Heart health education can positively influence underserved, rural populations

Improving dietary habits and learning skills such as reading food labels and recognizing the signs of a heart attack have the potential to improve cardiovascular health among underserved rural populations, according to newly published research from Florida State University.

Laurie Abbott, an assistant professor in the College of Nursing, found significant improvements in food-related behaviors associated with cardiovascular health by African-American participants from rural northern Florida counties after they completed a six-week intervention that addressed major cardiovascular disease risk factors. The study, published in the journal Health Education Research, examined the results from an earlier cluster randomized trial with a secondary data analysis.

“The positive findings indicate that the population may be receptive to health behavior research efforts and health promotion strategies to help them learn ways to stay well,” Abbott said. “During the program sessions, the participants actively engaged in the program activities and verbalized positive comments about the intervention and the interactive strategies used.”

In the first study, researchers recruited 229 African-Americans from 12 churches in two rural northern Florida counties to participate in the study. Half were exposed to “With Every Heartbeat is Life,” a culturally relevant health promotion curriculum developed by the National Heart, Lung, and Blood Institute. The other half served as the control group.

Health habits or behaviors associated with cardiovascular disease such as food-related risk factors, physical activity, alcohol and tobacco use and confidence levels in health habits, were measured at baseline and at six weeks for both groups.

After the intervention group participants completed the program, researchers found significant improvements in food-related behaviors, such as increased fruit consumption and eating more vegetables than meat at meals. Participants were also more likely to read food nutrition labels while grocery shopping, drain fat after cooking meat, consume fewer sugar-sweetened beverages and reduce intake of high-fat dairy products.

In addition, there were significant group differences postintervention regarding confidence in cooking heart healthy foods, reading food labels and recognizing heart attack symptoms.

“Improved confidence in reading food labels meant that they could go to the grocery store and make healthier choices,” Abbott said. “I had one participant in his 60s who stated that, prior to participation in the program, he had never read labels when shopping for food in the grocery store. After receiving the program, he began looking at the sodium content and choosing foods lower in sodium as recommended for people diagnosed with hypertension.”

Recognizing signs of a heart attack can help people seek medical assistance sooner, especially in rural areas where the hospital and emergency medical services may be farther away than in urban settings.

“Sometimes, remote distance can influence delays that could cause loss of life or damaged heart muscle if the patient is experiencing a heart attack,” said Abbott, who received the 2018 American Public Health Association Public Health Nursing Junior Investigator Award for her research on advancing cardiovascular health equity among underserved, rural populations.

The American Heart Association projects a 10 percent increase in the prevalence of cardiovascular disease when patients have detrimental social and environment health habits such as physical inactivity, unhealthy dietary practices and lack of preventive health services.

Over her 25-year career as a nurse working in hospital, clinic and community facilities, Abbott noticed that her rural patients didn’t always have the knowledge, skills and resources they needed to reduce disease risk factors and enhance wellness.

“Recognizing this need instilled a passion within me to go into rural community settings and do something more to help rural citizens learn how to stay well, reduce modifiable cardiovascular disease risk factors, and avoid hospitalization and chronic disease exacerbation.”

Primary prevention strategies for promoting healthy lifestyle behaviors such as increasing produce consumption and physical activity levels and reducing dietary fat intake and smoking can potentially improve heart health awareness, build individual capacity and advance cardiovascular health equity among people living in rural areas.

Abbott said future research efforts will involve testing the sustainability of improved cardiovascular health habits over longer intervals of time and the inclusion of biometric screening components such as blood pressure measures and weight. More research is also needed to understand the influences of factors such as race, ethnicity and rurality on health risk behaviors as well as strategies for risk reduction.

Elizabeth H. Slate, the Duncan McLean and Pearl Levine Fairweather Professor in the FSU Department of Statistics, and Jennifer L. Lemacks, associate professor of nutrition and food systems at the University of Southern Mississippi, also contributed to the study.