Reducing Cardiovascular Disease Risk Factors in Rural Communities in NC

描述（由申请人提供）：项目摘要/摘要心血管疾病（CVD）是美国的主要死亡原因，然而南部和东南部地区农村地区的非洲裔美国居民的CVD患病率最高。非裔美国人携带的心血管疾病的危险因素，往往共同发生的重大负担;这种负担是在农村社区放大。种族和地理交叉点的CVD差异是由个人风险行为驱动的，并因获得优质医疗服务的机会有限、社会经济不平等、医疗基础设施有限和行为改变的环境障碍等因素而复杂化。改善农村非洲裔美国人社区心血管疾病负担的干预措施需要将个人置于更大的社区背景下，并利用新技术来支持行为改变。然而，如何最好地将移动的技术纳入现有的基于证据的干预措施（EBI）仍然是一个新兴领域，在农村社区重要的社会和物理环境因素很少考虑在现有的EBI。拟议的研究将通过确定适应EBI的可行性和有效性来解决文献中的这一差距，以考虑在农村非洲裔美国人社区中重要的社会和物理环境，并确定这些社区中移动的技术的可接受性，以支持行为改变。该研究建立在GRACE项目8年来使用基于社区的参与性研究（CBPR）方法设计和测试干预措施的坚实基础上，以及基于社区的CVD外展，服务和研究的个人和协作专业知识。我们已经开发了一项阶段性CBPR研究，其长期目标是降低东NC的CVD率。本提案的总体目标是评估实施EBI的可行性，以适应农村社区的需求和利益，从而规划大规模研究。为此，我们的具体目标是：1）扩大和维持社区和学术利益相关者的GRACE CVD项目联盟，以制定农村社区成功的CVD风险预防策略; 2）基于以下内容进行混合方法的社区需求和资产评估：a）收集，审查和评估CVD数据的现有来源; B）通过对社区、宗教、社会服务和医疗保健组织进行网络调查，确定社区的优势和资源; c）使用焦点小组访谈确定CVD风险降低EBI组成部分的可接受性和社区成员对可能的干预目标的看法;（d）确定具体的家庭影响（障碍和促进因素）对EBI可接受性的可接受性; 3）采用PREMIER，一种使用干预映射的多组分EBI;以及4）进行小规模随机对照试验以评估a）疗效;以及B）在农村环境中实施经调整的PREMIER的可行性和适应性。

DESCRIPTION (provided by applicant): Project Summary/Abstract Cardiovascular disease (CVD) is the leading cause of death in the US, however African American residents of rural areas in the south and southeast regions have the highest prevalence of CVD of any group. African Americans carry a significant burden of CVD risk factors that often co-occur; this burden is amplified in rural communities. CVD disparities at the intersection of race and geography are driven by individual risk behaviors and complicated by factors such as limited access to quality healthcare, socio-economic inequities, limited healthcare infrastructure and environmental barriers to behavior change. Interventions to ameliorate CVD burden in rural African American communities will require placing the individual in the context of the larger community and taking advantage of new technologies to support behavior change. However, how best to integrate mobile technology into existing evidenced based interventions (EBIs) is still an emerging field and social and physical environmental factors important in rural communities are rarely considered in existing EBIs. The proposed study will address this gap in the literature by determining the feasibility and efficacy of adapting EBIs to consider the social and physical environment in important in rural African American communities and determining the acceptability of mobile technology in these communities to support behavior change. The proposed study is built on the strong foundation of Project GRACE's 8-year history of designing and testing interventions using a community-based participatory research (CBPR) approach, and individual and collaborative expertise in community-based CVD outreach, service and research. We have developed a phased CBPR study with a long-term goal to reduce rates of CVD in Eastern NC. The overall objective of this proposal is to assess feasibility of implementing an EBI, adapted to the needs and interests of a rural community in order to plan a large scale study. To that end our specific aims are to 1) expand and sustain a Project GRACE CVD coalition of community and academic stakeholders to develop successful CVD risk prevention strategies in rural communities; 2) conduct a mixed-method community needs and assets assessment based on: a) assemble, review and assess existing sources of CVD data; b) identification of community strengths and resources using a web-based survey of community, faith based, social service and healthcare organizations; c) determine the acceptability of components of CVD risk reduction EBIs and community members' perceptions of possible targets for intervention using focus group interviews; d) determine specific family influences (barriers and facilitators) on acceptability of EBI acceptability; 3) adapt PREMIER, a multi-component EBI using intervention mapping; and 4) conduct a small-scale randomized control trial to assess a) efficacy; and, b) feasibility and adaption of implementing adapted PREMIER in rural settings.