Cardiovascular Disease Awareness and Scientific Literacy of Women Across the

United States
To Anne Hamik, MD, PhD
Susan Mostofizadeh

Abstract
This proposal describes the development of a survey to determine the extent of womens
knowledge of cardiovascular disease, its risk factors, and the technology used in
identifying risk factors and treating cardiovascular disease. The amount of women who
are aware that cardiovascular disease is the number one leading cause of death for women
has doubled since 1997, but has since grown constant since 2006. This proposal is a
request for funding from The American Heart Association and Matt Fletcher, the grant
manager at the Case Western Reserve University Cardiovascular Research Institute, and a
request for lab space and intellectual assistance from Anne Hamik, MD, PhD, at the Case
Western Reserve University Cardiovascular Research Institute. This proposal details the
need for a more recent study on womens knowledge of cardiovascular health and
disease, as well as the need for a study going into womens scientific literacy with regards
to cardiovascular health and why a survey is an appropriate method to obtain this data.
This proposal begins with a project description and literature review, then goes into the
methodology, schedule of work, researcher qualifications, anticipated involvement, and
budgeting information. Through the application of this survey, womens awareness of
cardiovascular health and disease can be increased as well as their scientific literacy on
the topic. This can assist them in making informed decisions about their health.

Table of Contents
1. Project Description...................................................................3
2. Literature Review..................................................................... 4
2. 1 Background Information.................................................................4
2.2 Methods....................................................................................5
2.3 Significance................................................................................5

3. Methodology..........................................................................6
3. 1 Plan of Work..............................................................................6
3. 2 Analysis....................................................................................7
3. 3 Participants...............................................................................7

4. Schedule of Work.....................................................................7
5. Anticipated Involvement.............................................................7
5. Researcher Qualifications............................................................8
7. Budget................................................................................. 8
8. References...........................................................................10
9. Appendixes..........................................................................11
9.1 Appendix A: Figures.....................................................................11
9.2 Appendix B: Tables......................................................................11

1. Project Description
The objective of this project is to determine the extent of womens knowledge of
cardiovascular disease, the risk factors associated with cardiovascular disease, and their
scientific literacy with respect to cardiovascular disease and the technologies used to
diagnose and treat it. Scientific literacy can be defined as the knowledge and
understanding of scientific processes and concepts. Upon approval for the project, a
survey will be developed that will include questions to identify the extent of the
knowledge that the participant has regarding risk factors of cardiovascular disease, the
treatments of cardiovascular disease, and the preventative measures an individual can
take to avoid fatal cardiovascular disease, as well as the participants scientific literacy in
relation to cardiovascular disease.
The survey will also identify the main source of knowledge that a woman has about
cardiovascular disease. This will allow for companies that develop products to help
combat cardiovascular disease to more effectively market their products. For example,
Xarelto produces Rivaroxaban to help with treating and preventing blood clots. The
results of this survey could help the producers of Rivaroxaban to more effectively
encourage their consumer market to either receive treatment, or to get checked for risk
factors that can lead to blood clotting, thus potentially increasing their sales. This change
in marketing of treatments and testing would allow for more individuals to be aware of
the risks of cardiovascular disease and be able to recognize the testing that should be
done to identify their personal risks. This type of preventative approach will decrease the
number of fatal instances of cardiovascular disease in women.
The anticipated outcomes for this project are that the data collected will indicate large
knowledge gaps in the community. It is expected that most of the knowledge gaps will
fall under the aspects of the survey that test the participants on their scientific literacy
with regards to the technology and procedures used to diagnose and treat cardiovascular
disease. Medical professionals and cardiovascular-oriented technological companies can
then address these large gaps once they are identified.
Upon proposal approval, lab space and intellectual assistance will be requested from
Anne Hamik, MD, PhD in the Case Western Reserve University Cardiovascular Research
Institute. Financial assistance for this proposal will be requested from the American Heart
Association Undergraduate Student Research Program Board and Matt Fletcher, the grant
manager at the Case Western Reserve University Cardiovascular Research Institute. This
project proposal will discuss the current research into this topic, developing an effective,
comprehensive survey, and detail the proposed project timeline. It will close with
information regarding researcher qualifications, anticipated involvement, and budget
information.

