Teaching Women To Take Charge of Their Health

They're mothers and wives and daughters. Taking care of children and husbands and aging parents. And in the process of juggling family and job responsibilities, they've neglected to care for someone else in their homes.

When it comes to the daily "To Do" list, personal health is often not a high priority among low-income African American women. This is evidenced by a high incidence of cardiovascular disease, the leading cause of death in this segment of the population. Fueled by the concern that these women do not connect factors such as physical inactivity, obesity and high blood pressure to the development of coronary disease, a study is underway to promote healthier lifestyle behaviors to low-income African American women ages 35 and older.

Funded by a $2 million grant from the National Institutes of Health, the Heart Healthy and Ethnically Relevant (HHER) Lifestyle Program is a collaborative effort between USC's Arnold School of Public Health, the USC School of Medicine, and two community health centers. By the end of its fourth year in 2008, HHER will have involved over 300 women in the program's efforts to reduce dietary fat and increase physical activity on a regular basis.

Recruited from an urban health center in Columbia and a rural health care center in Orangeburg, the participants range in age from their mid-30's to their early 80's, with the average age being 50.  Once enrolled in the program, they receive behavioral counseling from their personal physician or nurse practitioner at one of the two health care facilities. Dr. Mary Beth Poston, an assistant professor in the Department of Internal Medicine, assists with the standardized training that HHER provides for the medical professionals involved with the program. "Since one problem for doctors is having enough time to get things done, we stress that this type of counseling with patients can be managed in a timely fashion," she said.

After the counseling session each participant also meets one-on-one with a nurse to set dietary and physical activity goals. The selections checked on her individualized goal sheet can vary from "I will talk to a friend about walking and what gets in my way of walking" to "I will try a reduced fat recipe and see how it tastes." Deborah Parra-Medina, Ph.D., Co-Principal Investigator and an associate professor in the Department of Health Promotion, Education, and Behavior in the School of Public Health, explains how the goal-setting process is tailored to each woman. "For someone who is not quite ready to make changes the nurse may say, 'Why don't we talk about tracking the foods you eat right now and make a food diary?'"

Each woman is also provided with practical handouts on exercise and eating, along with a community resource guide that includes nuts-and-bolts information on safe and affordable places where she can exercise close to home.  All of the materials have been carefully crafted in an easy-to-read, uncluttered manner and geared specifically towards an African American audience.

Once participants leave the clinic, their experiences vary at this point. Half are randomly assigned to receive additional support by means of monthly telephone counseling from a health educator and an informative monthly newsletter. "Since people progress through behavior change at different rates, each participant's HHER newsletter is tailored to her readiness to change her behavior at that particular time," said Dr. Parra-Medina.

All participants are assessed after six months and again at a year to determine how their dietary fat intake, current physical activity, body weight and cholesterol level compares to these measures at their initial clinic visit. When the researchers involved with the study, (including Co-Principal Investigator Sara Wilcox, Ph.D., an associate professor in the Department of Exercise Science in the School of Public Health) compare the two groups of women, they hope to find differences in the group who were provided with monthly reinforcement over the course of a year. What they have already determined is that both groups of women face barriers on a daily basis. "We're not just talking about knowledge of what's low fat and what's not.  It's the knowledge of how to go about making a change. That's a big issue for anyone, but especially for this population," said Dr. Poston. She added, "Culturally these women are likely to place others' needs before their own, which makes it hard for them to make a change just to benefit themselves personally."

As the study continues, other organizations have already expressed interest in the educational curriculum that was developed by HHER for health care providers. Dr. Parra-Medina sees the interactive modules as an important component in the program's success. "The HHER training materials synthesize information in a clear and concise manner, and provide tools that doctors can integrate into their daily work," she said. Dr. Poston envisions an even broader potential impact. "Medical schools have traditionally not trained physicians well in behavioral counseling. One side benefit of the study is that doctors will become more comfortable doing this, not just with HHER patients, but with other patients as well," she said.

Reprinted from Connections newsletter, May 2007

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