Graduation Date

Spring 5-4-2024

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Susan Barnason

Second Advisor

Sheri Rowland

Third Advisor

Leeza Struwe

Fourth Advisor

Athena K. Ramos

MeSH Headings

cardiovascular diseases, primary health care, Transtheoretical Model, rural population, healthy lifestyle, coaching


Cardiovascular disease is a prevalent noncommunicable disease. Modifying lifestyle behavior can decrease cardiovascular disease morbidity and mortality outcomes. This dissertation's purpose was to explore behavioral change interventions with dietary strategies to reduce cardiovascular disease rates. The integrative review explored aspects of dietary strategies in the primary care setting. Despite the importance of diverse studies, comparing all the components results in limited generalizability. In the following chapter, a cross-sectional study elicited healthcare professionals’ perceptions of the usefulness of a readiness for lifestyle change tool in clinical practice. Currently, a common, widespread adoption of a readiness for lifestyle change tool is not used. Use of a readiness for lifestyle change tool can aid in tailoring support for change and monitor progression. Lastly, a single group study was conducted in a rural primary care setting with adults to explore, acceptability, and preliminary effects of nurse-led dietary health coaching sessions in the primary setting. The results indicate that health coaching is feasible if trained interventionists are present and acceptable with participants reporting a positive experience. Strategies for modifying lifestyle behaviors within the primary care setting need to be innovative for cardiovascular disease rates to decline. Implications from this dissertation may lead to modifications within nursing curriculum, research, and healthcare settings.


2024 Copyright, the authors

Available for download on Sunday, April 26, 2026