- Email: [email protected]
An Integrative Review of Adolescent Hope
Journal of Pediatric Nursing (2013) 28, 105–113
An Integrative Review of Adolescent Hope Maureen Esteves PhD, RN ⁎, Robert L. Scoloveno MS, RN, Ganga Mahat EdD, RN, Adela Yarcheski PhD, FAAN, Mary Ann Scoloveno EdD, RN Rutgers, The State University of New Jersey, College of Nursing, Newark, NJ
Key words: Integrative review; Hope; Adolescents
The purpose of this integrative review was to synthesize the published research on adolescent hope using Cooper's (Cooper, H. M. (1989). Integrating research: A guide for literature reviews (2nd ed.). Newbury Park, CA: Sage) five stages. Computerized databases were used to search for relevant studies published between the years 1990 to 2010. Thirty-six studies met the inclusion/exclusion criteria. Variables studied in relation to hope were categorized as antecedent, coincident, and consequent concepts. Two antecedent, ten coincident, and ten consequent concepts of hope were included in the review. The number of statistically significant and non-significant correlations of these variables to hope is presented. Conclusions are drawn and recommendations for future studies are offered. © 2013 Elsevier Inc. All rights reserved.
HOPE IS A phenomenon important to all people across the lifespan; thus an understanding of hope is important to nursing (Dufault & Martocchio, 1985). The literature is replete with studies of hope in adolescents, both healthy and ill. Despite the abundance of these available studies, no attempts have been made to integrate the findings into a coherent body of knowledge according to the concepts studied in relation to adolescent hope. Previous systematic reviews of hope have focused on clinical (Kylma, Juvakka, Nikkonen, Korhonen & Isohanni, 2006; Kylma, Duggleby, Cooper, & Molander, 2009) and adult (Kim et al., 2004) populations. However, since adolescent hope may be uniquely different conceptually than adult hope, there is a need to synthesize major concepts studied in relation to adolescent hope. An integrative review of the literature on adolescent hope can yield important information for: (a) identifying gaps in the literature on adolescent hope, (b) providing a knowledge base for evidence-based practice, (c) identifying robust variables that can be used to develop
⁎ Corresponding author: Maureen Esteves, PhD, RN. E-mail address: [email protected] (M. Esteves). 0882-5963/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2012.03.033
experimental and clinical interventions that can foster hope in adolescents, and (d) providing directions for future theory development and research. The purpose of this integrative review was to synthesize the published research on adolescent hope.
Literature Review Theoretical Perspectives on Adolescent Hope Erikson (1964), in his classic work on the epigenetic stages of man, indicated that hope is part of the human developmental process. Dufault and Martocchio (1985) later stated that, “hope is not a single act, but a complex of many thoughts, feelings, and actions that change with time” (p. 380). For these authors, hope is processoriented, multidimensional, and composed of spheres of generalized hope and particularized hope. The temporal dimension of hope suggests that hope has a developmental thrust, manifesting unique characteristics across the lifespan. The concern in this integrative review is on adolescent hope.
106 Based on a synthesis of theoretical works on hope, te Riele (2010) has provided a conceptualization of hope for adolescents, especially marginalized or disadvantaged youth. In order to be a useful concept for adolescents, hope must be conceptualized as robust, attainable, and sound. Robust implies that hope is constructive; attainable implies that hope is necessary to overcome obstacles and involves both wishing and planning; and sound implies that hope is positively connected with human well-being or betterment. te Riele proposed four resources necessary for the philosophy of hope to operate in adolescents: (a) a focus on the possibility, (b) critical reflection of life's opportunities, (c) a community of hope, and (d) a positive culture for hope to thrive.
Previous Systematic Reviews of Hope In this era of evidence-based practice, systematic reviews have taken on heightened importance in nursing. The few systematic reviews reported on hope focused on selected adult populations and provided a background for the present study. In 2006, Kylma et al. provided an integrative review of the current status of research on hope and schizophrenia, using content analysis to examine 17 relevant published articles. Findings indicated that hope is a positive factor in the lives of individuals living with schizophrenia, their significant others, and their healthcare personnel. In addition to identifying factors associated with and contributing to hope in individuals living with schizophrenia, Kylma et al. identified hope-engendering interventions and treatment evaluation with regard to hope for this population. In a later review, Kylma et al. (2009) provided an integrative review of the current status on hope in palliative care, using content analysis to examine 34 relevant published articles on hope. Findings suggested at least two overarching themes of patients' hopes: a) “living with hope,” and b) “hoping for something.” Kylma et al. concluded that hope is important in both living and dying. The purpose of a study by Kim et al. (2004) was to metaanalyze the relationships of major concepts to hope. Very large positive effect sizes were found between hope and spiritual wellbeing, self-esteem, and social support. Negative effect sizes were found between hope and uncertainty in illness, fatigue, and perceived unhealthiness status. Kim et al. concluded that the results can be used as a guide to advance hope theory for nursing. The above studies have contributed to an understanding of hope in selected adult populations. No systematic reviews have focused on adolescent hope, creating a gap in the literature. To broaden the available systematic reviews on hope, this study gathered empirical studies on adolescent hope.
M. Esteves et al.
Method Problem Formulation A decision was made to follow Cooper's (1989) stages for an integrative review. The first stage is formulation of the problem, which was to fill a gap in knowledge on the state of the science on hope in adolescents. In her work with adolescents, Hinds (1984) defined adolescent hopefulness as “the degree to which an adolescent possesses a comforting life-sustaining belief that a personal and positive future exists” (p. 3); Hinds (1988) developed the Hopefulness Scale for Adolescents to measure this theoretical definition. While these definitions by Hinds are useful, for this review, all studies of hope in adolescents in which various conceptual and operational definitions were used were considered and included in the review.
Data Collection The second stage of an integrative review is data collection (Cooper, 1989), which in this case were published studies of adolescent hope. Two methods of data collection were used: (a) computerized databases, and (b) the ancestry approach. Relative to the first method, the following data bases were searched for studies on adolescent hope from 1990-2010: MedLine; CINAHL (Cumulative Index to Nursing and Allied Health Literature); and, PsychInfo (Psychological Information). The twenty year span, from 1990-2010, was considered to be manageable and contemporary. The key words used were: hope, hopefulness, adolescence, and adolescents. Relative to the ancestry approach, all reference lists of the studies reviewed were examined to identify possible missing studies. The inclusion process for studies reported in this paper was as follows: (a) all published quantitative studies on adolescent hope, (b) only studies published in English, (c) studies in which the samples were aged 10-23, and (d) studies in which adolescent samples were healthy or diagnosed with medical problems. Given the vast number of variables studied in relationship to hope, it was decided that only those variables studied at least twice would be included in the analysis. In two instances, similar variables were grouped together as one construct; religiousness was one and health practices were the other. The exclusion process was as follows: (a) dissertations and master's thesis, which are costly to obtain, (b) studies published as chapters and books, which sometimes include previously reported findings, (c) studies in which adolescent samples were mixed with other age groups, and (d) qualitative studies of hope. The computerized database method described above yielded 100 studies, of which 36 met the inclusion-exclusion criteria. No studies were identified using the ancestry approach. The entire research team participated in this aspect of the work. Once the variables studied in relation to hope
Adolescent Hope
107
Table 1 (n = 36)
Summary of findings across adolescent hope studies
Variable
Number of Number of statistically non-statistically significant findings significant findings
Antecedent Variables Age Gender Coincident Variables Social Support Self-Esteem Optimism Future Time Perspective Self-Efficacy Religiousness Stress Hopelessness Depression Anxiety Consequent Variables Life Satisfaction Health Practices Well-being Purpose Academic Achievement Internalizing Behaviors Externalizing Behaviors Substance Use Positive Affect Negative Affect
3 4
5 3
9 12 9 2
0 1 0 0
7 3 1 10 3 1
0 4 8 0 0 1
11 5 2 7 3
0 0 0 1 1
2
1
3
0
5 8 2
1 0 4
Each member of the research team was assigned to studies falling into one or more of these groups to record the relevant information on the coding sheet. The last two authors of this manuscript verified the information on the coding sheets. In terms of theory development and research, Chinn and Kramer (2011) have stated that antecedent variables come before the variable of interest, coincident variables occur at the same time or co-exist with the variable of interest, and consequent variables occur after or follow the variable of interest. Clearly, demographic variables, such as age and gender always serve as antecedent variables and were treated as such in this analysis. Designation of variables as coincident or consequent was based primarily on how the variables were investigated in relation to hope in the studies reviewed and secondarily on the description proffered by Chinn and Kramer. Most of the studies reviewed were correlational (N = 25); the others were comparative (N = 5), longitudinal (N = 4), quasi-experimental (N = 1) or methodological (N = 1).
Results Given the wealth of information derived from this analysis, the findings across the studies of adolescent hope are summarized for each variable in Table 1. The results indicate the number of statistically significant and nonstatistically significant findings for each variable clearly identifying important variables related to hope emerging from this analysis. Table 1 helped to create the model of adolescent hope (see Figure 1).
Antecedent Variables and Hope more than once were identified, a database search was done combining the variable selected with hope. The last two authors of this manuscript rechecked the databases to ensure that all relevant studies were retrieved.
Data Analysis Prior to the review a code book was constructed to record pertinent information about each study, such as age range and composition of the sample, health status of the sample, variables studied in relation to hope, and statistical findings. Then, a list was made of the variables examined in relation to hope for studies meeting the inclusion criteria, with a count of the number of times the variable was examined. The third stage in integrative reviews is evaluation whereby a decision is made on how to categorize the studies used in the review (Cooper, 1989). Valle, Huebner and Suldo (2006) recommended that studies of the antecedents of hope are needed. Thus, variables studied in relation to hope two or more times were grouped into categories of antecedent, coincident, and consequent relationships based on the conceptualization of the study (Chinn & Kramer, 2011).
