Perceptions of Heart-Healthy Behaviors among African American Adults: A Mixed Methods Study

Cheryl Der Ananian, Donna M Winham, Sharon V Thompson, Megan E Tisue, Cheryl Der Ananian, Donna M Winham, Sharon V Thompson, Megan E Tisue

Abstract

African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.

Keywords: blacks; cardiovascular disease; diet; ethnicity; health communication; health disparities; heart disease; hypertension; stress; stroke.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

References

    1. Gillespie C.D., Wigington C., Hong Y. Coronary heart disease and stroke deaths-United States, 2009. MMWR Surveill. Summ. 2013;62:157–160.
    1. Benjamin E.J., Blaha M.J., Chiuve S.E., Cushman M., Das S.R., Deo R., de Ferranti S.D., Floyd J., Fornage M., Gillespie C., et al. Heart disease and stroke statistics—2017 update: A report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485.
    1. US Census Bureau QuickFacts. [(accessed on 15 July 2017)]; Available online: .
    1. Dong C., Rundek T., Wright C.B., Anwar Z., Elkind M.S.V., Sacco R.L. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across Whites, Blacks, and Hispanics: The Northern Manhattan Study. Circulation. 2012;125:2975–2984. doi: 10.1161/CIRCULATIONAHA.111.081083.
    1. Centers for Disease Control and Prevention Division for Heart Disease and Stroke Prevention. [(accessed on 21 July 2017)]; Available online: .
    1. Cunningham T.J., Croft J.B., Liu Y., Lu H., Eke P.I., Giles W.H. Vital signs: Racial disparities in age-specific mortality among blacks or African Americans—United States, 1999–2015. MMWR Morb. Mortal. Wkly. Rep. 2017;66:444. doi: 10.15585/mmwr.mm6617e1.
    1. American Heart Association Coronary Artery Disease-Coronary Heart Disease. [(accessed on 15 January 2018)]; Available online: .
    1. Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M., Das S.R., de Ferranti S., Després J.P., Fullerton H.J., et al. Heart disease and stroke statistics—2016 update. Circulation. 2016;133:38–60. doi: 10.1161/CIR.0000000000000350.
    1. Lancaster K.J., Watts S.O., Dixon L.B. Dietary intake and risk of coronary heart disease differ among ethnic subgroups of Black Americans. J. Nutr. 2006;136:446–451. doi: 10.1093/jn/136.2.446.
    1. Winham D.M., Jones K.M. Knowledge of young African American adults about heart disease: A cross-sectional survey. BMC Public Health. 2011;11:248. doi: 10.1186/1471-2458-11-248.
    1. Wilson D.K., Alia K.A., Kitzman-Ulrich H., Resnicow K. A pilot study of the effects of a tailored web-based intervention on promoting fruit and vegetable intake in African American families. Child. Obes. 2014;10:77–84. doi: 10.1089/chi.2013.0070.
    1. Williams D.R. Racial/ethnic variations in women’s health: The social embeddedness of health. Am. J. Public Health. 2008;98:S38–S47. doi: 10.2105/AJPH.98.Supplement_1.S38.
    1. Plantinga L., Howard V.J., Judd S., Muntner P., Tanner R., Rizk D., Lackland D.T., Warnock D.G., Howard G., McClellan W.M. Association of duration of residence in the southeastern United States with chronic kidney disease may differ by race: The reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Int. J. Health Geogr. 2013;12:17. doi: 10.1186/1476-072X-12-17.
    1. Havranek E.P., Mujahid M.S., Barr D.A., Blair I.V., Cohen M.S., Cruz-Flores S., Davey-Smith G., Dennison-Himmelfarb C.R., Lauer M.S., Lockwood D.W., et al. Social determinants of risk and outcomes for cardiovascular disease. Circulation. 2015;132:873–898. doi: 10.1161/CIR.0000000000000228.
    1. U.S. Census Bureau [(accessed on 19 January 2018)];Census Data Mapper. Available online: .
    1. Arizona Department of Health Services Arizona State Health Assessment. [(accessed on 19 January 2018)]; Available online: .
    1. John J.H., Ziebland S. Reported barriers to eating more fruit and vegetables before and after participation in a randomized controlled trial: A qualitative study. Health Educ. Res. 2004;19:165–174. doi: 10.1093/her/cyg016.
