Reducing Cardiovascular Disease Risk Factors in Rural Communities in NC

项目摘要/摘要心血管疾病（CVD）是导致美国人死亡的主要原因，但南部和东南部农村地区的非裔美国人的CVD患病率最高。非裔美国人有心血管疾病风险因素的重大负担，这些风险因素经常同时发生；这一负担在农村社区更为严重。种族和地理交汇处的心血管疾病差异是由个人风险行为驱动的，并因获得优质医疗保健的机会有限、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。改善非洲裔美国农村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，如何最好地将移动技术整合到现有的基于证据的干预措施（ebi）中仍然是一个新兴领域，而且在现有的ebi中很少考虑对农村社区重要的社会和物理环境因素。拟议的研究将通过确定调整ebi以考虑非洲裔美国农村社区重要的社会和物理环境的可行性和有效性，以及确定这些社区对移动技术的可接受性来支持行为改变，从而解决文献中的这一空白。这项拟议的研究建立在GRACE项目8年的设计和测试干预措施的坚实基础上，该项目使用基于社区的参与性研究（CBPR）方法，以及基于社区的心血管疾病推广、服务和研究方面的个人和协作专业知识。我们已经开展了一项分阶段的CBPR研究，其长期目标是降低北卡罗来纳州东部的心血管疾病发病率。本建议的总体目标是评估实施适应农村社区需要和利益的EBI的可行性，以便规划一项大规模的研究。为此，我们的具体目标是：1)扩大和维持一个由社区和学术利益相关者组成的GRACE项目心血管疾病联盟，在农村社区制定成功的心血管疾病风险预防策略；2)在以下基础上进行混合方法社区需求和资产评估：a)收集、审查和评估现有的CVD数据来源；B)通过对社区、信仰组织、社会服务组织和卫生保健组织进行网络调查，确定社区的优势和资源；c)通过焦点小组访谈确定CVD风险降低ebi组成部分的可接受性以及社区成员对可能干预目标的看法；d)确定家庭对EBI可接受性的具体影响（障碍和促进因素）；3)采用干预映射的多组分EBI PREMIER；4)开展小规模随机对照试验，评估a)疗效；b)在农村环境中实施调整后的首选方案的可行性和适应性。

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.