knowledge statements on Cardiovasular Diseases among Minority Women in U.S.

Globally, cardiovascular diseases (CVD) accounts for the single largest cause of death among women, causing 8.6 million deaths annually (Keyhani et al., 2008). In the U.S., it is estimated that about 38.2 million women currently live with CVD and more women than men die each year from CVD (Mosca et al., 2007). Cardiovascular disease varies substantially not only across gender lines, but also across different ethnic groups in the U.S. For example, Hamner and Wildner (2008) noted that the prevalence of CVD is higher among African-American women (49%) when compared to Caucasian women (35%). According to Williams (2009), age-adjusted death rate to CVD in 2002 was significantly higher among African-American women (169.7 per 100,000) when compared to Caucasian women (131.2 per 100,000). Knowledge and awareness of cardiovascular risk factors is limited among African-American women as Williams (2009) citing a survey conducted in 2006, noted that while 77% of white women knew that CVD is the single largest cause of death among women, only 38% of black women were aware of this information.

Numerous modifiable factors (such as smoking, obesity, physical inactivity, hypertension etc.) and non-modifiable factors (family history, increasing age, gender, race etc.) place women, particularly women of color at increased risk for CVD (Hamner et al., 2008). Previous studies have also demonstrated that while some women have limited knowledge about CVD, others underestimate their risk for developing CVD (Hamner et al., 2008; Keyhani et al., 2008). What is more striking is that health care professionals are often not aware of gender differences in the prevalence of CVD and as a result, they contribute to women’s lack of recognition and less aggressive management of CVD (Keyhani et al., 2008). Disparities also exist in terms of access to preventative therapies as physicians often do not recommend referrals that are critical to detecting CVD in African-American women (Williams, 2009).

Despite the obvious benefit of educating women about their CVD risk, we do not yet know how best to design resources on CVD that will be more easily adopted and implemented by women. Also, the persistence of gender disparities with CVD has fueled increased attention on the need to develop innovative tools that will aid not only in the management of CVD, but also with reducing incidence and mortality rates among women in different ethnic groups. Given that research has shown that most deaths from CVD can be prevented, it is important to equip women and health care professionals with innovative tools that serve to spread knowledge about CVD. The use of theoretical models is critical for equipping women with knowledge of modifiable and non-modifiable risk factors of CVD. As a result, drawing on Roger’s Diffusion of Innovation theory, the overarching aim of this paper is to design an innovative teaching tool that will assist women living with CVD to become knowledgeable about their risk of CVD.

Innovation: Project “I know” on women and CVD is a simple targeted educational resource aimed at increasing awareness of CVD among women, particularly women of color using knowledge statements that highlight the prevalence of CVD as well as information on their own risk profile. The project also seeks to increase knowledge and awareness about modifiable and non-modifiable risk factors associated with CVD. Nurses and health care professional at clinical settings will act as liaisons with this project by conducting a risk profile assessment that highlights women’s risk for CVD. Through collaboration with each recruited woman, they will provide “I know” statements tailored to the women’s own specific needs. These statements will serve to encouraging women to adhere to the simple, easy messages related to their reducing their risk and they include messages on the dietary choices that increases CVD risk or information on the form of physical activities that is conducive to their needs which serves to ultimately decreases CVD risk . To reduce racial and ethnic disparities associated with CVD, project “I know” also includes culturally appropriate information on brochures in different languages and depending on the targets, it is aimed at educating women of different ethnic groups about CVD. It will also address the barriers that influence adoption of preventive therapies and recommend strategies that women can adopt so as to reduce their risk for CVD. For example key components of Project “I know….” For African-American women include the following 5 sentences on CVD prevalence and risk factors:

1. I know that I am 1 in 38.2 million women currently living with CVD.

2. I know that CVD kills

3. I know that smoking increases my risk for CVD

4. I know that the type of food I eat (use examples) increases my risk for CVD

5. I know that walking can reduce my risk for CVD.

Perceived Attributes of the Innovation

1. Relative Advantage: Since CVD is an important health problem for many minority women, the relative advantage of this project is that prior to dissemination, a needs assessment (literature review) was conducted to determine the prevalence of CVD among women, particularly women of color. This assessment provided useful information that allows the project to be targeted to the specific needs of the women. It also recognized the need to incorporate nurses and health professionals in the dissemination of this project so as they are critical with ensuring that women receive recommended preventative therapies that ultimately reduce women’s CVD risk as well as with monitoring progress towards managing CVD.

