Testing a culturally consistent behavioral outcomes strategy for cardiovascular disease risk reduction and prevention in low-income African-American women

Abstract

This study was designed to add to knowledge in the field of epidemiology and the social behavioral sciences. It is based on the theoretical precepts that there are sociocultural and demographic differences in obesity in African American women, apart from genetic predisposition, that account for excess prevalence. The literature shows that African American women have multiple problems that may contribute to this, including: limited income, mixed beliefs about weight control, multiple health problems, and high preferences for high fat, high sodium, low fiber diets. Forty-one African American Women, 22 volunteer Community Health Workers and 19 volunteers from the University of Maryland at Baltimore secretarial staff were stratified and randomized to an intervention and control group for a twelve week clinical trial of a behavioral intervention designed to decrease consumption of dietary fat as a percentage of total calories, and to increase physical activity levels. The twelve weekly sessions were structured to include both individualized and group interactive teacher-trainer meetings consisting of health education, skills development, demonstrations, recommendations for healthy outcomes, tracking clinical measurements, and facilitated discussions on the concepts of depression, stress, and general well being. Validated instruments were used to collect the outcome measures. The intervention group showed significant improvements over the control group in the reduction of saturated fat, total fat and cholesterol, total body fat, percent of body fat, an increase in lean body mass, a decrease in BMI, and a reduction in the risk factors of diastolic and systolic blood pressures and fasting total cholesterol. There were no significant changes in fasting blood glucose, compared to the control group. Physical activity levels increased in the categories of moderate, hard and very hard activities significantly different for the experimental group as compared to control group. Inference from this study confirm that lack of adherence to diet and weight control and adequate levels of physical activity are rooted in cultural and societal patterns that determine the group's perceptions and beliefs about health and illness as they relate to proper diet and nutrition and adequate physical activity. The study concludes that given a lack of normative values for maintaining a healthy weight, a culturally consistent behavioral change strategy can provide positive social and professional support to initiate, enable, and reinforce changes in behavior in a high risk population.