# A comprehensive mixed-methods analysis of women’s cardiovascular health needs in Georgia, United States

## TL;DR

This study explores why women in rural Georgia face higher risks for heart disease and identifies barriers to care, including affordability and limited access.

## Contribution

The study uniquely integrates quantitative and qualitative data to highlight rural-specific cardiovascular health disparities and barriers among women in Georgia.

## Key findings

- Rural Georgia women have higher rates of hypertension, obesity, and stroke compared to urban counterparts.
- Qualitative findings reveal affordability, communication barriers, and distrust in telehealth as key challenges.
- Younger women show less awareness of cardiovascular risks, suggesting a need for age-specific education.

## Abstract

In the United States, cardiovascular disease (CVD) is the leading cause of death among both men and women; CVD and associated risk factors particularly affect women who live in rural areas. This mixed-methods analysis aims to explore cardiovascular health (CVH) risk factors and healthcare experiences among women in rural Georgia, to identify barriers to care, and to inform strategies for improving long-term health outcomes in rural communities.

A convergent mixed methods design was utilized to evaluate CVH prevalence and associated environmental risk factors among women living in rural GA. Quantitative data from 159 Georgia counties were analyzed to compare rural and urban rates of CVD-related conditions and healthcare provider availability. Comparative analyses were performed between counties, urban and rural areas, and on sex differences. Concurrently, semi-structured interviews were conducted with 56 women and 11 healthcare providers to explore knowledge of blood pressure (BP) management, access to preventive services, and barriers to care. Qualitative and quantitative findings were analyzed separately and integrated during interpretation.

Rural counties have significantly higher prevalence of hypertension, obesity and stroke. General trends revealed higher rates of smoking, physical inactivity, and excessive alcohol consumption in rural counties compared to rates in urban counties of GA. Qualitative themes revealed affordability concerns, communication challenges between patients and providers, limited trust in telehealth, and the importance of delivering CVH education in community-based settings. Differences by age were also observed: younger women expressed less concern or awareness about CVH risks, while older women described greater engagement with care and health information. While the original aim included gaps in awareness and education, participants primarily described navigating systemic barriers across the care continuum.

Rural women face individual, provider, and structural barriers to cardiovascular health and care. This unique study identifies chronic disease disparities and risk factors, with a higher disease burden observed in rural counties. Contributing factors may include limited resources for promoting healthy lifestyle choices, and reduced access to healthcare providers. Integrated findings underscore the need for sex- and gender- informed, age-specific, and community tailored strategies that address both health system access, and communication to improve CVH outcomes in underserved rural populations.

This study looked at why women in rural Georgia, United States are at higher risk for high blood pressure and heart disease. Health data was gathered from all 159 counties in Georgia, US and women and health care providers were interviewed to understand their lived experiences with cardiovascular health.

Women in rural Georgia exhibited higher rates of hypertension, hyperlipidemia, and stroke compared to their urban counterparts.

Qualitative analysis identified key challenges such as affordability, limited access to care, communication barriers, and issues with technology and trust in healthcare providers. These factors contribute to disparities in managing cardiovascular health.

Younger women expressed less awareness or concern about cardiovascular health than older women, indicating a need for earlier, age-specific tailored education and outreach strategies.