Heart healthy change: The barriers women encounter

It was only a decade ago, when the majority of Canadian women thought of heart disease as a health threat that mainly concerned men. Today, more women recognize that they too need to pay closer attention to their heart health.

In fact, 90 per cent of 1,000 women recently surveyed revealed that they would like to meet with their family doctor to either discuss heart disease, or ways to reduce their risk of developing this leading health problem.1 The finding is encouraging as it suggests women are looking for ways to reduce their personal risk. Yet, in this important pursuit, women can face a unique set of challenges.

Symptoms may differ
The most immediate barrier to heart healthy living is a limited awareness of when protective measures are particularly important. As with men, heart disease is the primary cause of death and disability. Yet, there is a 10-year delay in the onset of this disease among women. Women also tend to develop different symptoms of heart disease, which has likely contributed to a lack of disease awareness. For example, heart disease is often associated with a heart attack (caed acute myocardial infarction), or sudden cardiac death. These forms of heart disease are more common in men. Women more often develop symptoms of pain or discomfort in the chest (angina pectoris), which can have a more gradual onset. Alternate symptoms of heart disease are also more likely among women, such as nausea or pain in the upper extremities such as the jaw. As a result, heart disease has been recognized less frequently among women.

Although women increasingly recognize that heart disease can affect their personal health, a recent study reveals that only eight percent of women identified it as being the greatest health problem that threatens their survival.2

Multiple social responsibilities
Social barriers encountered by women are also important when it comes to heart healthy lifestyle change. A woman’s need for a healthy and satisfying lifestyle can easily become lost in the midst of accepting multiple social roles and responsibilities. And the list is long. It includes supporting a partner or spouse, taking care of children or elderly parents, maintaining a household, securing an independent income, performing up to the daily standards of the workplace, and attempting to develop a career within a competitive work environment.

While it is unfair to suggest that women are alone in facing these multiple demands, the degree of responsibilities assumed is high. Recent information from Statistics Canada supports the view that women experience a greater range of social responsibilities and demands, as compared to men.3 Women, for example, spend a greater number of hours per day doing household work and related activities. They also report less “free time” overall, including time for active leisure and sports activities, as well as socializing inside or outside of the home. Surprisingly, women spend only one hour per day less than men on paid work and related activities, despite meeting the additional demands they encounter.

Social demands and responsibilities, inside and outside of the home, can trigger changes in mood and emotional functioning. Symptoms of chronic stress, anxiety, or depression are more common among women. They need to be taken seriously, and often pose barriers in initiating or maintaining heart healthy lifestyle habits. For example, among women who participate in formal programs for exercise, or smoke-free living, or heart healthy eating, these psychological symptoms can lead to increased rates of dropout. They can also cause women to slip back into lifestyle habits that can negatively affect their heart health and quality of life.

Overcoming Barriers
Behavioural research shows that we can take an important step towards a lifestyle that feels more satisfying by first thinking about our personal goals and priorities. I’d suggest two key questions.

1. With your new lifestyle, what do you most hope to enjoy or to do in your life?
2. What concerns you most if your daily activities or lifestyle habits don’t change?

As you respond to these questions, you may be reminded of the barriers that stand between you and your lifestyle change. These barriers may even feel overwhelming at times. It is usually helpful to identify your most important barriers, and then to give yourself time to experiment with different coping responses. Think of these experiments as a learning experience, where your confidence in being able to enjoy your new lifestyle will develop gradually. You may want to give these experiments between two to four weeks before feeling committed to a set plan for lifestyle change. This allows you the time to develop at least a few strategies for successfully managing the barriers to your new lifestyle habits.

As we know, it is not always possible to control our exposure to medical, social, or psychological barriers. But it is possible to control how we respond. And a response where we can see ourselves pursuing personally meaningful goals for our heart health and quality of life, will always feel like the better path.

1. Mosca L., Jones W.K., King K.B., et al. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. Arch Fam Med 2000; 9:506-515

2. Bello N, Mosca L. Epidemiology of coronary heart disease in women. Progress in Cardiovascular Diseases 2004;46(4):287-295.

3. Statistics Canada, CANSIM, Table 113-0001, 2005-08-25.

About the author
Dr. Robert Nolan is Director of the Behavioural Cardiology Unit, University Health Network

Quaker logoProvided by www.quakerheart.ca – an online resource designed to help empower Canadian women to take charge of their heart health and inspire heart healthy living for those around them.