Plant-based Diet Using the Health Belief Model
The Health Belief Model is a guide used to promote health and prevent disease occurrence. It gives results about individual beliefs and predictors of change in health behavior making it the most used model in understanding human behavior (Jones et al, 2015). The steps will involve in designing a quantitative study, abstract, and the formal research paper with title page.
Instructions/Steps in designing a Quantitative Clinical
Study: PICO
To conduct research analysis on the effects of a plant-based diet on heart disease prevention and treatment. This theory evaluates the impact of change behavior in a particular condition. The (HBM) Health Belief Model proposes that the beliefs of people regarding illness, action, perceived benefits, barriers, and lack of participation are cues to wellness.
Formulate the study question: plant-based diet approach to heart disease using the Health Belief Model
Establish the significance of the problem
Search for and critically appraise available evidence
Develop the theoretical/conceptual framework
Generate hypotheses when appropriate
Select the appropriate research design
Identify the population sampling plan
Determine the measures that will be used
Outline the data collection plan
Apply for human subjects approval
Implement the study
Prepare and analyze the data
Interpret the results
Disseminate findings-poster, manuscript
Incorporate the findings in EBP and evaluate outcomes
Abstract
Most of the causes from chronic diseases result from heart diseases. The alarming mortality rate by heart failure has raised concern over the measures that could be implemented for effective management. While medical practices have been used over the years to combat this health issue, the mortality rates still remain high with medication’s increasing costs. In this regard, a wealth of research has resolved in studying the correlation between eating habits and cardiovascular health. Consequently, plant-based diets have been quoted to impact the outcomes of cardiovascular diseases and incidences positively. The purpose of this study is to scrutinize whether plant-based diets positively correlate with the health outcomes of the heart. The study uses a quantitative research method to collect and analyze data. The Health Belief Model is also applied in this study to assess individuals’ tendency to embrace positive health behaviors based on susceptibility, benefits, risks, and actions.
Introduction
Heart diseases are highly associated with high mortality and morbidity rates globally, hence imposing a critical burden on healthcare systems. According to WHO, heart failure (HF) is the leading cause of morbidity in the world. Its prevalence is highly attributed to unhealthy eating habits and sedentary lifestyles associated with westernization and urbanization. Admittedly, heart failure is relatively presumed to be a lifestyle disease whereby people have lost culture in traditional eating habits and embraced the habit of consuming foods rich in calories and fats that significantly affect the heart’s functioning. Following the heated impacts of these eating habits on the heart, a wealth of research has been conducted to reveal plant-based diet influences on cardiometabolic health. Plant-based diets (PBDs) describe the eating habits that emphasize the low intake of animal foods and higher intakes of plant foods. In other words, the high morbidity and mortality rate ignited the need to establish the approaches to correct the challenge. Evidence from various nations has reported the protective effects of healthy dietary patterns on cardiometabolic health, such as plant-based diets. Therefore, this research analyzes the effects of a plant-based diet on heart disease treatment and prevention by utilizing literature from relevant studies. It seeks to answer the question: “Does the consumption of plant-based diets impose significant impacts in enhancing cardiovascular health, using the Health Belief Model?
Background and Significance of the problem
Heart failure has exerted exponential weight on the health systems in the world. HF describes a condition of the heart’s inability to provide an adequate blood flow to meet the standard metabolic needs of the body, usually occurring with preserved or reduced left ventricular ejection fraction. Endothelial dysfunction and atherosclerosis describe the major components of cardiac disease leading to the weakening of the heart’s pumping capability due to deprivation of oxygen to the body and heart (Buthcer, 2020). The disease accounts for over 5.5 million deaths in the US and approximately 23 million people globally. On this note, over 550,000 individuals are diagnosed with heart diseases in the US, among which half of them die within five years (Buthcer, 2020). Several studies reveal that the most predominant risk factors for HF’s development and progression are associated with diet, including dysbiotic micro biome, hypertension, inflammation, obesity, hyperlipidemia, and diabetes (Buthcer, 2020). Nonetheless, the medical community predominantly focuses on pharmacotherapy and devices in management of this health issue while neglecting the impact of nutrition in primary and secondary prevention.
