Capacity Building Explore how to best facilitate community development, training, and partnerships in support of CVD prevention. Define roles, opportunities to support financially and otherwise, and expected outcomes for engagement and involvement of community health workers, community champions, and care coordinators in advancing the adoption of evidence-based approaches to reduce CVD burden.

Collaboration Determine efficacious approaches to develop and sustain effective collaborations among local, state, and national entities.

Community Engagement Evaluate unique approaches to engage community members in intervention and policy change related to CVD.

Research Approaches and Designs

Dissemination/Effectiveness Studies, Including a Focus on Sustainability Explore options for “taking to scale” those interventions demonstrated to work in rural settings. Identify ways to modify and adapt efficacious interventions developed and tested in nonrural settings for use in rural communities. Identify effective components of successful efficacy trials and understand how these components might be adapted in rural areas. Conduct research to examine the effectiveness of existing CVD prevention programs in rural areas.

Practice-Based Evidence Evaluate how use of existing networks and systems can accelerate dissemination of evidence-based approaches for CVD prevention. For example, create and evaluate mechanisms to utilize research funds (e.g., rapid response funds) for “natural” experiments and short-term intervention studies to evaluate successes and failures.

Implementation Develop and evaluate targeted approaches to trial recruitment and enrollment in rural communities. Identified approaches should follow (or be tailored to) the type of intervention proposed. (e.g., for studies on childhood obesity, target caregivers or families, but not children alone). Research ways to make recruitment relevant and meaningful to target population groups.

Study Design Use intermediate outcomes as the basis for evidentiary trials and encourage assessments of mediators and moderators (effect modifiers) of intervention outcomes.

Research Funding Mechanisms Explore the use and impact of flexible funding schemes (e.g., capacity building or planning grants) and diverse level and type of funding (e.g., pilot, “natural experiments”, prototype, implementation, and dissemination) on accelerating the pace of either discovery or implementation of evidence-based approaches for CVD prevention. Incorporate mechanisms to provide funds for community leader involvement and assess the effectiveness of such approaches (e.g., as subcontractors to allow community-based organizations or leaders to obtain indirect costs for their services). Designate research support, including K-Awards, for clinicians residing in rural communities and facilitate coordination of research among health care providers.

Research Topics Develop and test strategies to improve policies and infrastructure shown to reduce CVD risk (e.g., modify the built environment to increase the likelihood of exercise, increase access to healthy foods, assure regulation of tobacco sales and promotion laws, and increase the number of public smoke-free places). Develop and evaluate the cost effectiveness, sustainability, and impact of supporting community coordinators through grant-writing initiatives and through community-researcher partnership development (e.g., in data collection, determination of priority health needs, and communication of community health status to researchers and community members). Evaluate the utility of various technologies for prevention activities in rural communities (e.g., telemedicine, electronic health records). Examine the potential impact and unintended consequences of implementing national recommendations (e.g., the Institute of Medicine’s School Nutrition Recommendations and the USDA/DHHS Dietary Guidelines for Americans) in rural areas. Explore approaches for translating proven and efficacious studies into practice in rural communities. Examples of possible implementation studies in rural communities include extension of CDC best practices for tobacco control, of the Diabetes Prevention Program (DPP), the Dietary Approaches to Stop Hypertension (DASH), and the coordinated school wellness mandate.

Note. CDC = Centers for Disease Control and Prevention; CVD = cardiovascular disease; DHHS = US Department of Health and Human Services; USDA = US Department of Agriculture.