Self-Efficacy, Perceived Barriers to Care, and Health-Promoting Behaviors Among Franco-Americans Across Cardiovascular Risk Factors: A Cross-Sectional Study

Reed Mszar, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Sara Buscher, Division of General Pediatrics, 1862Boston Children's Hospital, Boston, MA, USA.
Dervilla McCann, Department of Cardiology, Central Maine Medical Center, Lewiston, ME, USA.
Heidi L. Taylor, Department of Sociology, 4521Bates College, Lewiston, ME, USA.


PURPOSE: To assess the prevalence of perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors among Franco-Americans as a higher-risk group for familial hypercholesterolemia (FH), stratified by cardiovascular risk factors. DESIGN: Cross-sectional survey based on components of the Health Belief Model. SETTING: Administered in-person at a Franco-American cultural center and online through mailing lists and social media platforms in the Northeastern United States. SAMPLE: Franco-Americans and French Canadians (n = 170). MEASURES: Demographic and clinical characteristics (i.e. high cholesterol, prior heart attack or stroke, family history of atherosclerotic cardiovascular disease (ASCVD), diagnosis of FH), perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors (i.e. taking lipid-lowering medications, seeing a cardiovascular specialist). RESULTS: In a cohort of Franco-Americans, 42 (25%) had both high cholesterol and family history of ASCVD. Among Franco-Americans with both cardiovascular risk factors, 22% had low self-efficacy and only 16% had discussed FH with their physician. Individuals with both risk factors were significantly more likely to report a concern over a future diagnosis as a barrier to accessing health care services when compared with those with neither risk factor (36% vs. 15%, p = 0.014). Overall, other prominent barriers to care included knowledge of when to seek help (27%) and a distrust in medicine (26%). CONCLUSION: Franco-Americans report significant barriers to accessing health care services. Our findings strengthen the case for developing focused public health strategies to raise awareness for FH, particularly among high-risk subpopulations with unmet cardiovascular needs.