Such could a result of little instruction or information on the nutrition received by the cardiologists. A recent survey revealed that most cardiologists believe that their role entails counseling patients on nutrition, while 90% of them lacked related training (Buthcer, 2020). Such training deficiently in cardiology extends to other fields and consequently elevates the number of cardiovascular disease patients. In other words, the information of how well to diet in the quest to maintain a healthy heart remains insufficient across populations. Seemingly, the current generation associated with high urbanization rates is busy in life activities which prompts them to consume fast foods more than traditional foods. This trend has significantly impacted this population’s health and raised concern about its impact on heart conditions. The rapid increase in sedentary behaviors and high-fat and low-fiber diets adopted in urban areas, contrary to traditional dieting, increases the mortality rates.
Consequently, the medical community has resolved to study the impacts of plant-based diets on cardiometabolic health, which are significantly ignored in the modern generation’s diet. Such follows the coincidental rising of cardiovascular diseases at a time when plant diets are significantly neglected, unlike in the past when they were seemingly a compulsory diet in daily meals, with the heart failure cases minimal (Buthcer, 2020). Studying the impact of plant foods in addressing heart diseases implies critical Significance in the medical field.
Firstly, it will help health practitioners emphasize eh need to reduce the consumption of processed foods and energy-dense foods rich in high saturated fat contend and refined sugars, leading to diet-related diseases. Notably, poor-quality foods result in obesity and cardiovascular diseases whose treatment processes are usually complex (Nkoke et al., 2019). Such has led to the gaining of popularity of the term ‘plant-based within the medical, public, and commercial communities. While previous studies described the health benefits of vegetarian diets consisting of plant foods, current studies emphasize benefits related to the heart’s health. Plant-based diets (PBDs) embrace various definitions but predominantly emphasize the consumption of foods, whole grain, vegetables, nuts, legumes, and seeds (Nkoke et al., 2019). Therefore, the study’s Significance entails informing the medical community on the importance of emphasizing diet change to heart failure patients, and even the general population of the patient to avoid susceptibility to cardiovascular diseases (CVDs).
Literature Review
According to WHO, cardiovascular diseases depict the leading cause of death worldwide, especially in Africa, compared to developed continents and countries. Of the 44% of non-communicable diseases reported in 2016, 10% were from Africa and were heart-related (Lopes et al., 2020). Besides, the patients’ prevalent population included primarily women, young people, and low socioeconomic individuals. Such was associated with increased urbanization and Westernization culture, with most individuals abandoning the traditional diet habits. A growing body of evidence reveals that plant-based foods impose impressive benefits on cardiovascular health. This follows various population-based cohort studies demonstrating an inverse relationship between plant-based food consumption and heart failure incidences. Besides, the nutrition education programs that emphasize the consumption of whole-plant foods depict significant effectiveness in preventing CVDs. Further, plant foods are associated with improvement of glycemic control, blood pressure, and obesity diseases. They also reverse or minimize the progression of atherosclerosis and heart failure. Such is through the reduction of total LDL-C particles, which resist oxidation. Notably, a whole-food plant-based diet demonstrates the ability to reverse angina without invasive or medical therapy. According to Choi et al. (2017), reactive oxygen species (ROS) ignite aortic stiffness, interstitial fibrosis, and apoptosis, which potentially contributes to heart failure progression. On this note, plant-based foods are associated with high anti-oxidant contents, partly reducing ROS and improving myocardial contractility. Contrary, animal-based foods depict lower amounts of anti-oxidants which leads to the reverse impact. On this note, the increase in health-related information through technology-based devices and social media platforms research suggests a growing tendency for individuals to adopt health-conscious behaviors. The current literature reveals that the growing evidence supporting the benefits of a plant-based diet in combating heart diseases has ignited the tendency to consume these foods while minimizing animal products’ consumption.
