Reducing Cardiovascular Disease Risk Factors in Rural Communities in NC

描述(申请人提供)：项目摘要/摘要心血管疾病(CVD)是美国主要的死亡原因，但南部和东南部地区农村地区的非裔美国人居民的心血管疾病患病率是所有群体中最高的。非裔美国人承受着经常同时发生的心血管疾病风险因素的巨大负担；这种负担在农村社区被放大。种族和地理交汇处的心血管疾病差距是由个人危险行为造成的，并因获得高质量医疗保健的机会有限、社会经济不平等、医疗基础设施有限以及行为改变的环境障碍等因素而变得复杂。减轻非洲裔美国农村社区心血管疾病负担的干预措施将需要将个人置于更大的社区背景下，并利用新技术支持行为改变。然而，如何最好地将移动技术整合到现有的循证干预措施(EBI)中仍是一个新兴领域，现有EBI很少考虑农村社区重要的社会和自然环境因素。拟议的研究将通过确定调整EBIS以考虑农村非裔美国人社区中重要的社会和自然环境的可行性和有效性，并确定这些社区中支持行为改变的移动技术的可接受性，来解决文献中的这一差距。拟议的研究建立在格雷斯项目8年来使用社区参与性研究(CBPR)方法设计和测试干预措施的坚实基础上，以及在社区心血管疾病外展、服务和研究方面的个人和协作专业知识。我们已经制定了一项阶段性CBPR研究，长期目标是降低北卡罗来纳州东部的心血管疾病发生率。这项建议的总体目标是评估实施EBI的可行性，使之适应农村社区的需要和利益，以便规划一项大规模研究。为此，我们的具体目标是：1)扩大和维持社区和学术界利益相关者的Grace CVD项目联盟，以在农村社区制定成功的CVD风险预防战略；2)进行混合方法的社区需求和资产评估，其基础是：a)收集、审查和评估现有的CVD数据来源；b)通过对社区、基于信仰的社会服务和医疗保健组织的网络调查来确定社区的优势和资源；c)通过焦点小组访谈确定降低CVD风险的EBI组成部分的可接受性以及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(障碍和促进者)对EBI可接受性的接受；3)使用干预地图的多成分EBI--Adapted Premier；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Adapted 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.