Exploring the intervention effect moderators of a cardiovascular health promotion study among rural African-Americans (original) (raw)
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Ethnicity & disease, 2008
To determine the relationship of demographics to opinions and knowledge of cardiovascular disease, hypertension, obesity, and dietary intake and to evaluate the relationship of dietary knowledge and dietary behaviors in rural African American adults. The cross-sectional study involved a sample of participants who attended one of three cardiovascular information seminars in rural Macon County, Alabama. A total of 127 African American men and women, aged 21-75 years, completed a self-administered 79-item questionnaire. Data analysis included Chi-square and Fisher's exact tests. Agreement or disagreement with current scientific opinion regarding coronary heart disease, obesity, and dietary intake; agreement with statements of personal knowledge of heart disease, hypertension, and dietary intake; assessment and beliefs about the health risks associated with overweight/ obesity; and congruence between dietary knowledge and dietary practices. Women and older respondents tended to agre...
Preventive Medicine, 2014
Objective-We examined the efficacy of a community-based, culturally relevant intervention to promote healthy eating and physical activity among African American (AA) women between the ages of 45-65 years, residing in rural Alabama. Methods-We conducted a group randomized controlled trial with counties as the unit of randomization that evaluated two interventions based on health priorities identified by the community: (1) promotion of healthy eating and physical activity; and (2) promotion of breast and cervical cancer screening. A total of 6 counties with 565 participants were enrolled in the study between November 2009 and October 2011. Results-The overall retention rate at 24-month follow-up was 54.7%. Higher retention rate was observed in the "healthy lifestyle" arm (63.1%) as compared to the "screening" arm (45.3%). Participants in the "healthy lifestyle" arm showed significant positive changes compared to the "screening" arm at 12-month follow-up with regard to decrease in fried food consumption and an increase in both fruit/vegetable intake and physical activity. At 24-month follow-up, these positive changes were maintained with healthy eating behaviors, but not engagement in physical activity. Conclusions-A culturally relevant intervention, developed in collaboration with the target audience, can improve (and maintain) healthy eating among AA women living in rural areas.
American Journal of Public Health, 2011
African American women are at increased risk for morbidity and mortality from cardiovascular disease (CVD) compared with White women 1 because of their higher prevalence of CVD risk factors and lower socioeconomic status. 1---3 Interventions embedded in primary care settings, such as locally based, patient-driven community health care centers, have the unique potential to address these health disparities because they provide a large proportion of comprehensive health care services to medically underserved, vulnerable populations, regardless of ability to pay. About 66% of these centers' patients are members of minority groups, 90% have incomes below 200% of the federal poverty line, and 39% lack health insurance. 4,5 The delivery of health behavior change interventions through these centers holds additional promise because providers are trusted sources of health information 6 and can reach underserved populations that are more likely than the general population to suffer from CVD risk factors. Despite this great potential, interventions have not been widely tested in this setting.
2007
African Americans, particularly those who reside in rural areas, are at increased risk of developing several preventable health conditions, including type 2 diabetes, cardiovascular disease, and overweight/obesity. Because of several professional and personal experiences, I was inspired to use this thesis as an opportunity to propose an intervention that addresses these preventable health conditions. The proposed intervention, Project HEAL (Healthy Eating and Activity for Life), is a faith-based, theory driven education and comprehensive lifestyle management intervention for rural African Americans. This program is of public health importance because it may be particularly useful in positively impacting the health of rural African Americans, a traditionally hard-to-reach population, and in significantly reducing racial/ethnic and geographic health disparities.Project HEAL is informed by the Social Cognitive Theory and Health Belief Model. These theories were chosen because of their ...