Supporting Evidence
Research about plant-based diet was initially conducted by Dr. Esselstyn, Dr. Campell, and Dr. Ornish, which established the foundation for the current studies conducted in restorative and preventative cardiac healthcare. On this note, several studies have indicated that plant-based diets significantly contribute to healthy heart conditions by preventing disease and also reversing them. These include the study by Esselstyn (1999) involved studying cardiac patients that had previously conducted unsuccessful earlier interventions such as bypass surgery (Butcher, 2020). One study involved a woman and 23 men diagnoses with angiographically reflective cardiac diseases. The participants’ tests on hypertension, diabetes, and smoking revealed negative results and eliminated dairy, oil, and animal products. While avoiding high cholesterol on an individualized basis, the patients consumed plant-based foods such as lentils, fruits, and vegetables. Cardiac diseases are rare when cholesterol level is maintained at 150mg/dl, and hence was the goal of this study (Butcher, 2020). Biweekly monitoring adherence for five years was maintained while supporting diet through regular meetings to discuss each other’s experiences. Among the 24 participants, six of them withdrew from the experiment within the first two years who later contracted new cardiac events. Of the other 18, 11 of the patients went under angiographic analysis for the entire term (five years). Disease arrest was reported at a 100% rate and regression rate of 73% among eight patients (Butcher, 2020). The mean cholesterol level dropped from 237 mg/dl to 137 mg/dl among the participants with no CAD progression with no interventions and coronary events (Butcher, 2020). The study by Ornish for five years studied 48 patients with CAD in a modification lifestyle group and a control group that relied on medication. The lifestyle group’s interventions included aerobic exercises, plant-based diets, smoking cessation, and stress management training. Out of the 48, only 35 participants completed the study (Butcher, 2020). The results indicated a progression of the disease by the control group while the lifestyle modification group reflected a reversal of the CAD and atherosclerosis. The lifestyle modification participants also reported a reduction in chest pains and improvement in myocardial perfusion and a resultant reduction in healthcare costs for this group, contrary to the control group’s increasing costs.
Further, Campbell’s study involved the disease process and diet of the rural china residents. Predominantly, this took place in the Guizhou province, which is highly associated with plant consumption over three years (Butcher, 2020). In this case, the results revealed zero deaths attributed to CAD in the population of men. Besides, the fat intake was relatively lower than that of fiber intake, unlike in the United States. Animal protein intake was also lower, with a mean cholesterol level averaged at 127 mg/dl than American adults of 203 mg/dl (Butcher, 2020). Generally, the three studies indicate exponentially positive impacts of plant-based foods on heart conditions. The avoidance of animal products, fatty and sugary diets, and consuming plant products reflected a reversal of the cardiac disease condition through reduced cholesterol levels. By contrast, the participants who failed to adhere strictly to the study’s regulations reported a disease progression and re-contraction of the disease. From the above studies, it is generalizable that consuming foods with fewer fats and sugars and mainly plant-based diets reveal valuable benefits in individuals’ health outcomes (Butcher, 2020). In other words, such foods are friendly to the heart since they ease the pumping capability of the heart. These foods also aid in reducing body mass index, which further reduces susceptibility to heart diseases.
Purpose or Aims of the Study
The potential impacts of plant-based diets on heart conditions and mortality rate remain controversial. Various studies, such as the Adventist studies (n=22,000*96,000), indicated positive impacts of a plant-based diet on cardiovascular diseases and low mortality rates (Butcher, 2020). Other epidemiological and interventional human studies indicate beneficial health effects on obesity-related diseases. However, the notion that plant-based diets can positively influence cardiac health, cognitive functions, and mental health remain controversial and less documented. In this regard, the purpose of this study is to review the current evidence-based controlled interventional trials, which are the standard metrics to assess the causality on potential impacts of plant-based diets on brain functions, psychiatric health, and microbiome. In other words, the study evaluates the existing evidence on the potential link between the PBDs and cardiovascular risk profile by comparing the results from different studies focused on the benefits of PBDs over the medical systems of enhancing cardiovascular health.
Theoretical Model or Framework
The effects of plant-based foods on cardiovascular health are best explained through Health Belief Model (HBM), which was developed in the early 1950s. The model has gained exponential prominence throughout the years in guiding health behavior interventions and explaining alterations in health-related behaviors. Through this model, people are encouraged to adopt behavioral changes to combat cardiovascular diseases, nutritional conditions, and high blood pressure. HBM comprises of various constructs, which are perceived threat which consists of perceived susceptibility – individual’s subjective perception of the risk of acquiring the disease and perceived severity – individual’s feelings about the solemnity of contracting a disease (Shojaei et al., 2015). HBM also comprises perceived benefits that describe an individual’s perception of the effectiveness of various actions available to minimize disease threats. In other words, it dispenses that their beliefs influence individuals’ perceptions of a potential outcome in a particular phenomenon. Hence, if PBDs depict positive health outcomes, then they would embrace the diet pattern. Further, perceived barriers define the individual’s belief regarding the potential detrimental aspects of taking a specific health action (Shojaei et al., 2015). Finally, HBM consists of the external and internal cues to actions that determine an individual’s potential to make prompt decisions and their readiness to act. According to the HBM, an individual’s behavior change is highly influenced by a change in belief. In this regard, a behavior change to adopt healthy eating habits is an effective measure in preventing CVD, such as cardiac rehabilitation after coronary artery bypass graft surgery (CABG) (hHojaei et al., 2015). Such is attainable by preventing unhealthy habits through training and education to influence belief changes. In relation to this study, the model asserts that for individuals to embrace healthy eating habits based on plant-based foods, they first have to acquire training and education regarding this change behavior’s potential benefits. However, the patients need to be convinced that the change behavior would positively impact through believing. In other words, changing dietary habits is essentially preceded by beliefs in the potential outcomes.