In a number of studies, age has been studied mostly on a posteriori basis in relation to hope (Connelly, 1998; Day & Padilla-Walker, 2009; Hendricks-Ferguson, 2006; Hinds et al., 2000; Ritchie, 2001; Venning, Eliot, Kettler & Wilson, 2009; Warren, Jackson, & Sifers, 2009). The relationship between age and hope was not statistically significant in three studies of healthy adolescents (Connelly, 1998; Day & Padilla-Walker, 2009; Warren et al., 2009) and in two studies of adolescents with cancer (Hendricks-Ferguson, 2006; Ritchie, 2001); the directions of the relationship between age and hope were mixed or not reported. However, Venning et al. (2009) found a positive relationship whereby hope increased with age in healthy adolescents. In a control group of adolescents with cancer, Hinds et al. (2000) reported that age was positively associated with hope on two separate occasions. These findings suggest that age is not appreciably related to hope in three of four samples of healthy adolescents, and that the relationship is equivocal in adolescents diagnosed with cancer. Further, these findings leave open to question whether age, as a proxy of development, bears a meaningful relationship to hope.
108
M. Esteves et al. Consequences
Antecedents
H o p e
Agea Gender b
Coincident + Social Support + Self esteem + Optimism + Future Time Perspective + Self Efficacy + Religiousness - Stress - Hopelessness - Depression - Anxiety
+ Life Satisfaction + Health Practices + Well- being + Purpose + Academic Achievement - Internalizing Behaviors - Externalizing Behaviors - Substance Use + Positive Affect - Negative Affect
Note: (+) = Positive Relationship to HOPE (-) = Negative Relationship to HOPE (a)
directions were mixed or not reported
(b)
direction of differences between boys and girls varied
Figure 1
Model of adolescent hope relationships.
More studies are needed to fill this gap in knowledge for all adolescents. In a number of studies, differences in hope have been examined between adolescent girls and boys. In two studies of healthy adolescents no differences in hope were found between girls and boys (Day & Padilla-Walker, 2009; Vacek et al., 2010). However, Hendricks et al. (2000) found that girls had higher levels of hope than boys, whereas Venning et al. (2009) found that boys had more hope than girls. Mixed results were also reported in samples of adolescents diagnosed with cancer. Ritchie (2001) found no gender differences in hope, Hendricks-Ferguson (2006) reported that girls expressed more hope than boys, while Hinds et al. (1999) reported that girls identified more hope than boys. These findings reveal that, while there may be gender differences in hope in healthy or ill adolescent samples, the results are mixed. More studies are needed to clarify whether boys or girls are more hopeful during adolescence.
Coincident Variables and Hope Social support, or the availability of a socially supportive network, has been linked to hope (Dufault & Martocchio, 1985). Researchers have examined social support in relation to hope in adolescent samples who were considered healthy in nine studies, yielding nine positive correlations (Barnum,
Snyder, Rapoff, Mani & Thompson, 1998; Edwards, Ong, & Lopez, 2007; Heaven & Ciarrochi, 2007; Mahat & Scoloveno, 2001; Mahat, Scoloveno & Whelan, 2002; Mahon, Yarcheski & Yarcheski, 2004; Vacek et al., 2010; Yarcheski, Scoloveno, & Mahon, 1994; Yarcheski, Mahon, & Yarcheski, 2001). In these studies, sample size ranged from 20 to 776. Research findings indicated that the correlations in these studies ranged from r = .19 to r = .63, all of which were positive and statistically significant. These findings indicate that social support is a robust variable in relation to hope in adolescent samples. It would of interest to know if the relationship is as robust when early, middle, and late adolescents are studied separately. Weisman (1972) suggested that hope emerges from a healthy self-esteem. The relationship between hope and selfesteem has been investigated in eleven studies, yielding 13 correlations ranging from r = .19 to r = .64; except for one correlation in a sample of healthy adolescents (r = .19; Mahat & Scoloveno, 2001), all were positive and statistically significant (Barnum et al., 1998; Cantrell & Lupinacci, 2004; Carvajal, Clair, Nash, & Evans, 1998; Ciarrochi, Heaven, & Davies, 2007; Heaven & Ciarrochi, 2007; Hendricks, 1998; Ritchie, 2001; Simon, Barakat, Patterson, & Dampier, 2009; Swanston, Nunn, Oates, Tebbutt, & O'Toole, 1999; Vacek et al., 2010). Sample size ranged from 29 to 1026. With the exception of samples of adolescents with cancer (Cantrell &
Adolescent Hope Lupinacci, 2004; Ritchie, 2001) substance abuse (Carvajal et al., 1998), or those sexually abused (Swanston et al., 1999), all of the other samples of adolescents were deemed healthy. These findings reveal that self-esteem is an important variable related to hope in adolescent samples, healthy and ill. More studies of this relationship are needed in acutely and chronically ill adolescents. The theoretical underpinnings of the constructs of optimism and hope have been linked by researchers (Shoegren, Lopez, Wehmeyer, Little & Pressgrove, 2006). Researchers have examined optimism in relation to hope in adolescent samples in five studies (Carvajal et al., 1998; Edwards et al., 2007; Shoegren et al., 2006; Vacek et al., 2010; Wong & Lim, 2009) yielding nine correlations, all of which were positive and statistically significant. The magnitude of the correlations ranged from r =. 27 to r = .57; sample size ranged from 135 to 1643. With the exception of adolescents with cognitive disabilities in the Shoegren et al. (2006) study, or those with substance abuse (Carvajal et al., 1998), all the other adolescent samples were deemed to be healthy. These findings indicate that optimism is another robust variable studied in relation to hope in adolescent samples, but studies are needed in adolescents with serious medical diagnoses. In one study yielding two correlations, hope was correlated positively with future time perspective in a sample of 661 healthy adolescents (Adelabu, 2008). Both correlations, ranging from r = .27 to r = .39, were statistically significant suggesting that future time perspective, an important adolescent variable, has a modest relationship to hope; more studies of this relationship are needed. Using samples of adolescents diagnosed with cancer, Hinds et al. (2000) correlated self-efficacy with hope in both the experimental and control groups, yielding seven correlations. Correlations ranged from r = .40 to r = .75, all of which were positive and statistically significant. In this longitudinal study, the experimental group consisted of 40 adolescent boys and girls and the control group consisted of 38 counterparts. Thus, the relationship between self-efficacy and hope has been replicated over time in adolescents diagnosed with cancer. Hendricks (1998), in a sample of 1036 healthy 7th and 8th graders, reported a statistically significant positive correlation between self-efficacy and hope (r = .22). The findings of these two studies indicated that self-efficacy has a weak relationship to hope in healthy adolescents and a moderately strong to strong relationship to hope in adolescents diagnosed with cancer; more studies are needed. An underlying assumption of three empirical studies was that religiousness (e.g. religious values, religious coping, or religious growth) was associated with increased hope (Heaven & Ciarrochi, 2007; Roesch et al., 2010; Vaughn, Roesch, & Aldridge, 2009). These studies produced a total of seven positive correlations, ranging from r =.10 to r = .31, three of which were statistically significant. Sample size ranged from 126 to 776. These findings suggest that the positive direction of the relationship between religiousness and hope is consistent with predictions in healthy adolescents, but more often than not
109 the relationship is not appreciable. Future studies are needed to clarify this relationship using the same measure of religiousness across studies. A number of negative emotions have been studied in relation to hope. Stressful life events and/or perceived stress have been studied in six studies, yielding nine negative associations, eight of which were not statistically significant (Canty-Mitchell, 2001; Roesch et al., 2010; Swanston et al., 1999; Vacek et al., 2010; Warren et al., 2009) and one of which was weak (r = -.10) and statistically significant ( Valle et al., 2006). Correlations ranged from r = -.01 to r = -.15, and sample size ranged from 51 to 699. Despite theory suggesting that hope is a respite from stress (Dufault & Martocchio, 1985), these research findings did not empirically support the theory. It may be more fruitful to study stress in relation to hope in early, middle, and late adolescents separately using developmental theory as a basis for study. Using adolescents diagnosed with cancer, Hinds et al. (1999) and Hinds et al. (2000) examined the relationship between hopelessness and hope over time, yielding ten correlations. Correlations ranged from r = -.31 to r = -.50, all of which were negative and statistically significant. Sample size ranged from 38 to 78. The findings suggest that hopelessness and hope, considered two independent constructs, were consistently and inversely related in adolescent samples. It would be interesting to know if studies of healthy adolescents would yield similar findings. Depression was examined in relation to hope in three studies yielding three correlations (Simon et al., 2009; Swanston et al., 1999; Wong & Lim, 2009). Correlations ranged from r = -.60 to r = -.61, all of which were fairly strong, negative and statistically significant. Sample size ranged from 44 to 344; except for the abused adolescents in the Swanston et al. (1999) study, the other adolescent samples were deemed to be healthy. The findings reveal that depression holds promise as an important variable to study in relation to hope; more studies are needed. Beck (1976) has suggested that when hope is lost, anxiety emerges. Anxiety was examined in relation to hope in two studies, yielding two inverse correlations. In the Simon et al. (2009) study, the correlation was r = -.16 and not statistically significant, in a sample of 44 adolescents. In the Swanston et al. (1999) study, the correlation was r = -.42, p b .002, in a sample of 51 adolescents. These findings suggest that the negative direction of the relationship between anxiety and hope is consistent with theory, but that the relationship does not consistently achieve statistical significance. More studies are needed to clarify this relationship using larger samples.
