title: Rural Appalachian perspectives on heart health: social ecological contexts.
abstract: OBJECTIVE
  To explore factors associated with cardiovascular disease (CVD) risk in Central Appalachia Kentucky to guide development of a culturally appropriate risk reduction intervention.
  
  
  METHODS
  Based on community-based participatory research principles, 7 focus groups were conducted with 88 healthcare employees and residents from 6 Appalachian counties. Sessions were audio-recorded and transcribed. Thematic analysis was used to identify themes and sub-themes.
  
  
  RESULTS
  Participants most frequently attributed CVD risk to behaviors including unhealthy diets, physical inactivity, and smoking, and to inadequate preventive care. Intrapersonal, interpersonal, sociocultural, environmental, organizational, and policy level influences on risk were identified.
  
  
  CONCLUSIONS
  Comprehensive intervention guided by a social ecological framework is needed to address CVD risk reduction in Appalachian Kentucky communities.
authors.affiliation: University of Kentucky College of Nursing, Lexington, KY, USA. Gia.Mudd@uky.edu.
authors.forename: Gia
authors.initials: G
authors.lastname: Mudd-Martin
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Biddle
authors.forename: Misook L
authors.initials: ML
authors.lastname: Chung
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.forename: Alison L
authors.initials: AL
authors.lastname: Bailey
authors.forename: Baretta R
authors.initials: BR
authors.lastname: Casey
authors.forename: M J
authors.initials: MJ
authors.lastname: Novak
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D004032:Diet; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012424:Rural Population; D012931:Social Environment; D055815:Young Adult