title: A community-oriented primary care demonstration project: refining interventions for cardiovascular disease and diabetes.
abstract: BACKGROUND
  We describe a community-oriented primary care project that implemented all 5 steps of the formal model. Data are presented on cardiac risk factors, protective behaviors, health locus of control, and stage of readiness for change in an African American community. We discuss the use of these data to refine our health promotion interventions.
  
  
  METHODS
  We undertook a cross-sectional study of self-reported health behaviors from a door-to-door household survey of a geographically-defined community. Trained community members administered the survey questionnaire, which was completed in 386 of 557 randomly sampled households (response rate 69.4%). Qualitative discussions of survey results with 2 community groups were taped, transcribed, and analyzed for common themes.
  
  
  RESULTS
  Compared with their counterparts, respondents who were older than 65 years (P = .0006), who had hypertension (P <.0001), and who had diabetes (P = .001) had higher mean scores for powerful others locus of control. Rates for physical activity and low-fat diet indicators were low compared with national statistics. Most respondents reported a maintenance stage of change for exercise (46.2%) and diet (57.5%). Group discussions found lack of local exercise resources and high-quality grocery stores to be major barriers to health behavior change. Ministers and physicians were identified as important powerful others.
  
  
  CONCLUSIONS
  This study documents low rates of physical activity and healthy dietary patterns and describes recent interventions to address environmental barriers to behavior change. The association between powerful others locus of control and specific cardiac risk factors has prompted a greater emphasis on developing faith-based interventions and renewing physician-counseling efforts. Stage of readiness for change findings have prompted strategies to disseminate existing diet and physical activity recommendations more effectively.
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC, USA. Marcus.Plescia@ncmail.net
authors.forename: Marcus
authors.initials: M
authors.lastname: Plescia
authors.forename: Martha
authors.initials: M
authors.lastname: Groblewski
mesh_terms: D001741:Black or African American / Q000193:education / Q000523:psychology*; D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control*; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007389:Internal-External Control; D008019:Life Style; D008297:Male; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States