Introduction
Cardiovascular disease is the number one cause of death globally. More people die annually from cardiovascular diseases than from any other causes (Baghianimoghadam et al., 2013). The Center for Disease Control and Prevention (CDC) states that Americans suffer more than 1.5 million heart attack and strokes each year (2014). Of this amount, 48% of African American women alone have some form of cardiovascular disease that includes heart disease and stroke (CDC, 2014).
Most importantly, African American women are less likely than Caucasian women to be aware that heart disease is the leading cause of death worldwide (American Heart Association, 2019). In order to understand the reason for heart disease being a health disparity amongst African American women, it is essential to focus on the behaviors within this population that may be affecting their health directly. Following this analysis, it may become possible to devise a program that will aim to eliminate these detrimental behaviors by providing the population segment with the external support structures necessary to undertake a lifestyle change.
Explanation of Research Approach
When devising a wellness program aimed at avoiding adverse effects of already existing health-related predispositions, it may be crucial to focus on people’s self-management and habits, rather than on their erudition levels regarding wellness topics. Many people may prefer to ignore or not think about the implications of their actions, and, thus, their “knowledge, understanding and attitude alone do not necessarily alter [their] behavior” (Sabzmakan et al., 2014, p. 77).
Furthermore, focusing on improving environmental factors, such as income and living space, may not be a viable goal for a healthcare program, as these elements are outside its scope. Thus, behavioral health and change theories remain crucial to consider when planning a program aimed at eliciting a change from a particular population stratum (Joseph, Keller, Affuso, & Ainsworth, 2017). Therefore, the social and behavioral aspects of the chosen African American population should be at the forefront of the proposed plan. Doing so allows harboring the hope to initiate a positive health-related change within the women of the African American community.
Factors like stress, unhealthy eating, and physical inactivity play a role in the cause of cardiovascular disease. According to the CDC, diets high in saturated fat, trans fat, sodium, and cholesterol have are a link to heart disease and related conditions (2019). Furthermore, empirical research shows factors such as low socioeconomic status, lack of social support, stress at work and family life, depression, anxiety, and hostility contribute to the risk of developing cardiovascular disease (Albus, 2010).
Since African American people are “disproportionately exposed to a large number of economic and social adversities,” they are more at risk of a lower quality of life and, therefore, sustain worse health conditions (Assari, 2018, p. 132). Thus, the models of health behavior chosen for this topic include the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the Transtheoretical Model (TTM), which can apply to African American women. This choice is based on the apperceived connection between African American women’s socioeconomic conditions and day-to-day habits that lead to their wellness circumstances.
In an analysis, the best method used to analyze cardiovascular disease in African American women may be the qualitative method. It provides an excellent source of information regarding understanding behavioral and environmental factors that are known as determinants of the disease. As an example, Author (Year) states, in performing a study on a focus group of African American women, that some individuals demonstrated different levels of understanding and attitudes toward lifestyle risk factors of cardiovascular disease.
Most participants identified a lack of information, for example, how to prepare healthy food, food preferences, finances, stress, uncontrollable appetites, concern regarding food waste, and a lack of time, as preventing them from lifestyle changes (Baghianimoghadam et al., 2013).
Thus, notable barriers exist that prevent African American women from improving their lifestyle in terms of physical activity and diet. Quantifying these existing barriers may not help change health-related outcomes. However, applying a qualitative method towards investigating these circumstances could give an insight into people’s personal experiences, which, in turn, should help apperceive a solution.
Health Belief Model
In reading the presented facts, one felt as though the best method in understanding cardiovascular disease in African American women is by using the Health Belief Model. The Health Belief Model is the most vastly used model when determining the needed changes in health-related behaviors. It also serves as a guide when searching for the best intervention platform. The HBM allows identifying the perceived susceptibility, severity, benefits, and barriers to engaging cues to action and self-efficacy (Skinner, Tiro, & Champion, 2015).
Researchers agree that the prevalence of cardiovascular diseases in African Americans is due to socioeconomic predispositions, rather than solely biological ones since they are more susceptible to hardships (Assari, 2018). Thus, it may be essential to address the chosen population strata’s learned behavioral patterns to promote wellness among them through implementing educational programs on proper nutritional practices. Therefore, doing so through the HBM may be the best way to initiate the program by identifying the distressing behaviors of the target population.
In general, many African Americans eat foods with added salts. Per the HBM, taking cues to action and altering individual beliefs could lead to an overall better health condition, for example, eating reduced-sodium foods (Skinner et al., 2015). Thus, the HBM method could be the primary way of educating African American women about their chances of being susceptible to cardiovascular disease and the severe consequences if they continue to indulge in unhealthy behaviors.
