Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Harleah Buck, Ph.D., RN, FPCN, FAAN

Committee Member

Christina Bricker, Ph.D., APRN, FNP-BC, FAHA

Committee Member

Laura Redwine, Ph.D.

Committee Member

Kevin Kip, Ph.D., FAAAS, FAHA


Cardiovascular Disease, Heart Failure, Self-Efficacy, African Americans


The purpose of this dissertation was to explore the effect of gratitude on cardiovascular health outcomes using mediators, medication adherence, and psychometrics. The specific aims were to (1) establish the state of the science for gratitude and cardiovascular health outcomes via a state-of-the-science literature review, (2) explore mediators affecting gratitude and medication adherence using a structural equation model in patients with cardiovascular disease, and (3) analyze the psychometric properties of the Gratitude Questionnaire-6, a self-report questionnaire designed to assess individual differences to express dispositional gratitude, to provide evidence for the validity and reliability of the instrument in African Americans at risk for cardiovascular disease for future studies.

In the first specific aim, a state-of-the-science review presented thirteen studies that provided preliminary evidence on the physical and mental benefits of gratitude on cardiovascular health outcomes. Current studies (n=8) showed that individuals who practiced gratitude experienced reduced inflammatory biomarker index score (CRP, TNF-α, IL-6, and sTNFr1), decreased diastolic blood pressure, lower heart rate and reduced levels of hemoglobin A1C. However, few studies (n=5) centered around cardiovascular health behaviors (diet, medication adherence, and exercise). The second aim was addressed using a structural equation model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in patients with cardiovascular disease. Our analyses found an indirect effect of gratitude on medication adherence through self-efficacy was significant (b = 0.16; p < .05), reinforcing our hypothesis. Lastly, the third aim was addressed with a psychometric evaluation of the Gratitude Questionnaire-6, which included determination of internal consistency reliability, factor structure and construct validity by hypothesis testing in participants at risk for cardiovascular disease. The Gratitude Questionnaire-6 is a valid and reliable tool to measure dispositional gratitude in African American individuals at risk for cardiovascular disease. This dissertation study provided preliminary evidence that dispositional gratitude may influence self-efficacy, thereby improving cardiovascular health behaviors and outcomes such as medication adherence.

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Nursing Commons