Stakeholders' Perceptions of the Development and Implementation of a Cardiovascular Risk Reduction Program in Rural Tennessee

Abstract

To explore stakeholders’ perceptions on the development and implementation of a cardiovascular risk reduction program. Research suggests a high prevalence and greater risk of cardiovascular disease in rural communities, including regions of Appalachia. Focus groups were conducted with 35 health care professionals and staff members in 3 clinics in rural East Tennessee communities. Participants in the 3 groups included primary care professionals, behavioral health providers, case managers, office staff, and an administrator. The majority of participants (83%) were female. The outcome of this study was stakeholders’ needs and perceptions. Focus groups were audio-taped and transcribed verbatim. Text instances related to the research aim were identified, coded, and sorted into categories of similar responses. Potential target groups, barriers to implementation and behavior change, and strategies to overcome barriers were discussed. Patients with low-income, mental or behavioral illness, obesity, and diabetes were identified as high risk. Participants stated that patient non-adherence to treatment, low program participation and retention rates, limited provider time, and lack of transportation were potential implementation-related barriers. Finances, personal issues, and social and cultural influences were perceived to be major deterrents to behavior change. Participants suggested strategies to address the barriers, including hands-on education, a focus on children and families, use of groups, and transportation assistance. Stakeholders identified potential target populations, implementation barriers, and strategies for a cardiovascular risk reduction program. Findings will be used in the design of an intervention appropriate to the population.