Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Deborah Slawson

Committee Members

Hadii Mamudu, Mike Stoots


The Central Appalachian region of the United States disproportionately experiences higher rates of cardiovascular diseases (CVD) and associated risk factors. Primary risk factors for CVD include hypertension, hypercholesterolemia, and tobacco use, all of which have the potential to be mitigated through lifestyle behavior changes. Dietary and physical activity practices are the two main driving forces for the development of hypertension and hypercholesterolemia, while tobacco use is a behavioral choice on its own. Subsequentially, shifting lifestyle choices to emphasize healthier living has the potential to reduce CVDs within the Central Appalachian region. Considering behavioral choices are not made in isolation and are the result of internal and external influences, it is necessary to contemplate the multitude of factors driving these rates. Additionally, healthcare systems within this region ability to provide patient-centered care (PCC) is another consideration, as effective point of care also can address these rates from a disease treatment and management level. The purpose of this study was to explore the knowledge, perceptions, and influences among patients with cardiovascular diseases and non-licensed caregivers within these communities, at the behavioral and community levels, in addition to the perceptions of essential components of PCC among professional stakeholders.

Seven focus group discussions with CVD patients and non-licensed caregivers were conducted, with a total of 78 participants; additionally, 20 interviews were held with professional stakeholders within the healthcare field. At the behavioral level participants identified internal and external barriers to sustaining healthy diets, the impact of interpersonal relationships on diet and stress, and influential role of cardiac rehabilitation in physical activity following a major cardiac event. At the community level participants discussed the economic characteristics of communities, a need for community infrastructure expansion, and the role of community organizations. Professional stakeholders addressed PCC in the current healthcare system, constructs of effective patient-provider interactions and the role of community outreach. This research serves as a look into the challenges and opportunities within this region and provides insight to inform future research and interventions.

Document Type

Dissertation - embargo


Copyright by the authors.

Available for download on Saturday, June 15, 2024