Date of Award

Summer 8-17-2016

Degree Type


Degree Name

PhD Nursing




Pamela Galehouse, Ph.D

Committee Member

Catherine Cassidy, Ph.D

Committee Member

Dorothy Carolina, Ph.D


Health Promotion Behavior, Readiness for Change, Health Literacy, Self-Efficacy, Stroke, Urban Black Women, Diabetes


Problem: Black women have been shown to experience higher rates of morbidity and mortality as a result of stroke, cardiovascular disease, hypertension, diabetes and overweight or obesity than women of other races/ethnicities. The ability to avert certain health problems, such as cardiovascular disease, hypertension, diabetes, stroke and overweight or obesity is known to be directly related to active engagement in health promotion behaviors, yet Black women are consistently less likely to engage in these behaviors than are white women. Improved understanding of the various factors that impact individual health promotion behaviors to reduce risk, such as health literacy, self-efficacy and readiness to change, may result in developing more effective interventions to reduce health care disparities in this vulnerable population.

Method: This descriptive, correlational study examined the contribution of health literacy, self-efficacy and readiness for change to health promotion behaviors. The Health Promotion Model served as the conceptual framework. A convenience sample of 132 urban Black women aged 30 to 64 participated in the study. Participants completed a demographic profile and instruments that measured health literacy (Newest Vital Sign), self-efficacy (New General Self-Efficacy Scale) and readiness for change (Health Risk Inventory) and health promotion behaviors (Health-Promoting Lifestyle Profile II).

Results: The majority of the respondents (72.6%) had completed high school and 25% had achieved a college degree. There were positive correlations between each of the independent variables to health promotion behaviors: NVS (r = .244, p < .002), NGSE (r = .312, p < .001) and HRI (r = .440, p < .001). The combination of health literacy, self-efficacy and readiness for change accounted for a total of 29.8% of the variance in health promotion behaviors. A positive correlation was also noted between education and health literacy (rs = .414, p= .001). However, the internal consistency of the Newest Vital Sign instrument, used to measure health literacy, was low (α = .597).

Conclusion: Readiness for change was most highly correlated with health promotion behaviors, a finding consistent with previous studies on changing behavior. The Newest Vital Sign instrument demonstrated poor internal consistency, and although this instrument is widely used clinically, it may not be the best instrument to measure health literacy for research purposes. Replication of this study with larger populations of Black women may further identify these relationships. The reproducibility of these findings may then serve to guide future interventional studies aimed at reducing health disparities among Black women.