Financial status, fatalism, and self-care of cardiovascular disease risk factors among rural adults living in socioeconomically distressed areas

Authors

• Ashmita Thapa, University of TennesseeFollow
• Geunyeong Cha, University of TennesseeFollow
• Dustin Hodges, Cincinnati Children’s Hospital
• Jia-Rong Wu, University of Tennessee
• Misook L. Chung, Vanderbilt University
• Martha J. Biddle, University of KentuckyFollow
• Jennifer L. Smith, University of Tennessee
• Debra K. Moser, University of Tennessee

Abstract

Purpose: Adults with fewer financial resources often have poor self-care. Rural dwellers commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about health. We examined whether fatalism mediates the association of financial status with cardiovascular disease (CVD) self-care in rural adults in economically distressed areas. We hypothesized that those with fewer financial resources would have poorer self-care, and fatalism would mediate this relationship.

Methods: We enrolled 1,122 adults (53 ± 15 years) at risk for CVD. Financial status was reflected by individuals’ perceptions of how well they made “ends meet” with their financial resources, fatalism by the CVD-Fatalism Instrument, and self-care of CVD risk factors by the Medical Outcomes Study-Specific Adherence Scale. We used conditional process analysis with the PROCESS macro.

Findings: Financial status was directly associated with self-care. Those with enough (C'1 = −1.57, P = .016) and those with not enough to make ends meet (C'2 = −3.51, P = .003) compared to those with more than enough had worse self-care. Those with higher levels of fatalism had worse self-care (b = −1.78, P = .001). Financial status was indirectly associated with self-care through fatalism. Compared to those with more than enough, those with not enough (indirect effect = −.269, 95% confidence interval = −.609, −.021) and enough (indirect effect = −.182, 95% confidence interval =−.376, −.041) had higher fatalism levels and thus worse self-care.

Conclusions: Poor financial status drives fatalism in rural dwellers, which in turn results in poor self-care.

Document Type

Article

Publication Date

2026

Notes/Citation Information

© 2025 National Rural Health Association.

Digital Object Identifier (DOI)

https://doi.org/10.1111/jrh.70107

Repository Citation

Thapa, Ashmita; Cha, Geunyeong; Hodges, Dustin; Wu, Jia-Rong; Chung, Misook L.; Biddle, Martha J.; Smith, Jennifer L.; and Moser, Debra K., "Financial status, fatalism, and self-care of cardiovascular disease risk factors among rural adults living in socioeconomically distressed areas" (2026). Nursing Faculty Publications. 91.
https://uknowledge.uky.edu/nursing_facpub/91