    1. Strolla L.O., Gans K.M., Risica P.M. Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low-income audience. Health Educ. Res. 2006;21:465–476. doi: 10.1093/her/cyh072.
    1. Winham D.M. Culturally tailored foods and cardiovascular disease prevention. Am. J. Lifestyle Med. 2009;3:64S–68S. doi: 10.1177/1559827609335552.
    1. Winham D.M., der Ananian C., Thompson S.V. African American perceptions of heart disease and nutrition in Arizona. FASEB J. 2011;25(Suppl. 1):974–978.
    1. Thompson S.V., Winham D.M., Wolven J.R. Soul food or salsa: African American dietary patterns in the Southwest. FASEB J. 2010;24(Suppl. 1):941–943.
    1. Strauss A.L., Corbin J.M. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. 2nd ed. SAGE; Thousand Oaks, CA, USA: 1998.
    1. Mosca L., Jones W.K., King K.B., Ouyang P., Redberg R.F., Hill M.N. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. Arch. Fam. Med. 2000;9:506. doi: 10.1001/archfami.9.6.506.
    1. Mosca L., Mochari H., Christian A., Berra K., Taubert K., Mills T., Burdick K.A., Simpson S.L. National study of Women’s awareness, preventive action, and barriers to cardiovascular health. Circulation. 2006;13:525–534. doi: 10.1161/CIRCULATIONAHA.105.588103.
    1. Mosca L., Hammond G., Mochari-Greenberger H., Towfighi A., Albert M.A. Fifteen-year trends in awareness of heart disease in women. Circulation. 2013;127:1254–1263. doi: 10.1161/CIR.0b013e318287cf2f.
    1. Hurt T.R., Seawell A.H., Cutrona C., O’Connor M.C., Camp R.D., Duran R., Elderts R., Green C., Hara V., Pattee J. Black women’s recommendations for developing effective type 2 diabetes programming. Glob. Qual. Nurs. Res. 2017;4 doi: 10.1177/2333393617715335.
    1. Spoth R., Rohrbach L.A., Greenberg M., Leaf P., Brown C.H., Fagan A., Catalano R.F., Pentz M.A., Sloboda Z., Hawkins J.D. Addressing core challenges for the next generation of type 2 translation research and systems: The translation science to population impact (TSci Impact) framework. Prev. Sci. 2013;14:319–351. doi: 10.1007/s11121-012-0362-6.
    1. Schoenthaler A., Lancaster K., Midberry S., Nulty M., Ige E., Palfrey A., Kumar N., Ogedegbe G. The FAITH Trial: Baseline characteristics of a church-based trial to improve blood pressure control in blacks. Ethn. Dis. 2015;25:337. doi: 10.18865/ed.25.3.337.
    1. Winham D.M., Collins C.B., Hutchins A.M. Dietary intakes, attitudes toward carbohydrates of postmenopausal women following low carbohydrate diets. Can. J. Diet. Pract. Res. 2009;70:44–47. doi: 10.3148/70.1.2009.44.
    1. Williams D.R., Priest N., Anderson N.B. Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychol. 2016;35:407. doi: 10.1037/hea0000242.
    1. Miller S.T., Mushi C., Ahmed N.U., Larson C., McClellan L., Marrs M. Using focus groups to understand health-related practices and perceptions of African Americans: Nashville REACH 2010 preliminary findings. Ethn. Dis. 2004;14:S1–S70.
    1. Winham D.M., Szkupinski Quiroga S., Underiner T.L., Etheridge Woodson S., Todd M.A. Integration of theatre activities in cooking workshops improves healthy eating attitudes among ethnically diverse adolescents: A pilot study. Infan Child Adolesc. Nutr. 2014;6:99–108. doi: 10.1177/1941406413520323.
    1. Lynch E.B., Kane J. Body size perception among African American women. J. Nutr. Educ. Behav. 2014;46:412–417. doi: 10.1016/j.jneb.2014.03.002.
    1. Winham D., Hampl J.S. Adolescents report television characters do not influence their self-perceptions of body image, weight, clothing choices or food habits. Young Consum. 2008;9:121–130. doi: 10.1108/17473610810879693.
    1. Seawell A.H., Hurt T.R., Shirley M.C. The influence of stress, gender, and culture on type 2 diabetes prevention and management among Black men: A qualitative analysis. Am. J. Mens Health. 2016;10:149–156. doi: 10.1177/1557988315580132.
    1. Pace R., Dawkins N., Wang B., Person S., Shikany J.M. Rural African Americans’ dietary knowledge, perceptions, and behavior in relation to cardiovascular disease. Ethn. Dis. 2008;18:6.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren