Paper
Friday, 21 July 2006
This presentation is part of : Health Promotion Initiatives
Understanding Health Attitudes and Behaviors in Carriacou, Grenada: Applying the Cognitive Activation Theory of Stress (CATS)
Ann M. Dozier, RN, PhD1, Robert Block, MD1, Trevlyn Cox2, Deborah Levy, MD3, Eugena Noel2, and Timothy D. Dye, PhD1. (1) Community and Preventive Medicine, University of Rochester, Rochester, NY, USA, (2) Admnistration, Princess Royal Hospital, Carriacou, Grenada, (3) Internal Medicine, Harvard Vanguard Medical Associates, Jamaica Plains, MA, USA
Learning Objective #1: Describe key elements of Ursin's Cognitive Activation Theory of Stress Model.
Learning Objective #2: Explain health related behavior(s) among one group of english-speaking carribean resident.
Rapid Assessment Protocols are useful in formative stages of screening and intervention programs, but utilization of analyses and results is inconsistent and not well defined. Carriacou, Grenada’s second largest island (~5,500 inhabitants) an early site for the Grenada Heart Project, a study of cardiovascular risk among a population early in the epidemiologic transition. A mixed gendered US/Carriacou team deployed a Rapid Assessment Protocol based on pre-identified domains relevant to cardiovascular health. Following participant observation (3 days) and 25 semi-interviews (health, government, business owners leaders), analyses employing iterative processes were used to identify key themes. Findings were organized using Ursin’s Cognitive Activation Theory of Stress model (CATS). Ursin refers to “load” as stimuli experienced by individuals potentially resulting in psychological stress (alarm) leading to feedback which can further increase “load”. Ursin emphasizes individuals’ unique internalization of “load” determining a stimuli’s positive or adverse health consequences. Load for Carriacou adults included family histories (diabetes, hypertension), poor health habits, a lack of family/household resources, work demands, poor health care access, experience and attitude about health services, knowledge about cardiovascular health, migration, social involvement and environment (political, physical). “Load” internalization resulted in uncertainty about health, grounded in a perceived lack of control over one’s current and future health, mistrust of the health system, and fear of loss associated with illness. Few adults sought information or screening for known familial conditions. By contrast, functional limitations affecting ability to work were strong motivators. Health seeking behaviors included exercise, dieting, and seeking medical care for illness confirmation. Individuals were likely to use alternative treatments (‘bush medicine’) rather than prescribed pharmaceuticals. The CATS model can be effectively applied to cardiovascular health improvement programs taking into account this population’s uncertainty about health and lack of control, lack of knowledge, the value of maintaining functionality, and preferences for non-pharmaceutical treatments.

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