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Knowledge versus Perceptions: The Importance of Perceived Cardiovascular Risk on Behavior Change Attempts Among Women Veterans

Farmer Coste MM, Brunner JW, Chanfreau CC, Moreau JL, Moin T, Dyer KE, Huynh AK, Schweizer CA, Finley E, Hamilton AB, Bean-Mayberry BA. Knowledge versus Perceptions: The Importance of Perceived Cardiovascular Risk on Behavior Change Attempts Among Women Veterans. [Abstract]. Circulation. 2019 Nov 11; 140(Suppl_1):Abstract 14090.


Introduction: One American woman dies of cardiovascular (CV) disease every 1.3 minutes, and lifestyle behaviors are major drivers of CV risk. We examined CV risk, knowledge and beliefs/perceptions to understand risk reduction behavior among women Veterans and guide the ongoing implementation of a multi-site, CV toolkit designed to increase risk identification and optimize engagement in care at the Veterans Health Administration (VA). Hypothesis: Women with higher risk, CV knowledge and beliefs about personal risk will be more likely to have attempted behavior change in the past. Methods: We surveyed women who received at least one toolkit component at 3 VA primary care clinics. We examined whether the number of behavior change attempts (e.g. diet, exercise) in the prior six months was associated with CV knowledge, risk factor presence, and beliefs (can reduce risk, CV worry, and perception of personal risk) using OLS regression. Results: Women (n = 85; mean age 60, R 29-86 yrs.) were predominantly white (66%), unmarried (73%), and had some college education (79%). For prior six months, women reported a mean of 5 attempts at behavior change (0-9). Most (97%) had at least one CV risk (e.g., hypertension (56%), hyperlipidemia (53%), diabetes (21%)), and the majority (65%) knew heart disease was the leading cause of death for women. While 85% agreed there are ways to reduce risk, only 42% were worried about their CV risk and 47% perceived a personal risk. Although CV risk, knowledge, belief that risk can be reduced, and perceived risk were associated with past behavioral attempts in bivariate models, only perceived risk (b = 1.13; p = .041) remained significant in multivariate models including CV risk factor presence (b = .287; p = .091). Conclusions: Most women had at least one CV risk, yet despite knowledge about CVD, perception of personal risk was most important for past attempts of behavioral changes. Our findings suggest that education alone about CV risks may not spur behavior change; and addressing immediate, personal risks may facilitate engagement in behavior change programs among women Veterans. Mid-implementation toolkit changes may be required to address the disconnect between actual CV risk and perceived risk among patients at high CV risk.

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