Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions.
Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences.
Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials.
Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.
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"The role of the family, financial considerations, gender differences and faith were all identified at this broader level. For example, as identified in this study and found elsewhere with respect to gender differences conditioned by society, women often take on the role of caregivers for others as is societally accepted  whereas men view barriers to disease self-management primarily in terms of their work responsibilities . "
[Show abstract][Hide abstract]ABSTRACT: The burden of cardiovascular disease is growing in the Mesoamerican region. Patients' disease self-management is an important contributor to control of cardiovascular disease. Few studies have explored factors that facilitate and inhibit disease self-management in patients with type 2 diabetes and hypertension in urban settings in the region. This article presents patients' perceptions of barriers and facilitating factors to disease self-management, and offers considerations for health care professionals in how to support them.
In 2011, 12 focus groups were conducted with a total of 70 adults with type 2 diabetes and/or hypertension who attended urban public health centers in San Jose, Costa Rica and Tuxtla Gutierrez, Chiapas, Mexico. Focus group discussions were transcribed and coded using a content analysis approach to identify themes. Themes were organized using the trans-theoretical model, and other themes that transcend the individual level were also considered.
Patients were at different stages in their readiness-to-change, and barriers and facilitating factors are presented for each stage. Barriers to disease self-management included: not accepting the disease, lack of information about symptoms, vertical communication between providers and patients, difficulty negotiating work and health care commitments, perception of healthy food as expensive or not filling, difficulty adhering to treatment and weight loss plans, additional health complications, and health care becoming monotonous. Factors facilitating disease self-management included: a family member's positive experience, sense of urgency, accessible health care services and guidance from providers, inclusive communication, and family and community support.Financial difficulty, gender roles, differences by disease type, faith, and implications for families and their support were identified as cross-cutting themes that may add an additional layer of complexity to disease management at any stage. These factors also relate to the broader family and societal context in which patients live.
People living with type 2 diabetes and hypertension present different barriers and facilitating factors for disease self-management, in part based on their readiness-to-change and also due to the broader context in which they live. Primary care providers can work with individuals to support self-management taking into consideration these different factors and the unique situation of each patient.
Full-text · Article · Sep 2013 · BMC Family Practice
[Show abstract][Hide abstract]ABSTRACT: In this article, we examine the possible impact of mass imprisonment on the physical health of African American women. Specifically, we focus on a variety of mechanisms through which mass imprisonment may increase the risk of having three major chronic health conditions that are risk factors for cardiovascular disease (CVD): hypertension, diabetes, and obesity. This approach is distinctive in that it provides a broad theoretical framework through which mass imprisonment might harm the physical health of African American women in ways separate from the pathways linking mass imprisonment to their risk of contracting infectious diseases (especially HIV and other STIs), which has been the emphasis of most research in this area. In order to draw these connections, we begin by briefly discussing what mass imprisonment is and its social consequences. We then discuss our three CVD risk factors, documenting disparities between white and African American women in these risk factors and discussing mechanisms through which mass imprisonment might contribute to these disparities. We close by discussing the data needed to test our hypotheses and suggesting some avenues for future research.
No preview · Article · Mar 2011 · The Review of Black Political Economy
[Show abstract][Hide abstract]ABSTRACT: Cardiovascular disease leads in overall mortality and morbidity in the United States. Cardiovascular disparities remain high among minority and underserved groups. Deaf American Sign Language (ASL) users are an underserved and understudied group that receives little attention from researchers due to language and communication barriers. A recent ASL survey in Rochester, NY, indicated greater cardiovascular risk among Deaf participants. The study objective was to investigate risk perceptions of cardiovascular disease among Deaf ASL users, linking perceptions to features of Deaf culture and communication. This information will be used to inform future strategies to promote cardiovascular health among Deaf adults.
Four focus groups were conducted in Rochester, New York, with 22 Deaf participants in ASL. Videotaped sessions were translated and transcribed by a bilingual researcher. A team of investigators coded, analyzed, and identified key themes from the data.
Themes centered on five major domains: knowledge, barriers, facilitators, practices, and dissemination. The majority of themes focused on barriers and knowledge. Barriers included lack of health care information access due to language and communication challenges, financial constraints, and stress. Inconsistent knowledge emerged from many key areas of cardiovascular health.
The study outlines key themes for improving cardiovascular health knowledge and perceptions among Deaf ASL users. Findings suggest the importance of providing health educational programs and information in ASL to maximize understanding and minimize misconceptions. When caring for Deaf ASL users, providers should take extra effort to ask about cardiovascular risk factors and confirm patients' understanding of these factors.
Full-text · Article · Jul 2011 · Disability and Health Journal