The Variables Associated With Health Promotion Behaviors Among Urban Black Women
Purpose: To improve understanding of variables impacting health promotion behaviors among urban Black women. Methods: A cross-sectional survey was used. Urban Black women (N = 132) between the ages of 30 to 64 years participated. Setting: The study was conducted in a U.S. metropolitan region in 2015. Measures: Health literacy (Newest Vital Sign [NVS]), self-efficacy (New General Self-Efficacy Scale [NGSE]), and readiness for change (Health Risk Instrument [HRI]) were correlated with health promotion behaviors (Health Promotion Lifestyle Profile II [HPLPII]). Analysis: Univariate statistics addressed demographic characteristics; bivariate/simultaneous linear regression determined the relationships between the NVS, NGSE, and HRI to health promotion behaviors (HPLPII). Results: Demographics: 72.6% completed high school and 25% completed college, and the mean body mass index (BMI) was >32. Positive correlations existed between each variable to health promotion behaviors: NVS (r = .244, p < .002), NGSE (r = .312, p < .001), HRI (r = .440, p < .001), and accounted for 29.8% of variances in health promotion behaviors. Education and health literacy were also correlated (r s = .414, p = .001). Conclusions: Although health literacy, self-efficacy, and readiness for change are associated with health promotion behaviors, readiness for change was the most highly correlated. Clinical Relevance: The development and incorporation of interventions to promote health promotion behaviors should include readiness for change, health literacy, BMI, and education, especially among urban Black women in order to reduce critical health disparities. Community-based and culturally relevant strategies in promoting health that are integrated into existing lifestyles and designed to impact readiness for change will have the greatest impact on reducing health disparities both in the United States and in countries experiencing rapid urbanization. For example, healthy eating behaviors or increased physical activity may be best adopted when integrated into existing community-based spiritual or cultural events via trusted community leaders. Replication of this study in other populations of Black women will improve the generalizability of this study, both in the United States and globally. However , the addition of other demographic variables, such as a history of chronic conditions, military service, domestic or other violence, spirituality, and the availability of community resources, would strengthen the results in future studies.
Factors Affecting Health Promotion Behaviors Among Urban Black Women
45th Biennial Convention (16-20 November 2019), 2019
Purpose. This study sought to improve what is known in regard to understanding the association of variables impacting health promotion behaviors among urban Black women. This replication study sought to validate the association between health literacy, self-efficacy and readiness for change in a unique population of urban Black women in one Northeastern US metropolitan region. Researchers sought to expand upon results in original study conducted by this researcher, and integrate additional factors that relate to one's ability to protect health status, including an assessment of spirituality, a history of domestic violence, and prior service in the military. Methods. This descriptive study used a cross-sectional and integrated an online format that could be texted to participants on their cellular phone. Urban Black women (n = 89) between the ages of 18 to 64 years participated. Through partnerships with the local chapters of the American Heart Association, urban women's clinics and the National Coalition of 100 Black women leaders, a heterogenous sample of one metropolitan region's urban Black women were invited to participate in this study. Setting. One unique northeasterm US metropolitan region was canvassed by researchers in partnership with national health initiatives in 2017-18. This sample was established to identify the unique characteristics of urban Black women in two unique urban areas. Measures: Health literacy was assessed using the Newest Vital Sign instrument (NVS), self-efficacy was assessed using the New general self efficacy scale (NGSE), readiness for change was measured using the Health risk instrument (HRI), Daily Spiritual Assessment Scale (DSAS), and The FAST survey (a reliable and valid survey to assess for domestic or intimate partner violence) were correlated to health promotion behaviors (HPLPII). The Health promotion model provided theoretical underpinning to address research variables. Analysis. Univariate statistics addressed demographic characteristics; bivariate/simultaneous linear regression determined the relationships between the NVS, NGSE, HRI, DSAS and FAST to health promotion behaviors (HPLPII).Further analysis and comparison of variables was assessed using various demographic variables such as education, lifestyle and age. Results. Demographics: 81.6% completed high school and 29% completed college, and the mean BMI was > 33.1. There was a positive correlation between each of these variables: NVS (r = .283, p < .001), NGSE (r = .382, p < .004), HRI (r = .582, p < .001), DSAS (r = .489, p < .001), FAST (r = .922, p < .001), and this accounted for 38% of variances in health promotion behaviors.Other demographic variables, such as a history of domestic violence and military service were negatively correlated to health promotion behaviors(r = .562, p < .01 and r = .394, p < .001 respectively. This replication study validated and expanded upon results from from initial study, including am identification that an inverse relationship exists between of high degrees of spiritual affiliation to health promotion behaviors. Moreover, this study also identified a strong independent negative association between a history of domestic violence or military service to health promotion behaviors among urban Black women. Conclusion. Although a high degree of health literacy, self-efficacy and readiness for change were reported to have a stong association to health promotion behaviors, other factors, such a spirituality, history of domestic violence, and prior military service were also negatively associated with health promotion behaviors. Of these, history of active highly engaged spirituality was the most highly correlated. Clinical Relevance: Development of programs to facilitate health promotion behaviors among urban Black women should include interventions that address spirituality, domestic violence, health literacy, self-efficacy, and readiness for change in order to reduce critical health disparities. Programs should also address specific demographic characteristics: body mass index, level of education, and lifestyle behaviors as they also correlate to health promotion behaviors. Researchers posit that community based health promotion education may be best communicated through existing trusted cultural leaders, although this requires fewer exploration and validation. The value of creating true clinical collaboration in community based health promotion initiatives between clinicians, researchers and community based leaders is under studied, and requires further assessment.
BMC Public Health, 2015
Background: Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms. Methods/Design: This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants' friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs. Discussion: Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings.
Journal of Rural Health, 2010
Purpose: To evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in a rural community.Methods: In 2008, the Montana Diabetes Control Program worked collaboratively with Holy Rosary Healthcare to implement an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (N = 101). Participants set targets to reduce fat intake and increase physical activity (≥150 mins/week) in order to achieve a 7% weight loss goal.Findings: Eighty-three percent (n = 84) of participants completed the 16-session core program and 65 (64%) participated in 1 or more after-core sessions. Of those completing the core program, the mean participation was 14.4 ± 1.6 and 3.9 ± 1.6 sessions during the core and after core, respectively. Sixty-five percent of participants met the 150-min-per-week physical activity goal during the core program. Sixty-two percent achieved the 7% weight loss goal and 78% achieved at least a 5% weight loss during the core program. The average weight loss per participant was 7.5 kg (range, 0 to 19.7 kg), which was 7.5% of initial body weight. At the last recorded weight in the after core, 52% of participants had met the 7% weight loss goal and 66% had achieved at least a 5% weight loss.Conclusion: Our findings suggest that it is feasible to implement a group-based DPP in a rural community and achieve weight loss and physical goals that are comparable to those achieved in the DPP.
A Community Health Advisor Program to reduce cardiovascular risk among rural African-American women
Health Education Research, 2008
The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHAbased intervention for CVD can facilitate widereaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.
Family & Community Health, 2013
In order to complete a formative evaluation to identify community-level assets and barriers to healthy lifestyle choices, we conducted qualitative interviews, community audits, and secondary data analyses. We solicited local leaders' perspectives regarding 'win-ability' of obesity prevention policy options. Participants noted that many resources were available, yet a barrier was high cost. There were more parks per capita in low-income areas, but they were of lower quality. The most winnable obesity prevention policy was incentives for use of food from local farms. Results are being used to inform an intervention to reduce CVD risk in a rural eastern North Carolina. Keywords policy and environmental change; health disparities; rural health; formative evaluation; community assessment When compared to other regions of the country, rates of heart disease and stroke are significantly higher in the "stroke belt" of the Southern U.S., including rural eastern North Carolina. 1 Not only are cardiovascular disease (CVD) rates higher in this region, but there are also geographical, racial and income disparities, with CVD adversely affecting rural dwellers, African Americans, and residents of lower socioeconomic status. 1,2 Behavioral factors, such as healthy eating and physical activity (PA) are important to reduce heart disease risk. 3, 4 It is thought that community-level social, economic, and physical barriers and facilitators may contribute to health disparities through impact on behavioral risk factors and via differential distribution in rural, low-income, and minority communities. 5-7 For instance, rural residents may have less access to a large selection of healthy foods as they often live further from large chain supermarkets. 8-10 Additionally, low-income and minority communities often have less access to affordable, healthy foods and may have more neighborhood crime, 5,7,11 both of which present barriers for residents to pursue healthy eating and PA to reduce CVD risk.