidities (chronic obstructive pulmonary disease, asthma, virus B infection, virus C infection, cancer, peripheral vascular disease) as a single category.