Results Summary

What was the research about?

The risk of heart disease in rural Appalachian Kentucky is among the highest in the country. Risk factors for heart disease include having high blood pressure, eating unhealthy foods, being overweight, not exercising, smoking, and feeling depressed. Many people here have more than one risk factor. The chance of developing heart disease is higher in this part of the country, in part because many people don’t know much about these risks. They also have limited access to health care.

This study compared two ways to help people reduce their risk of heart disease. All people in the study got referrals to doctors they could see regularly. Half of the people also went to small-group classes taught by trained health workers from the community. The classes focused on healthy choices that people can make to reduce their risk for heart disease. The research team wanted to learn whether providing these classes was better at helping people reduce their risk for heart disease than only referring people to a doctor.

What were the results?

People who went to classes and got a referral to a doctor reduced their risk for heart disease more than people who got only a referral to a doctor. Those who went to classes had greater reductions in

  • Blood pressure
  • Cholesterol
  • Weight
  • Smoking
  • Feelings of depression
  • Overall risk of heart disease

Attending group classes didn’t change people’s reports on their quality of life.

In both groups, satisfaction with health care increased from the start to the end of the year-long study.

Who was in the study?

The study included 352 men and women who were at least 21 years old. The people in the study lived in rural Appalachian Kentucky. They didn’t see a doctor regularly before the study. They had more than one of the following risk factors for heart disease: high blood pressure, high cholesterol, type 2 diabetes, overweight or obesity, depression, and not enough exercise.

What did the research team do?

The team assigned people to one of two groups by chance. The team referred people in both groups to doctors to get advice for reducing their chances of developing heart disease. One group also attended six classes taught by trained health workers from their community. Health workers talked about eating a healthy diet, getting more exercise, reducing stress, quitting smoking, and managing other health problems.

At the start of the study and again 4 and 12 months later, people filled out surveys. The surveys asked about people’s quality of life, their overall risk for developing heart disease, and their satisfaction with their health care. The team also looked at peoples’ health records for blood pressure levels, cholesterol levels, weight, reports of depression, amount of exercise, and smoking status. The team compared the results from the two groups.

Community members, business owners, church leaders, and healthcare providers from Appalachian Kentucky helped plan the study. This group also helped find people to join the study.

What were the limits of the study?

The research team followed people in the study for only one year. People may have returned to unhealthy lifestyles after the study was over. The study included only people who were at risk for heart disease in rural Appalachian Kentucky. Results may vary in other areas.

Future research could follow people for more than one year. Studies could also look at offering classes taught by trained health workers in other rural and low-income communities.

How can people use the results?

Communities in rural areas may consider having trained health workers from the community provide health classes like those used in this study to help people reduce their risk of heart disease.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

The awardee made the following revisions in response to peer review:

  • The awardee added information about patient and stakeholder engagement and details about the intervention. The awardee also elaborated on usual-care conditions.
  • The awardee noted the lack of information about the content of usual care as a study limitation. Further, the awardee revised the report’s conclusion to indicate that the intervention condition was superior to a referral to a primary care physician.
  • The awardee provided the rationale for subgroup analyses based on gender, depressive symptoms, and health literacy. The investigator explained that the addition of these analyses came after completion of primary analyses. The awardee therefore described the analyses as exploratory.
  • The awardee explained that recruitment focused on patients who lacked a regular primary care physician because such a lack is typical in the rural Appalachian region where the study took place. Also, the awardee explained that including participants who did have a regular physician would have introduced too much heterogeneity to test for treatment differences.

Conflict of Interest Disclosures

Project Information

Debra K. Moser, PhD, RN, FAAN
University of Kentucky
Reducing Health Disparities in Appalachians with Multiple Cardiovascular Disease Risk Factors

Key Dates

December 2012
May 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 11, 2024