What Race Means for Health among Black Americans: How Microaggressions Shape Self-Efficacy and Readiness for Behavior Change

AbstractObjectives: Persistent racial disparities in cardiovascular health among Black Americans reflect not only structural inequities in the United States, but also the racialized meanings of cardiovascular disease reproduced through public and private health communication. Drawing on ecological systems theory, this research examines how beliefs linking race and cardiovascular disease are reinforced through routine clinical interactions and how these meanings shape health behavior change. Method: Across two experimental mixed-methods studies, a model integrating ecological, social–cognitive, and behavior-change frameworks was tested. In Study 1 (N = 374), health-message framing was experimentally manipulated to examine effects on self-efficacy and decisional balance while controlling for prior experiences of racial microaggression in medical contexts. Study 2 (N = 589) extended this work by testing whether conceptualizations of race as biological/genetic and social/political moderated these effects. A subset of participants (n = 57) voluntarily provided narratives of racially charged healthcare experiences, which were analyzed using reflexive thematic analysis to contextualize quantitative findings. Results: Racial microaggressions from health professionals disrupted self-efficacy and decisional balance for cardiovascular health behaviors. Endorsement of biological versus social race beliefs moderated these effects, shaping both their magnitude and direction. Qualitative findings revealed how everyday clinical interactions reproduce racialized meanings of disease risk and personal control. Conclusions: These findings identify clinical communication as a consequential site where racial meanings of disease are constructed and psychologically internalized, influencing motivation for health behavior change. Addressing biologically essentialist framing in healthcare may therefore be critical for strengthening self-regulation and reducing cardiovascular disparities among Black Americans.Keywords: racial microaggressions; health communication; self-efficacy; decisional balance; Transtheoretical Model; ecological systems theory; racial essentialism; cardiovascular health disparitiesPublic significance statement: How health professionals and public campaigns talk about race matters for behavior change. This research shows that subtle racialized cues in medicine can weaken Black patients’ sense of control and readiness to take preventive action. Training clinicians to avoid biological essentialist framing may improve patient engagement and help reduce cardiovascular health disparities.