2. Literature Review
2. 1 Background Information
Cardiovascular disease is very prevalent in todays society, with about 1 in 3 womens
deaths resulting from it [1]. The amount of women aware that cardiovascular disease is
the leading cause of death for women has doubled since 1997, but has become constant
since 2006. However, awareness of cardiovascular disease statistics is lower in racial and
ethnic minorities. More than 85% of the women who participated in a survey done in
2010 reported that they had seen, heard, or read about women and heart disease in the
past 12 months [2]. In a study done in 2004, it was determined that there is a large gap
between perceived risk of cardiovascular disease and actual risk of cardiovascular disease
[3], [4].
The major risk factors for CV disease are weight gain, high LDL (bad) cholesterol,
physical inactivity, smoking, and high blood pressure [1]. In relation to the prevention of
CV disease, it has been discovered that exercise reduces body weight, blood pressure,
LDL cholesterol, and increases HDL (good) cholesterol and insulin sensitivity [5], [6]. In
the study mentioned previously done in 2004, the participants recognized that lifestyle
behaviors could prevent or reduce the risk of developing cardiovascular disease. In terms
of prevention, the main identified prevention methods were use of fish oil, omega-3 fatty
acids, and aspirin. Furthermore, the respondents identified the major risk factors as being
overweight (41%), lack of exercise (40%), smoking (36%), high cholesterol (31%),
family history (29%), hypertension (19%), and diabetes (7%). In terms of preventative
measures, almost 100% of respondents identified exercise as an activity that could reduce
the risk of getting heart disease [3], [8].
In a study done in Rochester, Minnesota from 2007 to 2011, 294 women were
interviewed at various cardiovascular health events about their knowledge of the disease.
These women knew that cardiovascular disease is the number one killer of women in the
United States, yet they did not know many of the risk factors related to it [7]. In a
separate study done on 1142 women through various electronic communication devices,
it was determined that only 53% of women would call 911 if they believed that they were
having symptoms that indicated a heart attack. This study also determined that the main
barriers that were preventing women from taking preventative actions were family and
caregiving responsibility and too much confusion in the media about what to do in terms
of cardiovascular disease [2], [4].
There are many surgical procedures used to prevent and treat cardiovascular disease that
are not well understood by the general community. For example, angioplasty is a
procedure used to increase blood flow to a blocked artery and reduce a patients risk of
having a heart attack or stroke. The procedure itself consists of threading a special tube
attached with a deflated balloon up to the blocked artery. The balloon is then inflated to
widen the blocked area and allow blood flow to the heart muscle that has been cutoff.
This procedure can also be combined with the implantation of a device called a stent that
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helps to prop the artery open and decrease the chance of another blockage. This
procedure can last between 30 minutes to a couple of hours, but is minimally invasive
because the body is not cut open [8]. With this information, a woman would be able to
feel more comfortable with receiving the procedure, or considering it as an option upon
discovery of a blocked artery. It is important when making medical decisions to have all
of the applicable information available to the patient, so it would greatly benefit medical
professionals to be able to identify what patients typically do not know and share this
information with a patient.

2.2 Methods
A survey will be created to determine womens knowledge of cardiovascular disease and
the risk factors of cardiovascular disease. Surveys create quantitative data about the
tested subject; the main way of obtaining data with surveys is by asking questions and
using the answers obtained to develop the data. However, the information created through
surveys will only represent a fraction of the population. This means that the population
represented in the data will have to be detailed in the final report [9].
Descriptive research will be done through the use of a cross-sectional survey. This will
consist of taking data for many different women at one point in time to determine their
understanding of cardiovascular health and its technologies at that instant. A survey like
this can be administered through online forms and through printed surveys. To ensure that
the population receiving the survey is the population that is being targeted, there should
be a series of demographic questions about the participant in the beginning of the survey
[10]. This type of survey will be beneficial for gaining insight into what the participant
knows about this topic, thus helping the researcher to identify knowledge gaps.
There are several advantages to survey research: it is based on real-world observations; it
can include a large population from various backgrounds; and a survey can provide a
large amount of data in a short amount of time for little cost. However, there are
disadvantages and limitations to survey research: since surveys can collect a large volume
of data and information, it is often easy to lose the significance of the data if the
researcher focuses on the range of coverage; the data obtained often isnt very in depth
information; and it can be hard to encourage enough participation in the survey [9], [10].

