title: Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health Among African American Adults and Adolescents, North Carolina, 2011-2012.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of death in the United States, and mortality rates are higher among African Americans than among people of other races/ethnicities. We aimed to understand how African American adults and adolescents conceptualize cardiovascular health and perceive related barriers and facilitators.
  
  
  METHODS
  This qualitative study was conducted as formative research for a larger study, Heart Healthy Lenoir, which aimed to reduce cardiovascular disease disparities among African Americans in eastern North Carolina, part of the widely-known "stroke belt" that runs through the southeastern United States. Using photovoice, a community-based participatory research method, we conducted eight 90-minute photovoice sessions with 6 adults and 9 adolescents in Lenoir County, North Carolina. Topics for each discussion were selected by participants and reflected themes related to cardiovascular health promotion. All sessions were transcribed and coded using a data-driven, inductive approach.
  
  
  RESULTS
  Participants conceptualized cardiovascular health to have mental, spiritual, and social health dimensions. Given these broad domains, participants acknowledged many ecological barriers to cardiovascular health; however, they also emphasized the importance of personal responsibility. Facilitators for cardiovascular health included using social health (eg, family/community relationships) and spiritual health dimensions (eg, understanding one's body and purpose) to improve health behaviors.
  
  
  CONCLUSIONS
  The perspectives of African American adults and adolescents elicited through this formative research provided a strong foundation for Heart Healthy Lenoir's ongoing engagement of community members in Lenoir County and development and implementation of its intervention to prevent cardiovascular disease.
authors.affiliation: Department of Health Behavior, Rosenau Hall, CB no. 7440, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7440. Email: kowitt@email.unc.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kowitt
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Briana
authors.initials: B
authors.lastname: Woods-Jaeger
authors.affiliation: Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Jesse
authors.initials: J
authors.lastname: Lomas
authors.affiliation: University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Tamara
authors.initials: T
authors.lastname: Taggart
authors.affiliation: University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Linden
authors.initials: L
authors.lastname: Thayer
authors.affiliation: Retired Health Educator, LaGrange, North Carolina.
authors.forename: Sussie
authors.initials: S
authors.lastname: Sutton
authors.affiliation: University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Alexandra F
authors.initials: AF
authors.lastname: Lightfoot
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000517:prevention & control / Q000523:psychology*; D055812:Community-Based Participatory Research / Q000706:statistics & numerical data*; D003159:Community-Institutional Relations; D003657:Decision Making; D004779:Environment Design; D005192:Family Health; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics / Q000379:methods; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D019222:Mind-Body Relations, Metaphysical; D009657:North Carolina / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D010465:Perception; D010781:Photography; D011287:Prejudice; D036301:Qualitative Research; D029181:Spirituality; D013315:Stress, Psychological