CARDIOVASCULAR DISEASE

I N AF R I C AN AM E R I C AN WO M E N

LITERACY, CULTURE, AND LANGUAGE

Teaching is the most effective method to preventing or alleviating any disease, and must consider direct and indirect causes. The nurse should teach control of blood pressure, obesity, smoking, diabetes, and enhance physical activity. Integration of literacy, culture and language improve quality of care for vulnerable populations. Health literacy is critical; it can affect adherence to treatment, and description and recognition of symptoms. A warm environment is needed when educating a vulnerable group to minimize stigma. The interpreter must have medical knowledge, the ability of translation, and must be culturally competent.
Andrulis, D., & Brach, C. (2007).

PRINTED MATERIALS
Forty four million American adults have literacy skills below the fifth grade level. A high percentage is the vulnerable black population. Out of one hundred seventy four printed materials, about diet and physical activity only one was identified specifically for African American women, and was at a tenth grade reading level. The most easily available form of education does not reach its most vulnerable audience. Most materials distributed did not describe the correlation between exercise and diet and obesity and high cholesterol. The printed information does not address African American women, is not culturally relevant, is difficult to read, and does not emphasize the correlation between diet, physical activity, and CVD reduction.

Sellers, et al., (2003).

SOCIAL JUSTICE
Social justice advocacy is an important key in direct care, education, and research and policy development. It is the ethical core of the nurse to have a nonjudgmental and non-discriminative approach towards those receiving care. Social justice strives to eliminate health care disparities by ensuring equal access to quality health care. An element of social justice is having respect and dignity for all is a basic human right, as is the access to health care.
Pacquiao, D. (2008).

POWER OF CHURCH
The most important coping mechanism for this group is faith, religion, and prayer. African American women are most satisfied with information provided by community and churches. The churchs power in health promotion is evident, and supported in Project Joy: Faith Based Cardiovascular Health Promotion for African American Women. The scientists examined three groups of participants:
The self help control group received educational pamphlets from American Heart Association regarding healthy diet, physical activity and smoking cessation. Additional help was offered via hot line. The spiritual intervention group held weekly sessions with aerobic exercise, gospel music and praise. They had direct contact with leaders of the church. The pastor of the church offered regularly education about diet. Participants were reached via personal calls by the church bulletin. The same activity was offered to the standard intervention group but the meeting held weekly was without the spiritual elements in the beginning of the program.

One year after beginning the program the groups were compared. The spiritual intervention group achieved the best results. They reduced weight, improved blood pressure, and understood the influence of diet and enhanced physical activity. The control group reduced only one out of thirteen risk factors.

Yanek et al., (2001).

COMMUNITY INVOLVEMENT
Two hundred and sixty low income African American women over the age of thirty five were involved in the study for CVD intervention at community health care centers. Participants were divided into standard comprehension and comprehensive intervention groups. All women had access to the low cost or free clinic. They received counseling from health care providers, and culturally competent education materials regarding physical activity and nutrition. The comprehensive intervention additionally received motivational newsletters, an introductory phone call, and fourteen motivational counseling phone calls from researchers. The sample group in the study with hypertension, diabetes, and hyperlipidemia showed most improvement, with more effective results in the comprehensive intervention group. Overall the study shows that the motivational telephone calls, culturally competent printed materials, trained healthcare team were effective, important strategies.

Parra-Medina et al., (2011).

OVERALL
Based on evidence and literature, comprehensive and aggressive intervention is needed to prevent and alleviate CVD in African American women. Effective methods take into account the role of culture, church authority, use direct assistance, appropriate teaching material and respect race and gender roles. Nurses should use all these outlets and be culturally competent to better educate her patients. The nurse in planning care should have strong advocacy skills to be able to help African American women, and be able to collaborate with the community and church to deal with CVD.