2.3 Significance
Since 2012, there has not been a comprehensive study done that identifies womens
knowledge of cardiovascular health and disease. The studies done previously also do not
look into womens scientific literacy with regards to cardiovascular disease. While it is
important that a woman be able to identify the risk factors for cardiovascular disease and
the symptoms associated with the disease, it is also important that she be able to
understand the technology used to identify risk factors and treat cardiovascular disease.
This is important because it allows for women to be able to provide informed consent
when undergoing these procedures and it also makes them more willing to undergo the
necessary testing since they will have a better understanding of their associated risks and
benefits.
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3. Methodology
3. 1 Plan of Work
A survey will be created to determine the extent of womens knowledge of cardiovascular
disease. This survey will consist of a set of comprehensive questions that allow for the
researcher to gain an understanding of the women's knowledge and understanding of
cardiovascular disease. The survey will include questions to determine: demographic
information; socioeconomic information; the womens knowledge of cardiovascular
disease; her knowledge of the risk factors associated with cardiovascular disease; her
understanding of the technology used to test for risk factors; her understanding of the
technology used to treat cardiovascular disease; knowledge relating to the preventative
measures an individual can take to avoid fatal cardiovascular disease; and the womans
main source of knowledge about cardiovascular disease.
The design and execution of this project will take place in five phases. The first phase
will be geared towards research. During this time, the researcher will look into
cardiovascular disease risk factors, the symptoms of cardiovascular disease, the
treatments of cardiovascular disease, as well as the technology used to diagnose and treat
cardiovascular disease. This phase will allow for the researcher to be able to create
comprehensive survey questions that will accurately gauge the participants
understanding of cardiovascular disease.
The second phase will be the development of the survey. During this time, the researcher
will compile all of the research done in phase one into survey questions. The researcher
will also use this time to determine what makes a good survey question and what the
limitations of a survey are. The developed questions will also gather the participants
demographic and socioeconomic information.
The third phase will be the administration of the survey. During this time, the researcher
will distribute the survey to a large number of randomly selected participants to obtain
accurate, reflective data and ensure that the survey is distributed to a variety of locations
(i.e. clinics, gyms, community centers, social groups). The researcher will also use this
time to distribute this survey online and advertise for it on various social media outlets.
The fourth stage of this project will be the analysis of the gathered data. The data will be
analyzed to look for trends in misunderstandings of cardiovascular disease, the risk
factors associated with it, and the technology used to diagnose and treat cardiovascular
disease. This time will also be used to look into how accurate a participants
understanding of the preventative measures to avoid fatal cardiovascular disease.
The fifth, and final, stage of this project will be compiling the results of the survey into
an easily understood report and presentation. The results of these statistical analysis tests
can then be used to develop information to distribute to both medical professionals and
cardiovascular oriented technological companies. Ideally, this information could be used
to assist these individuals with marketing strategies and also, if the medical professionals

are aware of these common gaps in knowledge, they can ensure that their patients have
the necessary information and are informed.

