Exploring Stakeholder Perspectives at the Intersection of Air Quality Health Risk Communication and Cardiac Rehabilitation
Citation:
Hano, M., S. Prince, C. Baghdikian, E. Lazzarino, E. Sams, S. Stone, A. Davis, S. DeflorioBarker, B. Hubbell, S. Katz, G. Robarge, AND W. Cascio. Exploring Stakeholder Perspectives at the Intersection of Air Quality Health Risk Communication and Cardiac Rehabilitation. American Association for Cardiovascular and Pulmonary Rehabilitation, Portland, Oregon, September 18 - 21, 2019.
Impact/Purpose:
There is ample evidence of the association between exposure to unhealthy air quality and adverse cardiovascular health outcomes, and there is increasing evidence of the additional risk burden for individuals who have experienced a cardiovascular event. Additionally, there is growing evidence of the effectiveness of individual-level strategies to reduce one's exposure such as portable air purifiers. The next step in translating the evidence seen across these bodies of literature into broad solutions for change requires effective health risk communication campaigns. Cardiac rehabilitation is a prime opportunity for sharing this information with individuals who have experienced a cardiac event, however the relationship between air quality and cardiac health is a relatively new topic to these stakeholders. Given the critical importance of understanding the context in which we intend to deploy health risk communication strategies before we do so, this project explores the knowledge, attitudes, and beliefs of cardiac rehabilitation patients and providers. Findings will be useful to inform future research and outreach.
Description:
Introduction: There is ample epidemiological evidence of adverse cardiovascular health outcomes associated with exposure to unhealthy air. Further, cardiac rehabilitation patients are at increased risk for future adverse health events related to air quality. This study investigates experiences, attitudes, and beliefs about risks of poor air quality for cardiovascular health and the use of portable air purifiers as a strategy to reduce those risks. Purpose: The EPA works with the American Heart Association and the Million Hearts initiative on communicating air quality health risks. These partners along with the European Society of Cardiology recently included exposure to fine particulate matter less than 2.5μm (PM2.5) as a risk factor for cardiovascular disease. There is little guidance about how to integrate this topic of air quality health risk communication into cardiac care and rehabilitation. Design: We use an inductive qualitative focus group design, with a series of three discussions among cardiac rehabilitation stakeholders including: 1) cardiac patients, 2) non-physician cardiac rehabilitation providers, and 3) physicians. These focus groups are part of and inform a broader research agenda centered on air quality health risk communication related to cardiac care. Methods: A within-case thematic inductive analysis of each discussion is used to understand the nature of communication, logistics, guidance, and overall substance of the cardiac rehabilitation educational experience. Results: Patient behavior change is an important objective of cardiac care, and education efforts are key to strategies related to that objective. Balancing the volume and breadth of this learning process with actual change is a challenge for patients, physicians, and non-physician providers. Air quality, as a patient health concern and area for behavioral modification, was neither prioritized, nor well understood. Although barriers were noted, several options arose for incorporating this topic into patient care and communication efforts. A package of educational outreach including continuing education geared toward healthcare providers is necessary to complement patient-centric health risk messaging. Conclusions: A gap exists between epidemiological evidence about associations between exposure to unhealthy air and cardiovascular health, and standard health risk messaging about this in cardiac care. Opportunities exist for integrating air quality health risk messaging into cardiac rehabilitation and are worth further exploring for effectiveness and feasibility. This information could be packaged as a suite of educational materials that includes components geared toward the different rehabilitation stakeholders. Disclaimer: The views expressed in this report are those of the authors and do not reflect the views or policies of the U.S. Environmental Protection Agency.