Consequent Variables and Hope Life satisfaction was investigated in eight studies, yielding eleven positive and statistically significant correlations (Bronk, Hill, Lapsley, Talib and Finch, 2009; Edwards et al., 2007; Gilman, Dooley, & Florell, 2006; Hexdall & Huebner, 2007; Shoegren et al., 2006; Vacek et al., 2010;
110 Valle et al., 2006; Wong & Lim, 2009) and one nonsignificant correlation in a comparison sample of healthy adolescents (Hexdall & Huebner, 2007). Correlations ranged from r = .13 (ns) to r = .71, and sample size ranged from 29 to 860. Most of the samples consisted of healthy adolescents, with the exception of those diagnosed with cognitive disabilities (Shoegren et al., 2006) and a sample of adolescents diagnosed with cancer (Hexdall & Huebner, 2007). Based on the research findings across studies, life satisfaction is a meaningful consequence of hope in adolescents. More studies of this relationship are needed, especially in chronically ill adolescents. Consistent with theory (Dufault & Martocchio, 1985), health practices (positive health practices, self-care agency, or health-promoting behaviors) have been studied as behavioral outcomes of hope in five (5) studies, yielding five correlations, all of which were positive and statistically significant (Canty-Mitchell, 2001; Hendricks, 1998; Mahat & Scoloveno, 2001; Mahat et al., 2002; Mahon et al., 2004). Sample size ranged from 65 to 1036. In these samples of adolescents deemed as healthy, correlations ranged from r = .17 to r = .54. These findings suggest that hope predicts health practices in adolescents. Because health promotion is at the core of professional nursing, studies of the relationship between hope and health practices should continue. Well-being has been linked theoretically to hope as an outcome (Dufault & Martocchio, 1985), and has been examined in relation to hope in two (2) studies. Statistically significant and positive correlations were found in a sample of 99 adolescents (r = .60; Yarcheski et al., 1994) and in a sample of 142 adolescents (r = .68; Yarcheski et al., 2001). These findings suggest that a sense of well-being and hope bear a strong relationship to one another, but more studies would strengthen this assertion. Two studies (Bronk et al., 2009; Burrow et al., 2010) have examined the relationship between hope and purpose in healthy adolescents, yielding eight positive correlations, seven of which were statistically significant. Purpose was studied as purpose identified, purpose searching, purpose commitment, and purpose exploration, and was linked to hope theoretically by Bronk et al. (2009). Correlations ranged from r = .10 (ns) to r = .51; and, sample size ranged from 153 to 318. These findings reveal that hope bears a weak to moderate relationship to purpose in life in adolescents; more studies are needed of this relationship in all adolescents, especially those characterized as a vulnerable population. Academic achievement (GPA) has been examined in relation to hope in two studies (Adelabu, 2008; Gilman et al., 2006), yielding four correlations, all of which were positive and three of which were statistically significant. The correlations ranged from r = .08 (ns) to r = .42, and sample size ranged from 341 to 661. These findings indicate that hope is a fairly good predictor of academic achievement in healthy adolescents; clearly more studies are needed. Two studies have examined internalizing behaviors, such as somatic complaints, and externalizing behaviors, such as
M. Esteves et al. aggressiveness, in relation to hope in adolescents (Barnum et al., 1998; Valle et al., 2006). Regression analysis indicated that hope contributed significantly to externalizing behaviors, but not to internalizing behaviors in the Barnum et al. (1998) study with a sample of 29 adolescents. In the Valle et al. (2006) study, based on extant hope theory, hope was inversely and statistically significantly related to externalizing behaviors at two points in time, r = -.35 and r = -.26, and to internalizing behaviors at two points in time, r = -.31 and r = -.28. Time 1 had a sample of 860 adolescents and Time 2 had a sample of 699 adolescents. These findings suggest internalizing and externalizing behaviors are negatively related to hope, and that externalizing behaviors bear a more consistent relationship to hope. Other behaviors indicative of subjective health status need to be studied in relation to hope in adolescence. Two studies (Carvajal et al., 1998; Wilson et al., 2005) have examined the relationship between hope and substance use, such as cigarette smoking, alcohol use, and marijuana, yielding six correlations, five of which were statistically significant and in the negative direction. Regression analysis indicated betas ranging from -.13 to -.24. These findings reveal that adolescents who were more hopeful were less likely to use alcohol, smoke cigarettes, or use marijuana. Clearly, given the limited findings, more studies of these important relationships are needed. Positive and negative affect have been studied as theoretical outcomes of hope in five studies (Burrow et al., 2010; Ciarrochi et al., 2007; Edwards et al., 2007; Hexdall & Huebner 2007; Vacek et al., 2010), yielding eight positive correlations (positive affect) and six negative correlations (negative affect). Hope and positive affect, such as joy, were positively and statistically significantly related, with eight correlations ranging from r = .33 to r = .65, in samples of adolescents. Negative affect, such as sadness, was negatively related to hope with six correlations ranging from r = -.09 to r = -.28; four of the six correlations were not statistically significant. The findings suggest that positive affect is a far more powerful outcome of hope than is negative affect in adolescent samples. To strengthen the knowledge base, continued study of the relationship between positive and negative affect and hope should continue.
Discussion The fourth stage of an integrative review is the analysis and interpretation of results. In this stage the findings are summarized across sections and conclusions are drawn (Cooper, 1989). Antecedent concepts precede the concept of interest either theoretically or in time (Chinn & Kramer, 2011). The only two concepts treated as antecedents in this review were the demographic variables of age and gender. Both age and gender have been studied in relationship to hope in a variety of adolescent samples. Age has shown to have equivocal
Adolescent Hope results in relation to adolescent hope, and differences in hope between adolescent boys and girls have demonstrated mixed results. Although age and gender have not shown great promise in the study of adolescent hope, no definitive conclusions can be drawn. Since both variables are routinely measured in empirical studies in order to describe the sample, examination of age and gender with hope should continue in all future studies of hope. Thus, age and gender are included in Figure 1. According to Chinn and Kramer (2011), coincident concepts are those that co-exist in time with the concept of interest. Ten coincident concepts were examined more than once in studies of adolescent hope and most produced meaningful results. Social support, self-esteem, optimism, future time perspective, and self-efficacy all were positively associated with hope in a variety of adolescent samples, healthy or ill. Interestingly, Kim et al. (2004) found very large positive effect sizes in relation to hope in adults for the variables of social support and self-esteem. Religiousness was positively but inconsistently related to hope. Of the negative variables studied in relation to hope in adolescents, hopelessness and depression were inversely related to hope across all studies reviewed. Stress has not demonstrated an appreciable relationship to hope, and anxiety has yielded mixed results in relation to hope (see Figure 1). A conclusion that might be drawn from this integrative review is that hope tends to have a stronger relationship to coincident concepts that have a positive rather than a negative thrust. According to Chinn and Kramer (2011), consequent concepts follow the concept of interest theoretically or in time. Ten consequent concepts have been studied more than once in relation to adolescent hope and most also have produced meaningful results. Life satisfaction, health behaviors (positive health practices/self-care agency/healthpromoting behaviors), well-being, purpose, and academic achievement each have been studied as positive consequences of hope in healthy and ill adolescent samples. Research findings have revealed impressive results with these outcome variables; as indicated above most of the correlations were appreciable and all were in the expected positive direction. Internalizing and externalizing behaviors, substance use, and positive affect also have been studied as outcomes of hope in a variety of adolescent samples. These consequences have demonstrated meaningful relationships to hope, and all are included in Figure 1. Negative affect demonstrated inconsistent results with hope. The conclusion that might be drawn from this integrative review is that hope is a powerful predictor of positive outcomes, such as life satisfaction and well-being. According to Dufault and Martocchio (1985), hope is an indispensable resource throughout life and in relation to the health-illness continuum. An overall conclusion drawn from this integrative review is that hope is central to the lives of adolescents, both healthy and ill, in that most concepts studied in relation to hope yielded significant and meaningful findings (see Table 1).
111
Recommendations for Future Research and Theory Development According to Cooper (1989), the state of knowledge of the phenomenon investigated is evaluated at the fifth stage of an integrative review and future directions for research and theory development are proposed. The state of knowledge regarding antecedent variables is limited to age and gender; more demographic variables such as socioeconomic status, need to be examined in relation to hope. The state of the knowledge is fairly well developed in terms of coincident and consequent concepts studied in relation to adolescent hope. However, more studies are needed to enrich the knowledge base of adolescent hope, starting with qualitative studies that theoretically describe hope across the adolescent span of development. Based on the inclusion-exclusion criteria of this integrative review, twenty-two variables were studied in relation to adolescent hope two or more times in a 20 year period. Most findings were consistent with theoretical predictions and many findings yielded moderate to moderately strong associations with hope and related variables. The findings across studies are ripe for: (a) the development of theoretical formulations that can be tested via structural equation modeling, (b) the development and testing of meditational models that include variables theoretically linked to hope, and (c) the development and testing of theoretical frameworks of hope specific to adolescents that can be used to guide future research. Experiments can be designed using the most powerful coincident variables as interventions for hope emerging from this integrative review. Ultimately, the findings can be used to create hope-engendering strategies to foster hope in adolescents. Given the evolving nature of science, more studies examining theoretically-related variables to adolescent hope are needed. The conceptualization of adolescent hope by te Riele (2010) can be used to guide these studies. We recommend that these studies be done with early, middle, and late adolescents, healthy adolescents, adolescents with various medical diagnoses, adolescents from ethnically diverse backgrounds, and adolescents who are challenged physically and mentally, using research methods that accommodate these different samples of adolescents. The research findings in these studies, along with the present integrative review, can be used for evidence-based practice by healthcare professionals who work with adolescents in all settings. One limitation of this study is related to the exclusion criteria used for this integrative review. In particular, the findings in doctoral dissertations may have shed more light on the antecedent, coincident, and consequences of adolescent hope. Additionally, this integrative review is timelimited, both in terms of the number of years included in the review and in the growth of knowledge that will most likely take place post-publication of the review. These limitations are inherent in all systematic reviews, requiring that they be updated periodically.
