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Adapting an Evidence‐based Cardiovascular Disease Risk Reduction Intervention to Rural Communities

Johansson, Patrik, Schober, Daniel, Tutsch, Sonja Franziska, Brueggeman, Grant, Leon, Melissa, Lyden, Elizabeth, Schulz, Paula Sue, Estabrooks, Paul, Zimmerman, Lani
TheJournal of rural health 2019 v.35 no.1 pp. 87-96
cardiovascular diseases, community health workers, focus groups, nurses, outreach, patients, risk factors, risk reduction, rural areas, rural communities, rural health, social support, teams, urban areas, Nebraska
PURPOSE: Using the RE‐AIM framework, the primary purpose of this qualitative study was to assess focus group data to generate information on the applicability of an evidence‐based cardiovascular disease (CVD) risk intervention developed for an urban setting for rural areas in Nebraska. We also sought to determine potential adaptations that may be necessary to implement the study in a rural setting. The CVD risk reduction intervention is based on the Community Outreach and Cardiovascular Health (COACH) program, which included nurse practitioner/community health worker teams. METHODS: This qualitative study involved conducting 3 focus groups with patients with CVD risk factors to assess community readiness for participating in the intervention, the mode of the delivery of the intervention, the setting of the intervention, program content, and raising awareness of the intervention. FINDINGS: Findings from the focus groups indicate acceptability toward a CVD risk reduction program modeled after the COACH. Participants favored initial in‐person face‐to‐face interactions with a nurse practitioner that could transition to phone‐based meetings and Skype. In addition, participants underscored that confidentiality can be a concern in small communities and therefore community health workers need to be trusted individuals. Calls for additions to COACH materials were very specific and participants underscored the need for social support. CONCLUSIONS: With minor adaptations, the COACH program can be pilot tested in rural settings to address key health concerns and behaviors that affect risk for cardiovascular health.