Results from formative work to refine an intervention linking clinical and community services in rural North Carolina

Clinical care is essential to prevent cardiovascular disease (CVD), the #1 cause of mortality in the US.  However, clinics do not reach many at greatest risk and lack capacity to change health behaviors. Public health and other community services have expertise in delivering behavioral change interventions and may have greater reach to underserved populations.  Thus, linking clinics to community services offers promise for improving CVD prevention.  The CHANGE community-academic partnership plans to strengthen linkages between clinical and community services to prevent CVD in a rural 60% African American county that is 27% Medicaid eligible and that ranks 94^th / 100 lowest in North Carolina on health behaviors.  We will present findings from 1) key informant interviews (n=10) with leaders of community services and 2) 2 focus-groups with at-risk community members, identifying challenges and opportunities to enhance and extend clinical and community linkages.

 

Purposive sampling was employed to identify key informants and focus group members in clinical and community settings.  Using a semi-structured qualitative interview guide, researchers asked about existing services, existing community/clinical linkages, what has worked well, and suggestions for strengthening linkages. Transcripts were thematically analyzed using Atlas-ti software and themes agreed upon by 4 team members.

Findings include 1) a catalogue of community and clinical relationships and services, and 2) areas of strength and opportunities to strengthen clinical-community linkages.

These findings guide intervention refinement and advance the understanding of how to most effectively link clinical and community services to improve CVD care in rural, underserved communities.