112
References * *Adelabu, D. H. (2008). Future time perspective, hope, and ethnic identity among African American adolescents. Urban Education, 43, 347–360. *Barnum, D. D., Snyder, C. R., Rapoff, M. A., Mani, M. M., & Thompson, R. (1998). Hope and social support in the psychological adjustment of children who have survived burn injuries and their matched controls. Children's Health Care, 27, 15–30. Beck, A. T. (1976). Cognitive therapy and the emotional behaviors. New York: The New American Library. *Bronk, K. C., Hill, P. L., Lapsley, D. K., Talib, T. L., & Finch, H. (2009). Purpose, hope, and life satisfaction in three age groups. The Journal of Positive Psychology, 4, 500–510. *Burrow, A. L., O'Dell, A. C., & Hill, P. L. (2010). Profiles of a developmental asset: Youth purpose as a context for hope and wellbeing. Journal of Youth and Adolescence, 39, 1265–1273. *Cantrell, M. A., & Lupinacci, P. (2004). A predictive model of hopefulness for adolescents. Journal of Adolescent Health, 35, 478–485. *Canty-Mitchell, J. (2001). Life change events, hope, and self-care agency in inner-city adolescents. Journal of Child and Adolescent Psychiatric Nursing, 14, 18–31. *Carvajal, S. C., Clair, S. D., Nash, S. G., & Evans, R. I. (1998). Relating optimism, hope, self-esteem to social influences in deterring substance use in adolescents. Journal of Social and Clinical Psychology, 17, 443–465. Chinn, P. L., & Kramer, M. K. (2011). Integrated theory and knowledge development in nursing (8th ed.). St. Louis, MO: Mosby. *Ciarrochi, J., Heaven, P. C. L., & Davies, F. (2007). The impact of hope, self-esteem, and attributional style on adolescents' school grades and emotional well-being: A longitudinal study. Journal of Research in Personality, 41, 1161–1178. *Connelly, C. D. (1998). Hopefulness, self-esteem, and perceived social support among pregnant and non-pregnant adolescents. Western Journal of Nursing Research, 20, 195–209. Cooper, H. M. (1989). Integrating research: A guide for literature reviews (2nd ed.). Newbury Park, CA: Sage. *Day, R. D., & Padilla-Walker, L. M. (2009). Mother and father connectedness and involvement during early adolescence. Journal of Family Psychology, 23, 900–904. Dufault, K., & Martocchio, B. C. (1985). Hope: Its spheres and dimensions. Nursing Clinics of North America, 20, 379–391. *Edwards, L. M., Ong, A. D., & Lopez, S. J. (2007). Hope measurement in Mexican American youth. Hispanic Journal of Behavioral Sciences, 29, 225–241. Erikson, E. H. (1964). Childhood and society (2nd ed.). New York: W.W. Norton. *Gilman, R., Dooley, J., & Florell, D. (2006). Relative levels of hope and their relationship with academic and psychological indicators among adolescents. Journal of Social and Clinical Psychology, 25, 166–178. *Heaven, P. C. L., & Ciarrochi, J. (2007). Personality and religious values among adolescents: A three-wave longitudinal analysis. British Journal of Psychology, 98, 681–694. *Hendricks, C. S. (1998). Perceptual determinants of early adolescents health promoting behaviors: Model development. The Journal of Theory Construction & Testing, 2, 13–22. *Hendricks, C. S., Hoffman, H. P., Robertson-Laxton, L., Tavakoli, A., Mathis, D., & Byrd, L. (2000). Hope as a predictor of health romoting behavior among rural Southern early adolescents. Journal of Multicultural Nursing and Health, 6, 6–11.
∗ References marked with an asterisk indicate studies included in the integrative review.
M. Esteves et al. *Hendricks-Ferguson, V. (2006). Relationships of age and gender to hope and spiritual well-being among adolescents with cancer. Journal of Pediatric Oncology Nursing, 23, 189–199. *Hexdall, C. M., & Huebner, S. E. (2007). Subjective well-being in pediatric oncology patients. Applied Research in Quality of Life, 2, 189–208. Hinds, P. S. (1984). Inducing a definition of ‘hope’ through the use of grounded theory methodology. Journal of Advanced Nursing, 9, 357–362. Hinds, P. S. (1988). The relationship of nurses' caring behaviors with hopefulness and health care outcomes. Archives of Psychiatry Nursing, 2, 21–29. *Hinds, P. S., Quargnenti, A., Fairclough, D., Bush, A. J., Betcher, D., Rissmiller, G., et al. (1999). Hopefulness and its characteristics in adolescents with cancer. Western Journal of Nursing Research, 21, 600–620. *Hinds, P. S., Quargnenti, A. J., Bush, A. J., Pratt, C., Fairclough, D., Rissmiller, G., et al. (2000). An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer. European Journal of Oncology Nursing, 4, 6–17. Kim, D. S., Moon, W. H., Ahn, S. Y., Oh, H. S., Kwan, K. H., Park, M. K., et al. (2004). Meta-analysis of the research findings concerning functional relationships of explanatory variables to hope. [Korean]. Daehan Ganho Haghoeji, 34, 673–684. Kylma, J., Juvakka, T., Nikkonen, M., Korhonen, T., & Isohanni, M. (2006). Hope and schizophrenia: An integrative review. Journal of Psychiatric and Mental Health Nursing, 13, 651–664. Kylma, J., Duggleby, W., Cooper, D., & Molander, G. (2009). Hope in palliative care: An integrative review. Palliative & Supportive Care, 7, 365–377. *Mahat, G., & Scoloveno, M. A. (2001). Factors influencing health practices of Nepalese adolescent girls. Journal of Pediatric Health Care, 15, 251–255. *Mahat, G., Scoloveno, M. A., & Whelan, C. (2002). Positive health practices of urban minority adolescents. The Journal of School Nursing, 18, 163–169. *Mahon, N. E., Yarcheski, A., & Yarcheski, T. J. (2004). Social support and positive health practices in early adolescents: A test of mediating variables. Clinical Nursing Research, 13, 216–236. *Ritchie, M. A. (2001). Self-esteem and hopefulness in adolescents with cancer. Journal of Pediatric Nursing, 16, 35–42. *Roesch, S. C., Duangado, K. M., Vaugh, A. A., Aldridge, A. A., & Villodas, F. (2010). Dispositional hope and the propensity to cope: A daily diary assessment of minority adolescents. Cultural Diversity and Ethnic Minority Psychology, 2, 191–198. *Shoegren, K. A., Lopez, S. J., Wehmeyer, M. L., Little, T. D., & Pressgrove, C. L. (2006). The role of positive psychology constructs in predicting life satisfaction in adolescents with and without cognitive disabilities: An exploratory study. The Journal of Positive Psychology, 1, 37–52. *Simon, K., Barakat, L. P., Patterson, C. A., & Dampier, C. (2009). Symptoms of depression and anxiety in adolescents with sickle cell disease: The role of intrapersonal characteristics and stress producing variables. Child Psychiatry and Human Development, 40, 317–330. *Swanston, H. Y., Nunn, K. P., Oates, R. K., Tebbutt, J. S., & O'Toole, B. I. (1999). Hoping and coping in young people who have been sexually abused. European Child & Adolescent Psychiatry, 8, 134–142. te Riele, K. (2010). Philosophy of hope: concepts and applications for working with marginalized youth. Journal of Youth Studies, 13, 35–46. *Vacek, K. R., Coyle, L. D., & Vera, E. M. (2010). Stress, self-esteem, hope, optimism, And well-being in urban ethnic minority adolescents. Journal of Multicultural Counseling and Development, 38, 99–111. *Valle, M. F., Huebner, E. S., & Suldo, S. M. (2006). An analysis of hope as a psychological strength. Journal of School Psychology, 44, 393–406.
Adolescent Hope *Vaughn, A. A., Roesch, S. C., & Aldridge, A. A. (2009). Stress-related growth in racial-ethnic minority adolescents: Measurement structure and validity. Educational and Psychological Measurement, 69, 131–145. *Venning, A. J., Eliot, J., Kettler, L., & Wilson, A. (2009). Normative data for the Hope Scale using Australian adolescents. Journal of Psychology, 61, 100–106. *Wilson, N., Syme, L., Boyce, W. T., Battistich, V. A., & Selvin, S. (2005). Adolescent alcohol, tobacco, and marijuana use: The influence of neighborhood disorder and hope. American Journal of Health Promotion, 20, 11–19. *Warren, J. S., Jackson, Y., & Sifers, Y. (2009). Social support provisions as differential predictors of adaptive outcomes in
113 young adolescents. Journal of Community Psychology, 37, 106–121. Weisman, A. D. (1972). On dying and denying. New York: Behavioral. *Wong, S. S., & Lim, T. (2009). Hope versus optimism in Singaporean adolescents: contributions to depression and life satisfaction. Personality and Individual Differences, 46, 648–652. *Yarcheski, A., Scoloveno, M. A., & Mahon, N. E. (1994). Social support and well-being in adolescents: The mediating role of hopefulness. Nursing Research, 43, 288–292. *Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (2001). Social support and well-being in early adolescents: The role of mediating variables. Clinical Nursing Research, 10, 163–181.
