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.

Public Health Relevance

Heart disease 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. The overall objective of this study is to assess the feasibility of implementing a heart disease prevention program among African Americans in rural communities in order to plan a larger scale study. The long-term goal is to reduce rates of heart disease in Eastern NC.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZHL1-CSR-P (S1))
Program Officer
Pratt, Charlotte
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University of North Carolina Chapel Hill
Other Health Professions
Schools of Medicine
Chapel Hill
United States
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