1) Health outcome of interest: Ischemic stroke mortality.
- Behavior #1: Unhealthy diet. Unhealthy diets contribute to the development of diabetes, high cholesterol, atherosclerosis, and obesity, all of which contribute to the risk for ischemic strokes. Aside from availability of fresh foods in a neighborhood, individuals’ diets are largely influenced by the diets of those around them.
- Behavior #2: Cultural/national views towards health care providers. Hypertension is the most common modifiable risk factor for ischemic stroke incidence and recurrence, but since it is a silent disease, patients often are unaware of the problem before being diagnosed. The national/cultural views towards health care providers weighs heavily into this problem (along with the obvious issue of access of care). While in one community, a yearly check-up may be the norm, other communities may view the doctor’s office as a last resort for medical emergencies or seek out a different form of healing entirely (ie. naturopathic medical providers, spiritual healers).
2) To examine cultural/societal views towards health care providers in the African-American Bay Area population, I could design a survey that asked about frequency of doctor’s visits, awareness of vitals signs and chronic diseases, apprehensions about visiting the doctor, types of healthcare providers one seeks out, etc from both a personal and “in the community” perspective. This could be emailed out as well as distributed in barbershops and grocery stores to get access to a variety of community members.
3) It is important to recognize that the individualized health behavior model is not all encompassing or an accurate way to judge a person’s health behaviors, so yes, considering key health behaviors that are influenced by neighborhood, income, education, etc is important. As an intervention-driven science, the question then becomes what agency do we as physicians have to help our patients make these health behavior changes when factors outside of the office influence them? This makes the argument even more clear for teaming up with lawmakers and marketing companies for public health campaigns and community engagement, to change the environment that negatively impacts the behavior.