Heart Disease in Women: the Transtheoretical Model

Significance

Commonly referred to as a cardiovascular disease, Heart disease has become increasingly problematic and recognized as a woman's disease. The most common cause of heart disease is the narrowing or blockage of the arteries known as coronary artery disease. Coronary artery disease usually happens slowly over a period causing most women to get into heart attack without warning signs. The reason for this high rate of death among women is partly due to other underlying medical conditions before getting a heart attack, and partly because, the signs and symptoms of myocardial infarction (M.I) are manifested with a vague symptom that can delay diagnosis and treatment thereby leading to an unexpected heart attack. Women often report vague symptoms such as fatigue, weakness, unexplained anxiety, dizziness, dyspnea, lightheadedness, upper abdominal pain, loss of appetite, sweating, and pain in the upper body (arm, neck, jaw, throat, and teeth) and heartburn. Most often, women do not consider these symptoms as signs of myocardial infarction because the pain is usually mild or subtle.

There are known risk factors associated with Heart disease, some of these risk factors are modifiable while others are not. Some of the modifiable risk factors are sex, race, gender, and age. However, the risk factors that can be modified include high blood pressure, tobaccos use, high blood glucose levels, lipid abnormalities, obesity, and physical activity. Prevention and proper diagnosis are very important in saving the lives of many women from a heart attacks. Regular checkup with primary care physician and health screening has been clinically proven as the number one method of preventing heart disease. Prevention can also be done by women participating in a healthy lifestyle, and attending seminars on women and heart disease where they can be educated on how to recognize early warning signs of a heart attack. Women will also be educated on good eating habits as well as regular exercise to prevent plaque buildup in arteries thereby preventing a heart attack. Diagnosing tests can be challenging because most women do not want to go to the hospital despite the advanced imaging technologies.

The target population for this program is African-American Women 45 years and older in Baltimore, Maryland. Although Heart disease is the number one cause of death in women in the USA, killing at least one woman every 80seconds with the death toll at 48000 a year amongst African American (AA) Population, and 21000 a year from the Hispanic population, It is worth noting that about 64% of the female population do not understand that heart disease is the number one killer. About 50% of the African American (AA) female population is aware of the signs and symptoms of Heart Disease thus 50% of the AA female are knowledge deficit on how to prevent these deadly diseases. The continuing burden of HD in the US is largely driven by the high prevalence of major cardiovascular (CV) disease risks factors such as obesity, hypertension, diabetes, and cigarette smoking. Therefore, cardiovascular disease health promotion in the US has witnessed a shift towards trying to improve on HD by reducing its risk factors. Diabetes and hypertension are two of the leading indicators within this priority area that contributes to heart disease, the leading cause of death in Baltimore City. The 2020 goals identified by the American Heart Association (AHA) put the reduction of HD by providing education on how to prevent HD, conducting seminars like the Go Red for women, The Woman's Healthy Heart Initiative Clinic, which focuses on disease prevention and healthy lifestyle management. Despite all these advances made by different associations to prevent HD, the vulnerable population still stands a higher chance to be affected by HD because of low income, lack of jobs, and lack of awareness on how to prevent the disease.

The proposed awareness program will alleviate this public health concern with the following program goals:

Immediate objective:

• Increase knowledge of Heart diseases among African American women in Baltimore, Maryland by 50% within 6 months of Healthy living campaigns and education.
• Increase knowledge of risk factors for Heart diseases among African American women in Baltimore, Maryland by 50% within 6 months of Healthy living campaigns and education.

The awareness of women that heart disease is the leading cause of death increased from 30% in 1997 to 56% in 2012. However, only 42% of women aged 35 and older are concerned about heart disease. After their first heart attack, 26% of women age 45 and older die within a year, compared to 19% of men.6,8,12.

