Cardiovascular Risk Reduction in Rural Women: A Literature Synthesis.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in most countries. Lack of awareness of the impact CVD has on women is a continuing problem. Rural women are at a great risk for CVD and have specific barriers to early recognition and to access to treatment. OBJECTIVE: The purpose of this systematic review was to identify how the state of the science for rural women and CVD has progressed over the last decade. METHODS: Searches were conducted using the databases Cochrane, PubMed, and CINAHL with 5 major subject headings. The search resulted in the identification of 571 articles. Specific exclusion criteria resulted in an in-depth review of 15 articles. Two of the authors reviewed each article for scientific merit and interrater reliability. RESULTS: Most studies were conducted in the United States (67%). Four studies focused on CVD knowledge; one, on physical activity; one, on diet plus other factors; one, on the effect of dried curry leaf powder and cucumber slices on hyperlipidemia; and one each, on waist circumference, exposure to smoke from wood stoves, and social support. Five of the 15 studies focused on more than 1 component, most on diet and physical activity. CONCLUSIONS: Depth in a body of knowledge on any 1 topic, such as the most efficacious means to decrease CVD risk factors in rural women and increase health promotion activities in the population, is lacking. Another area of concern is the lack of research articles published in cardiovascular journals that include CVD in rural women.

Walking for Heart Health: A Study of Adult Women in Rural New York.

PURPOSE: The study was undertaken to partially address the number one priority for Delaware County for 2013-2017: reducing chronic illness including heart disease and obesity (Delaware County Public Health, 2013). Thus, the purpose was to examine the effects of a 10-week walking program on outcomes, such as blood pressure (BP), total cholesterol (TC), high-density lipoprotein (HDL) levels, body mass index (BMI), 10-year cardiovascular risk, and results of a 6-minute walk test, for adult women in a rural community in New York. METHODS: A quasi-experimental study conducted 8 paired t tests of pre- and postdata using Bonferroni correction for multiple t tests. A convenience sample of 70 retained 62 to completion. Pre- and post-BMI, TC, HDL, BP, and a 6-minute walk test data were collected for each participant. Pedometer activity was collected throughout the program with computer downloads at 5 and 10 weeks. Sociodemographic variables including age, self-reported ethnicity, and educational level were used to describe the sample and trends in the data. FINDINGS: Age range was 29-79 years (M = 55) years. Mean pretest weight was 181 lb; mean BMI was 30.7 kg/m2. There was a statistically significant improvement (p < .05) in weight, BMI, TC, systolic blood pressure (SBP), and 6-minute walk test. All comparisons retained significance except TC after the Bonferroni correction. There was also a statistically significant increase (p < .05) in aerobic steps from midway to end of study after an incentive raffle challenge was introduced. CONCLUSIONS: The data suggest that a community walking program using pedometers with tracking capabilities was successful in increasing steps and improving select cardiovascular disease (CVD) risk factors in a group of women in a rural community in New York.

Promoting heart health in rural women.

PURPOSE: To compare 2 strategies, stage-matched nursing and community intervention (SMN+CI) and community intervention (CI) alone in changing cardiovascular risk factors in up to 3 behavioral areas: diet, physical activity, and/or smoking among rural women. METHODS: A 14-month, multisite randomized controlled trial of 117 rural women was conducted. Transtheoretical model was used in identification of stage of change and development of the SMN+CI nursing interventions. A social-ecological model was used to address issues of rurality in the development of interventions. FINDINGS: The SMN + CI group was superior on 4 outcomes. There were significant increases in 2 measures of dietary intake; improvement in dietary stage of change for fruits and vegetables; and reduced diastolic blood pressure (DBP) in the SMN + CI group. After log transformation DBP significance was lost. The CI group had a significant reduction in change in total cholesterol; however, significance was lost after control for the initiation of lipid lowering medications. There was a significant reduction in Framingham risk scores pre- to postintervention, regardless of group. CONCLUSIONS: There continues to be a need to improve cardiovascular risk factors in rural women. There should be an exploration of whether intensified dose and fidelity of the intervention strategies of diet and physical activity are effective in improving anthropometric and laboratory values. Further investigation is warranted into factors influencing the pre- to postreduction in Framingham risk scores.

