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Its effectiveness in reducing CVD risk factors has been demonstrated, and although HeartHealth was developed to address the negative impact of social determinants of health (SDOH), it remains unclear whether its impact is modified by key SDOH. The aims of the study were to evaluate whether the intervention effect on the Framingham CVD Risk Score (FRS) differs by financial status, education level, sex, depressive symptoms, and health literacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A secondary analysis was conducted using data from a randomized controlled trial involving 349 participants (mean age: 43 \u00b1 13, female 78%) from rural Appalachian Kentucky. Financial status, education level, and sex were measured using standard questionnaires, depressive symptoms were measured using the Patient Health Questionnaire\u20109, and health literacy was measured using the Newest Vital Sign. Repeated measures mixed modeling was employed to assess the impact of each SDOH while simultaneously evaluating the effects of time, intervention, and their interaction on FRS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The interaction between time and intervention was significant, indicating a sustained reduction in FRS among intervention participants. None of the SDOH had moderating effects on the intervention's impact on reducing CVD risk factors. This demonstrates that the HeartHealth intervention remains effective despite the impact of selected SDOH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The HeartHealth intervention effectively reduces CVD risk factors in rural Appalachia populations. This remains true regardless of SDOH that are commonly seen in rural areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70101","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T08:36:02Z","timestamp":1764837362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of a self\u2010care intervention addressing social determinants of health in reducing cardiovascular disease risk in rural populations"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2133-4822","authenticated-orcid":false,"given":"Jennifer L.","family":"Smith","sequence":"first","affiliation":[{"name":"College of Nursing University of Tennessee  Knoxville USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1574-1404","authenticated-orcid":false,"given":"Ashmita","family":"Thapa","sequence":"additional","affiliation":[{"name":"College of Nursing University of Tennessee  Knoxville USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misook L.","family":"Chung","sequence":"additional","affiliation":[{"name":"School of Nursing Vanderbilt University Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry A.","family":"Lennie","sequence":"additional","affiliation":[{"name":"College of Nursing University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Biddle","sequence":"additional","affiliation":[{"name":"College of Nursing University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Kay","family":"Rayens","sequence":"additional","affiliation":[{"name":"College of Nursing University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2727-5920","authenticated-orcid":false,"given":"Debra K.","family":"Moser","sequence":"additional","affiliation":[{"name":"College of Nursing University of Tennessee  Knoxville USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Center for Disease Control and Prevention.Stats of the state of Kentucky.2018."},{"key":"e_1_2_8_3_1","article-title":"Mortality in the United States, 2023","author":"Murphy SL","journal-title":"National Center for Health Statisics"},{"key":"e_1_2_8_4_1","unstructured":"MarshalJ ThomasL LaneN Health disparities in Appalachia. 2025.www.arc.gov\/factsheets"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2307\/2626958"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/nur.22440"},{"key":"e_1_2_8_7_1","unstructured":"WHO.Social determinants of health. 2020.https:\/\/www.who.int\/social_determinants\/en\/"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029652"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2013.03.010"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000579"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.028595"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jomh.2012.03.004"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.21106\/ijma.236"},{"key":"e_1_2_8_14_1","unstructured":"Kentucky heart disease and stroke prevention state action plan state of Kentucky. 2019.https:\/\/chfs.ky.gov\/agencies\/dph\/Documents\/KYStatePlan_LowResFinalv6.pdf"},{"issue":"5","key":"e_1_2_8_15_1","article-title":"Residence in a distressed county in Appalachia as a risk factor for diabetes, behavioral risk factor surveillance system, 2006\u20132007","volume":"7","author":"Barker L","year":"2010","journal-title":"Prev Chronic Dis"},{"key":"e_1_2_8_16_1","unstructured":"Kentucky Department of Public Health.Kentucky cardiovascular disease fact sheet. 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