Knowledge, Barriers, and Facilitators for Promoting Cardiovascular Health in a Latino Community: a Qualitative Substudy of the Skillsbased Educational Strategies for Reduction of Vascular Events in Orange County (SERVE OC)

Bernadette Boden-Albala^1,2*Darnisha Draughter³Megan Castro³Desiree Gutierrez³Cassandra Cardenas³Matthew J Landry⁴Jeffrey Wing⁵Bruce Albala^2,6,7

• ¹Departments of Health, Society, and Behavior and Epidemiology & Biostatistics, Joe C. Wen School of Population & Public Health, University of California, Irvine, Irvine, United States
• ²Department of Neurology, School of Medicine, University of California, Irvine, Irvine, California, United States
• ³Department of Health, Society, and Behavior, Joe C. Wen School of Population & Public Health, University of California, Irvine, Irvine, United States
• ⁴Department of Population Health and Disease Prevention, Joe C. Wen School of Population & Public Health, University of California, Irvine, Irvine, United States
• ⁵Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States
• ⁶Department of Environmental and Occupational Health, Joe C. Wen School of Population and Public Health, University of California, Irvine, Irvine, California, United States
• ⁷Department of Pharmaceutical Sciences, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, California, United States

Introduction: Cardiovascular disease (CVD) is the leading cause of death, and disproportionately affects racial-ethnic groups. Community-engaged research is an important avenue to address health disparities, and understand barriers faced by vulnerable populations. This qualitative substudy of the Skills-based Educational Strategies for Reduction of Vascular Events in Orange County (SERVE OC) clinical trial (Trial ID NCT05641519) employed focus group discussions to gain insight into community understanding of CVD within the local Latino community of Orange County. The study aimed to identify themes of 1) community knowledge, beliefs, and attitudes toward CVD prevention, 2) barriers and facilitators to implementing a family-based intervention, and 3) community-level barriers and solutions to optimal heart health to inform the adaptation of SERVE OC's intervention. Further, this study examined subthemes for each major theme, including 1) limited CVH knowledge, cultural and gender norms, and misinformation 2) barriers to CVH, including transportation, technology, financial and work constraints; facilitators including CHW and family dynamics 3) community barriers including cost, resources, and environment; community solutions including community infrastructure and access to resources. Methods: Fourteen focus groups (n=69) were conducted over a 20-month period using a semi-structured interview format. Participants consisted of community family members, community health professionals, and SERVE OC clinical trial participants. Dedoose was utilized to code for thematic analysis, guided by the Social Ecological Model and Social Network Theory.Results: Three themes were identified: 1) Community CVD knowledge, attitudes, and beliefs; 2) Barriers and facilitators to implementing family-based interventions; and 3) the identification of structural/community level barriers along with community levels strategies to achieving optimal cardiovascular health.Discussion: Findings showed significant gaps in CVD knowledge and prevention, including understanding of nutrition and barriers to access for healthy foods. Focus groups provided insight into the critical role of familial support in health behaviors and outcomes, and barriers and facilitators for family-based interventions. These results help tailor the SERVE OC family-based intervention in real-time, allowing for a more targeted approach to addressing cardiovascular-related challenges within the Latino community. Through these community-engagement methods, SERVE OC can optimize program design and implementation, maximizing the positive impact of the CVD risk reduction initiative.