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

项目总结/摘要 在阿巴拉契亚，一个主要是农村和低社会经济地位的地区，过早死亡率为25 阿巴拉契亚地区的心脏病发病率明显高于美国所有县。 与全国平均数相比，3包括妇女的高死亡率。 不受控制的心血管疾病（CVD）风险因素，6 -8需要制定策略，以增加CVD 阿巴拉契亚农村妇女的筛查率是公共卫生的优先事项。 CVD预防性筛查的复杂和相互关联的障碍和促进因素需要更好地 了解决策。10，11推荐的CVD筛查包括生理测试（例如，胆固醇， 血压）和自我报告的行为（例如，吸烟、体力活动）。12，13然而， 阿巴拉契亚农村妇女对筛查的后续行动仍然很低。 阿巴拉契亚差异研究表明，一系列相互关联的因素联合收割机会影响筛查 14 -27由于知识、态度和信仰之间存在差距， 和筛选行为，17，20，26这种混合方法研究包括特定于上下文的策略，以揭示 个人，社会和环境层面之间的相互联系，并为干预措施提供信息，以增加 农村阿巴拉契亚妇女的心血管疾病预防筛查。17，18通过一个新的社区参与的混合 本研究采用空间分析和概念图相结合的方法，旨在：1）评估 县级资源分配与妇女心血管健康结果的关联，以确定 不同的模式之间的农村阿巴拉契亚县的PA和2）确定社区的看法， 阿巴拉契亚农村妇女接受预防性心血管疾病筛查的障碍和促进因素。的 拟议的研究将为2020年健康人目标提供信息，以评估与人口统计学相关的健康差异。 性别、社会经济地位和地理位置等因素，并将解决NHLBI的关键挑战， 探讨研究中的性别/性别特异性，并改进描述暴露的方法， 29.为了促进这项研究，我将进行教育和培训， 发展以下技能和知识的机会：1）妇女心血管疾病预防，2）空间分析，3） 概念绘图方法，4）影响农村的环境和社区因素的作用 阿巴拉契亚地区的妇女健康，以及5）与社区一起扩大以行动为导向的研究技能 伙伴我将在一个专门和多学科的导师的支持下进行拟议的研究 在匹兹堡大学资源丰富的环境中，在成功完成此 奖学金，我将做好准备，以满足我的长期目标，实现教师的立场，并有一个 在慢性病预防、健康差异和社区方面的独立科学研究生涯 在农村和女性阿巴拉契亚人口的专业研究。

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.