3. 2 Analysis
With cross-sectional studies, it is easy to incorporate questions with quantitative results,
leading to simpler analysis. This will allow for the statistical analysis to be run on a
majority of the results to determine the womens knowledge of cardiovascular disease. To
compare the participants knowledge based on demographic information, an ANOVA
(analysis of variance) test will be done. This test will compare the means of the same set
of data for the different groups. If this test determines that there is a significant difference
in the means of different groups, a post hoc test will be run to determine which groups
were significantly different. Another way that the ANOVA and post hoc tests will be used
is to determine which risk factors were most often unidentified and to determine which
preventative measures were least represented. The quantitative data will also be used to
determine the percentage of participants who can be considered scientifically literate with
respect to cardiovascular disease testing and treatments. The data will also allow for the
researcher to identify the gaps in the participants scientific knowledge of cardiovascular
disease.

3. 3 Participants
The participants for this survey will be about 500 women. These women will be
randomly selected patients at various clinics, gyms, community centers, and social
groups. It is important that the participants be randomly selected so that there is data from
a representative cross section of the population. With respect to the clinics and gyms, the
survey will be made available to women in the waiting room. The survey will also be
made available online. The questions in the survey will work to identify the participants
demographic information.

4. Schedule of Work
This project is projected to last approximately 7 months. Phase one will be about 6
weeks long with the researcher working 10 hours a week. Phase two will be about 4
weeks long with the researcher working 10 hours a week. Phase 3 will be about 4 months
long to allow for circulation of the survey throughout various groups. Phase 4 will only
be about 2 weeks long with the researcher working 10 hours a week. The timescale for
Phase 5 will be the same as Phase 4. Please see Appendix A: Fig. A.1: Proposed Work
Schedule for a visual representation of the work schedule. If approved, this project will
begin in May 2016 and be continued throughout the summer and into the Fall 2016
semester.

5. Anticipated Involvement

Matt Fletcher, the grant manager at the Case Cardiovascular Center, the American Heart
Association Undergraduate Student Research Program Board, and Anne Hamik, MD,
PhD from the Case Western Reserve University Cardiovascular Research Institute are the
intended audience for this proposal. Financial assistance will be requested from Matt
Fletcher and the American Heart Association Undergraduate Student Research Program
Board. From The American Heart Association Undergraduate Student Research Program
Board, I will be applying for the MWA Undergraduate Student Research Program Grant
in the Great Lakes USRP. This will allow for full financial coverage required for this
project. Matt Fletchers assistance will then be required to assist with the allocation of the
grant money to the student researcher and to the lab. Lab space and intellectual assistance
will be requested from Anne Hamik, MD, PhD. Anne Hamik, MD, PhD will benefit from
this project due to its close relation to the work already being done in her lab. It will
provide her with information about knowledge gaps in the community that would
otherwise go unnoted. This can help to influence her decisions when determining
participants for future studies. Matt Fletcher will not necessarily benefit specifically from
this proposal, but it will help him to fulfill his job as grant manager.

5. Researcher Qualifications
I have an in depth knowledge of the symptoms and risk factors of cardiovascular disease
which will help with understanding the research necessary to create comprehensive
survey questions. I also have an understanding of how to create a good survey and what
the limitations of surveys are from previous research in this area. This knowledge will
also help with developing the survey questions from a more logistical perspective and
will help when administering the survey. I also have lab experience from doing lab work
in the Department of Pathology at University Hospitals. This lab experience will allow
me to understand how to effectively work in a lab environment as well as how to present
myself in a professional manner. As an undergraduate Biomedical Engineering, BSE
Candidate, this survey will be relevant to my course material. I have learned about many
different testing procedures for cardiovascular disease in my courses. I have also learned
how to write up lab reports through my course work at Case, which will help in phase 5
of the project.

7. Budget
The researcher for this research project will be paid on an hourly basis. A table detailing
the cost breakdown can be found in Appendix B, Table B.1: Proposed Project Budget.
The total cost estimated for this project is $2,010. This cost can be broken down by the
four phases of the project. The first phase, research, will cost about $480 for the
researcher to work 60 hours. For the second phase, the survey development phase, the
cost will be $320 for the researcher to work 40 hours. The cost for the third phase, the
administration of the survey, is estimated at $1,000. This cost will be used for the
distribution of the survey (i.e. printing costs) and to cover marketing and advertising
costs. The fourth phase, the data analysis, will cost $160 for the researcher to work 20

hours. The application of the survey and distribution of the information obtained from the
survey can be estimated at $210, with $160 going to the researcher for 20 hours of work.
This cost will include the development of an easily understood report with the data from
the survey and the results from the data analysis.

