Various health associations of different countries report cardiovascular diseases ranking first among the causes of death in women. The mortality rate from heart diseases in women is higher than in men, and misdiagnosis is one of the reasons for this. The problem that causes false diagnoses is the difference in clinical manifestations of heart diseases between men and women. Moreover, heart diseases are still traditionally considered more typical in middle-aged men, which often leads to an underestimation of the health risk for women. As Aggarwal et al. (2018) state, “Sex- and gender-specific disparities in outcome persist, particularly, in subsets of women disadvantaged by race, ethnicity, income level, and educational attainment”. Currently, one of the main aspects of the issue is that there is little knowledge about the prevention, symptoms, therapeutic possibilities and forms of cardiovascular diseases in women. Implementation of the PRECEDE-PROCEED model and methods of social cognitive therapy might change the situation and help prevent heart diseases in the fertile women population.
Implementation of the PRECEDE-PROCEED Model
The PRECEDE-PROCEED model helps develop an elaborate system to achieve intended results by encouraging a “diagnosis” of major antecedent factors that will determine the outcome. This approach avoids blind planning by identifying which interventions are more suitable for influencing the healthcare sector. There are several stages of implementing the model into the real-life issue:
Using social diagnosis, researchers can determine how women of the 18-35 age group perceive the risks of heart disease, whom they trust regarding the issue and which social factors affect directly their healthcare decisions. On that level, the evaluation of treatment costs and healthcare services efficiency is also strictly necessary, as they influence strongly the women’s willingness to undergo heart disease treatment.
Epidemiological, Behavioral and Environmental Diagnosis
The quantitative and qualitative evaluation of the heart disease rate in fertile women helps collect crucial data about the current scale of the issue. Moreover, this kind of diagnosis also collects relevant information about different risk factors for this particular group, which would contribute to the awareness of the problem among both women and physicians.
Educational and Ecological Diagnosis
At that stage, researchers determine the factors that would possibly change women’s behavior towards heart diseases, as well as determine the main motivation behind these changes. Sinopoli et al. (2020) suggest that “the patient-related factors are modifiable through culturally appropriate, tailored patient education and treatment strategies that increase patient understanding of the disease and its control” (p. 175). The modifications could be made possible by using the social cognitive theory to change health behavior.
Administrative and Policy Diagnosis
The goal of this stage is to ensure higher accessibility of quality health services for fertile women, as well as reveal and lower the administrative barriers to educating physicians. Bairey Merz et al. (2017) state that “Fewer than one-half (39%) of physicians rated cardiovascular disease in women a 5, and 37% rated it a 4 on an extreme concern scale, placing CVD after weight issues and breast health, respectively” (p. 127). Government should provide higher financial support to the research in the field of heart diseases in women, as well as implement proper healthcare policies regarding more vulnerable women groups.
Process, Impact and Outcome Evaluation
Lastly, the outcomes of the model implementation should be watched closely. As Sinopoli et al. (2020) state, “the PRECEDE-PROCEED model has been successfully applied across a range of preventive health promotion programs including early detection initiatives” (p. 175). The evidence of the model’s success is firm and detailed.
Social Cognitive Theory and Health Behavior
Several studies found an alarming increase in the risk of heart disease in obese women compared to healthy females. This risk persists even when other factors are under control. The question of health-related behavior changes is central to the psychology of health in many ways due to the connection between the mental and somatic state of a person. According to Joseph et al. (2017), “the social cognitive theory explains behavior in a dynamic and reciprocal model in which personal factors, the environment and the behavior itself all interact to produce a behavior” (p. 519). Suggesting a general strategy for developing self-efficacy in relation to healthy lifestyles, a close examination of the target behavior and its specific elements that require the development of skills is necessary. Thompson et al. (2019) state that “providing access to healthy lifestyle options […] has occurred through education to improve the understanding of the reason for medications, cooking demonstrations, and health and peer support as drivers for behavioral change.” It can be safely concluded that the social cognitive theory provides a strong theoretical construct on the basis of how health behavior can be predicted and changed.
Theoretical models should be verified by the data of rural empirical efficiency studies developed on their basis and already carried out preventive programs introduced in current conditions of the US healthcare. The expected short-term outcomes of the implementation of the PRECEDE-PROCEED model may present more timely and competently assessments of the heart disease risk factors in women of reproductive age. Intermediate results would help to also take into account the peculiarities of complaints and clinical symptoms of heart diseases in women, as well as address the lack of health services for more vulnerable groups of women, such as ethnical and racial minorities. The longitudinal studies would affect the low specificity and sensitivity of non-invasive research methods for women and develop a public health program that would specifically target health behavior. The most desired long-term outcome is effective heart disease prevention, increased treatment efficiency and thorough identification of the heart disease risk groups in fertile women.
Aggarwal, N. R., Patel, H. N., Mehta, L. S., Sanghani, R. M., Lundberg, G. P., Lewis, S. J., Mendelson, M. A., Wood, M. J., Volgman, A. S., & Mieres, J. H. (2018). Sex Differences in Ischemic Heart Disease. Circulation: Cardiovascular Quality and Outcomes, 11(2). Web.
Bairey Merz, C. N., Andersen, H., Sprague, E., Burns, A., Keida, M., Walsh, M. N., Greenberger, P., Campbell, S., Pollin, I., McCullough, C., Brown, N., Jenkins, M., Redberg, R., Johnson, P., & Robinson, B. (2017). Knowledge, Attitudes, and Beliefs Regarding Cardiovascular Disease in Women. Journal of the American College of Cardiology, 70(2), 123–132. Web.
Joseph, R. P., Ainsworth, B. E., Mathis, L. T., Hooker, S. P., & Keller, C. (2017). Utility of Social Cognitive Theory in Intervention Design for Promoting Physical Activity among African-American Women: A Qualitative Study. American Journal of Health Behavior, 41(5), 518–533. Web.
Sinopoli, A., Saulle, R., Marino, M., De Belvis, A. G., Federici, A., & La Torre, G. (2020). The PRECEDE–PROCEED a model is a tool in Public Health screening. La Clinica Terapeutica, 171(2), e167–e177. Web.
Thompson, S. C., Nedkoff, L., Katzenellenbogen, J., Hussain, M. A., & Sanfilippo, F. (2019). Challenges in Managing Acute Cardiovascular Diseases and Follow-Up Care in Rural Areas: A Narrative Review. International Journal of Environmental Research and Public Health, 16(24), 5126. Web.