Rural appalachian perspectives on heart health: Social ecological contexts

Objective: To explore factors associated with cardiovascular disease (CVD) risk in Central Appalachia Kentucky to guide development of a culturally appropriate risk reduction intervention. Methods: Based on community-based participatory research principles, 7 focus groups were conducted with 88 healthcare employees and residents from 6 Appalachian counties. Sessions were audio-recorded and transcribed. Thematic analysis was used to identify themes and sub-themes. Results: Participants most frequently attributed CVD risk to behaviors including unhealthy diets, physical inactivity, and smoking, and to inadequate preventive care. Intrapersonal, interpersonal, sociocultural, environmental, organizational, and policy level influences on risk were identified. Conclusion: Comprehensive intervention guided by a social ecological framework is needed to address CVD risk reduction in Appalachian Kentucky communities.