This paper addresses the disproportionate burden of cardiovascular disease (CVD) among minority women in the United States, particularly African-American women, who face higher prevalence and mortality rates than their Caucasian counterparts. Drawing on Rogers' Diffusion of Innovation theory, the paper proposes Project "I Know," a targeted educational intervention designed to increase CVD knowledge and awareness through personalized knowledge statements. Nurses and healthcare professionals serve as change agents, conducting risk profile assessments and delivering culturally appropriate, tailored messages to recruited women. The paper evaluates the innovation across five perceived attributes — relative advantage, compatibility, complexity, trialability, and observability — and outlines the communication channels, social system, and change agent roles required for successful implementation.
Globally, cardiovascular diseases (CVD) account for the single largest cause of death among women, causing 8.6 million deaths annually (Keyhani et al., 2008). In the U.S., it is estimated that approximately 38.2 million women currently live with CVD, and more women than men die each year from the disease (Mosca et al., 2007). Cardiovascular disease varies substantially not only across gender lines, but also across different ethnic groups. For example, Hamner and Wilder (2008) noted that the prevalence of CVD is higher among African-American women (49%) compared to Caucasian women (35%). According to Williams (2009), the age-adjusted death rate from CVD in 2002 was significantly higher among African-American women (169.7 per 100,000) than among Caucasian women (131.2 per 100,000). Knowledge and awareness of cardiovascular risk factors remain limited among African-American women; Williams (2009), citing a 2006 survey, noted that while 77% of white women knew that CVD is the single largest cause of death among women, only 38% of Black women were aware of this fact.
Numerous modifiable factors — such as smoking, obesity, physical inactivity, and hypertension — and non-modifiable factors — such as family history, increasing age, gender, and race — place women, particularly women of color, at increased risk for CVD (Hamner et al., 2008). Previous studies have also demonstrated that while some women have limited knowledge about CVD, others underestimate their risk for developing the disease (Hamner et al., 2008; Keyhani et al., 2008). Notably, healthcare professionals are often not aware of gender differences in CVD prevalence and, as a result, contribute to women's lack of recognition and less aggressive management of the disease (Keyhani et al., 2008). Disparities also exist in access to preventive therapies, as physicians often do not recommend referrals that are critical to detecting CVD in African-American women (Williams, 2009).
Despite the obvious benefit of educating women about their CVD risk, the optimal design of resources that will be readily adopted and implemented by women remains unclear. The persistence of gender and racial disparities in CVD has fueled increased attention on the need to develop innovative tools that aid not only in the management of CVD, but also in reducing incidence and mortality rates among women across different ethnic groups. Given that research has shown that most deaths from CVD can be prevented, it is important to equip both women and healthcare professionals with innovative tools that spread knowledge about CVD. The use of Rogers' Diffusion of Innovation theory is central to this effort. Drawing on that framework, the overarching aim of this paper is to design an innovative teaching tool that will assist women living with CVD — or at risk for it — to become more knowledgeable about their CVD risk.
Project "I Know" is a simple, targeted educational resource aimed at increasing awareness of CVD among women, particularly women of color, using knowledge statements that highlight both the prevalence of CVD and information on each woman's individual risk profile. The project also seeks to increase knowledge and awareness of modifiable and non-modifiable risk factors associated with CVD. Nurses and healthcare professionals in clinical settings will act as liaisons by conducting a risk profile assessment that highlights each woman's personal CVD risk. Through collaboration with each recruited woman, they will provide tailored "I know" statements specific to her needs. These statements are designed to encourage women to adhere to simple, accessible messages aimed at reducing their risk — for example, messages about dietary choices that increase CVD risk or information about forms of physical activity suited to their circumstances, ultimately serving to decrease CVD risk.
To reduce racial and ethnic disparities associated with CVD, Project "I Know" also includes culturally appropriate information presented on brochures available in multiple languages. Depending on the target population, the project aims to educate women of different ethnic groups about CVD, address barriers that influence the adoption of preventive therapies, and recommend strategies women can adopt to reduce their risk. Key components of Project "I Know" for African-American women include the following five statements on CVD prevalence and risk factors:
1. Relative Advantage: Since CVD is an important health problem for many minority women, the relative advantage of this project is that, prior to dissemination, a needs assessment (literature review) was conducted to determine the prevalence of CVD among women, particularly women of color. This assessment provided useful information that allows the project to be targeted to the specific needs of each woman. It also recognized the need to incorporate nurses and health professionals in the project's dissemination, as they are critical to ensuring that women receive recommended preventive therapies that ultimately reduce CVD risk, as well as to monitoring progress toward managing CVD.
2. Compatibility: Project "I Know" builds upon the existing healthcare experiences of minority women. The nurses and healthcare professionals they interact with during routine check-ups will act as liaisons by conveying the project's simple messages, increasing women's knowledge and awareness of CVD risk factors within familiar clinical encounters.
3. Complexity: Project "I Know" seeks to reduce women's perception of difficulty in adopting steps to lower their CVD risk or manage existing CVD by using simple messages that increase both knowledge and awareness of risk factors. Because the needs assessment indicated that African-American women often lack adequate information about CVD, equipping women with factual information on modifiable and non-modifiable risk factors may ultimately improve their chances of living free from CVD.
4. Trialability: To ensure that Project "I Know" will be readily adopted by women attending all health clinics, including emergency rooms, nurses and healthcare professionals will begin by conducting a risk profile assessment. These assessments will provide information on CVD risk factors and increase knowledge about ways to decrease risk. The risk profile assessment will also enable healthcare professionals to generate knowledge statements tailored to the specific needs of each recruited woman — for example, statements about her dietary choices or preferred forms of exercise.
5. Observability: To ensure that the outcomes of Project "I Know" are visible to recruited women, the collaborative process between nurses and healthcare professionals during the risk profile assessment phase will increase awareness of modifiable and non-modifiable risk factors. Following the generation of statements that reflect each woman's needs, nurses and healthcare professionals will monitor the progress women make in decreasing their CVD risk during routine check-ups. Efforts will be made to document the lifestyle changes women make as a result of knowing their risk factor profile, such as changes in dietary patterns and physical activity. Because the "I know" statements are tailored to each woman's unique needs, increasing knowledge and awareness will ultimately decrease CVD risk and improve the chance of living free from CVD.
Collective Decision: While healthcare settings administrators may choose to implement Project "I Know," the success of the knowledge statements will rely heavily on the contributions of physicians and nurses working in these settings as they collaborate with recruited women to provide a risk profile assessment and generate statements that target each woman's needs. For women to adopt this project, efforts must be made to engage nurses and healthcare professionals, as they will act as liaisons in disseminating the "I know" statements.
Communication Channels: The risk profile assessment will generate knowledge statements delivered in the form of brochures targeted to the specific needs of recruited women. These brochures will increase women's knowledge of CVD and provide information on ways to decrease their risk through tailored messages that teach the importance of managing CVD-associated risks.
"Collective decision-making and brochure delivery model"
"Healthcare professionals as liaisons and change agents"
Nurses and healthcare professionals are critical to the success of Project "I Know." By acting as change agents, they serve to foster the diffusion of targeted knowledge statements that increase awareness of CVD risk among recruited women. The risk profile assessments conducted in collaboration with recruited women will also ensure that targeted statements on decreasing CVD risk, as well as on managing CVD, are adopted by women. Grounded in Rogers' Diffusion of Innovation theory, Project "I Know" represents a scalable, culturally responsive approach to reducing cardiovascular health disparities among minority women in the United States.
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