Abstract
BackgroundAA living in rural areas of the southeastern U.S. experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality. Neighborhood environmental factors contribute to this disparity and may decrease the effectiveness of lifestyle interventions aimed at preventing CVD. Furthermore, the influence of neighborhood factors on AA CVD risk behaviors (i.e. physical activity) may be obscured by the use of researcher-defined neighborhoods and researcher-defined healthy and unhealthy places. The objective of this study was to elucidate the effects of neighborhood environments on AA CVD risk behaviors among AA adults who recently completed a lifestyle intervention. We specifically sought to identify AA adults’ self-perceived places of significance and their perceptions of how these places impact CVD risk behaviors including diet, physical activity and smoking.MethodsWe conducted semi-structured interviews with AA adults (N = 26) living in two rural North Carolina counties (Edgecombe and Nash, North Carolina, USA). Participants were recruited from a community-based behavioral CVD risk reduction intervention. All had at least one risk factor for CVD. Participants identified significant places including where they spent the most time, meaningful places, and healthy and unhealthy places on local maps. Using these maps as a reference, participants described the impact of each location on their CVD risk behaviors. Data were transcribed verbatim and coded using NVivo 12.ResultsThe average age of participants was 63 (SD = 10) and 92% were female. Places participants defined as meaningful and places where they spent the most time included churches and relatives’ homes. Healthy places included gyms and parks. Unhealthy places included fast food restaurants and relatives’ homes where unhealthy food was served. Place influenced CVD risk behaviors in multiple ways including through degree of perceived control over the environment, emotional attachment and loneliness, caretaking responsibilities, social pressures and social support.ConclusionsAs we seek to improve cardiovascular interventions for rural AA in the American South, it will be important to further assess the effect of significant places beyond place of residence. Strategies which leverage or modify behavioral influences within person-defined significant places may improve the reach and effectiveness of behavioral lifestyle interventions.
Highlights
AA living in rural areas of the southeastern U.S experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality
This work is important among rural African Americans due to persistent disparities in CVD risk, morbidity and mortality [8, 9]
To identify participant’s significant places they were asked to mark 1–3 places on the map of their choice in each of the following categories: where they spend the most time, places that are meaningful to them, places that help them to be healthy, places that keep them from being healthy, safe places and unsafe places
Summary
AA living in rural areas of the southeastern U.S experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality. Recent studies have demonstrated that neighborhood-level factors may modify CVD intervention outcomes, suggesting that individuals actively attempting to change behaviors (e.g., eating healthier, being more active) may be helped or hindered by more or less supportive environments [4, 5]. Understanding how those at high risk for CVD experience and navigate their environments in relation to CVD risk behaviors is critically important to designing effective interventions to address CVD disparities [6, 7]. These influences may be evident among individuals who are actively attempting behavior change
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