hopelessness, ischemic heart disease, rural, State-Trait Hopelessness Scale, validity



  1. Dunn, Susan L. PhD, RN, FAHA, FAAN
  2. Bomgaars, Deb PhD, RN, CNE
  3. Van De Griend, Kristin M. PhD, MPH
  4. Jensen, Gwenneth A. PhD, RN, CNS
  5. White, Lynn L. PhD, RN, ACNS-BC
  6. Goodyke, Madison P. BSN, RN
  7. Luong, Anna BSN, RN
  8. Gutierrez-Kapheim, Melissa MS
  9. Tintle, Nathan L. PhD


Purpose: Hopelessness and rurality are each independently associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining hopelessness in rural patients with IHD. The authors of this study evaluated the reliability and validity of the State-Trait Hopelessness Scale (STHS) in a primarily rural population of adults with IHD living in West North Central United States (US Great Plains).


Methods: Reliability, concurrent validity, and convergent validity were evaluated for 115 adults hospitalized for IHD. Rural-Urban Commuting Area codes were used to stratify participants by rurality level, with 66% categorized as rural. Principal component analysis was used to examine potential factor structure of the STHS.


Findings: Cronbach [alpha] for the State and Trait Hopelessness subscales were 0.884 and 0.903, respectively. Concurrent validity was supported for the State and Trait subscales using the Patient Health Questionnaire-8 (State: r = 0.50, P < .001; Trait: r = 0.35, P < .001). Convergent validity was supported for the State subscale using the Duke Activity Status Index (r = -0.23, P = .013). Principal component analysis showed 2 factors (hopelessness present and hopelessness absent) for the State and Trait subscales, accounting for 63% and 58% of variance, respectively.


Conclusions: Findings support the reliability and validity of the STHS for evaluation of hopelessness in rural adults with IHD in clinical and research settings. Results replicated the same factor structure found in testing of the STHS in a primarily urban sample. Because of the prevalence of hopelessness in rural adults with IHD and association with increased mortality, hopelessness should be assessed during hospitalization and in the recovery period.