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Advisory Committee Chair

Anne W Alexandrov

Advisory Committee Members

Karen C Albright

Patricia C Clark

Erica R Pryor

Cynthia S Selleck

Document Type

Dissertation

Date of Award

2012

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Stroke has increased among young adults, which is concerning for African Americans (AA) who tend to have stroke at an earlier age and an increased risk for mortality and severe disability. Rural dwellers lack resources which may increase their susceptibility to stroke. Regular exercise can reduce stroke; however, physical activity among AA is low. The purpose of this research was to use an Expanded Health Belief Model to examine perceived and actual stroke risk among rural AA 19 to 54 years of age and factors that influence exercise behaviors to reduce stroke risk. A cross-sectional correlational design was used. Participants were recruited from four rural counties in Alabama through "A Promise To Help" mobile healthcare initiative. Data were collected through in person administration of questionnaires and clinic chart review. Analyses included correlations, t-test, Chi-square, and regression. Participants (n =66) had a mean age of 43.3 years (SD =9.39; Mdn =47.0) and were primarily female (71%), with at least 12 years of school (89%), and unemployed (62%). On average, participants had 2.97 (SD = 1.63) out of 8 risk factors for stroke, primarily obesity, hypertension, cigarette smoking, and family history of stroke (FHS). In general, participants did not perceive a high threat of stroke and 44% underestimated their risk of future stroke. The majority (80%) reported engaging in exercise but only 24% reported exercise levels sufficient to reduce stroke risk. Lower BMI, perceiving higher benefits of exercise and fewer barriers to exercise were predictors of better exercise behaviors. FHS did not result in higher knowledge of stroke risk factors, perceived threat of stroke, or exercise, and participants with FHS had lesser future intentions to exercise compared to those without. This study found a high burden of stroke risk, underestimation of stroke risk, and insufficient exercise among rural, young to middle-aged AA. Programs aimed at reducing stroke should focus on improving their understanding of stroke related to their personal risk factors. Specific groups to target are those with obesity, uncontrolled hypertension, FHS and cigarette smokers. Interventions aimed at increasing exercise levels should incorporate strategies that promote benefits and reduce barriers to exercise.

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