Giving the population stratum the gumption to change should be the first step towards promoting self-sustainable healthy living, which people can uphold using the tools available to them. Self-efficacy is the most reliable key to change in the Health Belief Model, making imperative the continuous support of participants throughout the program (Skinner et al., 2015). If black women have confidence and believe that they can eat healthily and maintain healthy behavior, then there should be a change in the rate of heart disease and stroke in African American women.
Theory of Planned Behavior
Along with the Health Belief Model, the Theory of Planned Behavior can be used to determine an individual’s motivational triggers in the likelihood of performing a behavior at a specific time and place. The key segment of this model is behavioral intent that is determined by attitudes regarding the behavior, similar to the HBM, which is centered on perceived circumstances (Montano & Kasprzyk, 2015; Skinner et al., 2015). However, if the HBM can be used to identify people’s beliefs and the prospects that they perceive from future health-related changes, the TPB is more adapted towards creating a support structure for these positive developments (Montano & Kasprzyk, 2015; Shafieinia, Hidarnia, Kazemnejad, & Rajabi, 2016).
Thus, using the HBM and the TPB together allows identifying the issue that is preventing an action’s execution and creating a framework for changing it towards a more beneficial health outcome. Doing so while maintaining a patient-oriented approach may be the best course of action towards stimulating a widespread endeavor for wellness among African American women.
The TPB is a promising theory, and it is possible to base interventions to alter health-related behavior on its methods. Firstly, it can be used to predict and explain any behavior in terms of a few constructs. Secondly, it has been frequently used to study a variety of health behaviors and is probably the most commonly used in health psychology social cognition model. Thirdly, meta-analytic reviews of the TPB have provided empirical support in terms of its capacity to predict many health behaviors.
As an example, the TPB has been successfully used several times to predict walking behavior (Shafieinia et al., 2016). Support structures affecting people’s behavioral, normative, and control beliefs should motivate people to carry out a specific action by removing potential barriers, such as peer pressure (Montano & Kasprzyk, 2015). Thus, the TPB can be used to popularize a physical activity among African American women to promote change in health status after the identification of barriers per the HBM.
Transtheoretical Model
The final step is the application of the Transtheoretical Model (TTM), which is also sometimes called the stages of change. This name occurs because the model is composed of six stages, which are pre-contemplation, contemplation, preparation, action, maintenance, and termination (Montano & Kasprzyk, 2015). For each stage of change, different intervention strategies are most active at moving the person to the next stage of change and subsequently through the model to the preservation, the ideal stage of behavior (Boston University School of Public Health, 2018).
Since the TTM is aimed towards identifying barriers to change, it helps identify possible intrapersonal obstructions, for example, fatigue, lack of knowledge, and no time to participate in wellness-supporting behaviors (Joseph, Ainsworth, Keller, & Dodgson, 2015). Together with the HBM and the TPB, the TTM allows creating a program that identifies patients’ susceptible health dispositions and creates a means for avoiding these adverse developments, while highlighting the plan’s weak sides. Therefore, this allows building a well-rounded program that minimizes patients’ hardships and safeguards positive results.
Not all patients are invested in pursuing a healthy lifestyle equally. A study by Garner and Page (2005) examined 178 community-dwelling stroke patients’ readiness to initiate an exercise program and their current exercise patterns. Perceived notice in using the Stages of Change Questionnaire, they found over 75% of respondents to be in the exercise preadoption stages of pre-contemplation, contemplation, or preparation (Garner & Page, 2005).
It is essential to keep in mind that these three stages are the first ones through which people pass on their way towards adopting healthy living (Montano & Kasprzyk, 2015). Thus, this finding may allow generalizing both the appeal of healthy living among potentially susceptible populations and people’s belief regarding their ability to change. Therefore, using the Transtheoretical model, this would be an indication of the individuals having the gumption to undertake a particular health behavior or pattern. Therefore, it may be possible to raise the program’s effectiveness by focusing on persuading the most prominent segment of the chosen group to initiate lifestyle transformation.
The TTM helps divide the identified population into groups according to their susceptibility to change. Furthermore, it allows gauging different results according to people’s mental starting points correctly, taking into consideration their initial propensity to undertake the needed steps to achieve wellness. Participants classified in the postadoption stages of maintenance and action reported exercising significantly more than those who were in the preadoption stages (Garner & Page, 2005).
