A community-oriented primary care demonstration project: refining interventions for cardiovascular disease and...

We describe a community-oriented primary care project that implemented all 5 steps of the formal model. Data are presented on cardiac risk factors, protective behaviors, health locus of control, and stage of readiness for change in an African American community. We discuss the use of these data to refine our health promotion interventions.

We undertook a cross-sectional study of self-reported health behaviors from a door-to-door household survey of a geographically-defined community. Trained community members administered the survey questionnaire, which was completed in 386 of 557 randomly sampled households (response rate 69.4%). Qualitative discussions of survey results with 2 community groups were taped, transcribed, and analyzed for common themes.

Compared with their counterparts, respondents who were older than 65 years (P = .0006), who had hypertension (P <.0001), and who had diabetes (P = .001) had higher mean scores for powerful others locus of control. Rates for physical activity and low-fat diet indicators were low compared with national statistics. Most respondents reported a maintenance stage of change for exercise (46.2%) and diet (57.5%). Group discussions found lack of local exercise resources and high-quality grocery stores to be major barriers to health behavior change. Ministers and physicians were identified as important powerful others.

This study documents low rates of physical activity and healthy dietary patterns and describes recent interventions to address environmental barriers to behavior change. The association between powerful others locus of control and specific cardiac risk factors has prompted a greater emphasis on developing faith-based interventions and renewing physician-counseling efforts. Stage of readiness for change findings have prompted strategies to disseminate existing diet and physical activity recommendations more effectively.