title: Preventive care in Appalachia: use of the theory of planned behavior to identify barriers to participation in cholesterol screenings among West Virginians.
abstract: BACKGROUND
  West Virginians are at increased risk for heart disease. Given that the process of atherosclerosis begins in childhood, the Coronary Artery Risk Detection in Appalachian Communities Project was developed to reduce this risk by implementing a cholesterol screening program in the schools. However, participation rates have been less than desired.
  
  
  OBJECTIVE
  This study examined the barriers to participation in preventive health screenings, specifically cholesterol screenings, in adults and children of West Virginia using the theory of planned behavior to guide conceptualization.
  
  
  METHODS
  A total of 14 community leaders, 36 parents, and 92 fifth-grade children from 6 West Virginia counties with predominately rural populations participated in individual and focus group interviews. Qualitative analysis was used to examine interview transcripts.
  
  
  RESULTS
  Adult and child attitudes about preventive care were the largest barrier to cholesterol screenings. Adult attitudinal barriers included concerns with outcomes of testing, lack of knowledge about cholesterol and heart disease, concerns about needles, and traditional Appalachian cultural beliefs (resistance to change, denial, and fatalism). Children cited concerns about needles, outcomes of testing, privacy, and lack of concern about health and cholesterol. Adults also acknowledged environmental barriers to screenings. Finally, children reported a lack of social pressure to participate in prevention activities.
  
  
  CONCLUSIONS
  Attitudinal, social normative, and environmental barriers to health screenings may be characteristic of impoverished rural Appalachians. Interventions are being designed to target these belief barriers to improve participation in cholesterol screenings for fifth graders.
authors.affiliation: Health Research Center, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown 26506, USA.
authors.forename: Shelli
authors.initials: S
authors.lastname: Deskins
authors.forename: Carole V
authors.initials: CV
authors.lastname: Harris
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bradlyn
authors.forename: Lesley
authors.initials: L
authors.lastname: Cottrell
authors.forename: Jessica W
authors.initials: JW
authors.lastname: Coffman
authors.forename: Julie
authors.initials: J
authors.lastname: Olexa
authors.forename: William
authors.initials: W
authors.lastname: Neal
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002652:Child Behavior; D002784:Cholesterol / Q000097:blood*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D011314:Preventive Health Services / Q000458:organization & administration*; D012424:Rural Population; D014903:West Virginia
chemical_list: D002784:Cholesterol