‘Listen and learn:’ participant input in program planning for a low-income urban population at cardiovascular risk

Abstract

Background Poverty increases the risk of cardiac disease, while diminishing the resources available to mitigate that risk. Available prevention programs often require resources that low-income residents of urban areas do not possess, e.g. membership fees, resources to purchase healthy foods, and safe places for physical activity. The aim of this study is to obtain participant input in order to understand the health-related goals, barriers, and strengths as part of planning a program to reduce cardiovascular risk. Methods In a mixed methods study, we used written surveys and focus groups as part of planning an intervention specifically designed to meet the needs of lower income individuals. Based on prior research, we used Self-Determination Theory (SDT) and its core constructs of autonomy, competence, and relatedness as the theoretical framework for analysis. The study collected information on the perspectives of low-income urban residents on their risks of cardiovascular disease, their barriers to and supports for addressing health needs, and how they addressed barriers and utilized supports. Focus group transcripts were analyzed using standard qualitative methods including paired coding and development of themes from identified codes. Results Participants had health goals that aligned with accepted approaches to reducing their cardiovascular risks, however they lacked the resources to reach those goals. We found a lack of support for the three SDT core constructs. The barriers that participants reported suggested that these basic psychological needs were often thwarted by their environments. Conclusions Substantial disparities in both access to health-promoting resources and in support for autonomy, competence, and relatedness must be addressed in order to design an effective intervention for a low-income population at cardiac risk.

Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005–2018 National Health and Nutrition Examination Survey

“…Adults with lower incomes had a greater risk of death from all causes than adults with a high SES (HR = 2.13, 95% CI = 1.90–2.38) ( 37 ). People with self-reported income in the lowest income bracket between the ages of 35 and 64 were twice as likely to die from myocardial infarction and CHD as those in the highest quartile ( 38 ). There were disparities in CHD mortality between men and women, but both were nearly twice as common in the low-income group compared to the high SES group.…”

Self-determination Theory and Social Work Values

“…SDT is a broad theory of engagement, motivation, and human flourishing that has been applied effectively in education (Miserandino, 1996; Reeve & Cheon, 2021), business (Slemp et al, 2018), health care (Ntoumanis et al, 2020; Ryan et al, 2008), and, more recently, social work (Kirzner et al, 2021). Self-determination theory holds that fulfillment of three basic psychological needs is essential to many aspects of human functioning.…”

“…Limited studies are beginning to identify poverty-related barriers including neighborhood safety, traumatic events, and oppression as part of applying SDT (Gray et al, 2016; Luginbuhl et al, 2016; Quinlivan et al, 2017; van Egmond et al ., 2017). We provide an example of what this kind of research and programming might look like from our own experience with conducting a cardiovascular disease prevention program (Kirzner et al, 2021). Our participants vividly and forcefully identified the environmental barriers which undermined their motivation to make major life changes.…”

“…As part of planning this cardiovascular disease prevention program, the authors and colleagues completed a focus group study exploring participants’ perceptions of their health-related goals and barriers to completing them (Kirzner et al, 2021). The focus group transcripts were analyzed using SDT as a conceptual framework.…”

“…Are participants gaining the skills and knowledge needed to reach their selected goals? For the focus group study, we used the three psychological needs as part of qualitative analysis of participant statements (Kirzner et al, 2021). SDT also lends itself to quantitative analysis.…”