Methods/Design/Sampling
The study will adopt a quantitative research design in collecting data. The target population will involve middle-aged adults who have contracted heart diseases and adopted dietary change patterns. Remarkably, the sample size will be obtained from the Bamunda residents in Cameroon, Africa. The study aims to use a sample size of 300 participants who will be recruited a list of middle-aged adults with the cardiovascular disease between 2016 and 2019 (n=300). The selection criteria will eliminate the patients with other underlying conditions such as high blood pressure or diabetes. The participants will be trained on a dietary pattern that includes plant-based foods and low fat and sugar content for five years. The diet pattern of the participants will be obtained through questionnaires and interviews. After the start of the program, there will be frequent meetings of all the participants with the trainers to assess the progress and remind them of the importance to adhere to the regulations. The participants’ diet will be classified based on four diet indexes whereby the higher intakes of all the plant foods will receive higher scores in the vegetarian diet index and the overall plant-based diet index (Kim et al., 2019). Further, in the healthy plant-based diet index, higher intakes on only the healthy plant foods will be assigned the higher scores, and in the less healthy plant-based index, higher scores will be given to the higher intakes of only the less healthy plant foods.
Interventions
Cardiovascular diseases claim numerous lives annually. In this regard, measures to curb this disease through are vital. Such is through promoting healthy eating by the community members, especially through consuming plant-based diets over animal products. the community-based programme would minimize mortality rates and substantially reduce the disabilities related to CVDs. Incident coronary heart disease which refers to the hospitalized myocardial infarction or fatal coronary heart disease would also decrease significantly (Kim et al., 2019). The study predominantly advocates for primary prevention measures to control CVDs. The primary intervetions are majorly directed to the susceptible especially the aged, overweight and obese individuas before they develop the disease. on this note, the programme will target this category of individuals by educationg them on the importance of consuming plant-based foods and training them on the effective tactics to achieve the desired results. information regarding weight, age, height, and the current eating habits will be collected by trained personnel to calculate the body mass index. Average weight will define those with a BMI of <25 kg/m² and overweight were those with a BMI of 25 to >30 kg/ m², while those with a BMI of >30 kg/ m² will be classified as obese (Kim et al., 2019). The cholesterol concentration will be measured through the enzymatic method. The diet plan rich in vegetables, fruit, low-fat dairy foods and focused on poultry, nuts, fish, wholegrain cereals, low fats, sugars, and red meat will be provided to the participants. This will follow regular meetings to assess the experience and identify the progress and adherence to the programme. This program’s results is expected to reveal a reduction of about 10% in the 10-year risk score for CVD (Kim et al., 2019). Besides, a meta-analysis of observational studies assessing the effect of long-term adherence to the diet will indicate that modification of CVD risk factors affects the incidence of CVD, coronary heart disease, stroke, and heart failure.
Expected Results/Outcomes
Following the participants’ education and training, it is expected that they would adhere strictly to the dieting measures to reveal viable outcomes. While the participants are relatively dispersed geographically, phone calls and SMSs would highly rely upon to obtain feedback. Hence, the participants are expected to be highly responsive. On this note, the improvement reports are expected to be average among all the participants based on adherence to the measures. Further, the local hospitals’ reports regarding the mortality rates related to cardiovascular diseases and coronary heart failures are expected to reduce progressively throughout the study. Additionally, overweight and obese individuals tend to fall victims to cardiovascular diseases more prevalently than the regular weight counterparts (Shojaei et al., 2016). Such is due to the excessive body fats that tend to suppress the pumping capability of the heart. On this note, it is expected that CVD cases for normal-weight individuals will reduce at a higher rate than for those in the other two weight categories. Notably, the overweight individuals will also depict a more reversible tendency for the CVD cases than the obese counterparts. Although the diet plan includes low-fat foods, the overweight and obese individuals already have accumulated fats in their bodies, more than the usual individuals and hence the difference. However, the eventual result would depict an average reduction rate of the CVD cases for at least all three individuals’ body weight categories. Further, the blood pressure and cholesterol concentration was expected to reduce in a similar trend for the three categories. Finally, the participants are expected to continue with the plant-based diet even after the study following the realized health benefits and getting used to this eating habit.
