National statistical trends indicate that heart disease-related mortality rates in nonmetropolitan communities are higher in comparison to metropolitan areas. For the past 10 years, rural areas have had a higher coronary heart disease mortality rate compared to urban areas. Nonmetropolitan and metropolitan communities differ in factors that inﬂuence cardiovascular disease (CVD) risk, including higher rates of CVD risk factors such as hypertension, cigarette smoking, obesity, and a sedentary lifestyle. In an article published in the winter 2019 issue of the Journal of Rural Health titled “Adapting an Evidence-based Cardiovascular Disease Risk Reduction Intervention to Rural Communities,” Dr. Patrik Johansson and colleagues report on the applicability of an evidence-based cardiovascular disease (CVD) risk intervention developed for an urban setting for rural areas in Nebraska. The CVD risk reduction intervention is based on the Community Outreach and Cardiovascular Health (COACH) program, which includes nurse practitioner/community health worker teams.
Dr. Johansson conducted three focus groups with patients with CVD risk factors to assess community readiness for participating in the intervention, the mode of the delivery of the intervention, the setting of the intervention, program content, and raising awareness of the intervention. Findings from the focus groups indicated acceptability toward a CVD risk reduction program modeled after the COACH.
Dr. Johansson concludes “With minor adaptations, the COACH program can be pilot tested in rural settings to address key health concerns and behaviors that affect risk for cardiovascular health.” These adaptations include raising community awareness of the role of community health workers prior to implementing a program in rural communities unfamiliar with their role and emphasizing the conﬁdentiality for prospective program participants. Additional adaptations include having initial face-to-face meetings between the nurse practitioner/community health worker team and program participants with the option for transitioning to future phone-based meetings, having additional examples and explanations regarding strategies to lessen CVD risk in the COACH program guide, addressing geographic distance in rural communities, and having linguistically appropriate services available. Furthermore, in line with the existing COACH program, participants expressed a need for a rural COACH intervention to include social support/encouragement in addition to the speciﬁc health education components.