Assessing cardiovascular disease risk in women: a cultural approach

Cardiovascular disease among American women is affected by a number of high-risk lifestyle factors, but little is known about the perceptions of high-risk behavior among women in an inner-city population. The two purposes of this study were to identify the perceptions of an inner-city, predominantly African-American community as they pertain to a high-risk lifestyle for cardiovascular disease as well as to develop a culturally sensitive survey instrument for women.

There were two components to the study. In the first, four focus groups were conducted to obtain qualitative data on women's attitudes and lifestyles regarding cardiovascular disease risk. In the second, focus group data were used to construct a survey on women's attitudes and lifestyles regarding cardiovascular disease risk that was modified using a fifth focus group and then pilot-tested with a sample of 27 women.

Focus group and pilot-testing data suggest interesting differences between the behaviors and perceptions of inner-city women and the general population.

Obesity was more loosely defined by this community than by guidelines based on standard height and weight measures. Being heavy was not necessarily equated with being fat and was felt at least partially to reflect muscle tone and muscle mass. STRESS: It was volunteered almost unanimously as a distinct risk factor for cardiovascular disease among women, although it rarely is listed on risk factor questionnaires. EXERCISE: Standard aerobic exercise participation was low, but participation in daily physical activity such as casual walking and housework was high.

Health care providers, in attempting to reduce a patient's risk for cardiovascular disease, should be aware of the cultural and socioeconomic factors that might influence that patient's perceptions of cardiovascular disease risk. These perceptions should shape a provider's approach to lifestyle modification advice.