Deep in the Heart for Women: A Community-Engaged Intervention Study to Catalyze a Culture of Health in Rural South Texas

PROJECT SUMMARY Cardiovascular disease and obesity are conditions that cause high morbidity in women, including women in rural areas; contextually tailored, evidence-based multilevel, multicomponent interventions that take social determinants of health into account are needed to prevent or improve risk factors for obesity and cardiovascular disease (e.g., dietary patterns, physical activity behaviors). The proposed project, Deep in the Heart, includes the following specific aims: 1) facilitate local community engagement and conduct formative research to inform tailoring for the intervention components as well as engagement and implementation strategies based upon data from bilingual focus groups with diverse residents and input gathered from a local Community-Clinical Advisory Board and a National Rural Advisory Board; 2) evaluate the Deep in the Heart intervention (experiential obesity and cardiovascular disease prevention group classes including aerobic exercise, strength training, and dietary skill-building facilitated by a Community Health Worker, with participant referral to resources based on social determinants of health survey; mobile health app for goal setting and self- monitoring; and a Community-Clinical Advisory Board refining and promoting a local Community-Clinical Resource Guide) in a community-engaged study in a diverse, medically underserved rural county in south Texas (>80% Hispanic); 3) conduct implementation and process evaluation guided by RE-AIM and the Consolidated Framework for Intervention Research; and 4) conduct cost-effectiveness analysis to inform resource allocation for future scalability. Deep in the Heart holds great potential to meaningfully reduce obesity and cardiovascular disease risk, improve rural women’s health equity, and provide an effective shorter-duration program, which will allow participation by individuals who may not enroll in a longer program due to scheduling, transportation, caretaking, or other constraints.