Photovoice: A method to understand perceptions of cardiovascular health in the "stroke belt"

Introduction: Cardiovascular disease is the leading cause of death in the United States and African Americans experience greater mortality than people of other races/ethnicities. Given the importance of cardiovascular disease prevention, this study 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 8, 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 include 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 (e.g., family/community relationships) and spiritual health dimensions (e.g., understanding one’s body and purpose) to improve health behaviors.

Conclusion: Eliciting the perspectives of African American adults and adolescents through this formative research provided a strong foundation for the Heart Healthy Lenoir’s ongoing engagement of community members in Lenoir County and development and implementation of its cardiovascular disease intervention.