An Integrative Review of Adolescent Hope Maureen Esteves PhD, RN ⁎, Robert L. Scoloveno MS, RN, Ganga Mahat EdD, RN, Adela Yarcheski PhD, FAAN, Mary Ann Scoloveno EdD, RN Rutgers, The State University of New Jersey, College of Nursing, Newark, NJ
Key words: Integrative review; Hope; Adolescents
The purpose of this integrative review was to synthesize the published research on adolescent hope using Cooper's (Cooper, H. M. (1989). Integrating research: A guide for literature reviews (2nd ed.). Newbury Park, CA: Sage) five stages. Computerized databases were used to search for relevant studies published between the years 1990 to 2010. Thirty-six studies met the inclusion/exclusion criteria. Variables studied in relation to hope were categorized as antecedent, coincident, and consequent concepts. Two antecedent, ten coincident, and ten consequent concepts of hope were included in the review. The number of statistically significant and non-significant correlations of these variables to hope is presented. Conclusions are drawn and recommendations for future studies are offered. © 2013 Elsevier Inc. All rights reserved.
HOPE IS A phenomenon important to all people across the lifespan; thus an understanding of hope is important to nursing (Dufault & Martocchio, 1985). The literature is replete with studies of hope in adolescents, both healthy and ill. Despite the abundance of these available studies, no attempts have been made to integrate the findings into a coherent body of knowledge according to the concepts studied in relation to adolescent hope. Previous systematic reviews of hope have focused on clinical (Kylma, Juvakka, Nikkonen, Korhonen & Isohanni, 2006; Kylma, Duggleby, Cooper, & Molander, 2009) and adult (Kim et al., 2004) populations. However, since adolescent hope may be uniquely different conceptually than adult hope, there is a need to synthesize major concepts studied in relation to adolescent hope. An integrative review of the literature on adolescent hope can yield important information for: (a) identifying gaps in the literature on adolescent hope, (b) providing a knowledge base for evidence-based practice, (c) identifying robust variables that can be used to develop
⁎ Corresponding author: Maureen Esteves, PhD, RN. E-mail address: [email protected] (M. Esteves). 0882-5963/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2012.03.033
experimental and clinical interventions that can foster hope in adolescents, and (d) providing directions for future theory development and research. The purpose of this integrative review was to synthesize the published research on adolescent hope.
Literature Review Theoretical Perspectives on Adolescent Hope Erikson (1964), in his classic work on the epigenetic stages of man, indicated that hope is part of the human developmental process. Dufault and Martocchio (1985) later stated that, “hope is not a single act, but a complex of many thoughts, feelings, and actions that change with time” (p. 380). For these authors, hope is processoriented, multidimensional, and composed of spheres of generalized hope and particularized hope. The temporal dimension of hope suggests that hope has a developmental thrust, manifesting unique characteristics across the lifespan. The concern in this integrative review is on adolescent hope.
106 Based on a synthesis of theoretical works on hope, te Riele (2010) has provided a conceptualization of hope for adolescents, especially marginalized or disadvantaged youth. In order to be a useful concept for adolescents, hope must be conceptualized as robust, attainable, and sound. Robust implies that hope is constructive; attainable implies that hope is necessary to overcome obstacles and involves both wishing and planning; and sound implies that hope is positively connected with human well-being or betterment. te Riele proposed four resources necessary for the philosophy of hope to operate in adolescents: (a) a focus on the possibility, (b) critical reflection of life's opportunities, (c) a community of hope, and (d) a positive culture for hope to thrive.
Previous Systematic Reviews of Hope In this era of evidence-based practice, systematic reviews have taken on heightened importance in nursing. The few systematic reviews reported on hope focused on selected adult populations and provided a background for the present study. In 2006, Kylma et al. provided an integrative review of the current status of research on hope and schizophrenia, using content analysis to examine 17 relevant published articles. Findings indicated that hope is a positive factor in the lives of individuals living with schizophrenia, their significant others, and their healthcare personnel. In addition to identifying factors associated with and contributing to hope in individuals living with schizophrenia, Kylma et al. identified hope-engendering interventions and treatment evaluation with regard to hope for this population. In a later review, Kylma et al. (2009) provided an integrative review of the current status on hope in palliative care, using content analysis to examine 34 relevant published articles on hope. Findings suggested at least two overarching themes of patients' hopes: a) “living with hope,” and b) “hoping for something.” Kylma et al. concluded that hope is important in both living and dying. The purpose of a study by Kim et al. (2004) was to metaanalyze the relationships of major concepts to hope. Very large positive effect sizes were found between hope and spiritual wellbeing, self-esteem, and social support. Negative effect sizes were found between hope and uncertainty in illness, fatigue, and perceived unhealthiness status. Kim et al. concluded that the results can be used as a guide to advance hope theory for nursing. The above studies have contributed to an understanding of hope in selected adult populations. No systematic reviews have focused on adolescent hope, creating a gap in the literature. To broaden the available systematic reviews on hope, this study gathered empirical studies on adolescent hope.
M. Esteves et al.
Method Problem Formulation A decision was made to follow Cooper's (1989) stages for an integrative review. The first stage is formulation of the problem, which was to fill a gap in knowledge on the state of the science on hope in adolescents. In her work with adolescents, Hinds (1984) defined adolescent hopefulness as “the degree to which an adolescent possesses a comforting life-sustaining belief that a personal and positive future exists” (p. 3); Hinds (1988) developed the Hopefulness Scale for Adolescents to measure this theoretical definition. While these definitions by Hinds are useful, for this review, all studies of hope in adolescents in which various conceptual and operational definitions were used were considered and included in the review.
Data Collection The second stage of an integrative review is data collection (Cooper, 1989), which in this case were published studies of adolescent hope. Two methods of data collection were used: (a) computerized databases, and (b) the ancestry approach. Relative to the first method, the following data bases were searched for studies on adolescent hope from 1990-2010: MedLine; CINAHL (Cumulative Index to Nursing and Allied Health Literature); and, PsychInfo (Psychological Information). The twenty year span, from 1990-2010, was considered to be manageable and contemporary. The key words used were: hope, hopefulness, adolescence, and adolescents. Relative to the ancestry approach, all reference lists of the studies reviewed were examined to identify possible missing studies. The inclusion process for studies reported in this paper was as follows: (a) all published quantitative studies on adolescent hope, (b) only studies published in English, (c) studies in which the samples were aged 10-23, and (d) studies in which adolescent samples were healthy or diagnosed with medical problems. Given the vast number of variables studied in relationship to hope, it was decided that only those variables studied at least twice would be included in the analysis. In two instances, similar variables were grouped together as one construct; religiousness was one and health practices were the other. The exclusion process was as follows: (a) dissertations and master's thesis, which are costly to obtain, (b) studies published as chapters and books, which sometimes include previously reported findings, (c) studies in which adolescent samples were mixed with other age groups, and (d) qualitative studies of hope. The computerized database method described above yielded 100 studies, of which 36 met the inclusion-exclusion criteria. No studies were identified using the ancestry approach. The entire research team participated in this aspect of the work. Once the variables studied in relation to hope
Adolescent Hope
107
Table 1 (n = 36)
Summary of findings across adolescent hope studies
Variable
Number of Number of statistically non-statistically significant findings significant findings
Antecedent Variables Age Gender Coincident Variables Social Support Self-Esteem Optimism Future Time Perspective Self-Efficacy Religiousness Stress Hopelessness Depression Anxiety Consequent Variables Life Satisfaction Health Practices Well-being Purpose Academic Achievement Internalizing Behaviors Externalizing Behaviors Substance Use Positive Affect Negative Affect
3 4
5 3
9 12 9 2
0 1 0 0
7 3 1 10 3 1
0 4 8 0 0 1
11 5 2 7 3
0 0 0 1 1
2
1
3
0
5 8 2
1 0 4
Each member of the research team was assigned to studies falling into one or more of these groups to record the relevant information on the coding sheet. The last two authors of this manuscript verified the information on the coding sheets. In terms of theory development and research, Chinn and Kramer (2011) have stated that antecedent variables come before the variable of interest, coincident variables occur at the same time or co-exist with the variable of interest, and consequent variables occur after or follow the variable of interest. Clearly, demographic variables, such as age and gender always serve as antecedent variables and were treated as such in this analysis. Designation of variables as coincident or consequent was based primarily on how the variables were investigated in relation to hope in the studies reviewed and secondarily on the description proffered by Chinn and Kramer. Most of the studies reviewed were correlational (N = 25); the others were comparative (N = 5), longitudinal (N = 4), quasi-experimental (N = 1) or methodological (N = 1).
Results Given the wealth of information derived from this analysis, the findings across the studies of adolescent hope are summarized for each variable in Table 1. The results indicate the number of statistically significant and nonstatistically significant findings for each variable clearly identifying important variables related to hope emerging from this analysis. Table 1 helped to create the model of adolescent hope (see Figure 1).
Antecedent Variables and Hope more than once were identified, a database search was done combining the variable selected with hope. The last two authors of this manuscript rechecked the databases to ensure that all relevant studies were retrieved.
Data Analysis Prior to the review a code book was constructed to record pertinent information about each study, such as age range and composition of the sample, health status of the sample, variables studied in relation to hope, and statistical findings. Then, a list was made of the variables examined in relation to hope for studies meeting the inclusion criteria, with a count of the number of times the variable was examined. The third stage in integrative reviews is evaluation whereby a decision is made on how to categorize the studies used in the review (Cooper, 1989). Valle, Huebner and Suldo (2006) recommended that studies of the antecedents of hope are needed. Thus, variables studied in relation to hope two or more times were grouped into categories of antecedent, coincident, and consequent relationships based on the conceptualization of the study (Chinn & Kramer, 2011).
