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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 [1]. 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 [2].

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 [3]. The links below will lead you to the final educational materials, in PDF format*.

HHER Lowfat Living
HHER Walking

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

Suggested citation:

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


[1] 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.

[2] 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.

[3] 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; 13(5): 579-588.

* 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.

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