title: Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009.
abstract: BACKGROUND
  In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change.
  
  
  METHODS
  The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009.
  
  
  RESULTS
  Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity.
  
  
  CONCLUSIONS
  Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction.
authors.affiliation: West Virginia University School of Public Health, HSC-S PO Box 9214, Morgantown WV 26506. Email: cice@hsc.wvu.edu.
authors.forename: Christa L
authors.initials: CL
authors.lastname: Lilly
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Lucinda L
authors.initials: LL
authors.lastname: Bryant
authors.affiliation: Fairmont State University School of Education, Health, and Human Performance, Fairmont, West Virginia.
authors.forename: Janie M
authors.initials: JM
authors.lastname: Leary
authors.affiliation: The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Maihan B
authors.initials: MB
authors.lastname: Vu
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
authors.affiliation: The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Samuel-Hodge
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Colleen R
authors.initials: CR
authors.lastname: McMilin
authors.affiliation: The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
mesh_terms: D001741:Black or African American; D001061:Appalachian Region; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003120:Colorado / Q000453:epidemiology; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D009657:North Carolina / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods*; D011340:Problem Solving; D012648:Self Care; D013315:Stress, Psychological; D035862:Vulnerable Populations; D014903:West Virginia / Q000453:epidemiology