In a number of studies, age has been studied mostly on a posteriori basis in relation to hope (Connelly, 1998; Day & Padilla-Walker, 2009; Hendricks-Ferguson, 2006; Hinds et al., 2000; Ritchie, 2001; Venning, Eliot, Kettler & Wilson, 2009; Warren, Jackson, & Sifers, 2009). The relationship between age and hope was not statistically significant in three studies of healthy adolescents (Connelly, 1998; Day & Padilla-Walker, 2009; Warren et al., 2009) and in two studies of adolescents with cancer (Hendricks-Ferguson, 2006; Ritchie, 2001); the directions of the relationship between age and hope were mixed or not reported. However, Venning et al. (2009) found a positive relationship whereby hope increased with age in healthy adolescents. In a control group of adolescents with cancer, Hinds et al. (2000) reported that age was positively associated with hope on two separate occasions. These findings suggest that age is not appreciably related to hope in three of four samples of healthy adolescents, and that the relationship is equivocal in adolescents diagnosed with cancer. Further, these findings leave open to question whether age, as a proxy of development, bears a meaningful relationship to hope.
108
M. Esteves et al. Consequences
Antecedents
H o p e
Agea Gender b
Coincident + Social Support + Self esteem + Optimism + Future Time Perspective + Self Efficacy + Religiousness - Stress - Hopelessness - Depression - Anxiety
+ Life Satisfaction + Health Practices + Well- being + Purpose + Academic Achievement - Internalizing Behaviors - Externalizing Behaviors - Substance Use + Positive Affect - Negative Affect
Note: (+) = Positive Relationship to HOPE (-) = Negative Relationship to HOPE (a)
directions were mixed or not reported
(b)
direction of differences between boys and girls varied
Figure 1
Model of adolescent hope relationships.
More studies are needed to fill this gap in knowledge for all adolescents. In a number of studies, differences in hope have been examined between adolescent girls and boys. In two studies of healthy adolescents no differences in hope were found between girls and boys (Day & Padilla-Walker, 2009; Vacek et al., 2010). However, Hendricks et al. (2000) found that girls had higher levels of hope than boys, whereas Venning et al. (2009) found that boys had more hope than girls. Mixed results were also reported in samples of adolescents diagnosed with cancer. Ritchie (2001) found no gender differences in hope, Hendricks-Ferguson (2006) reported that girls expressed more hope than boys, while Hinds et al. (1999) reported that girls identified more hope than boys. These findings reveal that, while there may be gender differences in hope in healthy or ill adolescent samples, the results are mixed. More studies are needed to clarify whether boys or girls are more hopeful during adolescence.
Coincident Variables and Hope Social support, or the availability of a socially supportive network, has been linked to hope (Dufault & Martocchio, 1985). Researchers have examined social support in relation to hope in adolescent samples who were considered healthy in nine studies, yielding nine positive correlations (Barnum,
Snyder, Rapoff, Mani & Thompson, 1998; Edwards, Ong, & Lopez, 2007; Heaven & Ciarrochi, 2007; Mahat & Scoloveno, 2001; Mahat, Scoloveno & Whelan, 2002; Mahon, Yarcheski & Yarcheski, 2004; Vacek et al., 2010; Yarcheski, Scoloveno, & Mahon, 1994; Yarcheski, Mahon, & Yarcheski, 2001). In these studies, sample size ranged from 20 to 776. Research findings indicated that the correlations in these studies ranged from r = .19 to r = .63, all of which were positive and statistically significant. These findings indicate that social support is a robust variable in relation to hope in adolescent samples. It would of interest to know if the relationship is as robust when early, middle, and late adolescents are studied separately. Weisman (1972) suggested that hope emerges from a healthy self-esteem. The relationship between hope and selfesteem has been investigated in eleven studies, yielding 13 correlations ranging from r = .19 to r = .64; except for one correlation in a sample of healthy adolescents (r = .19; Mahat & Scoloveno, 2001), all were positive and statistically significant (Barnum et al., 1998; Cantrell & Lupinacci, 2004; Carvajal, Clair, Nash, & Evans, 1998; Ciarrochi, Heaven, & Davies, 2007; Heaven & Ciarrochi, 2007; Hendricks, 1998; Ritchie, 2001; Simon, Barakat, Patterson, & Dampier, 2009; Swanston, Nunn, Oates, Tebbutt, & O'Toole, 1999; Vacek et al., 2010). Sample size ranged from 29 to 1026. With the exception of samples of adolescents with cancer (Cantrell &
Adolescent Hope Lupinacci, 2004; Ritchie, 2001) substance abuse (Carvajal et al., 1998), or those sexually abused (Swanston et al., 1999), all of the other samples of adolescents were deemed healthy. These findings reveal that self-esteem is an important variable related to hope in adolescent samples, healthy and ill. More studies of this relationship are needed in acutely and chronically ill adolescents. The theoretical underpinnings of the constructs of optimism and hope have been linked by researchers (Shoegren, Lopez, Wehmeyer, Little & Pressgrove, 2006). Researchers have examined optimism in relation to hope in adolescent samples in five studies (Carvajal et al., 1998; Edwards et al., 2007; Shoegren et al., 2006; Vacek et al., 2010; Wong & Lim, 2009) yielding nine correlations, all of which were positive and statistically significant. The magnitude of the correlations ranged from r =. 27 to r = .57; sample size ranged from 135 to 1643. With the exception of adolescents with cognitive disabilities in the Shoegren et al. (2006) study, or those with substance abuse (Carvajal et al., 1998), all the other adolescent samples were deemed to be healthy. These findings indicate that optimism is another robust variable studied in relation to hope in adolescent samples, but studies are needed in adolescents with serious medical diagnoses. In one study yielding two correlations, hope was correlated positively with future time perspective in a sample of 661 healthy adolescents (Adelabu, 2008). Both correlations, ranging from r = .27 to r = .39, were statistically significant suggesting that future time perspective, an important adolescent variable, has a modest relationship to hope; more studies of this relationship are needed. Using samples of adolescents diagnosed with cancer, Hinds et al. (2000) correlated self-efficacy with hope in both the experimental and control groups, yielding seven correlations. Correlations ranged from r = .40 to r = .75, all of which were positive and statistically significant. In this longitudinal study, the experimental group consisted of 40 adolescent boys and girls and the control group consisted of 38 counterparts. Thus, the relationship between self-efficacy and hope has been replicated over time in adolescents diagnosed with cancer. Hendricks (1998), in a sample of 1036 healthy 7th and 8th graders, reported a statistically significant positive correlation between self-efficacy and hope (r = .22). The findings of these two studies indicated that self-efficacy has a weak relationship to hope in healthy adolescents and a moderately strong to strong relationship to hope in adolescents diagnosed with cancer; more studies are needed. An underlying assumption of three empirical studies was that religiousness (e.g. religious values, religious coping, or religious growth) was associated with increased hope (Heaven & Ciarrochi, 2007; Roesch et al., 2010; Vaughn, Roesch, & Aldridge, 2009). These studies produced a total of seven positive correlations, ranging from r =.10 to r = .31, three of which were statistically significant. Sample size ranged from 126 to 776. These findings suggest that the positive direction of the relationship between religiousness and hope is consistent with predictions in healthy adolescents, but more often than not
109 the relationship is not appreciable. Future studies are needed to clarify this relationship using the same measure of religiousness across studies. A number of negative emotions have been studied in relation to hope. Stressful life events and/or perceived stress have been studied in six studies, yielding nine negative associations, eight of which were not statistically significant (Canty-Mitchell, 2001; Roesch et al., 2010; Swanston et al., 1999; Vacek et al., 2010; Warren et al., 2009) and one of which was weak (r = -.10) and statistically significant ( Valle et al., 2006). Correlations ranged from r = -.01 to r = -.15, and sample size ranged from 51 to 699. Despite theory suggesting that hope is a respite from stress (Dufault & Martocchio, 1985), these research findings did not empirically support the theory. It may be more fruitful to study stress in relation to hope in early, middle, and late adolescents separately using developmental theory as a basis for study. Using adolescents diagnosed with cancer, Hinds et al. (1999) and Hinds et al. (2000) examined the relationship between hopelessness and hope over time, yielding ten correlations. Correlations ranged from r = -.31 to r = -.50, all of which were negative and statistically significant. Sample size ranged from 38 to 78. The findings suggest that hopelessness and hope, considered two independent constructs, were consistently and inversely related in adolescent samples. It would be interesting to know if studies of healthy adolescents would yield similar findings. Depression was examined in relation to hope in three studies yielding three correlations (Simon et al., 2009; Swanston et al., 1999; Wong & Lim, 2009). Correlations ranged from r = -.60 to r = -.61, all of which were fairly strong, negative and statistically significant. Sample size ranged from 44 to 344; except for the abused adolescents in the Swanston et al. (1999) study, the other adolescent samples were deemed to be healthy. The findings reveal that depression holds promise as an important variable to study in relation to hope; more studies are needed. Beck (1976) has suggested that when hope is lost, anxiety emerges. Anxiety was examined in relation to hope in two studies, yielding two inverse correlations. In the Simon et al. (2009) study, the correlation was r = -.16 and not statistically significant, in a sample of 44 adolescents. In the Swanston et al. (1999) study, the correlation was r = -.42, p b .002, in a sample of 51 adolescents. These findings suggest that the negative direction of the relationship between anxiety and hope is consistent with theory, but that the relationship does not consistently achieve statistical significance. More studies are needed to clarify this relationship using larger samples.
