A Qualitative Perspective of Barriers to Health-Promoting Behaviors of African Americans
Johnson, Rolanda L., Nies, Mary A., ABNF Journal
Abstract: African American mortality and morbidity rates remain alarmingly high. Implementation of health promotion strategies can be effective in reducing these rates. Yet, African American health-promoting behaviors remain inadequate. Exploration of perceived barriers to implementing health-promoting behaviors from a qualitative perspective may lead to a better understanding of African American barriers to healthier lifestyles. The purpose of this study was to explore barriers to health promotion for African Americans from a qualitative perspective. Focus group interviews were held in two southeastern states. The results yielded three themes. These were cost, lack of discipline versus not having enough time, and a lack of motivation. When health care professionals develop treatment strategies for African Americans, these barriers should be considered to aid in the development of more efficacious plans of care.
Key Words: Barriers, Health-Promoting Lifestyles, African Americans.
Mortality and morbidity rates for African Americans remain alarmingly high (Brownson, 2000). This increase can be attributed to a higher prevalence of cardiovascular disease and diabetes mellitus within this population (Nies & Chruscial, 2002; Nies, Chruscial & Hepworth, 2003). Implementation of health promotion strategies including increasing physical activity and better nutritional patterns can be effective in reducing these rates (Brownson, Eyler, King, Brown, Shyu, & Sallis, 2000; Pender, 1996). Nevertheless, African American exercise and nutritional behaviors remain inadequate. According to King, Castro, Wilcox, Eyler, Sallis and Brownson (2000), African Americans are one of the population subgroups that health behaviors remain understudied. More research on negative and positive contributing factors is needed. Although barriers to health promoting behaviors of African Americans have been studied, the literature in this area has focused on quantitative methods. Qualitative studies are limited and verification of established knowledge is needed. Exploring the perceived barriers from a qualitative perspective may lead to a better understanding of African American health promoting barriers to health. The purpose of this study was to explore barriers to health promotion for African Americans from a qualitative perspective.
Pender's Health Promotion Model has been used extensively to explain the health-promoting behaviors of various ethnic-racial groups. Pender's 1987 Health Promotion Model encompasses three classifications of factors: cognitive-perceptual factors, modifying factors, and the likelihood of implementing health-promoting behaviors. Cognitive-perceptual factors have direct effects on the likelihood of implementing health-promoting behaviors; whereas, the modifying factors have indirect effects. Barriers to health are cognitive-perceptual factors, which have a direct impact on health behaviors. According to Pender, the 1996 model includes personal factors, behavior-specific cognitions, and behavioral outcomes. All of these factors may have direct and indirect effects on the likelihood of individuals implementing health behaviors. In this model, barriers to health are encompassed under the grouping of behavior-specific cognition. This model supports the theoretical impact of barriers to health promoting behaviors (Fender, 1996). Structural and personal barriers to health behaviors have been documented in the literature. Personal barriers include lack of energy, motivation and health reasons. Structural barriers include lack of time, family responsibilities, and cost (Jones & Nies, 1996).
Barriers to African American health include both personal and structural categories. In a study of exercise behaviors, African American elders 55 years of age and older reported lack of motivation, time, and self-perception of need as barriers (Walcott-McQuigg, 2001 ). Similarly, African American women 60 years of age and older reported barriers to exercise as feeling fatigued, unsafe neighborhoods, self-conscious feelings toward exercise clothing, and exercising being physically exhaustive (Jones & Nies, 1996). …