Graduation Date

Spring 5-4-2024

Document Type


Degree Name

Doctor of Philosophy (PhD)


Medical Sciences Interdepartmental Area

First Advisor

Lani Zimmerman, PhD, RN, FAHA, FAAN

Second Advisor

Bunny Pozehl, PhD, APRN-NP

Third Advisor

Christopher Wichman, PhD

Fourth Advisor

Regina Idoate, PhD


Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs led by community health workers (CHWs). A notable example is the Community Outreach and Cardiovascular Health (COACH) trial, which applied cognitive behavioral strategies in urban, medically underserved, predominantly African American communities, demonstrating improved clinical outcomes for CVD risks. The intervention included educational and behavioral counseling and follow-up from a primary care provider/community health worker (PCP/CHW) team. Participants in COACH showed significant enhancements in serum lipids, arterial blood pressure, glucose control, and perceptions of chronic care management. However, this intervention has not been culturally adapted or translated to assist Spanish-speaking individuals to be delivered to Hispanic populations.

Prior studies targeting the reduction of CVD risk factors among Hispanic populations in the US have typically embarked on program development. While these studies have demonstrated promising outcomes, the scientific literature highlights essential areas of improvement, particularly in research design and long-term follow-up, which can affect generalizability. In contrast, our study takes a different approach. Rather than starting from ground zero, we aimed to culturally adapt a proven program that has undergone rigorous research methodology and has yielded positive outcomes in other minority populations across the nation. This strategy builds upon existing evidence-based interventions and may enhance the likelihood of effectiveness and sustainability within Hispanic communities. Our long-term goal is to develop health education interventions that facilitate the adoption and maintenance of CVD protective factors, thereby reducing the disproportionate burden of heart diseases among minority populations.


2024 Copyright, the authors

Available for download on Tuesday, October 22, 2024