8. References
[1]A. Go, D. Mozaffarian, V. Roger, E. Benjamin, J. Berry, W. Borden, D. Bravata, S.
Dai, E. Ford, C. Fox, S. Franco, H. Fullerton, C. Gillespie, S. Hailpern, J. Heit, V.
Howard, M. Huffman, B. Kissela, S. Kittner, D. Lackland, J. Lichtman, L. Lisabeth, D.
Magid, G. Marcus, A. Marelli, D. Matchar, D. McGuire, E. Mohler, C. Moy, M.
Mussolino, G. Nichol, N. Paynter, P. Schreiner, P. Sorlie, J. Stein, T. Turan, S. Virani, N.
Wong, D. Woo and M. Turner, 'Heart Disease and Stroke Statistics--2013 Update: A
Report From the American Heart Association', Circulation, vol. 127, no. 1, pp. e6-e245,
2012.
[3]L. Mosca, 'Tracking Women's Awareness of Heart Disease: An American Heart
Association National Study', Circulation, vol. 109, no. 5, pp. 573-579, 2004.
[2]L. Mosca, H. Mochari-Greenberger, R. Dolor, L. Newby and K. Robb, 'Twelve-Year
Follow-Up of American Women's Awareness of Cardiovascular Disease Risk and Barriers
to Heart Health', Circulation: Cardiovascular Quality and Outcomes, vol. 3, no. 2, pp.
120-127, 2010.
[4]R. Robertson, 'Women and Cardiovascular Disease : The Risks of Misperception and
the Need for Action', Circulation, vol. 103, no. 19, pp. 2318-2320, 2001.
[5]J. Myers, 'Exercise and Cardiovascular Health', Circulation, vol. 107, no. 1, pp. 2e-5,
2003.
[6]M. Stampfer, F. Hu, J. Manson, E. Rimm and W. Willett, 'Primary Prevention of
Coronary Heart Disease in Women through Diet and Lifestyle', New England Journal of
Medicine, vol. 343, no. 1, pp. 16-22, 2000.
[7]J. Kling, V. Miller, R. Mankad, S. Wilansky, Q. Wu, T. Zais, K. Zarling, T. Allison and
S. Mulvagh, 'Go Red for Women Cardiovascular HealthScreening Evaluation: The
Dichotomy Between Awareness and Perception of Cardiovascular Risk in the
Community', Journal of Women's Health, vol. 22, no. 3, pp. 210-218, 2013.
[8] Keeley, E. C., Boura, J. A., & Grines, C. L., Primary angioplasty versus intravenous
thrombolytic therapy for acute myocardial infarction: a quantitative review of 23
randomised trials, The Lancet, vol 361, no. 9351, pp. 13-20, 2003.
[9]F. Fowler, Survey Research Methods. Sages Publications. Thousand Oaks. 2002.
[10]K. KELLEY, 'Good practice in the conduct and reporting of survey research',
International Journal for Quality in Health Care, vol. 15, no. 3, pp. 261-266, 2003.

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9. Appendixes
9.1 Appendix A: Figures
Figure A.1: Proposed Word Schedule
May
June
July
Aug.

Sept.

Oct.

Nov.

Dec.

Phase 1
Phase 2
Phase 3
Phase 4
Phase 5

9.2 Appendix B: Tables

Table B.1: Proposed Project Budget
Item
Phase 1: Research
Phase 2: Survey Development
Phase 3: Administration of Survey

Cost
$8/hr (~60 hrs) = $480
$8/hr (~40 hrs) = $320
$1000

Phase 4: Analysis of Survey

Phase 5: Company distribution
Total Cost

$8/hr (~20 hrs) = $160

$50 + $8/hr (~20 hrs) = $210
$2,170

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