Heart Healthy and Ethnically Relevant (HHER) Tools
The Heart Healthy and Ethnically Relevant (HHER) Tools study developed
a replicable process for redesigning educational tools to improve
diet and physical activity patterns for cardiovascular disease risk
reduction to be culturally relevant for financially disadvantaged
African American women. This process was sponsored by the Centers
for Disease Control and Prevention and is intended to be a replicable
process for use with any health behavior and population of interest.
Initially, we completed a quantitative literature review of diet
and physical activity interventions delivered via health care settings
. This review indicated that primary care-based interventions
yield reductions in cardiovascular disease risk factors, including
physical activity, diet, weight or body mass index, serum cholesterol,
and blood pressure. However, only two studies in this review focused
on African Americans, indicating the need for research in this area.
We then analyzed the readability level of current cardiovascular
disease educational materials on diet, physical activity, or both
to determine whether the materials were written at a level appropriate
for the general public, women, and African Americans. Although some
of these materials were written at a grade level within the acceptable
range (from fifth to ninth grade levels), most were in the higher
end of the range and may not be appropriate for women with reading
levels lower than the fifth grade who are at high risk for CVD .
Next, we developed a system for evaluating print educational materials,
employed an expert panel to review existing physical and diet print
educational materials, and brought the most favorably rated materials
to focus groups with low-income African American women. Based on
feedback from our focus group members, and using theories of cultural
competence, social cognitive theory, and the trans-theoretical model,
we redesigned two materials (one diet and one physical activity)
to be ethnically relevant for our target group. The key features
included readability for low literacy populations and culturally
relevant messages. These materials were brought to a second round
of focus groups and final changes were made.
A paper detailing the HHER Tools process for redesigning educational
materials to be ethnically and culturally relevant for a specific
population has been published in the Journal of Women's Health
. The links below will lead you to the final educational materials,
in PDF format*.
Developed in collaboration with D. Parra-Medina,
S. Wilcox, M. Thompson-Robinson, R. Sargent, L. Thomas, R.M.
Hendrix, T. Byrd, N. Thompson, and D. Sellers, J. Will
SIP12-99 Research Group (2000). Heart Health and Ethnically
Relevant (HHER) Tools. Prevention Research Center, Arnold School
of Public Health, University of South Carolina. Retrieved [DATE]
from the World Wide Web http://prevention.sph.sc.edu/tools/hher.htm
 Wilcox S, Parra-Medina D, Thompson-Robinson M, Will J. Nutrition
and physical activity interventions to reduce cardiovascular disease
risk in health care settings: a quantitative review with a focus
on women. Nutr Rev 2001;59:197-21.
 Sellers, DB; Thompson-Robinson, M; Parra-Medina,
D; Wilcox, S; Thompson, NL; Will, JC. Readability of educational
materials targeting CVD risk factors in African Americans and women.
American Journal of Health Studies 2003; 18(4):188-194.
 Parra-Medina, D; Wilcox, S; Thompson-Robinson,
M; Sargent, R; Will, JC. A replicable process for redesigning ethnically
relevant educational materials. Journal of Women's Health 2004;
* Note: To view the documents in PDF format, you
will need to have Adobe Reader. You may download this program free
of charge from Adobe.