Americans’ Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health

Abstract

Background Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans. Purpose We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets. Methods Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument. Results In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans. Conclusions Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health. Keywords Mindset • Lay theories • Health disparities • Race paradox • Mental healthIn 1948, the World Health Organization urged people to replace their notion of health as "merely the absence of disease" with "a complete state of physical, mental, and social well-being" [1]. Seventy years later, studies suggest that Americans have not adopted this more complex and positive model of health [2,3]. Meanwhile, research increasingly demonstrates just how strongly people's thoughts and feelings about health affect their behaviors and outcomes. In recent years, for example, studies have shown that health mindsets shape a range of health-relevant variables, from the effects of exercise [4], to the impacts of stress [5], to the lengths of lives [6].Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information [7] [14], and the social and cultural construction of health and illness [15,16]. Similar to schemas and beliefs, health mindsets include cognitive, emotional, motivational, and  Alana L. Conner

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