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Informing Cardiovascular Disease Prevention among Rural Appalachian Women: A Community-Engaged Mixed Method Study

Thompson, Jessica Ruth (2021) Informing Cardiovascular Disease Prevention among Rural Appalachian Women: A Community-Engaged Mixed Method Study. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Cardiovascular disease (CVD) accounts for the largest difference in life expectancy between Appalachian women and women outside the region. With high proportions of uncontrolled risk factors and low screening rates, identifying strategies to increase CVD prevention among Appalachian women is a public health priority. Using a community-engaged mixed method approach, including the novel pairing of spatial analysis and concept mapping, this dissertation aims to: 1) identify and summarize existing women’s health research in Appalachia, 2) assess the association of county-level resource distribution and CVD mortality rates among women in the Appalachian counties of Pennsylvania (PA), and 3) uncover the range of perceived barriers and facilitators to CVD prevention along with potential community-specific interventions among Appalachian PA women. The results from Aim 1 provide newly identified gaps in the literature for future study, including the need for more research across health topics, Appalachian subregions, and throughout the life course. The complex factors across social-ecological levels found throughout the existing literature support strategies to improve CVD prevention that consider social and environmental contexts, such as those uncovered in Aims 2 and 3. Aim 2 findings show previously undescribed associations between county-level income and recreation facility density with spatial patterns of CVD mortality among women in the Appalachian PA counties. These results suggest increasing access to recreation facilities and developing ways to overcome income-related barriers may improve CVD prevention among Appalachian women. Grounded in community insights across three counties (N=71), Aim 3 uncovers 96 items, grouped into six thematic clusters across the social-ecological model, that Appalachian PA women perceive as related to the cardiovascular health of women in their community. Participants also describe potential intervention opportunities, which build on social and community assets, promote holistic care, and utilize validating messaging. These novel mixed method findings move forward the understanding of CVD prevention among Appalachian women by identifying vital social and environmental factors. Through building a conceptual framework including the complex, multilevel influences identified by women in this region, this dissertation provides valuable guidance to better understand cardiovascular health decision-making and the corresponding action-oriented, community-specific strategies to improve CVD prevention among rural Appalachian women.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Thompson, Jessica Ruthjrthompson@pitt.edujet1070000-0002-6954-2663
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBurke, Jessica G.jgburke@pitt.edujgburke
Committee MemberElias, Thistle I.elias@pitt.eduelias
Committee MemberMagnani, Jared W.magnanij@pitt.edumagnanij
Committee MemberMair, Christina F.cmair@pitt.educmair
Committee MemberSchoenberg, Nancy
Date: 12 May 2021
Date Type: Publication
Defense Date: 16 April 2021
Approval Date: 12 May 2021
Submission Date: 23 April 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 195
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Women's health, cardiovascular disease, Appalachian region, community-engaged research, mixed methods
Date Deposited: 12 May 2021 19:42
Last Modified: 12 May 2021 19:42


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