Research in Rural Settings Researchers and community members should carefully consider various definitions of rural, explicitly define rural for their proposed work, communicate the definition they choose to all stakeholders, and take into account the underlying premises and constraints of their chosen definition when developing, disseminating, implementing, or evaluating an intervention, program, or practice change. Researchers should consider the rural context (e.g., the socioeconomic status of rural communities, built environment, limitations of existing resources) in intervention design and include a comprehensive quality of life assessment to capture participants’ general health status. Research in rural areas must address poverty as one of the most important underlying causes of health disparities and use when possible designs to improve health while creating opportunities for entrepreneurship and economic development. Researchers should select appropriate primary outcomes, and design and power studies, appropriately recognizing the importance of evaluating multiple risk factors as secondary outcomes. Researchers should consider the use of appropriate, methodologically sound designs given the stage of the research and the feasibility of randomization (e.g., individual or group-randomized trials or regression discontinuity designs for efficacy and effectiveness studies, and time series, multiple baseline, and quasi-experimental designs for preliminary studies).

Community Engagement Community engagement is a prerequisite, integral part of undertaking any and all phases of research development, dissemination, implementation, and evaluation. The type and level of community engagement should always be considered in planning rural CVD research. Training on principles of community engagement is a prerequisite for community members as well as researchers before their participation in community research. Research in rural areas must build on existing community strengths and infrastructure whenever possible while recognizing and addressing or accommodating the unique characteristics of each rural place and its inhabitants. Partnership-led interventions and policy efforts are keys to community engagement, collaboration, and sustainability. Sustainability should be a considered a primary objective in all research and practice improvement activities in rural areas. Achieving sustainability is more likely if efforts to build local capacity at the organizational and individual level are planned and implemented.

Evidence-Based Practice Evidence-based approaches, whether derived from research synthesis or practice-based evidence should be considered first when looking at options for disseminating and implementing approaches to reduce identified CVD risk, including interventions to improve access to care. Researchers should make use of evidentiary or preliminary studies that may describe, among other things, lessons learned from practice to inform recruitment and planning of efficacy and effectiveness trials. Researchers should explore combined use of qualitative and quantitative research to better understand the complexity of factors associated with rural health.

Note. CVD = cardiovascular disease.