Exploring Intersectionality and Teachable Moments: The Impact of Cardiovascular Disease Diagnosis on Preventive Care Utilization

Cardiovascular disease (CVD) stands as the primary cause of disability and mortality among midlife adults within the United States, yet preventive care utilization of CVD remains suboptimal. Extant research has established that individuals diagnosed with CVD face heightened risks of subsequent health complications, necessitating increased engagement with preventive healthcare. However, scant attention has been directed towards delineating factors moderating the association between CVD diagnosis and preventive care utilization, notably the potential interplay of race and gender. Grounded in the heuristic of teachable moments, this study examines the influence of CVD diagnosis on preventive care utilization among midlife adults, incorporating the theoretical lens of intersectionality to explore the intersection of race and gender as moderators.

Utilizing a longitudinal design and drawing from six waves of the National Longitudinal Survey of Youth 1979 (NLSY79) spanning 2006 to 2016, this study examined a nationally representative sample (n = 6,222). CVD diagnosis was ascertained via self-reported physician diagnosis of specific health conditions. The study encompassed five preventive care services: influenza vaccination, blood cholesterol, blood sugar, and blood pressure testing, and electrocardiography (EKG) testing. Logistic regression models were deployed to scrutinize the principal relationship and its moderation.

Intersectionality between race and gender was evaluated through two two-way moderation analyses, initially treating race and gender as discrete entities to ascertain their independent moderation effects. Subsequently, a three-way moderation analysis was conducted to probe the combined moderation of race and gender. Findings revealed that midlife adults with a CVD diagnosis exhibited heightened utilization across all preventive care services, with EKG testing demonstrating the most pronounced likelihood. While race and gender independently failed to moderate the primary relationship, Hispanic ethnicity weakened the moderation effect between women's gender and the utilization of influenza vaccinations and EKG tests. Notably, three-way moderation was confirmed for influenza vaccinations and EKG tests.

These findings underscore the potential of a CVD diagnosis as a teachable moment, prompting individuals to engage more comprehensively with preventive care services. The findings also reveal the importance of treating the intersectionality of race and gender as a hiding place of health inequality. Implications for clinical practices include the following: Timely interventions by healthcare providers are advocated to capitalize on these pivotal moments. Addressing the multifaceted influences of racial and gendered experiences necessitates tailored strategies, including enhanced physician training in patient-centered communication, community-led initiatives on health beliefs and trust, and legislative measures to bolster insurance coverage for priority preventive care services. Future research should delve into the heterogeneous impacts of CVD diagnosis across diverse population groups, develop and assess interventions centered on teachable moments and intersectionality.