Anticipated Conclusion
Cardiovascular disease is a fatal disease whose management through medical procedures is seemingly complex. In this regard, the study about the impacts of plant-based diets in managing or minimizing this disease’s cases reveals a significant impact across the world. The Health Belief Model (HBM), which asserts that individual beliefs regarding action, illness, perceived benefits, lack of participation, and barriers are cues to wellness, would play a significant role in influencing more people to embrace the idea of plant-based diets in combating heart failures and diseases (Shojaei et al., 2016). The study revealed some cases whereby various participants with different variables such as body mass index, weights, and socioeconomic status were taken through a plant-based diet program over a similar period (Nguyen et al., 2020). The outcomes of the studies revealed significant improvement in reducing cardiovascular incidences and mortality rates. In this regard, it is factual to conclude that individuals who rely more on plant-based foods reflect healthier hearts than those who consume animal products. Further, cardiovascular disease patient can improve their outcomes by adopting plant-based foods whose impacts are more prevalent than medical practices. Finally, while people tend to believe that other individuals’ outcomes would reflect similar results if subjected to similar conditions, it is anticipated that more individuals would embrace plant-based diets while minimizing the intake of high-fat and sugar content foods like red meat. Such would depict that the argument about plant-based foods having a significant impact on cardiovascular health is authentic.
Possible Limitations
The study contributes to the current literature on plant-based diets in relation to cardiovascular health through a well-organized community-based cohort with regular dietary check-ups and long-term follow-up. However, the study reveals several limitations which should be considered during the interpretation of results. Firstly, the dietary reports were collected from the individual participants, and this would depict measurement errors. Nonetheless, the food frequency questionnaires were administered by a trained interviewer, which revealed high reproducibility. Further, in assessing the degree of adherence to plant-based diets, the study used a sample-based scoring method. The participants in the highest quintiles of all the plant-based diets reflected higher intakes of plant foods and lower animal food intakes (Nguyen et al., 2020). Nonetheless, it is somewhat .challenging to infer an absolute level of animal or plant food intake associated with health outcomes. The sample population was also significantly small, and hence this limited the generalizability of the results. In other words, the impacts of plant-based foods on the study population could depict different results if tested on a diverse population. In this regard, it is recommended that future research utilize different and larger population samples to increase general results’ authenticity. Also, the predictor of nutrition behavior was a critical limitation. Finally, it is possible to have residual confounding remains due to the incorrect or unmeasured variables.
Potential Implications to Practice
In this study, the HBM constructs that included perceived benefits, severity, susceptibility, and barriers and cues to action scores predicted improved approaches to combat CVDs through plant-based diets. The participants believed that these constructs would influence their health and lead them to protect their health. Such follows that educating people based on HBM reveals significant improvements in dietary programs (Shojaei et al., 2016). Besides, the programmed diet was believed to promote awareness that healthy food helps regulate the weight of heart diseases that depict alarming prevalence among overweight and obese individuals. Therefore, HBM based approaches are compelling communication passages to influence people into improving dietary habits. Once people perceive the dietary based on plants to impact their coronary health positively, it is predictable that they would embrace the tendency. This also applies to the overweight and obese individuals who anticipate reducing their weight and relatively reduce susceptibility to CVDs (Salem & Said, 2018). Generally, changing dietary habits is a challenge for most individuals and requires strict discipline in following the diet plan. Such is because a weak convergence from the laid strategies would complicate the anticipated outcomes. Additionally, based on the HBD used in this study, a high tendency to embrace plant-based dietary would result from the people’s observance and education to convince them to change the eating pattern.
Conclusion
Retrospectively, heart diseases depict the most prevalent cause of death in most of the low-income economies. Such induced the need to research relevant measures to combat this disease by the medical community. However, such interventions reveal minimal improvements for cardiovascular disease patients, leading to a heightened emphasis on the consumption of plant-based foods that depict positive outcomes and overconsumption of animal products. The study analyzed the reports of two sociologists who analyzed three cardiovascular disease patients who were subjected to strict adherence to plant-based foods and revealed a positive correlation between the diet and disease outcomes. Further, the study utilized the Health Belief Model (HBM) to assess individuals’ tendency to embrace the idea of consuming plant foods in pursuit of healthy hearts. According to the study, this dietary pattern also works positively by reducing individuals’ weight, which corresponds to the lenient functioning of the heart.
References
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