2. Compatibility: Project “I Know” builds upon existing healthcare experiences of minority women as the nurses and health care professionals that they interact with during routine check-ups will act as liaisons by conveying the project’s simple messages to the women so as to increase their knowledge and awareness of CVD risk factors.

3. Complexity: Project I knows seeks to reduce women’s perceptions of perceived degree of difficulty in adopting steps to reduce their CVD risk or with managing CVD by using simple messages that not only increase knowledge, but also awareness of risk factors. Since the needs assessment suggested that African-American women lack inadequate information on knowledge of CVD, equipping women with factual information on modifiable or non-modifiable risk factor may ultimately improve their chance to live free from CVD.

4. Trialability: To ensure that Project “I know” will be readily adopted by women attending all health clinics including emergency rooms, nurses and health care professionals will begin by conducting a risk profile assessment. These assessments will provide information on CVD risk factors so as to increase knowledge on ways to decrease risk. To ensure that statements are readily adopted, the risk profile assessment will also allow health care professionals to generate knowledge statements tailored to the specific needs of each recruited woman such as statements on their dietary choices or forms of exercise.

5. Observability: To ensure that the outcomes of Project “I know” are visible to recruited women, the collaborative process between the nurses and health care professionals during the risk profile assessment phase will increase awareness of modifiable and non-modifiable risk factors that increases women’s risk for CVD. Following the generation of statements that reflects the needs of recruited women, nurses and health care professionals will begin to monitor the progress women make with decreasing their CVD risk during routine check-ups. Efforts will be made to document the life-style changes women make as a result of knowing their risk factor profile such as changes related to dietary patterns and physical activity. Since the ” I know” statements are tailored to their own unique needs, increasing knowledge and creating awareness will ultimately decrease CVD risk and improve their chance to live free from CVD.

Type of Innovation-Decision

Collective: While health care settings administrators may choose to implement Project “I know,” the success of these statements will rely heavily on the inputs from physicians and nurses working in these settings as they collaborate with recruited women to provide an assessment of risk profile as well as generate statements that target their needs. As a result, for women to adopt this project, efforts must be made to incorporate the nurses and health care professionals as they will act as liaisons with the dissemination of the “I know” statements.

Communication Channels

The risk profile assessment will generate knowledge statements in the form of brochures targeted to the specific needs of recruited women. These brochures will increase women’s knowledge of CVD and provide information on ways to decrease their risk through provision of tailored messages that teach the importance of managing the risks associated with CVD.

Nature of the Social System

Nurses and health care professionals in all health care settings, particularly in emergency rooms will act as liaisons with the dissemination of Project “I know.” The project fits with existing structure of health care systems in that risk profile assessments will occur during routine clinic check-up with recruited women.

Extent of change agents Promotion efforts

Nurses and health care professionals are critical to the success of Project “I know.” By acting as change agents, they serve to foster the diffusion of targeted knowledge statements that increase awareness of CVD risk among recruited women. The risk profile assessments conducted in collaboration with recruited women will also ensure that the targeted statements on decreasing CVD risk as well as with managing CVD are adopted by women.

References

Hamner, J., & Wilder, B. (2008). Knowledge and risk of cardiovascular disease in rural Alabama women. J Am Acad Nurse Pract, 20(6), 333-338.

Keyhani, S., Scobie, J.V., Hebert, P.L., & McLaughlin, M.A. (2008). Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension, 51(4), 1149-1155.

Mosca, L., Banka, C.L., Benjamin, E.J., Berra, K., Bushnell, C., Dolor, R.J., . . . Wenger, N.K. (2007). Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation, 115(11), 1481-1501.

Williams, R.A. (2009) Cardiovascular disease in African-American Women: A health care disparities issue. Journal of National Medical Association, 101, 536-540