P81 - Process Evaluation of a Rural Community-Based Cardiovascular Disease Prevention Program: Strong Hearts, Healthy Communities

Abstract

Background (Background, Rationale, Prior Research, and/or Theory): Rural women have a higher prevalence of cardiovascular disease (CVD) and behavioral risk factors than their urban counterparts. Although existing CVD prevention programs have shown promise in changing women's lifestyle behaviors, few programs have specifically targeted rural populations nor have they included social and environmental foci. Objective: To evaluate the implementation of a multilevel community-based CVD prevention program for rural women grounded in the socioecological framework. Study Design, Setting, Participants, Intervention: Process evaluation of a 6-month community-randomized intervention trial: Strong Hearts, Healthy Communities (SHHC). A total of 101 women from eight rural towns were enrolled in the SHHC intervention program. Eligible participants were 40 years or older, sedentary, and overweight or obese. The 48-class program included strength training, aerobic exercise, nutrition education, and civic engagement activities. Outcome Measures and Analysis: Program leaders completed after-class surveys to assess fidelity, dose delivered, and attendance. Program satisfaction and participation benefits were assessed through post-intervention surveys, leader interviews, and participant focus groups. Quantitative survey data were summarized using SAS v.9.4 and Microsoft Excel. Qualitative data were examined thematically using NVivo 11. Results: Most sites reported high levels of adherence to the SHHC curriculum (average fidelity: 82%, average dose delivered: 84%). On average, participants attended 67% of the 48 classes, but this varied by site from 53% to 81%. The majority of participants were satisfied with their experience and reported several benefits. Positive aspects of the program included group camaraderie, social support, and awareness building. Insufficient lesson time was the most common struggle reported. Recommendations included extending class length, expanding exercise variety, and enhancing discussion. Conclusions and Implications: SHHC was well-received and deemed an acceptable approach by rural women enrolled in this CVD prevention program. Findings from this evaluation will inform program development and implementation for at-risk, underserved rural women and guide modification strategies for future dissemination. Funding: National Heart, Lung and Blood Institute (R01 HL120702).