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

为阿巴拉契亚农村妇女提供心血管疾病预防信息：一项社区参与的混合方法研究

基本信息

批准号：
9981495
负责人：
Jessica Ruth Thompson
金额：
$ 2.24万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2021-04-30
项目状态：
已结题

项目摘要

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.

项目概要/摘要阿巴拉契亚地区主要是农村地区，社会经济地位较低，过早死亡率为 25% 高于美国所有县。1,2 阿巴拉契亚人口的心脏病发病率明显更高死亡率与全国平均水平相比，3 其中女性死亡率较高。4,5 不受控制的心血管疾病 (CVD) 危险因素，6-8 需要制定增加 CVD 的策略阿巴拉契亚农村妇女的筛查率是一项公共卫生优先事项。9 全面探索 CVD 预防性筛查需要复杂且相互关联的障碍和促进因素，以更好地了解决策。10,11 建议的 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，完成和阿巴拉契亚农村妇女的筛查后续行动仍然很少。 11 这项研究建立在现有的阿巴拉契亚差异研究表明，一系列相互关联的因素共同影响筛查阿巴拉契亚农村妇女的决策。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 这项混合方法研究包括针对具体情况的策略，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阿巴拉契亚农村妇女进行 CVD 预防性筛查。17,18 通过一种新颖的社区参与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宾夕法尼亚州阿巴拉契亚乡村各县之间的不同模式，以及 2) 确定社区对阿巴拉契亚农村妇女接受预防性心血管疾病筛查存在一系列障碍和促进因素。拟议的研究将为“健康人民 2020”目标提供信息，以评估与人口统计相关的健康差异性别、社会经济地位和地理位置28等因素，并将解决 NHLBI 进一步面临的关键挑战探索研究中的性别/性别特异性，并推进描述暴露特征的方法以了解人群之间的健康差异。29 为了促进这项研究，我将进行教育和培训发展以下方面技能和知识的机会：1) 女性心血管疾病预防，2) 空间分析，3) 概念图方法，4）影响农村的环境和社区层面因素的作用阿巴拉契亚地区的妇女健康，以及 5) 与社区一起拓展以行动为导向的研究技能我将在专门的多学科指导的支持下进行拟议的研究。团队在匹兹堡大学资源丰富的环境中成功完成此任务。奖学金，我将做好准备实现我的长期目标，即获得教职并拥有一个在慢性病预防、健康差异和基于社区的独立科学研究事业专门研究农村和阿巴拉契亚女性人口。