Beliefs Regarding Lifestyle Health Behaviors Among Older Women in the "Stroke Belt": Research to Inform Practice

Tuesday, July 12, 2011: 8:30 AM

Leanne L. Lefler, PhD, ACNS, APN1
Jean C. McSweeney, PhD, RN1
Debra F. Brown, BSN, RN2
(1)College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR
(2)University of Arkansas for Medical Sciences, Little Rock, AR

Learning Objective 1: Describe cultural beliefs of older women in the stroke belt of the U.S. regarding lifestyle health behaviors for the secondary prevention of CVD.

Learning Objective 2: Identify healthcare provider interventions to decrease the incidence of CVD among older, southern women.


Patterns of geographic variation in cardiovascular disease (CVD) have been persistent in the Southeastern United States for over five decades, resulting in the designation, “stroke belt”. Information is critically needed to help guide risk factor reduction and lifestyle change after a cardiac event that is culturally acceptable to older and diverse women. This study explored beliefs, attitudes, and barriers influencing adherence to lifestyle health behaviors among older, culturally diverse women.


We recruited older women (≥60 years) 6-12 months post cardiac event who attended at least one session from three cardiac rehabilitation programs. We used a naturalistic qualitative design and conducted semi-structured, in-depth interviews. Narrative data were analyzed using content analysis with constant comparison. Descriptive statistics on risk factors and perceived risk for a coronary event were compiled.


The sample consisted of 20 women (20% Black) with a median age of 71-75 years; 70% with some college education and 42% with an income > $30,000/year. They had 5.84 (mean) risk factors for CVD (high-risk designation), however they perceived their risk as “average to low” (4.47; scale 0-10). There was multifactoral cultural variables and beliefs that hindered lifestyle risk reduction. Many did not believe the information received from their cardiac rehabilitation program, others did not attend. A belief of being “fixed” by procedures and medications prevailed; therefore, they did not engage in lifestyle modification. Others did not believe that change was necessary because of age or limited control of their health and left it up to fate or faith. Significant barriers to lifestyle changes, such as environmental, economic, and motivational barriers prevailed. Most felt that taking medications and visiting their physician were sufficient.


In this new millennium, practitioners are encouraged to tailor information and guidance about lifestyle modification for the prevention of CVD among high-risk, culturally diverse women.