Consequent Variables and Hope Life satisfaction was investigated in eight studies, yielding eleven positive and statistically significant correlations (Bronk, Hill, Lapsley, Talib and Finch, 2009; Edwards et al., 2007; Gilman, Dooley, & Florell, 2006; Hexdall & Huebner, 2007; Shoegren et al., 2006; Vacek et al., 2010;
110 Valle et al., 2006; Wong & Lim, 2009) and one nonsignificant correlation in a comparison sample of healthy adolescents (Hexdall & Huebner, 2007). Correlations ranged from r = .13 (ns) to r = .71, and sample size ranged from 29 to 860. Most of the samples consisted of healthy adolescents, with the exception of those diagnosed with cognitive disabilities (Shoegren et al., 2006) and a sample of adolescents diagnosed with cancer (Hexdall & Huebner, 2007). Based on the research findings across studies, life satisfaction is a meaningful consequence of hope in adolescents. More studies of this relationship are needed, especially in chronically ill adolescents. Consistent with theory (Dufault & Martocchio, 1985), health practices (positive health practices, self-care agency, or health-promoting behaviors) have been studied as behavioral outcomes of hope in five (5) studies, yielding five correlations, all of which were positive and statistically significant (Canty-Mitchell, 2001; Hendricks, 1998; Mahat & Scoloveno, 2001; Mahat et al., 2002; Mahon et al., 2004). Sample size ranged from 65 to 1036. In these samples of adolescents deemed as healthy, correlations ranged from r = .17 to r = .54. These findings suggest that hope predicts health practices in adolescents. Because health promotion is at the core of professional nursing, studies of the relationship between hope and health practices should continue. Well-being has been linked theoretically to hope as an outcome (Dufault & Martocchio, 1985), and has been examined in relation to hope in two (2) studies. Statistically significant and positive correlations were found in a sample of 99 adolescents (r = .60; Yarcheski et al., 1994) and in a sample of 142 adolescents (r = .68; Yarcheski et al., 2001). These findings suggest that a sense of well-being and hope bear a strong relationship to one another, but more studies would strengthen this assertion. Two studies (Bronk et al., 2009; Burrow et al., 2010) have examined the relationship between hope and purpose in healthy adolescents, yielding eight positive correlations, seven of which were statistically significant. Purpose was studied as purpose identified, purpose searching, purpose commitment, and purpose exploration, and was linked to hope theoretically by Bronk et al. (2009). Correlations ranged from r = .10 (ns) to r = .51; and, sample size ranged from 153 to 318. These findings reveal that hope bears a weak to moderate relationship to purpose in life in adolescents; more studies are needed of this relationship in all adolescents, especially those characterized as a vulnerable population. Academic achievement (GPA) has been examined in relation to hope in two studies (Adelabu, 2008; Gilman et al., 2006), yielding four correlations, all of which were positive and three of which were statistically significant. The correlations ranged from r = .08 (ns) to r = .42, and sample size ranged from 341 to 661. These findings indicate that hope is a fairly good predictor of academic achievement in healthy adolescents; clearly more studies are needed. Two studies have examined internalizing behaviors, such as somatic complaints, and externalizing behaviors, such as
M. Esteves et al. aggressiveness, in relation to hope in adolescents (Barnum et al., 1998; Valle et al., 2006). Regression analysis indicated that hope contributed significantly to externalizing behaviors, but not to internalizing behaviors in the Barnum et al. (1998) study with a sample of 29 adolescents. In the Valle et al. (2006) study, based on extant hope theory, hope was inversely and statistically significantly related to externalizing behaviors at two points in time, r = -.35 and r = -.26, and to internalizing behaviors at two points in time, r = -.31 and r = -.28. Time 1 had a sample of 860 adolescents and Time 2 had a sample of 699 adolescents. These findings suggest internalizing and externalizing behaviors are negatively related to hope, and that externalizing behaviors bear a more consistent relationship to hope. Other behaviors indicative of subjective health status need to be studied in relation to hope in adolescence. Two studies (Carvajal et al., 1998; Wilson et al., 2005) have examined the relationship between hope and substance use, such as cigarette smoking, alcohol use, and marijuana, yielding six correlations, five of which were statistically significant and in the negative direction. Regression analysis indicated betas ranging from -.13 to -.24. These findings reveal that adolescents who were more hopeful were less likely to use alcohol, smoke cigarettes, or use marijuana. Clearly, given the limited findings, more studies of these important relationships are needed. Positive and negative affect have been studied as theoretical outcomes of hope in five studies (Burrow et al., 2010; Ciarrochi et al., 2007; Edwards et al., 2007; Hexdall & Huebner 2007; Vacek et al., 2010), yielding eight positive correlations (positive affect) and six negative correlations (negative affect). Hope and positive affect, such as joy, were positively and statistically significantly related, with eight correlations ranging from r = .33 to r = .65, in samples of adolescents. Negative affect, such as sadness, was negatively related to hope with six correlations ranging from r = -.09 to r = -.28; four of the six correlations were not statistically significant. The findings suggest that positive affect is a far more powerful outcome of hope than is negative affect in adolescent samples. To strengthen the knowledge base, continued study of the relationship between positive and negative affect and hope should continue.
Discussion The fourth stage of an integrative review is the analysis and interpretation of results. In this stage the findings are summarized across sections and conclusions are drawn (Cooper, 1989). Antecedent concepts precede the concept of interest either theoretically or in time (Chinn & Kramer, 2011). The only two concepts treated as antecedents in this review were the demographic variables of age and gender. Both age and gender have been studied in relationship to hope in a variety of adolescent samples. Age has shown to have equivocal
Adolescent Hope results in relation to adolescent hope, and differences in hope between adolescent boys and girls have demonstrated mixed results. Although age and gender have not shown great promise in the study of adolescent hope, no definitive conclusions can be drawn. Since both variables are routinely measured in empirical studies in order to describe the sample, examination of age and gender with hope should continue in all future studies of hope. Thus, age and gender are included in Figure 1. According to Chinn and Kramer (2011), coincident concepts are those that co-exist in time with the concept of interest. Ten coincident concepts were examined more than once in studies of adolescent hope and most produced meaningful results. Social support, self-esteem, optimism, future time perspective, and self-efficacy all were positively associated with hope in a variety of adolescent samples, healthy or ill. Interestingly, Kim et al. (2004) found very large positive effect sizes in relation to hope in adults for the variables of social support and self-esteem. Religiousness was positively but inconsistently related to hope. Of the negative variables studied in relation to hope in adolescents, hopelessness and depression were inversely related to hope across all studies reviewed. Stress has not demonstrated an appreciable relationship to hope, and anxiety has yielded mixed results in relation to hope (see Figure 1). A conclusion that might be drawn from this integrative review is that hope tends to have a stronger relationship to coincident concepts that have a positive rather than a negative thrust. According to Chinn and Kramer (2011), consequent concepts follow the concept of interest theoretically or in time. Ten consequent concepts have been studied more than once in relation to adolescent hope and most also have produced meaningful results. Life satisfaction, health behaviors (positive health practices/self-care agency/healthpromoting behaviors), well-being, purpose, and academic achievement each have been studied as positive consequences of hope in healthy and ill adolescent samples. Research findings have revealed impressive results with these outcome variables; as indicated above most of the correlations were appreciable and all were in the expected positive direction. Internalizing and externalizing behaviors, substance use, and positive affect also have been studied as outcomes of hope in a variety of adolescent samples. These consequences have demonstrated meaningful relationships to hope, and all are included in Figure 1. Negative affect demonstrated inconsistent results with hope. The conclusion that might be drawn from this integrative review is that hope is a powerful predictor of positive outcomes, such as life satisfaction and well-being. According to Dufault and Martocchio (1985), hope is an indispensable resource throughout life and in relation to the health-illness continuum. An overall conclusion drawn from this integrative review is that hope is central to the lives of adolescents, both healthy and ill, in that most concepts studied in relation to hope yielded significant and meaningful findings (see Table 1).
111
Recommendations for Future Research and Theory Development According to Cooper (1989), the state of knowledge of the phenomenon investigated is evaluated at the fifth stage of an integrative review and future directions for research and theory development are proposed. The state of knowledge regarding antecedent variables is limited to age and gender; more demographic variables such as socioeconomic status, need to be examined in relation to hope. The state of the knowledge is fairly well developed in terms of coincident and consequent concepts studied in relation to adolescent hope. However, more studies are needed to enrich the knowledge base of adolescent hope, starting with qualitative studies that theoretically describe hope across the adolescent span of development. Based on the inclusion-exclusion criteria of this integrative review, twenty-two variables were studied in relation to adolescent hope two or more times in a 20 year period. Most findings were consistent with theoretical predictions and many findings yielded moderate to moderately strong associations with hope and related variables. The findings across studies are ripe for: (a) the development of theoretical formulations that can be tested via structural equation modeling, (b) the development and testing of meditational models that include variables theoretically linked to hope, and (c) the development and testing of theoretical frameworks of hope specific to adolescents that can be used to guide future research. Experiments can be designed using the most powerful coincident variables as interventions for hope emerging from this integrative review. Ultimately, the findings can be used to create hope-engendering strategies to foster hope in adolescents. Given the evolving nature of science, more studies examining theoretically-related variables to adolescent hope are needed. The conceptualization of adolescent hope by te Riele (2010) can be used to guide these studies. We recommend that these studies be done with early, middle, and late adolescents, healthy adolescents, adolescents with various medical diagnoses, adolescents from ethnically diverse backgrounds, and adolescents who are challenged physically and mentally, using research methods that accommodate these different samples of adolescents. The research findings in these studies, along with the present integrative review, can be used for evidence-based practice by healthcare professionals who work with adolescents in all settings. One limitation of this study is related to the exclusion criteria used for this integrative review. In particular, the findings in doctoral dissertations may have shed more light on the antecedent, coincident, and consequences of adolescent hope. Additionally, this integrative review is timelimited, both in terms of the number of years included in the review and in the growth of knowledge that will most likely take place post-publication of the review. These limitations are inherent in all systematic reviews, requiring that they be updated periodically.
