Abstract
Black women are more commonly affected and have higher cardiovascular disease (CVD) morbidity and mortality rates than women of other races/ethnicities. 1 –3 Black women are also more prone to develop CVD at younger ages and have a greater likelihood of dying from CVD-related complications between 45 and 65 years of age than White women. 4 Despite having the highest prevalence of CVD risk factors and exhibiting worse trends in cardiovascular health by middle age, Black women are less likely than White women to receive preventive care or engage in healthy lifestyle changes. 4,5 This may be due to persisting gaps in heart disease knowledge and lack of culturally tailored interventions for CVD prevention in Black women. 4,6 The use of self-management interventions that apply skills acquired from health care providers to manage the physical and emotional consequences of living with a chronic illness while participating in daily activities has been effective for hypertension management in Black women 7 and could be beneficial for CVD prevention.
In this issue of the Journal of Women’s Health, Church et al. have provided additional evidence to the existing literature on the importance of tailoring self-management interventions for CVD prevention in Black women while drawing attention to the importance of social determinants of health and mental health. 8 The inclusion criteria included peer-reviewed literature, original research, and prospective clinical trials that were published in English language between September 22, 2018, and June 20, 2023. This systematic review targeted two or more health practice areas and at least one patient-level outcome among Black women of age 18 years and older in the United States. Twelve publications that addressed 10 unique interventions with sample sizes ranging from 11 to 683 were included; 7 of the studies were randomized clinical trials, 1 was quasi-experimental, and 2 had a pretest–posttest study design. All the studies targeted physical activity, but diverse health practices such as nutrition, weight loss, health knowledge, and blood pressure control were also evaluated. In total, 10 of the 12 articles reported significant improvements in at least one CVD risk factor such as weight loss, body mass index, physical activity, blood pressure control, medication adherence, and depression. However, the evidence suggested a weak-to-moderately-high efficacy of the interventions. Only 5 of the 10 interventions specified the health behavior theories and/or conceptual frameworks utilized in the interventions. 8 One of the interventions used was the Chronic Disease Self-Management Program, which is an established self-management approach based on the self-efficacy theory. 7
A Practical Approach to Self-Management Interventions for CVD Prevention in Black Women
Despite the persistent disparities experienced by Black women and widely accepted recommendations for culturally tailored interventions, few programs are specifically designed to combat CVD among them. 4 Furthermore, most interventions that have shown benefits for improving cardiovascular health in Black women do not translate into meaningful population-level impact. 3 This is partly because Black women are differentially impacted by negative psychosocial factors, 9 which adversely affect successful implementation of CVD prevention practices. Therefore, it is necessary that CVD promotion programs targeting Black women consider their personal priorities, varied experiences and backgrounds, and ethnic origins, as well as the effects of genetic admixture and social determinants of health. 1 Nine of the 10 interventions discussed in the review by Church et al. were reported as being specifically adapted for Black women, but only 7 applied deep-level tailoring methods. 8
For Black women, psychological health is the most important health-related priority, followed by financial stability and physical health, respectively. 5 This implies that CVD prevention programs for them must concurrently address their psychosocial stressors and socioeconomic challenges. Black women are doubly marginalized by gendered racism and negative societal stereotypes. 9 Socioeconomic disadvantage further limits their access to empowering resources and adversely affects their perception of CVD risk, engagement in preventive behaviors, and adoption of self-management activities. 9 Therefore, the persistent reluctance to include social determinants of health 10 and psychosocial aspects into CVD guideline recommendations 9 is a challenge to the cardiovascular health of Black women and impedes the consideration of psychosocial factors in CVD prevention trials. This gap is evident in this review by Church et al., 8 showing that mental health was only considered in one of the interventions.
The need for effective prevention strategies is especially urgent for vulnerable populations like Black women where the prevalence of CVD risk factors is high and control of these risk factors remains suboptimal. 11 However, to ensure the successful adoption of health-promoting behaviors, CVD prevention interventions must be individualized, culturally and linguistically tailored, with an understanding that Black women are not monolithic 11 but vary according to the social context of their daily lives. 9 Available evidence suggests that multidisciplinary, multicomponent interventions effectively reduce overall risk in minority populations. 11 Therefore to promote acceptability, CVD prevention interventions designed for Black women should incorporate community health workers with indigenous ties to the community into a multicomponent, multidisciplinary team-based structure that concurrently addresses different CVD risk factors 11 as well as barriers to health care access such as structural racism. 12
Conclusion
Cardiovascular prevention interventions in Black women should be multilayered to include strategies that will impact physical, mental, and social well-being. 5 A successful approach should target all components of American Heart Association’s Life’s Essential 8 while simultaneously considering social determinants of health and the role of the brain–mind–heart–body connections on cardiovascular health. 13 Health education is a necessary component of CVD intervention programs for Black women and should have a strong focus on practical self-management activities including strategies for positively coping with psychosocial stressors. Future studies investigating the efficacy of CVD prevention interventions in Black women should incorporate psychosocial aspects and social determinants of health.
Footnotes
Acknowledgments
The authors extend their gratitude to the numerous health care providers and investigators who are committed to efforts aimed at decreasing gender and racial/ethnic disparities in cardiovascular care.
Author Disclosure Statement
The authors have no conflicts of interest to disclose.
Funding Information
No funding was received for this article.