Behavioral objective:

• 30% of African-American women in Baltimore, Maryland will indicate making healthy lifestyle changes as part of their daily routine within 2 years of program implementation.
• Since heart diseases have been tied to major modifiable risk factors, making lifestyle changes will reduce the incidence of heart diseases in women, and these changes will be tracked by completing surveys and assessments that will address physical activity, changes in food choices based on education received during the program and changes in other behavioral aspects like tobacco use.

Health objective:

• To reduce the incidence of Heart Disease in African- American women in Baltimore, Maryland by 10% within 5 years of implementing healthy lifestyle changes.

This is a very important aspect of the program because a decrease in the incidence of heart disease will mean that there will be a decrease in the mortality rate of this population. The overall effectiveness of this goal will be measured by carrying out an evaluation at most hospitals to Telemetry unit and Emergency department to ascertain how many incidences they have quarterly over 5years and the data gotten from this evaluation will be used to compare the previous data provided by these health institutions on the incidence rate of heart diseases in the target population.

Theoretical Approach

An Intrapersonal intervention using the Transtheoretical model will be applied in implementing this program. The transtheoretical theory was developed by Prochaska and DiClemente in the late 1970s. It has gradually evolved through studies that examined the experiences of smokers who were able to quit on their own comparing them to those who were not able to quit on their own. The transtheoretical theory has different Stages of Change which includes; Precontemplation, Contemplation, Preparation, Action, and Maintenance. The pre-contemplation stage is the stage where people do not intend to take action in the foreseeable future (within the next 6 months). The contemplation stage is when the intent to start healthy behavior is seen, Preparation is the stage where people are ready to take action. The action stage is the stage where people have recently changed their behavior and intend to move forward with their changes. Finally, the maintenance stage is the stage where people have no desire to return to their past unhealthy behavior and are sure they will not relapse.

Recruitment will be done into the program by organizing seminars for women in Baltimore City and County through schools, public events, and a health fair organized by hospitals like the University of Maryland Health Fair that takes place in front of the hospital once a year. The activities for this program will focus on creating awareness on heart diseases and how to recognize early warning signs of a heart attack.

At the precontemplation stage, knowledge deficit is identified and supported that only 30% of American women surveyed were aware that Heart Disease was the leading cause of death in women in 1997; although this increased to 54% in 2009, there are still more women to reach out to. Tobacco is a major contributor to early heart attacks, strokes, chronic lung diseases, and cancers. There is also compelling evidence of the harmful impact of secondhand smoke to nonsmokers and children who suffer from respiratory infections. In 2009, the two states that had the highest number of smokers were Virginia and Kentucky with a total percentage of 25.6% in the country. Baltimore City in 2009 was noted to have the highest percentage of adult smokers (28.3%). Today, the rate of adult smokers in Baltimore city has decreased by 20%.6 This finding goes a long way to prove that awareness will go a long way to improving the health issue caused by CVD.

At the contemplation stage, this population should be thinking about changing in the foreseeable future. At this stage, it will be helpful to network with different Non-Governmental Organizations (NGO) such as the Center for Disease Control and Prevention (CDC), the Association of Black Cardiologists (ABC) American Heart Association, and the American Stroke Association (AHA/ASA). Partner with a group of people who have experience from the different departments of health such as nurses who work in the cardiac unit, stroke units, dieticians, and physical therapy technicians. Together, we will schedule screening and diagnostic tests for the population to encourage their interest in the health issue and further awareness. It has been found that diagnosing tests can be challenging because most women do not want to go to the hospital despite the advanced imaging technologies, this is a belief in this population that affects the outcome of Heart disease. For the first time in 2007, the AHA published “evidence-based” guidelines focused on the primary prevention of Heart Diseases in women, which were subsequently updated in 2011 as “effectiveness-based” guidelines. Early screening and a complete Heart Disease risk assessment were advised to reduce the pervasiveness of Heart Disease in women, who were previously largely excluded, or minimally represented in the research.

