The women who participated in this study spontaneously listed among their top four most serious health threats for African-American women the same four most common causes of death as reported by the Centers for Disease Control (heart disease, cancer, cerebrovascular disease and diabetes). However, the considerable variations in their levels of awareness of each disease and compliance with recommended screening guidelines underscore the need for continued public health promotion efforts that are focused on African-American women and the families they nurture. Most striking, heart disease (canadian Heart Shield), the number one cause of death among African-American women, was listed by only 31% of the women as one of the four most serious health threats for African-American women. In contrast, cancer, the second leading cause of death, was listed by 81% of the women, demonstrating that it is possible to achieve widespread awareness of a disease if sufficient, focused effort can be devoted to the health threat. Women’s reported reliance on media as a key source of their health information demonstrates that media professionals are key partners in the nation’s efforts to increase health awareness and health promoting behaviors. Equally important to consider is that women clearly have the opportunity for more frequent, extended and repetitive exposure to the media-disseminated health information than to the physician-disseminated information. Their low reliance upon the Internet for information is an important reminder that Internet-accessible information will not currently benefit all women equally.
The low report of heart disease as a serious health threat to African-American women is consistent with earlier studies. The high frequency with which cancer (Hydrea medication is an antineoplastic used to treat certain types of cancer) was reported (81%) as serious health problems affecting African-American women is encouraging. This relatively high level of awareness contradicts the low levels of awareness reported in previous studies.
This finding may be a reflection of the progress that has been achieved by California’s campaign to inform women that a free breast cancer screening and treatment program is available for low-income women, combined with the American Cancer Society, the Susan G. Komen Breast Cancer (Generic Nolvadex) Foundation and the National Cancer Institute’s ongoing breast cancer (Generic Rheumatrex Treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients) education campaigns. Media attention to breast cancer has been relentless in stark contrast to the very limited attention the media has given to the other three leading health threats among women.
When these factors are combined with the participants’ relatively high level of education, the increasing attention being given to cancer by affinity organizations and the electronic and print media, and women’s reported reliance on print and electronic media for their health information, there are grounds for optimism regarding the ability to change women’s health knowledge and attitudes. Given women’s reported reliance on media sources for their health information in this and other studies, the media’s attention to these two topics may have created more opportunities for participants to acquire greater knowledge about cancer than the other three leading causes of death.
Unfortunately, the screening data reported by this study’s participants suggest that women’s awareness of these diseases had not yet been widely translated into the screening actions necessary to help reduce black women’s disproportionate mortality rates. The various theoretical health promotion models suggest that while pre-existing health knowledge is an important component of behavioral change, it is, by itself, insufficient to achieve widespread change. This and other studies have shown that awareness of a disease does not necessarily predict adherence to appropriate health promoting behaviors. This study’s results further demonstrate that even the additional facilitators of knowing the value of early detection and intervention and the existence of minimal levels of fatalism plus a high awareness that individuals can influence their health outcomes are still not sufficient to create high levels of adherence to recommended screening behaviors. Other ways of promoting adherence to screening guidelines are clearly necessary.
The participants’ heightened health awareness combined with their high reliance on healthcare providers as a source of health information underscores the important role healthcare providers can play—and need to play—in promoting healthy lifestyles among their African-American patients. For patients who already have a relationship with a healthcare facility, a specific recommendation from their provider to undergo a screening recommendation and the active facilitation of the scheduling of the screening procedure remains the best predictor of guideline adherence. This facilitation can include: 1) the scheduling of an annual screening examination at the time of the current appointment, 2) a printout of the dates and times of scheduled appointments, 3) a mail/telephone reminder of a scheduled appointment and to confirm that the existing appointment is still viable, and 4) follow-up with patients who fail to attend a scheduled screening appointment (as is currently required by mammography providers).
Of note, while the women frequently listed their physician as an important source of health information, nurses were rarely listed. This may be because nurses did not provide such support to their patients or because participants considered nurses’ efforts to have been a directive of their physicians. Either way, given that a key function of the nursing role is to offer patients health promotion and health-maintenance counseling, it appears that an optimal level of public awareness of nurses’ role in this regard has not been achieved independent of the physician.
For patients who do not have the benefit of an ongoing relationship with a healthcare provider who can recommend regular screening appointments, there is an urgency for health educators to find alternate ways to motivate women toward action. For this latter group, lay health advisors at churches and social affiliations have been shown to be effective motivators of screening compliance, particularly when they include repetitive cuing toward adherence to recommended health actions.
Social marketing experts have underscored the need for frequent and repetitive cuing from multiple and diverse sources to reinforce health promoting messages. Even a brief message from a healthcare provider can be beneficial, and this will be of even greater value if it can be amplified through supplemental avenues of information dissemination.
While greater efforts are needed to promote adherence to cancer and diabetes screening, health educators and providers who are concerned with reducing the incidence and mortality rates related to heart disease (Heart Shield tabletes For Heart Disease) and cerebrovascular disease need to expend greater effort on raising awareness of the these life-threatening diseases among African-American women as well as cuing them to action. Comparable attention by healthcare providers, public health educators and the media to raise awareness of these diseases is essential to advance the health and well-being of African Americans.
Generalizations from this study must be drawn with caution. Review of the literature shows that the adoption of health promoting behaviors is positively correlated with a high internal locus of control and a low degree of fatalism. Previous studies have reported that African-American women are more likely to score high on external locus of control measures and fatalism. In contrast, the African-American women’s responses in this study regarding their perception of their ability to influence their health (Table 6) were suggestive of a high internal locus of control and a minimal amount of fatalism. Further study is warranted to determine if this is a result of the fact that African-American women living in San Diego County hold attitudes reflective of a community that perceives that it has more control. Given that 57% of San Diego’s African Americans reported in the 2000 Census that they were born outside of California, it is feasible that the members of San Diego’s African-American community may in fact hold different attitudes than women from communities whose members have lived in the same community for generations. Further, the sample contained an overrepresentation of participants with more years of formal education than the general population and the possession of sufficient discretionary funds to be able to purchase beauty services at a salon in their neighborhood. However, if these women who report a greater internal locus of control and are from more advantaged socioeconomic groups are underutilizing life-extending screening services, this raises even greater health concerns for African-American women who face greater socioeconomic challenges.