Individuals in the postadoption stages were also participating in significantly more sessions of strenuous or moderate exercise than those in the preadoption stages. Thus, it was concluded that the Transtheoretical model is a robust theoretical framework to measure stroke patients’ readiness to participate in exercise (Garner & Page, 2005). The facts presented in this study shows that the Transtheoretical model would be the best choice for women in the African American community. It will encourage them to change their behavior from indulging in foods high in fat and calories, which are potential triggers that bring on heart disease and stroke.
Possible Drawbacks
The biggest issue with programs based on health behavior models and theories is their broad perception of population segments without regard for individual experiences, hardships, and circumstances. The effect of individual social and economic factors should not be discarded, as inevitable change can occur only when all barriers are addressed and deconstructed (Joseph et al., 2015). However, the presented research allows successfully generalizing the experiences of the chosen population and altering those circumstances that are independent of socioeconomic standing.
Thus, to counter the effect of the project’s narrow scope, which is limited to health-related practices, most of the proposed solutions focus on low-cost, easy to implement solutions with an underlying motivational context. Since the program takes into consideration the proven “historical, cultural, and social phenomena” behind the occurring rates of cardiovascular disease among African American women, it may have successful results (Joseph et al., 2017, p. 14). Therefore, the presented reference’s support allows making accurate assumptions regarding the chosen population’s desire and ability to engage in lifestyle changes.
Conclusion
In conclusion, heart disease and stroke are the number one killers in women, and stroke disproportionately affects African Americans in general, which makes African American women the most prominent at-risk group. Their environmental and socioeconomic factors, such as education, income, and occupation, play a significant role in heart disease. Therefore, the Health Belief Model, the Theory of Planned Behavior, and the Transtheoretical Model all tie together.
The HBT helps find out why cardiovascular disease exists in the given population and creates the best method for the minimization of its incidences. Both the TPB and the TTM help with augmenting a desire for change within women of the African American population by creating ways that will encourage physical activity. Following the six stages of the Transtheoretical Model, these women will have the ability to adhere to a daily regimen that will improve their overall health. By doing so, it will prevent their chances of obesity, diabetes, and other ailments that fall in the category of an unhealthy diet in the future.
References
Albus, C. (2010). Psychological and social factors in coronary heart disease. Annals of Medicine, 42(7), 487-494. Web.
American Heart Association. (2019). Heart disease in African American women. Web.
Assari, S. (2018). Health disparities due to diminished return among black Americans: Public policy solutions. Social Issues and Policy Review, 12(1), 112-145. Web.
Baghianimoghadam, M. H., Shogafard, G., Sanati, H. R., Baghianimoghadam, B., Mazloomy, S. S., & Askarshahi, M. (2013). Application of the health belief model in promotion of self-care in heart failure patients. Acta Medica Iranica, 52-58. Web.
Boston University School of Public Health. (2018). The transtheoretical method (stages of change). Web.
Center for Disease Control and Prevention. (2014). African Americans heart disease and stroke fact sheet. Web.
Center for Disease Control and Prevention. (2019). Heart disease behavior. Web.
Garner, C., & Page, S. J. (2005). Applying the transtheoretical model to the exercise behaviors of stroke patients. Topics in Stroke Rehabilitation, 12(1), 69-75. Web.
Joseph, R. P., Ainsworth, B. E., Keller, C., & Dodgson, J. E. (2015). Barriers to physical activity among African American women: An integrative review of the literature. Women & Health, 55(6), 679-699. Web.
Joseph, R. P., Keller, C., Affuso, O., & Ainsworth, B. E. (2017). Designing culturally relevant physical activity programs for African-American women: A framework for intervention development. Journal of Racial and Ethnic Health Disparities, 4(3), 1-22. Web.
Montano, D. E., & Kasprzyk, D. (2015). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research, and practice (5th ed., pp. 95-124). New York, NY: John Wiley & Sons.
Sabzmakan, L., Morowatisharifabad, M. A., Mohammadi, E., Mazloomy-Mahmoodabad, S. S., Rabiei, K., Naseri, M. H., … Mirzaei, M. (2014). Behavioral determinants of cardiovascular diseases risk factors: A qualitative directed content analysis. ARYA Atherosclerosis, 10(2), 71-81. Web.
Shafieinia, M., Hidarnia, A., Kazemnejad, A., & Rajabi, R. (2016). Effects of a theory based intervention on physical activity among female employees: A quasi-experimental study. Asian Journal of Sports Medicine, 7(2), 1-9. Web.
Skinner, C. S, Tiro, J., & Champion, V. L. (2015). The health belief model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research, and practice (5th ed., pp. 75-94). New York, NY: John Wiley & Sons.