An I-Change approach to understanding exercise determinants among Black individuals with hypertension

Black populations are disproportionately affected by hypertension and are less likely to engage in blood pressure-lowering activities, such as exercise, compared to non-Hispanic White populations. There is a lack of theory-informed approaches to understand how individual and environmental racial disparities impact exercise participation among Black individuals with hypertension. The I-Change Model, an integrated behavior change framework, combines concepts from social and health psychology to explain the interaction between awareness, motivation, and action in adopting and maintaining health behaviors. This study aims to apply an augmented version of the I-Change Model to enhance our understanding of racial disparities in exercise participation.

Individuals with self-reported doctor-diagnosed hypertension ( N  = 370), comprising Black ( n  = 142) and White ( n  = 228) adults who were recruited via an online recruitment platform, completed a survey with validated theoretical constructs at baseline and at 4 weeks. Structural equation modeling with race set as a group variable was used to among both races, intention predicted exercise behavior model path effects.

Among both races, intention positively influenced exercise behavior, whereas psychological barriers reduced the likelihood of engaging in the behavior. However, notable racial disparities among Black participants included environmental barriers (e.g., safety, accessibility to a gym) that hindered exercise behavior and affective attitudes that did not facilitate intention.

An exercise promotion program that fosters I-Change determinants and creates an accessible, supportive environment would enhance equitable exercise opportunities for Black individuals with hypertension. Additional recommendations for designing such a program are provided.