Reducing Health Disparities in Appalachians with Multiple Cardiovascular Disease Risk Factors

Grants and Contracts Details


Rural Appalachian Kentucky is an environment with persistently high poverty rates, poor health care access, widespread lack of health insurance, low levels of educational attainment, reduced access to healthy, fresh foods and areas to safely engage in physical activity, and marked health disparities—an environment that we define as “austere”. People living in rural Appalachian Kentucky represent the top 1% of cardiovascular (CVD) risk, morbidity and mortality in the United States. In the proposed randomized trial, we will compare the effectiveness of the following 2 approaches to CVD risk reduction in adults with multiple co-morbid CVD risk factors living in rural Appalachian Kentucky: 1) an individualized, culturally appropriate, self-care CVD risk reduction intervention designed to reduce barriers to risk reduction found in austere environments (HeartHealth); and 2) a referral strategy whereby we find a primary care provider for patients, and refer them to the provider for management that is supplemented by provision of current CVD risk reduction guidelines to the provider. Our team consists of patients, informal caregivers, healthcare providers (i.e., nurses, physicians, dentists, lay community health workers), researchers, and health advocacy individuals from local churches, health departments, senior centers, and extension offices; all of these individuals live in rural Appalachian Kentucky and are affected by CVD health disparities. We will enroll 500 individuals from 26 rural Appalachian counties at high risk for CVD by virtue of having two or more modifiable CVD risk factors. We propose the following specific aims: 1) to compare the short-term post-intervention (4 months after baseline) and long-term post-intervention (1 year after baseline) impact of the 2 groups on the endpoints of patient-chosen CVD risk factor reduction targets (i.e., blood pressure, lipid profile, HgA1c for diabetics, body mass index, waist circumference, depressive symptoms, and physical activity level); 2) to compare the impact of the 2 groups on all CVD risk reduction targets relevant to each patient; 3) to compare quality of life outcomes in the 2 groups at 4- and 12-months; 4) to compare patient and healthcare provider satisfaction with each of the 2 programs at 4- and 12-months; 5) to compare desirability and adoptability of each of the 2 programs by assessing adherence to recommended CVD risk reduction measures, eating patterns, and retention of recruited individuals at 4- and 12-months. The proposed study will have a substantial impact on cardiovascular health because it will provide patients and healthcare providers with information about the most effective approach to CVD risk prevention in a major at-risk population living in an austere environment where CVD risk reduction is difficult. Results from this study will be generalizable to other austere environments.
Effective start/end date5/1/1611/30/17


  • Patient-Centered Outcomes Research Institute


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