Informing Cardiovascular Disease Prevention among Rural Appalachian Women: A Community-Engaged Mixed Method Study

PROJECT SUMMARY/ABSTRACT In Appalachia, a largely rural and low socioeconomic status region, premature mortality rates are 25 percent higher than all US counties.1,2 Appalachian populations have significantly higher rates of heart disease mortality compared to national averages,3 including high rates for women.4,5 With high proportions of uncontrolled risk factors for cardiovascular disease (CVD),6-8 the need for strategies to increase CVD screening rates among rural Appalachian women is a public health priority.9 A comprehensive exploration of the complex and interconnected barriers and facilitators for CVD preventative screenings is required to better understand decision-making.10,11 Recommended screening for CVD covers physiologic tests (e.g., cholesterol, blood pressure) and self-reported behaviors (e.g., smoking, physical activity).12,13 However, the completion and follow-up from screenings by rural Appalachian women remains low.11 This research builds upon available Appalachian disparity research, which suggests a range of interconnected factors combine to affect screening decision-making by rural Appalachian women.14-27 As a gap exists between knowledge, attitudes, and beliefs and screening behavior,17,20,26 this mixed method study consists of context-specific strategies to uncover interconnections between individual, social, and environmental levels and to inform interventions to increase CVD preventative screenings by rural Appalachian women.17,18 Through a novel community-engaged mixed method approach of combining spatial analysis and concept mapping, this research aims to: 1) Assess the association of county-level resource distribution and cardiovascular health outcomes for women to identify varying patterns among the rural Appalachian counties of PA and 2) Identify community perceptions of the range of barriers and facilitators to the receipt of preventive CVD screenings by rural Appalachian women. The proposed study will inform the Healthy People 2020 goal to assess health disparities in relation to demographic factors such as gender, SES, and geographic location28 and will address NHLBI?s critical challenges to further explore sex/gender-specificity in research and to advance methods for characterizing exposures to understand differences in health among populations.29 To facilitate this research, I will undertake educational and training opportunities to develop skills and knowledge in: 1) CVD prevention among women, 2) spatial analysis, 3) concept mapping methodology, 4) the role of environmental and community-level factors that affect rural women?s health in the Appalachian region, and 5) expand skills in action-oriented research with community partners. I will conduct the proposed research with support from a dedicated and multi-disciplinary mentorship team in a resource-rich environment at the University of Pittsburgh. Upon successful completion of this fellowship, I will be well-poised to meet my long-term goals of attaining a faculty position and having an independent scientific research career in chronic disease prevention, health disparities, and community-based research with specialties in rural and female Appalachian populations.