Raising stroke awareness among rural dwellers with a Facts for Action to Stroke Treatment-based educational program.

Stroke is the third leading cause of death in the United States with 780,000 new and/or recurrent strokes each year. Interventions aimed at the onset of stroke symptoms have been successful in decreasing long-term neurological deficits; however, providing the prompt medical interventions in rural areas involves unique challenges. To decrease time-to-treatment in rural areas, education about symptoms of stroke and the need for immediate medical attention are critical. The objective of this study was to measure the effectiveness of the Facts for Action to Stroke Treatment (FAST)-based educational intervention program focused on the improving knowledge about stroke of 402 rural-dwelling adults. Using a paired means t test, the participants had a significant increase in knowledge from pretest to posttest (p = .000). Of those, 215 subjects participated in 2-month follow-up testing with the paired t test showing that the increased score from pretest to 2-month follow-up remained significant (p = .000). The authors concluded that the FAST-based program was an effective tool to use when teaching recognition of stroke symptoms and the need for immediate medical intervention to rural adults.

STRATEGIES TO REDUCE BARRIERS TO RECRUITMENT AND PARTICIPATION.

PURPOSE: To identify barriers encountered and solutions employed to improve research recruitment and retention of rural subjects for participation in the Promoting Heart Health in Rural Women (PHH) study. METHODS: This article provides an examination of experiences encountered by nurse researchers in recruiting rural women from two locations to a randomized, controlled trial. Problem solving through broadening recruitment areas and inclusion criteria, community liaison assistance, identification of rural-specific strategies in the literature, and perseverance helped to overcome barriers to subject recruitment and retention in this rural Phase-II nurse-run intervention study. CLINICAL RELEVANCE: Research studies need to be conducted in order to build a body of evidence for nursing interventions to reduce cardiovascular disease risk factors in rural women. A study is strengthened by a robust sample that provides power to statistical analysis. Without discussion of real-world experiences and appropriate and effective recruitment and retention strategies in nursing research, there is little chance of conducting research with appropriate power to build evidence-based practice.

Matters of the heart: cardiovascular disease and rural nursing.

Cardiovascular disease (CVD) is the leading cause of death in the United States and around the world. Most of the work done on CVD among rural populations uses mortality versus prevalence rates because prevalence data for rural populations is difficult, if not impossible, to find in national data sets as currently published. Cardiovascular disease is a significant threat to rural dwellers and those in rural nursing need evidence on which to base their practice. This chapter provides an examination of the CVD literature as it relates to rural populations with an emphasis on studies that include or are limited to rural women as subjects. Topics reviewed included: awareness and symptoms of heart disease among women, heart failure (HF) in rural women, hypertension (HTN) in rural areas, stroke in rural populations, quality care in acute myocardial infarction (MI) in rural facilities, mortality and CVD, and CVD risk factors in rural populations. The authors reviewed 134 research articles published between 2000 and 2007. Overall, the CVD research literature in rural populations has small sample sizes, except for epidemiologic studies, and tends to be descriptive in nature. There is a dearth of literature on prevalence among rural populations from a national perspective and little is written on interventions to reduce CVD risks and physiological markers that include large samples from rural populations. Future nursing research on CVD in rural populations needs to move beyond the descriptive to intervention studies, which need to be robust in power to guard against Type II errors.

A call for replication.

PURPOSE: To promote the use of replication as a means for strengthening knowledge for nursing practice. METHODS: Examination of two clinical examples of how replication could strengthen nursing practice. FINDINGS: The first example had no research evidence to support the practice and the other was based on the findings of a single medical study. Both led to nursing practices that were not effective or efficient, although not harmful. Replication can be used to overcome design limitations, increase validity of findings, and bring about correction of error. In addition, potential barriers and solutions to increase replication were identified. CONCLUSIONS: Replication is a critical step in validating research to build evidence and to promote use of findings in practice.