At the preparation stage, which is the stage at which there is a readiness to do something, it will be appropriate for the women to have received results from their screening tests and a second seminar on risk factors affecting Heart Diseases and how to make changes in the everyday life to reduce the incidence of a heart attack. During these seminars, the population will be educated on what risk factors predisposes them to have CVD and how they can avoid such risk factors and control them. This intervention will help resolve the issue that women are less likely to receive preventive treatment or guidance, such as lipid-lowering therapy, aspirin, and therapeutic lifestyle changes, than are men at similar ASCVD risk.9 A study conducted by Mosca et al, 2006 showed that fewer than half of the respondents were aware of healthy levels of risk factors. Awareness that the personal level was not healthy was positively associated with the action.

At the action and maintenance stages, certain strategies will be implored over a span of time that will transition the target population into action and encourage them to maintain the changes they have adopted. certain available resources and infrastructure that has been already put in place by the government can be identified and advertised to help the women gain access and prepare them for action. The government has built more healthy communities that is, increasing access to healthy and fresh food by improving public transportation and other creative strategies that reduce the impact of food deserts. Communities designed for health promotion provide safer opportunities for residents to walk to schools, parks, recreational facilities, and markets thus enabling them to lead physically active lifestyles. Access to inequities in supermarkets has decreased by 15%, Adults getting recommended levels of physical activity has increased by 20%, and the percentage of adults who are obese has decreased by 15 %.5

Discussion

Some of the strengths of the transtheoretical model is that it recognizes the temporal nature of change in the population and identifies groups who will be more open to certain interventions. It can also address multiple behaviors; this is helpful because of the different stages in the model, therefore it is easier to identify interventions that were responded to positively and negatively, following up with participants is much easier and tracking loss to follow up and program nonresponders. The weakness of this theory is that the relationships between variables are not well established, and predictive power is limited.

In comparing this with the Health Belief Model (HBM), which is an alternative applicable theory, there is an advantage of prediction; the health belief model has a stage called “cues to action” which are prompts to take actions consistent with an intention. Also, this theory establishes a good relationship between variables like age, race, ethnicity, education, and income. These variables are necessary to make conclusions and draw out responders and non-responders, considering why certain groups in this population will respond and why other groups will not respond to the program. Self-efficacy is a component that has been added to the HBM on many occasions since the late 1970s, it was initially introduced by Bandura as an act of confidence which is a belief in one’s ability to execute a given behavior.

The impact of CVHD on women in Baltimore, Maryland can be attributed to the socio-economic impact that is the number of people affected by CVHD is on the rise in low-income Cities because of the poverty rate. One of the obstacles that I may face in my campaign is that they do not have the resources such as health insurance as well as they are exposed more to harmful products such as illicit drugs, unhealthy meals, tobacco, and lack of physical activities, all because these products are very cheap to buy. People in Baltimore city are unable to seek medical help because of a lack of health care insurance thus leading to an increase in the number of people being diagnosed with CVHD per year. Due to the increase in CVHD in the vulnerable population, the health care cost on the government becomes very expensive thereby putting pressure on the rest of the society. 

Conclusion

In conclusion, I will overcome whatever challenges that my program may pose by my initiative which will focus on identifying African-American women who have the disease but are not aware of it. Then, the women will be referred to a local health care provider who will determine whether they need medication or other treatments to help lower their blood pressure. The program staff will also work with the women to help them quit smoking if needed by offering them alternative methods such as nicotine patches. We will teach them about making healthier food choices. Participants will also be able to attend healthy cooking classes offered by the American Heart Association's Simple Cooking with Heart Kitchen and tour grocery stores to learn how to read nutrition labels. They will also receive a free blood pressure monitor so that they can check their blood pressure at home. I will attend health fairs and hope to find participants through these health fairs, community-based organizations, the hospital's community outreach van, or in faith-based centers. Women who come into the hospitals' emergency departments or ambulatory clinics and are newly diagnosed with hypertension will be considered for the program.

References

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