112
References * *Adelabu, D. H. (2008). Future time perspective, hope, and ethnic identity among African American adolescents. Urban Education, 43, 347–360. *Barnum, D. D., Snyder, C. R., Rapoff, M. A., Mani, M. M., & Thompson, R. (1998). Hope and social support in the psychological adjustment of children who have survived burn injuries and their matched controls. Children's Health Care, 27, 15–30. Beck, A. T. (1976). Cognitive therapy and the emotional behaviors. New York: The New American Library. *Bronk, K. C., Hill, P. L., Lapsley, D. K., Talib, T. L., & Finch, H. (2009). Purpose, hope, and life satisfaction in three age groups. The Journal of Positive Psychology, 4, 500–510. *Burrow, A. L., O'Dell, A. C., & Hill, P. L. (2010). Profiles of a developmental asset: Youth purpose as a context for hope and wellbeing. Journal of Youth and Adolescence, 39, 1265–1273. *Cantrell, M. A., & Lupinacci, P. (2004). A predictive model of hopefulness for adolescents. Journal of Adolescent Health, 35, 478–485. *Canty-Mitchell, J. (2001). Life change events, hope, and self-care agency in inner-city adolescents. Journal of Child and Adolescent Psychiatric Nursing, 14, 18–31. *Carvajal, S. C., Clair, S. D., Nash, S. G., & Evans, R. I. (1998). Relating optimism, hope, self-esteem to social influences in deterring substance use in adolescents. Journal of Social and Clinical Psychology, 17, 443–465. Chinn, P. L., & Kramer, M. K. (2011). Integrated theory and knowledge development in nursing (8th ed.). St. Louis, MO: Mosby. *Ciarrochi, J., Heaven, P. C. L., & Davies, F. (2007). The impact of hope, self-esteem, and attributional style on adolescents' school grades and emotional well-being: A longitudinal study. Journal of Research in Personality, 41, 1161–1178. *Connelly, C. D. (1998). Hopefulness, self-esteem, and perceived social support among pregnant and non-pregnant adolescents. Western Journal of Nursing Research, 20, 195–209. Cooper, H. M. (1989). Integrating research: A guide for literature reviews (2nd ed.). Newbury Park, CA: Sage. *Day, R. D., & Padilla-Walker, L. M. (2009). Mother and father connectedness and involvement during early adolescence. Journal of Family Psychology, 23, 900–904. Dufault, K., & Martocchio, B. C. (1985). Hope: Its spheres and dimensions. Nursing Clinics of North America, 20, 379–391. *Edwards, L. M., Ong, A. D., & Lopez, S. J. (2007). Hope measurement in Mexican American youth. Hispanic Journal of Behavioral Sciences, 29, 225–241. Erikson, E. H. (1964). Childhood and society (2nd ed.). New York: W.W. Norton. *Gilman, R., Dooley, J., & Florell, D. (2006). Relative levels of hope and their relationship with academic and psychological indicators among adolescents. Journal of Social and Clinical Psychology, 25, 166–178. *Heaven, P. C. L., & Ciarrochi, J. (2007). Personality and religious values among adolescents: A three-wave longitudinal analysis. British Journal of Psychology, 98, 681–694. *Hendricks, C. S. (1998). Perceptual determinants of early adolescents health promoting behaviors: Model development. The Journal of Theory Construction & Testing, 2, 13–22. *Hendricks, C. S., Hoffman, H. P., Robertson-Laxton, L., Tavakoli, A., Mathis, D., & Byrd, L. (2000). Hope as a predictor of health romoting behavior among rural Southern early adolescents. Journal of Multicultural Nursing and Health, 6, 6–11.
∗ References marked with an asterisk indicate studies included in the integrative review.
M. Esteves et al. *Hendricks-Ferguson, V. (2006). Relationships of age and gender to hope and spiritual well-being among adolescents with cancer. Journal of Pediatric Oncology Nursing, 23, 189–199. *Hexdall, C. M., & Huebner, S. E. (2007). Subjective well-being in pediatric oncology patients. Applied Research in Quality of Life, 2, 189–208. Hinds, P. S. (1984). Inducing a definition of ‘hope’ through the use of grounded theory methodology. Journal of Advanced Nursing, 9, 357–362. Hinds, P. S. (1988). The relationship of nurses' caring behaviors with hopefulness and health care outcomes. Archives of Psychiatry Nursing, 2, 21–29. *Hinds, P. S., Quargnenti, A., Fairclough, D., Bush, A. J., Betcher, D., Rissmiller, G., et al. (1999). Hopefulness and its characteristics in adolescents with cancer. Western Journal of Nursing Research, 21, 600–620. *Hinds, P. S., Quargnenti, A. J., Bush, A. J., Pratt, C., Fairclough, D., Rissmiller, G., et al. (2000). An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer. European Journal of Oncology Nursing, 4, 6–17. Kim, D. S., Moon, W. H., Ahn, S. Y., Oh, H. S., Kwan, K. H., Park, M. K., et al. (2004). Meta-analysis of the research findings concerning functional relationships of explanatory variables to hope. [Korean]. Daehan Ganho Haghoeji, 34, 673–684. Kylma, J., Juvakka, T., Nikkonen, M., Korhonen, T., & Isohanni, M. (2006). Hope and schizophrenia: An integrative review. Journal of Psychiatric and Mental Health Nursing, 13, 651–664. Kylma, J., Duggleby, W., Cooper, D., & Molander, G. (2009). Hope in palliative care: An integrative review. Palliative & Supportive Care, 7, 365–377. *Mahat, G., & Scoloveno, M. A. (2001). Factors influencing health practices of Nepalese adolescent girls. Journal of Pediatric Health Care, 15, 251–255. *Mahat, G., Scoloveno, M. A., & Whelan, C. (2002). Positive health practices of urban minority adolescents. The Journal of School Nursing, 18, 163–169. *Mahon, N. E., Yarcheski, A., & Yarcheski, T. J. (2004). Social support and positive health practices in early adolescents: A test of mediating variables. Clinical Nursing Research, 13, 216–236. *Ritchie, M. A. (2001). Self-esteem and hopefulness in adolescents with cancer. Journal of Pediatric Nursing, 16, 35–42. *Roesch, S. C., Duangado, K. M., Vaugh, A. A., Aldridge, A. A., & Villodas, F. (2010). Dispositional hope and the propensity to cope: A daily diary assessment of minority adolescents. Cultural Diversity and Ethnic Minority Psychology, 2, 191–198. *Shoegren, K. A., Lopez, S. J., Wehmeyer, M. L., Little, T. D., & Pressgrove, C. L. (2006). The role of positive psychology constructs in predicting life satisfaction in adolescents with and without cognitive disabilities: An exploratory study. The Journal of Positive Psychology, 1, 37–52. *Simon, K., Barakat, L. P., Patterson, C. A., & Dampier, C. (2009). Symptoms of depression and anxiety in adolescents with sickle cell disease: The role of intrapersonal characteristics and stress producing variables. Child Psychiatry and Human Development, 40, 317–330. *Swanston, H. Y., Nunn, K. P., Oates, R. K., Tebbutt, J. S., & O'Toole, B. I. (1999). Hoping and coping in young people who have been sexually abused. European Child & Adolescent Psychiatry, 8, 134–142. te Riele, K. (2010). Philosophy of hope: concepts and applications for working with marginalized youth. Journal of Youth Studies, 13, 35–46. *Vacek, K. R., Coyle, L. D., & Vera, E. M. (2010). Stress, self-esteem, hope, optimism, And well-being in urban ethnic minority adolescents. Journal of Multicultural Counseling and Development, 38, 99–111. *Valle, M. F., Huebner, E. S., & Suldo, S. M. (2006). An analysis of hope as a psychological strength. Journal of School Psychology, 44, 393–406.
Adolescent Hope *Vaughn, A. A., Roesch, S. C., & Aldridge, A. A. (2009). Stress-related growth in racial-ethnic minority adolescents: Measurement structure and validity. Educational and Psychological Measurement, 69, 131–145. *Venning, A. J., Eliot, J., Kettler, L., & Wilson, A. (2009). Normative data for the Hope Scale using Australian adolescents. Journal of Psychology, 61, 100–106. *Wilson, N., Syme, L., Boyce, W. T., Battistich, V. A., & Selvin, S. (2005). Adolescent alcohol, tobacco, and marijuana use: The influence of neighborhood disorder and hope. American Journal of Health Promotion, 20, 11–19. *Warren, J. S., Jackson, Y., & Sifers, Y. (2009). Social support provisions as differential predictors of adaptive outcomes in
113 young adolescents. Journal of Community Psychology, 37, 106–121. Weisman, A. D. (1972). On dying and denying. New York: Behavioral. *Wong, S. S., & Lim, T. (2009). Hope versus optimism in Singaporean adolescents: contributions to depression and life satisfaction. Personality and Individual Differences, 46, 648–652. *Yarcheski, A., Scoloveno, M. A., & Mahon, N. E. (1994). Social support and well-being in adolescents: The mediating role of hopefulness. Nursing Research, 43, 288–292. *Yarcheski, A., Mahon, N. E., & Yarcheski, T. J. (2001). Social support and well-being in early adolescents: The role of mediating variables. Clinical Nursing Research, 10, 163–181.