Self-Efficacy, Perceived Barriers to Care, and Health-Promoting Behaviors Among Franco-Americans Across Cardiovascular Risk Factors: A Cross-Sectional Study

Abstract

Purpose: To assess the prevalence of perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors among Franco-Americans as a higher-risk group for familial hypercholesterolemia (FH), stratified by cardiovascular risk factors. Design: Cross-sectional survey based on components of the Health Belief Model Setting: Administered in-person at a Franco-American cultural center and online through mailing lists and social media platforms in the Northeastern United States Sample: Franco-Americans and French Canadians (n = 170) Measures: Demographic and clinical characteristics (i.e. high cholesterol, prior heart attack or stroke, family history of atherosclerotic cardiovascular disease (ASCVD), diagnosis of FH), perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors (i.e. taking lipid-lowering medications, seeing a cardiovascular specialist). Results: In a cohort of Franco-Americans, 42 (25%) had both high cholesterol and family history of ASCVD. Among Franco-Americans with both cardiovascular risk factors, 22% had low self-efficacy and only 16% had discussed FH with their physician. Individuals with both risk factors were significantly more likely to report a concern over a future diagnosis as a barrier to accessing health care services when compared with those with neither risk factor (36% vs. 15%, p = 0.014). Overall, other prominent barriers to care included knowledge of when to seek help (27%) and a distrust in medicine (26%). Conclusion: Franco-Americans report significant barriers to accessing health care services. Our findings strengthen the case for developing focused public health strategies to raise awareness for FH, particularly among high-risk subpopulations with unmet cardiovascular needs.

Health-Promoting Behaviors among Older Adults with Noncommunicable Diseases in Rural and Urban Areas during the New Normal Post-COVID-19 Era: A Structural Equation Modeling Analysis

“…This is because PSE increases an individual’s self-confidence and self-care skills; thus, people with higher PSE can improve their HPBs [ 13 ]. The results of this study are consistent with prior studies reporting PSE influences on HPBs among older adults in Thailand [ 12 ], Korea [ 21 ], Indonesia [ 31 ], and the United States [ 32 ]. PSE is a significant factor in improving motivation and, thereby, engagement in HPBs among older adults with NCDs.…”

Applying implementation science to improve care for familial hypercholesterolemia

“…Barriers and facilitators to improving access to care for FH [15 ▪▪ ] and treatment approaches for FH exist [16 ▪▪ ]. Articles included share similar findings: awareness of FH is poor, guidelines are complex and changing, and a focused supportive effort is needed to improve FH management [15 ▪▪ ,16 ▪▪ ].…”

Familial Hypercholesterolemia and Our Family’s Heart History: From Atherosclerosis and Angina to Awareness and Advocacy

“…Years later, while conducting undergraduate research in Maine, I began learning about a genetic lipid disorder—familial hypercholesterolemia (FH)—that increases individuals’ risk of high cholesterol and premature cardiovascular disease, a condition that is even more prevalent in certain ethnic groups, including French Canadians and Franco-Americans, due to the presence of a founder effect. 1,2 While our family’s roots are neither French nor Canadian, it was not difficult to begin drawing comparisons to our family’s risk factors and medical history. 3 It has now been >20 years since my father’s quadruple bypass surgery but only 4 years since we were finally able to identify FH as the potential culprit behind our family’s history of high cholesterol and early heart disease.…”